Pain in the foot is a consequence of pathological processes in the bones and soft tissues of the foot, damage to blood vessels, nerves of the overlying sections. It can be dull, acute, weak, strong, diffuse, local, constant, periodic. Most often, there is a connection with physical activity, prolonged stay in a standing position. To determine the cause of pain, a survey, external examination, radiography, CT, MRI, sonography, and laboratory tests are carried out. Until the etiology of the pain syndrome is determined, rest is recommended, sometimes taking painkillers is indicated.
Foot injury occurs when a heavy object falls, hits or stumbles. It is manifested by moderate gradually subsiding pain, swelling, bruising. The support is preserved, sometimes limited. Symptoms disappear after 1-2 weeks. Foot fractures develop for the same reasons as bruises. Characterized by explosive sharp pain, significant swelling, gross dysfunction. The clinical picture is determined by the location of the fracture:
Fractures of the bones of the foot in children, as a rule, are detected in the region of the metatarsus. With single fractures, the absence of displacement, the pain syndrome may be moderate, but severe swelling and bruising indicate the presence of severe damage. Dislocations of the bones of the foot are rare, accompanied by extremely intense sudden pain, which practically does not subside over time. The foot is edematous, grossly deformed, with extensive hemorrhages. The point of maximum pain corresponds to the location of the dislocation of the bones of the metatarsus or tarsus.
A marching foot (stress or fatigue fracture) is a special type of damage to the bones of the metatarsus, which is detected during intense overload of the feet. Pain in the feet develops acutely 2-4 days after overexertion or gradually over 1-2 weeks. Patients complain of strong, sometimes unbearable pain in the middle part of the foot.
Chilling is formed with high humidity and periodic cooling, manifested by burning, bursting pains, itching, sensitivity disorders, the formation of zones of dense cyanotic-purple edema. With frostbite, the pain is at first insignificant, tingling, appearing against the background of a cold snap, pallor of the limb. Then the painful sensations become intense, burning, supplemented by edema, cyanosis, blistering, in severe cases, necrosis.
For all forms of arthritis of the foot, pain is typical, which is aggravated by standing and walking, stiffness of movements, most pronounced in the morning, swelling, redness of the skin in the area of the affected joints. In rheumatoid arthritis, the joints are affected symmetrically on both sides, an acute onset with severe pain, fever, or a primary chronic course is possible. The intensity of pain sensations ranges from weak, short-term to strong, constant. Other manifestations correlate with the severity of the pain syndrome.
In post-traumatic arthritis, one joint is affected, and the pain usually builds up slowly over months or years. Nonspecific infectious arthritis develops against the background of bacterial, fungal, viral infections, manifests as acute severe pain at rest and during movement, increasing edema, local hyperthermia, and manifestations of general intoxication.
Gouty arthritis is characterized by damage to the I metatarsophalangeal joint. The attack begins suddenly, usually at night with very sharp acute pain, local swelling, redness of the skin, fever. The pain persists for 3-1 days, then all symptoms completely disappear. Repeated attacks can develop after several months or years, the intervals between attacks are gradually reduced. Tophi are formed on the skin.
With chondrocalcinosis (pseudogout), arthritis of similar localization is sometimes observed, which can make diagnosis difficult due to a similar clinical picture. Pseudogout is also accompanied by intense pain, swelling, hyperemia of the joint, unlike gout is the absence of general hyperthermia, tophi. An attack of chondrocalcinosis lasts about 1 week, on the first day the pain increases, then decreases.
Simple periostitis of the foot is rare, usually the result of an injury, manifested by moderate pain, slight swelling in the affected area. Ossifying periostitis develops after injuries, with arthritis, tumors, trophic ulcers, and some other diseases. It is characterized by moderate or slight pain in combination with increasing limitation of movement. With a long course, fusion of the bones of the tarsus is possible.
Osteomyelitis of the bones of the foot is provoked by open fractures, infected wounds, purulent diseases, operations on the foot. It is manifested by an increase in pain, a deterioration in the general condition. The pains are jerking, bursting, boring, aggravated by any movement. The intensity of symptoms decreases after the formation of a fistula.
Foot pain
Gonorrheal arthritis in the area of the metatarsophalangeal joints is more often diagnosed in men, manifested by intense pain during movement, fever, chills, local edema, hyperemia. After the subsidence of acute phenomena, the disease acquires a chronic relapsing course, resembling the clinical picture of rheumatoid arthritis. There are restrictions of movements, deformations are formed.
With the development of osteoarticular tuberculosis, patients are worried for some time by periodic mild pain in the foot, weakness, lethargy, and decreased ability to work. Then the intensity of pain increases, the foot becomes edematous, hyperemic. Walk is disturbed. Gradually, the pains reach the degree of unbearable, the general condition continues to deteriorate, fistulas form on the foot, ankylosis of the joints is formed.
Tenosynovitis often affects the tendons of the dorsum of the foot. The acute non-specific form of the pathology is manifested by sudden moderate pain, limitation of movements, significant swelling, which can spread to the entire foot, ankle joint, lower leg. With infectious tendovaginitis, the pain syndrome is more pronounced than with the usual nonspecific. Fever, lymphadenitis are observed.
In acute crepitating tendovaginitis, along with pain during movement, a soft crunch is noted, swelling is less than in other forms, and there is no fever. In the chronic course of aseptic tendovaginitis, a cord-like seal is formed along the course of the tendon. Palpation is painful, movements are limited due to pain. Edema is insignificant.
Keller's disease I is detected in boys aged 3-7 years, accompanied by pain in the proximal part of the foot, closer to its inner edge. The pain is aggravated by walking and palpation, forcing the child to lean not on the entire foot, but on its outer edge. Over time, the pain syndrome becomes constant, does not disappear even at rest. Lameness occurs. Edema and hyperemia are absent. All symptoms of osteochondropathy disappear within a year; in the absence of treatment, foot deformity is possible.
With Keller II disease, which develops in girls 10-15 years old, pain is noted in the anterior sections of the foot, in the projection of the II-III metatarsal bones. At first, the pains are not intense, they appear with prolonged walking, then they intensify, become prolonged. Patients complain of increased pain when wearing shoes with thin soles, walking on uneven surfaces. Then the pain becomes permanent. Recovery occurs within 2-3 years, shortening of the affected metatarsal bone is possible.
Transverse flat feet is manifested by aching, pulling, burning pains in the feet, a feeling of heaviness in the legs. Symptoms are aggravated after long walking, standing. Soreness is localized in the forefoot along the inner edge. Hallux valgus is formed. The pain syndrome in the projection of the 1st metatarsophalangeal joint becomes longer and more intense, worries at night, combined with external deformity, restriction of movement.
In patients with longitudinal flat feet, pain is localized mainly in the middle parts of the foot. Grade 1 is accompanied by non-intense pain after a significant load. At grade 2, pain appears after small loads, is felt at rest, spreads to the ankle joint. At 3 degrees, pain is constant, intense. Difficulty walking, using ordinary shoes. In the combined form of the disease, symptoms of longitudinal and transverse flat feet are revealed, pain is diffuse.
With the calcaneus and horse foot, the pain is also diffuse, captures the ankle joint and lower leg, is supplemented by a rough restriction of flexion of the foot to the plantar or dorsal side. With a hollow foot, pain is localized in the proximal parts of the foot, due to compression of the tarsal bones by shoes. The pain syndrome is more pronounced in the case of a combination of a hollow foot with a transverse flat foot.
A stiff big toe is initially manifested by slight pain in the metatarsophalangeal joint after a heavy load. Then the pains become prolonged, remain at rest. Due to the restriction of movements, the patient experiences an overload of the outer sections of the foot, pain appears in the zone V of the metatarsophalangeal joint. Subsequently, pain in the foot disturbs at night, there are no movements, walking is difficult.
With hallux valgus deformity of the foot, pain occurs mainly in the inner parts of the foot and above the outer ankle. The pain syndrome intensifies with exercise, the use of uncomfortable shoes, is combined with pain in the lower leg, caused by constant muscle strain.
Clubfoot is characterized by pain along the outer edge of the foot, which eventually spread throughout the foot, to the overlying parts of the limb. The foot is deformed, the sole is turned inside. With congenital pachyonychia, extensive painful calluses form on the protruding areas of the feet, cracks form. Changes in the feet are combined with onychodystrophy, the appearance of warty growths, peeling of the skin, and plantar hyperhidrosis.
Diabetic osteoarthropathy is a type of diabetic foot that primarily affects the metatarsal joints. Pain in the feet at first is not intense, it occurs against the background of already existing swelling, hyperemia, and some deformation of the feet. Then the duration of the pain syndrome increases, soreness appears at rest, a gross deformity is formed.
The neuropathic form is characterized by the formation of zones of hyperkeratosis, painful ulcers, abrasions, cracks on the plantar surface of the foot. In the ischemic form of the diabetic foot, pain develops when walking, provokes intermittent claudication, is combined with persistent edema, weakening of the pulsation of the arteries. In severe cases, diabetic gangrene is detected, characterized by pain, swelling in the area between the affected and healthy tissues.
Pain in the feet is observed with obliterating lesions of the arteries of the lower extremities. Initially noted only during walking, cause intermittent lameness. Soreness worries mainly in the area of the sole, spreads to the fingers and shins. Gradually, the "painless" distance is reduced. In the later stages, the pain syndrome persists at rest. The extremities are pale, cold, the pulse is weakened or not determined. Such symptoms are typical for the following diseases:
In addition, pain in the feet is detected with trophoneurosis - erythromelalgia. The pain is very intense, burning, baking, begins with one finger, spreads to both feet. Occur suddenly, provoked by compression or overheating of the limb, supplemented by edema, bright hyperemia. Remain from several minutes to several hours, prevent walking.
Morton's neuroma is characterized by burning local pains at the level of the heads of the metatarsal bones (usually in the 3rd interdigital space, less often in the 2nd), radiating to the fingers. Shots are possible. Soreness is associated with wearing tight shoes, physical activity. There is an undulating course. With progression, the pains become constant, disturb in any shoe, decrease, but do not disappear when it is removed, combined with numbness of the fingers.
Pain in the feet also occurs with tibial nerve neuropathy. The burning nature of pain is typical, combined with sensory disturbances, muscle weakness. The localization of the pain syndrome is determined by the level of the lesion:
Neuropathy of the peroneal nerve is manifested by pain on the outside, and neuropathy of the sciatic nerve - on the posterior surface of the foot and lower leg. With neuropathy of the femoral nerve, pain is noted along the inner surface of the foot.
Of the tumor diseases in the foot area, there is a chondroma, which proceeds benignly, manifests itself as short-term weak pains with indistinct localization, aggravated by the growth of neoplasia, shoe pressure. Soreness in the feet can also occur with depression, some mental disorders. The pain syndrome caused by mental disorders is characterized by a discrepancy between the clinic of a certain disease, the absence of anatomical changes, and sometimes the bizarre nature of sensations.
Determining the causes of pain in the foot is carried out by orthopedic traumatologists. To make a diagnosis, data from an objective examination and additional studies are used. The following procedures are performed:
Taking into account the nature of the disease, consultations of other specialists are appointed: an endocrinologist, a neurologist, a vascular surgeon. According to the indications, CT, MRI are performed, a biopsy of bones and soft tissues is performed to study their morphological structure.
Plaster cast on the foot
Limbs provide peace, lofty position. For skeletal injuries, cold is applied, immobilization is carried out with a splint or fixing bandage. In case of frostbite, an insulating bandage is applied, intensive warming of the feet is prohibited, since it can aggravate existing tissue damage. For non-traumatic foot pathologies, local anti-inflammatory, analgesics are used.
In case of fractures and dislocations, blockades, reduction or reposition, and the application of a plaster cast are performed. The conservative therapy plan includes:
Surgical interventions are carried out to reduce the time and improve the results of treatment. Taking into account the characteristics of the disease are carried out:
After operations, antibacterial and painkillers are used, dressings are performed. An obligatory part of surgical treatment is complex rehabilitation programs, including physiotherapy exercises, physiotherapy techniques.