Bottom foot pain plantar
The most common cause of pain in the bottom of the foot which is called the plantar region is plantar fasciitis. Plantar fasciitis is a painful condition due to inflammation of the plantar fascia. Plantar fasciitis also occur as a result of physical activities that stress the fascia, including sports, vigorous exercise, or other types of exertion. Poorly constructed shoes can cause the problem if they do not provide enough arch support, heel cushion, or flexibility. Plantar fasciitis may follow intense athletic training, especially in runners who push themselves too quickly. Symptoms can occur at any time. When they occur suddenly, there is usually intense heel pain on taking the first morning step, known as first-step pain. This pain subsides as the patient begins to walk around, but it may return later in the day. If symptoms occur gradually, a chronic form of heel pain causes patients to shorten their stride while running or walking. Patients also may shift the weight toward the toes, away from the heel. Sometimes the pain is felt in the arch.
Surgery is usually a last resort, particularly recently with the use of minimally invasive procedures such as percutaneous needle tenotomy with autologous tissue graft. In this procedure, a physician will- using local anesthetic- slightly irritate the plantar fascia with a small needle. He then will inject a small amount of platelet rich plasma which is derived from a blood specimen that has been drawn from the patient. Platelets are cells in the blood that contain multiple growth and healing factors. Most people who have failed other measures will respond to this treatmen regimen and surgery is rarely necessary. Another cause of bottom of the foot pain towards the toe region is Morton’s neuroma.
A Morton's neuroma is a benign growth of the nerve sheath of a nerve that courses between the toes. A Morton’s neuroma usually occurs in the third interspace, between the third and fourth toes.
This condition is an abnormal growth, but it is not a cancer. It is a painful nuisance. Occasionally, people may also experience symptoms of shooting pains or tingling extending into the toe next to the neuroma. Pain is usually most significant with more strenuous activity and when wearing shoes with a narrow toebox. Problems often develop in this area because part of the lateral plantar nerve combines with part of the medial plantar nerve here. When the two nerves combine, they are typically larger in diameter than those going to the other toes. Also, the nerve lies in subcutaneous tissue, just above the fat pad of the foot, close to an artery and vein. Above the nerve is a structure called the deep transverse metatarsal ligament. This ligament is very strong, holds the metatarsal bones together, and creates the ceiling of the nerve compartment. The ground pushes up on the enlarged nerve with each step and the deep transverse metatarsal ligament pushes down. This causes increased pressure in a confined space. The reason the nerve enlarges has not been determined. Flat feet can cause the nerve to be pulled more medially than normal, which can cause irritation and possibly enlargement of the nerve. The syndrome is more common in women than men, possibly because women wear confining shoes more often. High heels cause more weight to be transferred to the front of the foot and tight toe boxes create lateral compression. As a result, there is more force being applied in the area and the nerve compartment is squeezed on all sides. Under such conditions, even a minimal enlargement in the nerve can elicit pain. The most common symptom of Morton's neuroma is localized pain in the third interspace between the third and fourth toes. It can be sharp or dull, and is worsened by wearing shoes and by walking. Pain usually is less severe when the foot is not bearing weight. The pain is described as an uncomfortable burning pain. Patients will take their shoes off and rub their food trying to get relief. Morton's neuroma is the most common cause of localized pain in the third interspace and these diagnostic tests produce good indications of the condition. It is also important to rule out other, potentially serious, problems. The physician commonly palpates the area to elicit pain, squeezing the toes from the side. Next he or she may try to feel the neuroma by pressing a thumb into the third interspace. The physician then tries to elicit Muldor's sign, holding the patient's first, second, and third metatarsal heads with one hand and the fourth and fifth metatarsal heads in the other and pushing half the foot up and half the foot down slightly. In many cases of Morton's neuroma, this causes an audible click, known as Muldor's sign. An x-ray may be taken to ensure that there is not a fracture. X-rays also can be used to examine the joints and bone density, ruling out arthritis (particularly rheumatoid arthritis and osteoarthritis). An MRI scan (magnetic resonance imaging) is used to ensure that the compression is not caused by a tumor in the foot. An MRI also determines the size of the neuroma and whether the syndrome should be treated conservatively or aggressively. If surgery is indicated, the surgeon can determine how much of the nerve must be resected. This is important, because different surgical techniques can be used, depending on the size and the position of the neuroma. In most cases, initial treatment consists of padding and taping to disperse weight away from the neuroma. If the patient has flat feet, an arch support is incorporated. The patient is instructed to wear shoes with wide toe boxes and avoid shoes with high heels. An injection of local anesthetic to relieve pain and a corticosteroid to reduce inflammation may be administered. The patient is advised to return in a week or 2 to monitor progress. If the pain has been relieved, the neuroma is probably small and caused by the structure of the patient's foot and the type of shoes the patient wears. It can be relieved by a custom-fitted orthotic that helps maintain the foot in a better position. Conservative treatment does not work for many patients and minor surgery usually is necessary.
Return to arthritis home page.
|
