Our foot and ankle is one of the most important joint and structure. It takes all the load of our spine, pelvis, hip and knee and help us maintain proper stance and movement. The human foot consists of 26 bones, 33 joints, and more than 100 ligaments, tendons & muscles when combined. On an average, we walk 10000 steps/day, 1000000 steps/years & 115000 miles in our lifetime. One can imagine the amount of load, stress, wear and tear. Moreover, when we run, walk uphill or trek in uneven surface or in contact sports, our heels can undergo twist and sprain, leading to ligament, tendon sprains or tears and subsequent chronic pain. Let’s briefly discuss common heel or foot pain causes, and treatment options, although the list is quite exhaustive.
Causes of Foot Pain
Our foot is divided into 3 parts- Forefoot, mid-foot and hind-foot or back of the foot.
Common causes include:
- Plantar Fasciitis- a very common cause of heel pain where patients experience pain over heel, more during early morning or when walking from prolonged sitting position and then slowly it becomes better. This is because a small fascia in the heel get inflamed, thickened, develop microtear leading to manifestation of pain.
- Achilles Tendinosis- Another very common cause of hind-foot pain in the back of the heel. The tendon of calf muscle which attaches to the back of heel is known as “Achilles Tendon” and this tendon because chronic wear and tear become thickened or inflammatory fluid accumulates leading to pain, especially during walking.
- Nerve impingement/Compression or Neuropathy- Foot is supplied by 5 terminal nerves and they travel under a retinaculum in a tunnel like wrist and nerve compression can cause tingling, burning, stabbing, electric-shock type pain in foot known as tarsal tunnel syndrome (similar to carpal tunnel syndrome of wrist & hand). That being said, patients may experience neuropathic pain in foot following trauma, surgery, injury, diabetes, alcoholism, and slip disc from spine (sciatica).
- Injury/Trauma- Trauma or Injury from sports, road accidents is a common cause of foot pain. Ligament sprain or tear can lead to chronic pain as they heal slowly and further walking, weight-bearing aggravate the pain further.
- Degenerative changes or arthritis of foot & ankle- Although foot is not a common joint to get affected by arthritis, still lot of patients, especially older age population, persons with repeated foot injury or previous fracture, and obesity are at risk of developing ankle arthritis and subsequent chronic pain.
- Structural abnormalitylike flat foot, high-arched foot, bony irregularity (bunion, bony spurs) cause frequent and recurrent foot pain
- Goutor high uric acid is a well known cause of foot pain, especially big toe pain
- Tumor, infection, vascular cause, ulcer, rheumatoid arthritis, inflammatory arthropathy, bursitis are other causes of foot pain
Home remedy and treatment
- Proper shoe and use of orthotics to overcome structural abnormalities like flat foot goes a long way in stabilizing the bones, ligaments, tendons and protect the foot from early wear and tear.
- Regular exercise, healthy diet, maintaining a healthy body weight prevents many degenerative changes
- When pain is occurs and do not subside in few days or weeks despite stretching, exercise or simple pain killers, then one should not hesitate to see a specialist. Early consultation helps in finding the exact cause of pain, proper treatment in the form of medication, exercise, physiotherapy and injection therapy
- Patients who do not respond to medications and physiotherapy, may benefit from various ultrasound-guided intervention/injections done for providing pain relief and complete cure. These include Platelet-rich plasma (PRP) for plantar fasciitis, Achilles tendinosis, or nerve blocks, hydrodissection for diabetic neuropathy and entrapment or trauma-neuropathy. Patients in rheumatoid arthritis benefit significantly from ultrasound-guided joint injections.
At Neuron Pain & Spine Clinic, we use sophisticated technology like musculoskeletal ultrasound which enables us to scan the foot and its different parts for accurate diagnosis of cause of foot/heel pain. The small nerves of foot which can get damaged or get compressed to cause neuropathic pain can be precisely identified with ultrasound technology and treated. Similarly plantar fasciitis, Achilles tendonitis or tendinosis, or even tendon rupture, major joint inflammation or effusion along with bursitis can be diagnosed accurately and the joint, bursa or fascia interventions (injections) can be accurately carried out with ultrasound. Our Physician is trained in USA & Canada and double-certified in musculoskeletal ultrasound and is a known pioneer in the field of musculoskeletal ultrasound and pain management in South-East Asia region.