Many feet problems not related to age
By Dr. Asef
While specific foot problems are more likely to develop as we age, there are various conditions that are more the result of individual foot structure and can cause discomfort at any time.
As with all other systems in the body, the tendons, muscles, nerves, ligaments, and bones of the foot must work in harmony with every step. As these bones alternatively bear the body's weight for various lengths of time, seemingly minor imperfections can cause the foot to "go-out-of-alignment".
Everyone's feet may be different, but there are some standard ranges and ratios of overall foot size and width to the specific sizes of the various bones of the foot. For example, bones on the bottom of the foot that form the "ball-of-the-foot" are connected to the heel and bones of the toes. If they are too long, too wide or misshapen and rub together or constantly pull tendons or muscles, they create a problem.
One specific situation where this occurs is the heel. The heel bone is the largest bone in the foot and projects backward beyond the leg bone to provide a useful lever for the muscles of the calf. The heel bone bears all of the body's weight with each step. The stress on it and its associated structures is tremendous. People with structural problems in the foot, such as flat feet, high arched foot deformities and tight Achilles' tendon are more likely to suffer painful heels and heel spur syndrome as are those who have recently gained weight, participate in high impact athletic activities and prolonged walking or standing.
A podiatrist's evaluation, along with a history and physical can best determine a course of treatment. Inflammation of the various structures of the foot cause the pain, thus treatment is aimed at reducing stress on the foot and decreasing inflammation. Usually treatment begins on a conservative level, unless x-rays indicate that surgery is needed to remove or reduce a portion of bone, or relieve a tendon or muscle. Conservative treatments include rest, steroid injections, anti-inflammatory oral medication, physical therapy, and shoe inserts including heel cups to relieve stress on sensitive areas.
Another situation that causes inflammation in the foot occurs when nerves are pinched between the bones on the bottom of the foot that form the "ball" of the foot. As nerves are irritated they become enlarged, causing sharp pain, cramping and burning. Symptoms can also be more toward the tips of the toes. This condition, called a neuroma, occurs most commonly between the third and fourth toes, although it can occur between any other toes and on the inner portion of the heel.
A podiatrist can evaluate the condition and make treatment recommendations including injections, padding and physical therapy. In many instances, conservative therapy works while surgery offers the most relief in more severe situations. The patient and physician can make this determination based on the degree of pain and impairment, general history and physical, and an evaluation of other possible treatments.
One specific treatment that offers relief is the use of cortisone injections. Under the supervision of a podiatrist, cortisone is used primarily to reduce inflammation. Such treatment is often used in combination with rest, physical therapy, medications and shoe modifications to promote long-lasting results.
Cortisone is one of the hormones secreted by the adrenal gland and is released in response to stress caused by trauma, infection, intense cold or heat, surgery and almost any serious disease. Inflammation is a reaction to injury, trauma, surgery or overuse and signs include redness, swelling, heat and pain. Manmade cortisone-like preparations are used for localized injections and should not be mistaken for anabolic steroids used by some athletes to enhance their performance. Local injections use a small amount of cortisone, in a small, limited area to provide relief. Some patients report dramatic improvements in pain and stiffness within 24 hours and may continue for up to two weeks or longer. A podiatrist will discuss a specific treatment protocol, as well as possible adverse reactions.
Podiatrists have numerous treatment options available to them. Patients are often unaware of the variety of treatments available that will offer relief. In many instances surgery is not needed. By identifying a problem early and seeking medical help, patients are very satisfied with treatment. Through regular follow-up, a podiatrist can evaluate the condition and suggest treatment modifications as necessary to encourage a normal lifestyle.
For more information, contact Dr. Asef at 440-953-1003.
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