Non-surgical Treatment for Foot Pain

Introduction

The foot is a complex body part susceptible to various stresses, resulting in problems that mostly present with foot pain. The foot has 26 bones connected by muscles, tendons, joints, and ligaments. Foot problems can result in pain, swelling, or injury and limit mobility and movement.

Foot pain mostly occurs due to improper foot function. Improperly fitting shoes can worsen foot problems or even result in foot issues. Different types of foot problems can affect the toes, tendons, nerves, ligaments, joints, and heels of the foot.

Most causes of foot pain are preventable by using appropriate footwear and foot care. Conservative or non-surgical options can manage most conditions resulting in foot pain. The physician usually recommends non-surgical approaches initially before going for surgical options.

What Are Some Common Foot Problems Resulting in Foot Pain?

• Morton's Neuroma - Morton's Neuroma is characterized by the thickening of tissues around a nerve that leads to the toes. It is a compressive neuropathy (nerve damage) of the interdigital nerve of the forefoot region. The commonest location is between the third and fourth metatarsal heads. The exact cause of Morton's neuroma is unknown.

The symptoms are:

• • Sharp or burning pain about the ball of the foot.
  • Patients usually complain of the sensation of walking on marble or stone.
  • Some complain of numbness between the toes.

• Bunions - Bunions are painful bony projections at the base of the big toe joint that develop when the big toes lean towards the remaining toes. It is more prevalent in women. Pain can occur in the bony projection due to shoe irritation and the alteration of mechanical forces on the ball of the feet.

• Ingrown Toenail - The condition in which the toenail grows into the skin around it is an ingrowing toenail. It is also referred to as onychocryptosis. The skin may get damaged, resulting in pain and infection. It mostly affects the big toenail. The condition is most prevalent in young males and accounts for 20 percent of foot issues in primary care.

• Corns and Calluses - Calluses are areas of thickened or hardened skin on the foot that develop due to friction or pressure. Corns are callus growths that develop on the top of the toes due to irritation. The symptoms include pain on pressure about the area, white rubbery skin bumps, etc.

• Foot Fractures - The feet consist of 26 bones, and there is a chance that any of these can fracture. These foot fractures usually do not require surgical correction and heal independently. The fracture site usually becomes inflamed and painful. The treatment depends on the fracture site.

• Plantar Fasciitis - Plantar fascia is the band of connective tissue that extends from the heel bone to the toe base in the plantar surface of the foot. The inflammation of plantar fascia is called plantar fasciitis. Plantar fasciitis occurs due to overuse injury of the plantar foot surface and is characterized by heel pain.

• Achilles Tendonitis - Achilles tendonitis occurs due to overuse of the Achilles tendon (the tendon that connects the heel bone and calf muscles) and calf muscles, which results in tendon inflammation.

• Bursitis- it is the irritation or inflammation of a bursa (fluid-filled small sac that acts as a cushion between the bones and tendons) that results in pain.

• Hammertoes - Hammertoes are conditions in which the toes curl downward due to the toe's middle joint pocking out. Ill-fitting shoes can worsen the condition, and corn may develop at the site.

• Ankle Sprain - Injury to the ankle ligaments results in ankle sprain. It can occur when the ankle twists, turns, or rolls beyond its range of motion. The symptoms depend on the severity of the ligament injury and include pain, swelling, or bruising.

What Are the Non-surgical Treatment Options for Foot Pain?

1. Footwear Change:

Shoes with a wide-toe box must be used. Certain shoes are used with a stretcher that stretches out the areas that put pressure on the feet.

2. Orthotics:

Orthotics aid in slowing the progression of the condition. Foot orthotics are shoe inserts specially designed to support the foot and correct imbalances. It helps improve foot posture and treats certain foot and ankle problems. Podiatrists may prescribe foot orthoses for individuals with foot or leg conditions affecting their health and function.

Foot orthotics are mainly of three types -

• • Over-the-counter foot orthotics or off-the-shelf foot orthotics.
  • Custom-made or prescription orthotics.
  • “Kiosk-generated” foot orthotics.

Over-the-counter or off-the-shelf foot orthotics are the ones that are widely available and are chosen based on the condition and shoe size. “Kiosk-generated” foot orthotics are based on the foot scan. A particular orthotic is recommended based on the foot problem and foot scan.

In the case of custom-made or prescription orthotics, the podiatrists consider the patient’s health history, medical history, height, weight, activity level, etc. The best material for the patient and the level of flexibility of the orthosis are determined, and a mold impression of the foot is taken. They are used for personalized correction of biomechanical issues.

3. Splints and Spacers:

Toe spacers can be used to keep the toes in a normal position. Splints are used at night to keep the toes straight, preventing the joint from stiffening. The main goal of using splints and spacers is to slow down the disease and reduce the symptoms.

4. Medications:

Pain and swelling at the base of the big toe joint region are common bunion symptoms. Analgesics like NSAIDs (non-steroidal anti-inflammatory drugs) can be used as ointments or tablets to reduce pain and swelling. Tablets should be avoided for a longer period due to the potential side effects associated with them.

5. Injections:

Corticosteroid injections aid in relieving pain and inflammation associated with foot pain.

Ultrasound-guided or blind steroid injections help reduce nerve inflammation and are useful in the case of Morton’s neuroma. Nerve ablation is another injection preventing the nerve from sending pain signals.

Platelet-rich plasma injections contain platelets and promote healing. These are used for treating pain due to plantar fasciitis in cases where steroid injections fail to reduce pain and inflammation.

6. Exercises:

Physiotherapy can be done to stretch and strengthen the foot muscles.

Exercise may also aid in increasing flexibility and reducing pain. However, exercises alone do not correct bone misalignment.

7. Paddling:

Protective silicone pads are worn shoes; this cushions the painful region over the bunion. These can be purchased from a pharmacy or drug store.

8. Hot and Cold Therapy:

Cold therapy constricts the blood vessels and helps reduce swelling. So the feet are soaked in cold water to reduce inflammation.

Heat therapy improves blood flow and helps relax sore joints and muscles.

Heating pads and ice packs are used. Icepacks can be wrapped in a tea towel and applied to the affected region for about 5 minutes.

A combination of heat and cold therapy may aid in relieving the symptoms.

9. Immobilization:

The casting of the injured foot prevents the movement of the fractured bone. A walking boot may be recommended to immobilize the injured foot, further reducing pressure during walking.

10. Healthy Weight Maintenance:

Maintenance of a healthy weight prevents excess pressure on the foot.

11. EPAT (extracorporeal pulse activation technology):

EPAT is a non-invasive shockwave therapy that accelerates the healing process. The pressure waves are used to improve blood circulation and help in healthy tissue regeneration. These are used for neuromas, plantar fasciitis, soft tissue injuries, and heel spurs.

12. Natural Remedies -

Some natural remedies one can follow for foot pain relief are:

• Keep the feet elevated when in a sitting or lying position.

• Foot exercises.

• Foot massage.

• Take off the shoes and stretch the toes whenever possible.

Conclusion

Foot pain, in most cases, can be managed by conservative or non-surgical treatment options. The cause of foot pain, the severity of the condition, the severity of symptoms, etc., play a role in determining the treatment. Initially, the physician mostly recommends non-surgical options.Surgery is mostly indicated in severe cases of bone malalignment, in cases where the symptoms are severe and affect the patient’s daily activities, or where the non-surgical options fail.