By Laurence J. Kinsella, M.D., F.A.A.N. * Reprinted from Neuropathy News (Issue 35--September 2009).
The human foot is comprised of 26 bones, 38 muscles, 56 ligaments, and many more blood vessels and nerves, all of which can cause foot pain when injured. From fallen arches and calluses to ingrown nails and peripheral neuropathy, foot pain has many forms.
Approximately 40 percent of adults in the United States experience foot problems.¹ Foot pain can be disabling and can impact every aspect of your life. It is an indication that something is amiss with either the interfacing of the internal structures of the foot or with interfacing of the foot with external influences like shoes (poorly fitting shoes or high heels) or the ground. How and when the pain occurs and the site of the pain usually provide clues to what may be causing it. You may find yourself compensating to minimize the pain.
The following is a list of conditions that can cause foot pain:
Skin Conditions:
Ingrown toe nails—This occurs when the edges of the nail grow through or into the skin, resulting in irritation and, sometimes, causing an infection.
Calluses and corns—These are conditions resulting from the thickening of the skin from friction or pressure. Calluses appear on the balls of the feet or heels, while corns appear on the toes.
Musculoskeletal Conditions:
Plantar fasciitis—This is the most common cause of heel pain resulting from inflammation of the tissue (called the plantar fascia) connecting the heel bone to the toes.
Neurological Conditions:
Small fiber neuropathy—This is increasingly recognized as a major cause of painful burning sensations in the feet resulting from diabetes, impaired glucose tolerance, and HIV, among other conditions.
Focal entrapment—This occurs when a nerve(s) is chronically compressed or mechanically injured at a specific location, e.g., tarsal tunnel syndrome.
Morton’s neuroma—This is a non-cancerous growth (or thickening) of nerve tissue in the foot, often between the third and fourth toes, causing a sharp, burning pain in the ball of the foot.
Bone Conditions:
Arthritis—Arthritic conditions, particularly osteoarthritis and gout, can cause foot pain.
Osteoporosis—Osteoporosis, in which bone loss occurs, can cause foot pain.
Stress fractures—These are tiny cracks in a bone caused by the repetitive application of force, often by overuse, e.g., occupational injuries such as athletes may experience.
Bunions—This is a protrusion at the base of the big toe, which can become inflamed. Bunions often develop over time from wearing narrow-toed shoes.
Bony feet—Some people lack sufficient padding in the soles of their feet, making their feet bony and more painful.
Vascular or Circulatory Conditions:
Peripheral artery disease (PAD)—This is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs, causing leg pain when walking.
Foot pain can be disabling and impact daily activities. It is important to visit your primary care physician for an evaluation, particularly when your symptoms interfere with your activities of daily living or if you cannot perform your activities without pain. Your primary care physician will also determine whether you will need further evaluation by a specialist for certain foot conditions.
References:
¹Karasick D., Wapner K.L. “Hallux Valgus Deformity: Preoperative Radiologic Assessment.” American Journal of Roentgenology. 1990; 155:119–23.1.
Laurence J. Kinsella, M.D., F.A.A.N. is professor of Neurology and Psychiatry at Saint Louis University Health Sciences Center and chief of Neurology and Neurophysiology at Forest Park Hospital. Dr. Kinsella also serves on The Neuropathy Association’s Medical Advisory Committee.
* Reprinted from Neuropathy News (Issue 35--September 2009).
http://www.neuropathy.org/site/News2?page=NewsArticle&id=7912&news_iv_ctrl=1221
MD,
former dean of Stanford’s medical school was preparing to head to
Washington, D.C. to meet with top federal health officials when he
leaned down in his office and felt the sharp sting of pain. It would be
the beginning of a long odyssey into the world of chronic pain – the
very subject he had planned to go to Washington to discuss.
The chair of an Institute of Medicine panel on pain, Pizzo and his colleagues had issued a report in late 2011 calling for a transformation in approaches to pain, which affects more than 100 million Americans. Suddenly he would find himself among the afflicted as he sought the opinions of multiple physicians and underwent four MRI’s, turning increasingly despondent as the months dragged on with no diagnosis.
“I could easily still have been one of the many tens of thousands or millions facing chronic pain without explanation, because I had been through all the standard testing,” he said in an interview. “I had four MRI scans and none showed the lesion that ultimately contributed to my finding. The reality was because I am a physician and I kept saying, ‘Gee, there is something wrong that hasn’t been found,’ people were responsive.”
In writing about the experience in today’s New England Journal of Medicine (subscription required), Pizzo says the specialists he encountered were often circumscribed in seeking answers. He told me, “While it’s not an indictment of the medical system, it’s a reality that many have faced – physicians and providers are rushed, specialization is so significant that many people think within narrow boundaries. They don’t leap beyond their own expertise. That is another thing we have to challenge ourselves with - to think beyond the usual.”
As time wore on, he said, at least one physician would suggest that his condition was largely psychological - essentially “all in your head.”
“What I experienced is what many do when you get beyond the point when conventional tests aren’t revelatory. The medical community gets frustrated – gee we can’t find anything – and begin to think maybe there are other things happening, some suggestion perhaps that it was distress or depression… It’s easy for physicians to say you are depressed and that’s why you have pain. But it’s important to recognize that patients may be depressed because they have pain.”
A marathon runner with boundless energy and a perennially upbeat attitude, Pizzo indeed had become clinically depressed as a result of his disabling condition. But once the underlying cause of the chronic pain was diagnosed and treated – albeit with a major surgical procedure – that depression immediately lifted, along with the pain. Ultimately, it was an unusual test - an imaging study that tracked the path of the sciatic nerve - that unearthed the source of his distress, a congenital condition involving compression of the nerve.
After the surgery, Pizzo learned another valuable lesson for physicians - that not all patients respond well to opioids, typically the drugs of choice for control of severe pain. He proved highly sensitive to the medications and landed in intensive care.
Today, Pizzo is back to running and working full-time in his office on the medical school campus. In writing his personal story, he says he hopes to draw more physician attention to the overwhelming problem of chronic pain in the United States.
“My hope is that by doing this, it will generalize the discussion and create more dialogue about the realities that 100 million people face, many of whom don’t have the opportunity to have their voices expressed.”
- See more at: http://scopeblog.stanford.edu/2013/09/18/a-physicians-personal-odyssey-with-chronic-pain/#comments
The chair of an Institute of Medicine panel on pain, Pizzo and his colleagues had issued a report in late 2011 calling for a transformation in approaches to pain, which affects more than 100 million Americans. Suddenly he would find himself among the afflicted as he sought the opinions of multiple physicians and underwent four MRI’s, turning increasingly despondent as the months dragged on with no diagnosis.
My hope is that by sharing my personal story, it will generalize the discussion and create more dialogue about the realities that 100 million people face…
“I could easily still have been one of the many tens of thousands or millions facing chronic pain without explanation, because I had been through all the standard testing,” he said in an interview. “I had four MRI scans and none showed the lesion that ultimately contributed to my finding. The reality was because I am a physician and I kept saying, ‘Gee, there is something wrong that hasn’t been found,’ people were responsive.”
In writing about the experience in today’s New England Journal of Medicine (subscription required), Pizzo says the specialists he encountered were often circumscribed in seeking answers. He told me, “While it’s not an indictment of the medical system, it’s a reality that many have faced – physicians and providers are rushed, specialization is so significant that many people think within narrow boundaries. They don’t leap beyond their own expertise. That is another thing we have to challenge ourselves with - to think beyond the usual.”
As time wore on, he said, at least one physician would suggest that his condition was largely psychological - essentially “all in your head.”
“What I experienced is what many do when you get beyond the point when conventional tests aren’t revelatory. The medical community gets frustrated – gee we can’t find anything – and begin to think maybe there are other things happening, some suggestion perhaps that it was distress or depression… It’s easy for physicians to say you are depressed and that’s why you have pain. But it’s important to recognize that patients may be depressed because they have pain.”
A marathon runner with boundless energy and a perennially upbeat attitude, Pizzo indeed had become clinically depressed as a result of his disabling condition. But once the underlying cause of the chronic pain was diagnosed and treated – albeit with a major surgical procedure – that depression immediately lifted, along with the pain. Ultimately, it was an unusual test - an imaging study that tracked the path of the sciatic nerve - that unearthed the source of his distress, a congenital condition involving compression of the nerve.
After the surgery, Pizzo learned another valuable lesson for physicians - that not all patients respond well to opioids, typically the drugs of choice for control of severe pain. He proved highly sensitive to the medications and landed in intensive care.
Today, Pizzo is back to running and working full-time in his office on the medical school campus. In writing his personal story, he says he hopes to draw more physician attention to the overwhelming problem of chronic pain in the United States.
“My hope is that by doing this, it will generalize the discussion and create more dialogue about the realities that 100 million people face, many of whom don’t have the opportunity to have their voices expressed.”
- See more at: http://scopeblog.stanford.edu/2013/09/18/a-physicians-personal-odyssey-with-chronic-pain/#comments
A physician’s personal odyssey with chronic pain
on September 18th, 2013
5 Comments
The chair of an Institute of Medicine panel on pain, Pizzo and his colleagues had issued a report in late 2011 calling for a transformation in approaches to pain, which affects more than 100 million Americans. Suddenly he would find himself among the afflicted as he sought the opinions of multiple physicians and underwent four MRI’s, turning increasingly despondent as the months dragged on with no diagnosis.
My hope is that by sharing my personal story, it will generalize the discussion and create more dialogue about the realities that 100 million people face…
“I could easily still have been one of the many tens of thousands or millions facing chronic pain without explanation, because I had been through all the standard testing,” he said in an interview. “I had four MRI scans and none showed the lesion that ultimately contributed to my finding. The reality was because I am a physician and I kept saying, ‘Gee, there is something wrong that hasn’t been found,’ people were responsive.”
In writing about the experience in today’s New England Journal of Medicine (subscription required), Pizzo says the specialists he encountered were often circumscribed in seeking answers. He told me, “While it’s not an indictment of the medical system, it’s a reality that many have faced – physicians and providers are rushed, specialization is so significant that many people think within narrow boundaries. They don’t leap beyond their own expertise. That is another thing we have to challenge ourselves with - to think beyond the usual.”
As time wore on, he said, at least one physician would suggest that his condition was largely psychological - essentially “all in your head.”
“What I experienced is what many do when you get beyond the point when conventional tests aren’t revelatory. The medical community gets frustrated – gee we can’t find anything – and begin to think maybe there are other things happening, some suggestion perhaps that it was distress or depression… It’s easy for physicians to say you are depressed and that’s why you have pain. But it’s important to recognize that patients may be depressed because they have pain.”
A marathon runner with boundless energy and a perennially upbeat attitude, Pizzo indeed had become clinically depressed as a result of his disabling condition. But once the underlying cause of the chronic pain was diagnosed and treated – albeit with a major surgical procedure – that depression immediately lifted, along with the pain. Ultimately, it was an unusual test - an imaging study that tracked the path of the sciatic nerve - that unearthed the source of his distress, a congenital condition involving compression of the nerve.
After the surgery, Pizzo learned another valuable lesson for physicians - that not all patients respond well to opioids, typically the drugs of choice for control of severe pain. He proved highly sensitive to the medications and landed in intensive care.
Today, Pizzo is back to running and working full-time in his office on the medical school campus. In writing his personal story, he says he hopes to draw more physician attention to the overwhelming problem of chronic pain in the United States.
“My hope is that by doing this, it will generalize the discussion and create more dialogue about the realities that 100 million people face, many of whom don’t have the opportunity to have their voices expressed.”
A physician’s personal odyssey with chronic pain
on September 18th, 2013
5 Comments
The chair of an Institute of Medicine panel on pain, Pizzo and his colleagues had issued a report in late 2011 calling for a transformation in approaches to pain, which affects more than 100 million Americans. Suddenly he would find himself among the afflicted as he sought the opinions of multiple physicians and underwent four MRI’s, turning increasingly despondent as the months dragged on with no diagnosis.
My hope is that by sharing my personal story, it will generalize the discussion and create more dialogue about the realities that 100 million people face…
“I could easily still have been one of the many tens of thousands or millions facing chronic pain without explanation, because I had been through all the standard testing,” he said in an interview. “I had four MRI scans and none showed the lesion that ultimately contributed to my finding. The reality was because I am a physician and I kept saying, ‘Gee, there is something wrong that hasn’t been found,’ people were responsive.”
In writing about the experience in today’s New England Journal of Medicine (subscription required), Pizzo says the specialists he encountered were often circumscribed in seeking answers. He told me, “While it’s not an indictment of the medical system, it’s a reality that many have faced – physicians and providers are rushed, specialization is so significant that many people think within narrow boundaries. They don’t leap beyond their own expertise. That is another thing we have to challenge ourselves with - to think beyond the usual.”
As time wore on, he said, at least one physician would suggest that his condition was largely psychological - essentially “all in your head.”
“What I experienced is what many do when you get beyond the point when conventional tests aren’t revelatory. The medical community gets frustrated – gee we can’t find anything – and begin to think maybe there are other things happening, some suggestion perhaps that it was distress or depression… It’s easy for physicians to say you are depressed and that’s why you have pain. But it’s important to recognize that patients may be depressed because they have pain.”
A marathon runner with boundless energy and a perennially upbeat attitude, Pizzo indeed had become clinically depressed as a result of his disabling condition. But once the underlying cause of the chronic pain was diagnosed and treated – albeit with a major surgical procedure – that depression immediately lifted, along with the pain. Ultimately, it was an unusual test - an imaging study that tracked the path of the sciatic nerve - that unearthed the source of his distress, a congenital condition involving compression of the nerve.
After the surgery, Pizzo learned another valuable lesson for physicians - that not all patients respond well to opioids, typically the drugs of choice for control of severe pain. He proved highly sensitive to the medications and landed in intensive care.
Today, Pizzo is back to running and working full-time in his office on the medical school campus. In writing his personal story, he says he hopes to draw more physician attention to the overwhelming problem of chronic pain in the United States.
“My hope is that by doing this, it will generalize the discussion and create more dialogue about the realities that 100 million people face, many of whom don’t have the opportunity to have their voices expressed.”
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