Foot Pain and Problems

The fix for foot pain could be a surgery you didn’t know about

Foot Pain and Problems | Johns Hopkins Medicine

Brian Adams was born with very flat feet.

They didn’t stop him from playing a variety of sports — volleyball, baseball, basketball — in his youth. He grew to be a 6-foot-3-inch man who loved to “run, not jog.” Those flat feet served him well.

In the last few years, Adams, now 50, started having shin splints. The odd out-toed positioning of his feet compressed a nerve in his leg.

“It felt a burning poker behind my left ankle,” said Adams, a state property management specialist who lives in Edgewater Park, N.J. The pain grew so intense that he started dragging his foot “ Igor.

” Neither a special orthopedic boot nor physical therapy helped. His knees started hurting, too. The inside of his foot was numb.

“I was worried that this one issue was going to disrupt the balance and structure of everything,” Adams said. “I thought I was just doomed, to be honest with you.”

But he wasn’t, Steven Raikin, director of the foot and ankle service at Rothman Orthopaedic Institute, told him. That is how Adams ended up in an operating room in Bensalem recently, his bare left foot held high in the air as Raikin prepared to surgically repair its fallen arch. many people, Adams had not even known that the procedure existed.

It would not be easy. Raikin would make multiple incisions and then cut, hammer, saw and sew the foot into a more normal shape. Full recovery will take a year, but Raikin said most patients wind up with about 80 percent of normal function, far better than they had before surgery.

Foot problems are among the most common complaints of middle and older age. They are not trivial. When people’s feet hurt, they are less ly to exercise and more ly to fall, doctors said. About a third of people over 65 have foot pain, stiffness or aches. Almost everyone will have it at some point.

“It’s incredibly prevalent,” said Casey Jo Humbyrd, chief of the foot and ankle division at Johns Hopkins Medical Center and head of health policy for the American Orthopaedic Foot and Ankle Society. It’s harder, she said, to find older people who don’t have foot problems.

‘You should only be having surgery for pain’

Many of us take our feet for granted, but we quickly learn how much they matter when they hurt. Surgeons, Raikin said, often tell patients, “You take 10,000 steps a day and you never think about your feet until they hurt. Then that’s all you think about.”

Later-life problems with bones and tendons stem from a combination of unfortunate genes, wear and tear, old injuries, and more controllable risk factors such as obesity and diabetes. Women who cram their feet into too-small, too-pointy, too-tall shoes may pay for their fashion consciousness with bunions, hammer toes, and arch problems.

Though they can happen at any time, the deformities become more common as people reach their 50s and increase from there. You just have to live with some conditions, such as thinning fat pads on the ball of the foot and the heel. The pain from others can be controlled with orthotics, physical therapy, and better-fitting, lower-heeled shoes with arch support.

When none of those work, surgery is a last-resort fix for several of the most common complaints: flat feet, bunions, arthritis, and hammer toes.

Surgeons said the test for whether you should go under the knife is never how your feet look. “You should only be having surgery for pain,” Humbyrd said.

The foot is made up of 28 bones that are supported and moved by multiple muscles, tendons and ligaments. They absorb three to five times more force than the hips, Raikin said, one reason they are stressed by extra body weight.

You might expect that the arch of the foot is a hard structure a bridge, but the primary support is ligaments that, over time, can become stretched or torn.

“I tell patients it’s a rubber band,” Raikin said. “Once a rubber band has been in the sun too long and lost its elasticity, it can never get its elasticity back.”

Older patients also often have severe arthritis in joints that affect the arch.

Every foot is different, and repairs involve a tapas menu of small steps that may replace and reroute tendons, free constricted muscles and nerves, realign the heel and, in the case of arthritis, fuse painful joints.

Each patient may need a different combination of four to six surgical steps, said Kate O’Connor, a Penn Medicine orthopedic surgeon.

To watch short videos of a surgeon explaining the biomechanics of flat feet, bunions, arthritic ankles and hammertoes and surgery to repair them, click on the arrow below.

In Adams’ case, Raikin began by releasing the calf muscle. It had been compressing the tibial nerve, causing the foot numbness.

Compared with orthopedic surgeons who replace big joints such as hips and knees, he used more delicate tools, a small scalpel, and long-handled tweezers. He made two more incisions along the side and back of the foot. He found the posterior tibial tendon, which runs underneath the arch. It was about twice the normal size — bloated and riddled with tears.

Raikin explained that the tendon enlarged as it tried, futilely in this case, to heal itself. He cut away about 2¼ inches of the damaged tendon. He pointed out a yellow, Y-shaped structure, a nerve that had been compressed by the awkward position of the foot, which tends to roll outward when feet are flat.

He cut away bands of tissue that were constricting it. Then he pulled out the flexor digitorum longus, a tendon that normally moves the toes. This one was healthy. It was stretchier, thinner and shinier than the one Raikin had removed. He would reroute it to take the place of the damaged tendon.

Tendons, he said, travel on specific tracks, trains. He moved this one from the toe track to the arch track. Other tendons would allow Adams to keep moving his toes but not as well as before. He pulled the tendon until an arch formed — “Right now, that’s a normal arch,” he said — and attached it to a bone with a special screw.

Raikin was not done. In severe flat footedness, the heel bone tilts outward “ a banana falling on its side.” Fixing that required yet another incision. Then Raikin inserted a slim, rectangular saw blade that cut the 1.

5-inch heel bone in half laterally. He shifted the back piece half inward about 3/8 inch and screwed the two pieces together with a long, titanium screw. He sawed off some extra bone and tamped the heel in place with a hammer.

He pressed the foot against a clear piece of plastic to make sure the arch on the inside looked right. It did. It was noticeably thinner and more shapely.

In less than an hour, Raikin was done. Next it would be Adams’ turn to work, but first he would have to go home and do nothing for two weeks.

Help for other common foot problems

Surgical procedures are also available to help people with unremitting pain from bunions, arthritic joints, and hammer toes.

Arthritis can affect any of the 33 joints in the foot and ankle. Ankle replacement surgery is growing in popularity, but patients should know that replacement parts don’t last forever, O’Connor said. Some may prefer fusion surgery, which affects mobility but lasts longer than artificial joints.

Fixing bunions is a bigger deal — requiring longer recovery time — than many people realize. Bunions look a growth on the inner edge of the front of the foot, but they actually are a malformed joint.

Some combination of genetics and too-tight shoes makes the big toe migrate toward the outer edge of the foot. This puts pressure on the metatarsophalangeal joint — the place where the toe joins the foot — and makes it bow outward. To fix the bunion, surgeons cut and realign bones leading to the big toe. Many people with bunions also have hammer toes.

Recovery takes time, no matter what the surgeon has done. After arch repair, patients such as Adams are told to stay still with the leg elevated most of the time for two weeks. “For the first two weeks, I tell patients they’re going to jail,” Raikin said. “They’re pretty much going home and doing nothing.”

As Adams soon learned, that’s boring. But he was pleased to learn that his foot, which was in a cast, was no longer numb. He had pain, but wasn’t complaining about it. So far, there’s no need for surgery in the other foot.

He would start physical therapy at about six weeks. One goal is to teach the transferred tendon its new job. “It’s a whole new tendon reeducation program,” Raikin said.

It will be a long road to recovery. Patients, the surgeon said, “have different types of pain on and off for a year.”

Source: https://www.inquirer.com/health/foot-pain-surgery-fallen-arches-ankle-heel-shin-20190129.html

Eric H. Williams MD

Foot Pain and Problems | Johns Hopkins Medicine

Eric H. Williams MD graduated from Johns Hopkins School of Medicine in 1999 after receiving his undergraduate degree in Biology from Swarthmore College in the suburbs of Philadelphia, Pennsylvania. Dr.

Williams completed his General Surgery Residency at Vanderbilt University Medical Center in Nashville, Tennessee in 2004. He then completed his Plastic Surgery Residency at the University of Alabama in Birmingham in June of 2006. Dr.

Williams then completed another full year in fellowship training in Peripheral Nerve Surgery with Dr. A. Lee Dellon, a world renowned specialist in peripheral nerve surgery, in 2007.

Dr. Williams is board certified in Plastic and Reconstructive Surgery.  After his fellowship, Dr. Williams was employed by The Dellon Institute for Peripheral Nerve Surgery for two additional years, until he became a full partner at The Dellon Institute in Baltimore, Maryland in 2010 dedicating the majority of his time to caring for the nerve injured patient.

   

His focus since 2007 has been centered on the surgical care and rehabilitation of lower extremity and upper extremity complex peripheral nerve syndromes with an emphasis in nerve injury, entrapment, and chronic regional pain syndromes, and diabetic peripheral neuropathy.

   Other areas of interest and expertise include groin pain, knee pain after knee replacement, intercostal nerve injury, and migraine headaches. 

He has independently developed procedures to improve the sensation, pain, and muscle function in the lower extremity, and has been part of a team that has helped describe many other advancements in peripheral nerve surgery and peripheral nerve imaging.  He has written and is co-author on many publications in the field. 

While working in private practice, he is an Assistant Professor of Plastic and Reconstructive Surgery at Johns Hopkins University Medical Center in Baltimore, Maryland, and works closely with the Musculoskeletal Radiology Division to help improve the diagnostic capabilities of Magnetic Resonance Imaging of the peripheral nerve (MR Neurography). 

Assistant Professor: Johns Hopkins University School of Medicine; Department of Plastic Surgery; Baltimore, MD 2010.

Undergraduate Education:

1991 – 1995

Bachelor of Arts

Biology

Swarthmore College 

​Graduate Education:

1995 – 1999

Doctor of Medicine

Johns Hopkins University School of Medicine

Baltimore, Maryland

Post-Graduate Education:

1999 Jul – 2000 Jun              

Internship, General Surgery

Vanderbilt University Medical Center

Nashville, Tennessee

Program Director:  John Tarpley, M.D.  

2000 Jul – 2004 Jun  

Residency, General Surgery

Vanderbilt University Medical Center

Nashville, Tennessee

Program Director:  John Tarpley, M.D.  

2004 Jul – 2006 Jun

Residency, Plastic and Reconstructive Surgery

University of Alabama Medical Center

Birmingham, Alabama

Program Director:  Jorge De la Torre, M.D.                  

2006 Jul – 2007 Jun

Fellowship, Peripheral Nerve Surgery

Dellon Institute for Peripheral Nerve Surgery

Baltimore, Maryland

Program Director: A. Lee Dellon, M.D.

Professional Experience

2006 Jul – 2008 Jul      Employed Physician; Dellon Institute for Peripheral Nerve Surgery

2006 Jul – present        Consulting/Treating Physician; Union Memorial Hospital

2006 Jul – 2008 Jul     Clinical Instructor – Plastic Surgery; Johns Hopkins Medical Center

2008 Jul – present        Full Partner Physician; Dellon Institute for Peripheral Nerve Surgery

2008 Jul – present       Assistant Professor – Plastic Surgery; Johns Hopkins Medical Center

2009 Jul – 2018           Medical Director of Timonium Surgical Center

Areas of Clinical Interest

  • Peripheral nerve injuries
  • Peripheral nerve entrapment disorders in upper and lower extremity, and trunk
    • Carpal tunnel, cubital tunnel, radial tunnel, radial sensory nerve, pronator syndrome, brachial plexus compression (neurogenic thoracic outlet), common peroneal nerve, proximal tibial nerve, superficial peroneal nerve, deep peroneal nerve, tarsal tunnel syndrome, morton’s neuroma, Meralgia paresthetica
  • Chronic knee pain after knee replacement
  • Chronic groin pain after hernia repair, C-section, Hysterectomy
  • Causalgia
  • RSD / Chronic regional pain syndrome
  • Occipital Neuralgia
  • Chronic Migraine Headaches
  • Neuroma pain
  • Chronic post – surgical neuropathic pain
  • Diabetic peripheral neuropathy and overlapping nerve compressions
  • Breast pain after reconstruction or breast surgery
  • Intercostal nerve pain

Publications:

Peer-reviewed original research articles:

1.   Williams, E.H., McCarthy, E., Bickel, K.  The Histologic Anatomy of the Volar Plate.  Journal of Hand Surgery, American Volume. 23A: 805-810.  1998.

2.   Espinosa-de-los-Monteros A., de la Torre JI., Rosenberg LZ., Ahumada LA., Stoff A., Williams E.H. Vasconez LO. Abdominoplasty with Total Abdominal Liposuction for Patients with Massive Weight Loss.  Aesthetic Plastic Surgery. 30(1):42-6, 2006 Jan-Feb.

3.   Williams E.H., Rosenberg. L., De la Torre, J., Fix, R. J.  Immediate Nipple Reconstruction on Free TRAM Breast Reconstruction.  Plastic and Reconstructive Surgery.  120 (5): 1115-1124, 2007.

Immediate Nipple Reconstruction and Maintenance of Breast Mound Projection in Free TRAM Flaps, American Society of Reconstructive Microsurgery, Tucson, Arizona 01/15/2006.

Immediate Nipple Reconstruction on a Coned Free TRAM flap. Alabama Society of Plastic Surgeons. 2006.

Source: https://www.baltimoreperipheralnervepain.com/bio/eric-h-williams-md.cfm

Plantar Fasciitis: Causes, Symptoms & Treatment

Foot Pain and Problems | Johns Hopkins Medicine

If the first few steps you take in the morning are painful, you might be experiencing plantar fasciitis. It's one of the most common causes of foot pain, with 2 million to 3 million patients seeking medical treatment each year, said Dr.

Michael Greaser, an orthopedic surgeon and assistant professor at McGovern Medical School at The University of Texas Health Science Center at Houston. Many of the patients typically seek treatment after having months or years of heel pain.

There are most ly many others who have plantar fasciitis that never seek treatment.

The stabbing pain that is felt is caused by inflammation of a band of tissue known as the plantar fascia that connects the heel bone to the toes.

The pain is normally localized near the heel but can be felt anywhere along the plantar fascia ligament, according to Dr.

Dominic Catanese, professor and chief of podiatric surgery at Montefiore Medical Center at Albert Einstein College of Medicine in New York.

The pain tends to beworse first thing in the morning and after long periods of sitting or standing. When there is no weight put on the foot, the ligament shortens and tightens, Catanese said. Then when the patient stands, the sudden stretching of the plantar fascia with the added weight may result in pain. Usually the pain subsides after a few minutes of walking and stretching.

Causes and diagnosis

There are many reasons why one might develop plantar fasciitis, according to the American Orthopedic Foot & Ankle Society. Some of these factors include being overweight, being on your feet for extended periods and wearing shoes with inadequate support.

In addition, impact exercises such as running, tight calf muscles that limit ankle mobility, flat feet or high arches, excessive pronation (when the foot rolls severely inward when walking) or wearing high heels on a regular basis can be aggravating factors.

Heel spurs are commonly thought to cause plantar fasciitis, but the opposite is more ly to be true, Greaser said. A heel spur is the bony outgrowth on the edge of the heel that's often the result plantar fasciitis, but it's rarely the cause of heel pain.

Treatment options

To diagnose plantar fasciitis, a doctor will question the patient about their pain and examine the foot, including looking for areas of tenderness, the height of the arch and ankle mobility, according to the American Academy of Orthopedic Surgeons (AAOS).

Imaging tests such as X-rays or MRIs may also be used to rule out other potential causes of foot pain, such as fractures or arthritis.

According to Catanese, there are three main ways to treat plantar fasciitis: stretching the plantar fascia and the muscle group in the back of the leg, using good quality and supportive shoes or orthotics, and reducing inflammation. More than 90 percent of people with plantar fasciitis experience a significant reduction in pain after less than a year of treatment.

Stretching is the single most important thing to do to eliminate and prevent pain, Catanese told Live Science.

According to AAOS, two of the most important stretches are for the calves (place one leg in front of the other with the front leg bent, both heels on the ground, and lean into the wall) and the plantar fascia (from a seated positing, cross the foot with plantar fasciitis over the knee of your opposite leg and carefully stretch the toes towards your body). Doctors recommend taking a break from high-impact exercises running and switching to low-impact exercises swimming or yoga.

Over-the-counter anti-inflammatory medications such as ibuprofen or a steroid injection are other ways to reduce the inflammation and associated pain. Ice and massage are also used to reduce inflammation.

Another option is to use splints at night to stretch the plantar fascia while sleeping. Physical therapy and extracorporeal shock wave therapy, which sends high-energy pulses to stimulate the plantar fascia, may also promote healing.

If none of those options improve plantar fasciitis, more invasive options are available. Common surgical options include removing scar tissue around the plantar fascia, partially removing the plantar fascia from the heel, or surgically lengthening the calf muscles.

Don't ignore it

If plantar fasciitis remains untreated, chronic heel pain can develop with irreversible consequences, including scarring and thickening of the plantar fascia at its origin in the heel, Greaser said. The ligament could also become partially or completely ruptured if a person with plantar fasciitis continues their high-impact activities.

Some cases of chronic heel pain have also been found to develop into distal tarsal tunnel syndrome, similar to carpal tunnel syndrome in the wrists, where the nerves running along the bottom of the foot can become entrapped. According to Johns Hopkins Medicine, symptoms can include shooting pain, a tingling or burning sensation, or numbness.

The feet are relatively small body parts that experience significant pressure and stress on a daily basis for most people, according to the Institute for Preventive Foot Health. For that reason, it's important to make sure your feet stay healthy and be aware of the symptoms of foot conditions such as plantar fasciitis.

Additional resources:

This article is for informational purposes only and is not meant to offer medical advice.

Source: https://www.livescience.com/63816-plantar-fasciitis-causes-symptoms-treatment.html

Research pushes back on benefits of compounded topical pain creams

Foot Pain and Problems | Johns Hopkins Medicine

In an effort to reduce chronic pain, many people look for hope by paying $20 to thousands of dollars for a tube of prescription topical pain cream or gel.

Now, results of a rigorous federally funded study mandated by Congress shows no statist significant statistically significant difference between relief offered by these creams and placebos, according to researchers at Johns Hopkins Medicine and Walter Reed National Military Medical Center. A report of the study is published in the Feb. 5 issue of Annals of Internal Medicine.

“Our study of nearly 400 pain patients suggests that people who use these compounded creams and gels are being taken advantage of, because the scientific evidence to support a benefit is not there,” says Steven P. Cohen, M.D.

, professor of anesthesiology and critical care medicine, neurology, and physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. He also serves as the director of pain research at Walter Reed.

Tricare, a government-managed health insurance plan covering some active duty and retired military personnel and their family members, reported it spent $259 million on compounded topical pain creams in fiscal year 2013, and the cost increased to $746 million in 2014.

For the first month of 2015, the Department of Defense spent about $6 million per day on the medications. Similarly, the Medicare Part D program paid out more than half a billion dollars for the creams in 2015. The big spending and limited efficacy data triggered news reports and requests for investigations, say the researchers.

Finally, Congress demanded evidence for the efficacy of the creams.

Cohen says the conceptual appeal of the creams is that they appear to be a safer way to get pain relief without the risks or side effects of potentially addictive or dangerous drugs that are usually given orally or by injection.

The compounded creams and gels generally contain one or more prescription or other anesthetic, analgesic, sedative, antidepressant, anti-seizure or muscle relaxant drugs that are used to treat pain.

To explore the effectiveness of these creams, the researchers conducted a double-blind, randomized and placebo-controlled study at Walter Reed from August 2015 to February 2018. The research involved 399 participants ages 18-90.

Nearly 43 percent were active duty military personnel; the remaining participants were retired or dependents, such as spouses. More than half (51 percent) were female.

All the participants were patients at military treatment facilities and were eligible to use TRICARE outside the military treatment facilities.

First, participants were randomly divided into two groups — one for the compounded topical cream and the other a placebo cream (both the real and placebo creams had the same consistency and feel).

Then the participants were divided into three equally numbered groups according to their history of chronic localized pain: neuropathic pain caused by disease or damage to the nerves, such as shingles or diabetes; nociceptive pain (non-neuropathic) caused by injury to tissue, such as burns or sprains; and so-called mixed pain caused by damage to the nerves and tissues, such as certain types of back pain.

All the participants had pain localized to specific areas: the face, back, buttocks, neck, abdomen, chest, groin and/or up to two extremities.

During the week before the study, the average pain score for participants was 4 or greater on the 0-10 pain scale. The average duration for their symptoms was 6.7 years. Some of the patients had been treated with opiates in the past, but the percentage of those patients was not recorded.

Participants were instructed to apply the cream three times per day, and to make entries in a pain diary twice per day, which contained average and worst pain scores. The diaries were used to determine the outcomes.

Cohen says that after the treatment period ended, the investigators found no statistically significant difference between the mean reduction in average self-reported pain scores for all patients in the treatment and placebo groups.

For the neuropathic pain group, there was a 0.1-point difference between the drug group (-1.4) and the placebo group (-1.3).

For the mixed pain group, there was a -1.3-point reduction for the placebo group, and a -1.6 reduction for the treatment group, for a difference of 0.3 points.

Cohen says that all participants improved slightly throughout the study, affirming the long-recognized placebo effect, which is generally stronger for pain treatment than for other medical disorder therapies.

“With the number of research participants studied as long as they were studied, we should have been able to see a statistically significant difference in pain reduction if these creams were actually working,” says Cohen, senior author of the paper.

“But we didn't see this in our data.

The pain reduction we saw in patients being treated with the pain cream was nearly the same pain reduction we saw in placebo — there was just not a large enough difference for the reduction to be scientifically meaningful.”

The researchers think there was a tiny difference favoring the pain creams because they contained two substances — lidocaine and prescription non-steroidal anti-inflammatory drugs, particularly ketoprofen and diclofenac — that were shown in earlier randomized trials to be effective topically.

Without outside assistance, the Walter Reed research pharmacy team, which included principal investigator Lt. Col. Robert Brutcher, prepared the pain creams that contained combinations of many of the same drugs used in commercially available compounded topical creams.

The neuropathic pain group used cream containing ketamine, gabapentin, clonidine and lidocaine. The cream used by the nociceptive pain group contained ketoprofen, baclofen, cyclobenzaprine and lidocaine. In the mixed-pain group, participants used cream containing ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine and lidocaine.

Cohen cautioned that the new study was somewhat limited in terms of applicability for specific conditions, in part because of the wide variety of medical conditions and pain disorders among the participants.

In addition, capsaicin, a pepper derivative commonly used in lotions and creams for muscle pain, could not be used in the study compounds because the recognizable smell and application requirements would have undermined the double-blinding process that kept both caregivers and subjects unaware if they were getting active creams or placebos.

However, Cohen says, considering the high cost and relatively minor benefits from the creams, routine prescription and use of these compounded creams is not a good idea and does not move forward efforts being made toward high value health care.

Other researchers who participated in the study are Parvaneh Moussavian-Yousefi, Pharm.D.; Lt. Col. Robert E. Brutcher, Pharm.D., Ph.D., U.S. Army; Connie Kurihara, R.N.; Maj. David E. Reece, M.D., U.S. Army; Petty Officer 1st Class Lisa M. Solomon, B.S., U.S. Navy; Col. Scott R. Griffith, M.D., U.S. Army; and David E. Jamison, M.D., and Mark C. Bicket, M.D., from Johns Hopkins.

Primary funding for the research came from the Center for Rehabilitation Sciences Research, Defense Health Agency, U.S. Department of Defense.

Story Source:

Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.

Source: https://www.sciencedaily.com/releases/2019/02/190205102542.htm

Foot Pain and Problems

Foot Pain and Problems | Johns Hopkins Medicine

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Anatomy of the foot

The foot is one of the most complex parts of the body. It is made up of 26 bones connected by many joints, muscles, tendons, and ligaments. The foot is susceptible to many stresses. Foot problems can cause pain, inflammation, or injury. These problems can result in limited movement and mobility.

What are the different types of foot problems?

Foot pain is often caused by improper foot function. Poorly fitting shoes can worsen and, in some cases, cause foot problems. Shoes that fit properly and give good support can prevent irritation to the foot joints and skin. There are many types of foot problems that affect the heels, toes, nerves, tendons, ligaments, and joints of the foot.

The symptoms of foot problems may look other medical conditions and problems. Always see your healthcare provider for a diagnosis.

What are heel spurs?

A heel spur is a bone growth on the heel bone. It is usually located on the underside of the heel bone where it attaches to the plantar fascia, a long band of connective tissue running from the heel to the ball of the foot.

This connective tissue holds the arch together and acts as a shock absorber during activity. If the plantar fascia is overstretched from running, wearing poor-fitting shoes, or being overweight, pain can result from the stress and inflammation of the tissue pulling on the bone.

Over time, the body builds extra bone in response to this stress resulting in heel spurs. Treatment options may include:

  • Rest

  • Cold packs

  • Anti-inflammatory medication, such as ibuprofen

  • Proper stretching before activity

  • Proper footwear or shoe inserts

  • Corticosteroid injections

  • Surgery (for more severe, prolonged conditions)

What is a corn?

Corns are yellowish, callus growths that develop on top of the toes. Corns develop because of abuse or stress. Often, a corn develops where a toe rubs against a shoe or another toe. Corns can cause extreme discomfort and pain. Treatment may include:

  • Trimming the corn by shaving the layers of dead skin

  • Applying pads around the corn area

  • Wearing larger shoes to comfortably fit your foot without rubbing

  • Surgery

To avoid corn development, always buy shoes that fit properly.

What is a bunion?

A bunion is a protrusion of bone or tissue around a joint. Bunions may occur at the base of the great toe or at the base of the little toe, and often occur when the joint is stressed over a period of time. Women get bunions more often than men do because they may wear tight, pointed, and confining shoes. Bunions can also be a result of arthritis, which often affects the big toe joint.

Treatment of bunions may vary depending on the pain and deformity. Treatment may include:

  • Wearing comfortable, well-fitting shoes (particularly shoes that conform to the shape of the foot and do not cause pressure areas)

  • Surgery (for pain, not for cosmetic purposes)

  • Applying pads to the affected area

  • Medications, such as ibuprofen

A bunion, also known as hallux valgus, develops on the big toe joint when the bones of the big toe become misaligned. It looks a large bump on the side of the toe. The big toe angles in toward the second toe, and, in severe cases, may overlap or tuck beneath the second toe. Bunions are more common in women than in men.

What is Morton neuroma?

Morton neuroma is a buildup of benign (noncancerous) tissue in the nerves running between the long bones of the foot. Morton neuroma occurs when two bones rub together and squeeze the nerve between them. Most often, neuromas develop between the bones leading to the third and fourth toes.

Morton neuroma often causes swelling, tenderness, and pain. If the pain becomes severe, it may cause tingling, numbness, and burning in the toes. It usually occurs after standing or walking for a long period of time. Treatment for this condition may involve rest or a change in footwear that does not restrict the foot.

If the problem persists, cortisone injections or surgery may be considered.

This condition is a thickening of the nerve sheath that surrounds a nerve in the ball of the foot. It most commonly develops between the third and fourth toes. It also commonly occurs between the second and third toes.

What are hammertoes?

A hammertoe is a condition in which the toe buckles, causing the middle joint of the affected toe to poke out. Tight-fitting shoes that put pressure on the hammertoe often aggravate this condition. Often a corn develops at this site. Treatment for hammertoes may include:

  • Applying a toe pad specially positioned over the bony protrusion

  • Changing your footwear to accommodate the deformed toe

  • Surgical removal

This condition is a deformity in which a toe bends downward at the middle joint. The second toe is the one most ly to be affected, but this deformity can occur in other toes as well. Sometimes, more than one toe is affected.

What is an ankle sprain?

An ankle sprain is an injury to the foot's ligaments in the ankle. Ligaments are tough bands of elastic tissue that connect bones to each other. Ankle sprains may occur if the ankle rolls, turns, or twists beyond its normal range of motion.

Ankle sprains may be caused by awkward foot placement, irregular surfaces, weak muscles, loose ligaments, or wearing shoes with spiked heels. The symptoms of a sprain will depend on how severely the ligaments are stretched or torn, but usually include swelling, pain, or bruising.

Treatment will depend on the severity of the sprain, but may include:

  • Resting the ankle

  • Wrapping the ankle with elastic bandage or tape

  • Ice pack application (to reduce inflammation)

  • Elevating the ankle

  • Nonsteroidal anti-inflammatory drugs, such as ibuprofen to help reduce the pain and inflammation

  • Gradual return to walking and exercise

  • A walking cast (for moderate sprains)

  • Surgery (for severe sprains)

  • Physical therapy

Ligaments are fibrous, elastic bands of tissue that connect and stabilize the bones. An ankle sprain is a common, painful injury that occurs when one or more of the ankle ligaments is stretched beyond the normal range of motion. Sprains can occur as a result of sudden twisting, turning or rolling movements.

What is a foot fracture?

With 26 bones in a single foot, almost any of them can be broken. Many fractures do not require surgery, or even a cast, as they will heal on their own with some support. When a foot is fractured, the site of the fracture usually is painful and swollen. The site of the fracture will determine the course of treatment, if needed, including:

  • Ankle joint fractures. These fractures may be serious and require immediate medical attention. Ankle fractures usually require a cast, and some may require surgery if the bones are too separated or misaligned.

  • Metatarsal bone fractures. Fractures of the metatarsal bones, located in the middle of the foot, often do not require a cast. A stiff-soled shoe may be all that is needed for support as the foot heals. Sometimes, surgery is needed to correct misaligned bones or fractured segments.

  • Sesamoid bone fractures. The sesamoid bones are 2 small, round bones at the end of the metatarsal bone of the big toe. Usually, padded soles can help relieve pain. However, sometimes, the sesamoid bone may have to be surgically removed.

  • Toe fractures. Fractures of the toes normally can heal with or without a cast.

What is foot pain?

Foot pain can be debilitating to an active lifestyle. Foot pain can have many sources, from fractures and sprains to nerve damage. Listed below are 3 common areas of pain in the foot and their causes:

  • Pain in the ball of the foot. Pain in the ball of the foot, located on the bottom of the foot behind the toes, may be caused by nerve or joint damage in that area.

    In addition, a benign (noncancerous) growth, such as Morton's neuroma, may cause the pain. Corticosteroid injections and wearing supportive shoe inserts may help relieve the pain.

    Sometimes, surgery is needed.

  • Plantar fasciitis. Plantar fasciitis is characterized by severe pain in the heel of the foot, especially when standing up after resting. The condition is due to an overuse injury of the sole surface (plantar) of the foot and results in inflammation of the fascia, a tough, fibrous band of tissue that connects the heel bone to the base of the toes.

    Plantar fasciitis is more common in women, people who are overweight, people with occupations that require a lot of walking or standing on hard surfaces, people with flat feet, and people with high arches. Walking or running, especially with tight calf muscles, may also cause the condition.

    Treatment may include:

    • Rest

    • Ice pack applications

    • Nonsteroidal anti-inflammatory medications

    • Stretching exercises of the Achilles tendons and plantar fascia

Plantar fasciitis is an irritation of the plantar fascia. This thick band of connective tissue travels across the bottom of the foot between the toes and the heel. It supports the foot's natural arch. It stretches and becomes taut whenever the foot bears weight.

  • Achilles tendon injury. The Achilles tendon is the largest tendon in the human body. It connects the calf muscle to the heel bone. However, this tendon is also the most common site of rupture or tendonitis, an inflammation of the tendon due to overuse.

    Achilles tendonitis is caused by overuse of the tendon and calf muscles. Symptoms may include mild pain after exercise that worsens gradually, stiffness that disappears after the tendon warms up, and swelling. Treatment may include

    • Rest
    • Nonsteroidal anti-inflammatory medications
    • Supportive devices and/or bandages for the muscle and tendon
    • Stretching
    • Massage
    • UltrasoundStrengthening exercises
    • Surgery

Diabetes and vascular disease

Diabetes affects the nerves and blood vessels and blood flow throughout the whole body, including the legs and feet. People with diabetes need to check their feet regularly to identify sores or wounds on their feet before complications develop. In addition, they will need to see a podiatrist to help manage diabetes-related foot problems.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/foot-pain-and-problems