Cause Of Foot Pain Research Articles

Intrinsic foot muscle structure and function: Rethinking our approach to managing plantar heel pain

Plantar heel pain is a common and persistent cause of foot pain in athletes and active individuals. Emerging evidence of intrinsic foot muscle (IFM) deficits associated with plantar heel pain and other foot and ankle conditions, along with enhanced understanding of the role of the IFMs, challenges our conventional approach to management.

Painful Foot Disorders in the Geriatric Population: A Narrative Review.

Painful foot disorders are highly prevalent among older adults causing a significant impact on mobility, function, and risk of falls. Despite its significance, foot pain is often interpreted as a normal part of aging and relatively ignored by health care providers as well as by the older people themselves. Accurate diagnosis of the cause of foot pain is possible for most cases via clinical evaluation without a costly workup. Clinicians should consider, not only musculoskeletal pathologies but also vascular and neurological disorders in older patients with foot pain. Fortunately, most patients improve with physiatric, nonoperative interventions involving biomechanical analysis, function-oriented rehabilitation programs and therapeutic exercise, the use of proper footwear and orthoses, and selected percutaneous interventions, as indicated. In this review, we discuss the physiologic changes of the aging foot relevant to foot pain, the impact of painful foot disorders on function and other key outcomes, and principles of diagnosis and intervention. We also briefly describe painful foot disorders of the older people commonly encountered in a physiatric practice.

Effect of debridement of plantar hyperkeratoses on gait in older people – An exploratory trial

Hyperkeratoses are a common cause of foot pain due to the release of inflammatory mediators, which can have an impact on the mobility and independence of people suffering from them. However, the repercussions that hyperkeratoses have on gait parameters remain uncertain. AimThe aim of this study is to analyze the repercussions that plantar hyperkeratosis debridement has on several kinematic and kinetic variables of gait in a group of older participants. Methods98 older participants (75.1 ± 6.7 years) were randomly assigned to two groups: Group A, Scalpel debridement of plantar hyperkeratoses; and Group B, Control group (Simulated debridement). Plantar hyperkeratotic pain was measured before and after treatment on a visual analog scale. Several kinematic and kinetic variables of gait were measured before and after treatment using a Win-Track pressure sensitive walkway. ResultsA significant difference was found in the level of pain between the treated group and the control group (p < 0.01 [8.55–18.15; 95% confidence interval]). Regarding the gait parameters, statistically significant reductions were found in peak pressures (p < 0.05; Cohen’s d = 2.688) and maximum force (p < 0.04; d = 0.262). ConclusionsData suggests that debridement of plantar hyperkeratosis may lead to a reduction in pain and appear to reduce peak maximum force and peak plantar pressure. No significant changes were observed in the kinematic variables analyzed. The duration of the benefits remain unknown.

Clinical Outcomes After Extracorporeal Shock Wave Therapy for Chronic Plantar Fasciitis in a Predominantly Active Duty Population

Chronic plantar fasciitis is a common cause of foot pain, with conservative treatment providing relief for most patients. However, because of the common occurrence of this pathology, this leaves many patients dissatisfied. The purpose of the present study was to determine the effectiveness of extracorporeal shock wave therapy (ESWT) to treat chronic plantar fasciitis (PF) in a largely active duty population. A review of 82 patients (115 heels) who had undergone ESWT for chronic PF was performed. Outcome data were obtained by patient telephone interviews. All ESWT was conducted at 24 kV for 2000 shocks. Of the 82 patients (115 heels), 76 (93%; 111 heels) agreed to participate. Their mean age was 42 ± 10 years, with 41 males (54%) and 35 females (46%). The mean follow-up period was 42 ± 22 months. Of the patients, 73.6% were active duty military personnel. The mean preoperative pain score of 7.8 ± 2 had improved to 2.5 ± 2 at the last follow-up visit (p < .0001). Active duty patients reported a mean improvement in pain of 4.8 ± 3 compared with 6.8 ± 3 in non-active duty patients (p = .005). Of the 76 patients, 75 (98%) underwent 1 ESWT session, and 1 (2%) requiring 2 sessions. Overall, 74% of patients rated the outcome of their procedure as either good or excellent, with 87% stating that ESWT was successful. Ten patients (18%) left the military because of continued foot pain, with 76% able to return to running. For patients with chronic PF, these results support the use of ESWT to relieve pain in >85% of patients, with a preponderance for better pain relief in patients who are not active duty military personnel.

Hallux valgus: Surgical treatment with open proximal wedge osteotomy using low-profile plate — A case series

Objectives: Hallux valgus is one of the common causes of foot pain and deformity in the adult and adolescent population with multiple possible causes. Surgical correction with the opening proximal wedge osteotomy using low-profile plate system (LPS) fixation has been gaining popularity in the recent literature. This study report results from a case series of feet with hallux valgus corrected utilizing open proximal wedge osteotomy using LPS fixation. Methods: This was a retrospective case series of 12 consecutive patients (14 feet). All surgeries were done by a single orthopedic surgeon. A proximal wedge osteotomy using Arthrex opening wedge LPS fixation was done to all patients. Follow-up was 3 years minimum except for four patients who were lost to follow. Patient subjective satisfaction, radiographic assessment, and physical examination were reported. Results: The overall satisfaction was at 100% of followed patients. Shoe wear and foot shape were improved in 11 feet, and 12 had postoperative pain improvement. Mean preoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA) were at 30.07° and 12.36°, respectively. Postoperatively, the mean HVA and IMA improved to 13.36° and 6°, respectively (P

Clinical Outcome Following Total Joint Replacement and Arthrodesis for Hallux Rigidus: A Systematic Review.

Hallux rigidus is a common cause of foot pain in the elderly and has a negative impact on quality of life. Several operative treatment options are available for feet that are refractory to conservative treatment. Of these, total joint replacement and arthrodesis of the first metatarsophalangeal joint are the most commonly performed interventions. Nevertheless, it is still not known which intervention results in the best clinical outcome and the fewest complications. PubMed/MEDLINE, Embase, and the Cochrane Library were systematically searched for studies assessing outcome with the American Orthopaedic Foot & Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) score, Foot Function Index (FFI), visual analog scale (VAS) for pain, or Short Form-36 (SF-36) in patients who underwent an arthrodesis or total joint replacement for the treatment of symptomatic hallux rigidus. Secondary outcomes were complications and revision rates. The screening of titles and abstracts, data collection, data extraction, and study quality assessment were performed independently by 2 reviewers. Study quality was determined with use of risk-of-bias tools. Results of included studies were presented in a qualitative manner, and the results of high-quality studies were pooled. Thirty-three studies, describing a total of 741 arthrodeses and 555 total joint replacements, were included in the qualitative analysis. Six different prostheses were used for total joint replacement, and various fixation techniques were used for arthrodesis. The results of 6 arthrodesis studies and 7 total joint replacement studies were pooled in the quantitative analysis. Pooled results showed superiority of arthrodesis compared with total joint replacement for improving clinical outcome (by 43.8 versus 37.7 points on the AOFAS-HMI score) and reducing pain (a decrease of 6.56 versus 4.65 points on the VAS pain score). Because of the rare reporting of the FFI and SF-36, no comparison could be made for these outcomes. Fewer intervention-related complications (23.1% versus 26.3%) and revisions (3.9% versus 11%) were reported after arthrodesis as compared with total joint replacement, with pain and nonunion and prosthetic loosening being the most commonly reported complications after arthrodesis and total joint replacement, respectively. The present systematic review of the literature indicated that arthrodesis is superior for improving clinical outcome and reducing pain, and is less often accompanied by intervention-related complications and revisions, compared with total joint replacement in patients with symptomatic hallux rigidus. Prospective, randomized controlled trials will need to be conducted to verify this conclusion. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy

To determine whether platelet-rich plasma (PRP) injections are associated with improved pain and function scores when compared with corticosteroid injections for plantar fasciopathy. A systematic review of published literature was performed for studies comparing PRP injections and corticosteroid injections for plantar fasciopathy. Studies were assessed using the Cochrane Risk of Bias Tool and the Newcastle Ottawa Scale (NOS). The primary endpoint was pain and function score at three and six month follow-up. Sensitivity analysis was performed for high quality studies and randomised studies. Ten studies totalling 517 patients were included. Seven studies were randomised. All studies included patients who had failed conservative measures and excluded patients with systemic illness and other causes of foot pain. Studies reported outcomes using the visual analogue score (VAS) and American Orthopaedic Foot and Ankle Score (AOFAS). At 3-month follow-up, PRP injections were associated with improved VAS scores (standard mean difference [SMD], -0.66; 95% CI, -1.3 to -0.02; p=0.04) and AOFAS scores (SMD, 1.87; 95% CI, 0.16-3.58; p=0.03). At 6-month follow-up, there was no difference in VAS score (SMD, -0.66; 95% CI, -1.65 to 0.3; p=0.17) or AOFAS scores (SMD, 1.69; 95% CI, -1.06 to 4.45; p=0.23). No studies reported adverse event rates or cost analysis. There was no difference in pain or function score at one, six- or 12-month follow-up. Sensitivity analyses of high-quality studies showed no differences between the PRP and steroid group at any of the follow-up points. PRP injections are associated with improved pain and function scores at three month follow-up when compared with corticosteroid injections. Information regarding relative adverse event rates and cost implications is lacking. Further, large-scale, high-quality, randomised controlled trials with blinding of outcome assessment and longer follow-up are required.

A rare cause of foot pain: Osteoid osteoma of the cuboid bone

A rare cause of foot pain: Osteoid osteoma of the cuboid bone

Bunion: Strengthening Foot Muscles to Reduce Pain and Improve Mobility.

Foot pain discourages physical activity, and less activity harms overall health. Bunion, extra bone and tissue at the base of the big toe, is a frequent cause of foot pain. More than 64 million Americans have bunions that can lead to painful walking. Bunions affect some 35% of women over the age of 65. Bunions can be removed by surgery, which can reduce pain and improve your ability to walk and exercise, but up to 15% of bunions return. Weak muscles may play a role in bunion-related pain and movement problems. In a review of prior research and commentary on this topic published in the July 2016 issue of JOSPT, the author identifies muscle-strengthening exercises that may help people with bunions. J Orthop Sports Phys Ther 2016;46(7):606. doi:10.2519/jospt.2016.0504.

The STAP-study: The (cost) effectiveness of custom made orthotic insoles in the treatment for plantar fasciopathy in general practice and sports medicine: design of a randomized controlled trial.

BackgroundPlantar fasciopathy is a common cause of foot pain, accounting for 11 to 15 % of all foot symptoms requiring professional care in adults. Although many patients have complete resolution of symptoms within 12 months, many patients wish to reduce this period as much as possible. Orthotic devices are a frequently applied option of treatment in daily practice, despite a lack of evidence on the effectiveness. Therefore, the objective is to study the (cost)-effectiveness of custom made insoles by a podiatrist, compared to placebo insoles and usual care in patients with plantar fasciopathy in general practice and sports medicine clinics.Method/designThis study is a multi-center three-armed participant and assessor-blinded randomized controlled trial with 6-months follow-up. Patients with plantar fasciopathy, with a minimum duration of complaints of 2 weeks and aged between 18 and 65, who visit their general practitioner or sport physician are eligible for inclusion. A total of 185 patients will be randomized into three parallel groups. One group will receive usual care by the general practitioner or sports physician alone, one group will be referred to a podiatrist and will receive a custom made insole, and one group will be referred to a podiatrist and will receive a placebo insole. The primary outcome will be the change from baseline to 12 weeks follow-up in pain severity at rest and during activity on a 0–10 numerical rating scale (NRS). Secondary outcomes include foot function (according to the Foot Function Index) at 6, 12 and 26 weeks, recovery (7-point Likert) at 6, 12 and 26 weeks, pain at rest and during activity (NRS) at 6 and 26 weeks and cost-effectiveness of the intervention at 26-weeks. Measurements will take place at baseline and at, 2, 4, 6, 12 and 26 weeks of follow-up.DiscussionThe treatment of plantar fasciopathy is a challenge for health care professionals. Orthotic devices are frequently applied, despite a lack of evidence of the effectiveness on patient reported outcome. The results of this randomized controlled trial will improve the evidence base for treating this troublesome condition in daily practice.Trial registrationDutch Trial Registration:NTR5346. Date of registration: August 5th 2015.

Diagnosing causes of foot pain in the horse

Equine HealthVol. 2015, No. 23 DiagnosticsDiagnosing causes of foot pain in the horseMeredith SmithMeredith SmithSearch for more papers by this authorMeredith SmithPublished Online:12 May 2015https://doi.org/10.12968/eqhe.2015.23.32AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetailsCited byImpacts to real estate transaction practices by the amendment to Civil Code of JapanThe Japanese Journal of Real Estate Sciences, Vol. 30, No. 1 2 May 2015Volume 2015Issue 23ISSN (print): 2047-9867ISSN (online): 2052-2967 Metrics History Published online 12 May 2015 Published in print 2 May 2015 Information© MA Healthcare LimitedPDF download

Systematic review: plantar fasciitis and prolonged weight bearing.

Plantar fasciitis (PF) is one of the most common causes of foot pain. Work can involve factors that may predispose to foot pain. To systematically review the evidence of the association between weight bearing (walking or standing) and PF among workers. Literature search of relevant indexing databases from inception to May 2012, grey literature, websites of relevant organizations and reference lists for all identified articles. Two reviewers independently selected studies for full review, assessed methodological quality and graded evidence. Findings were summarized qualitatively. Four studies were included; all were assessed as high or unclear risk of bias. Three studies were case-control studies; two used clinic populations and one used volunteers. The other study was cross-sectional involving the workforce of an assembly plant. A number of associations between PF and risk factors were identified including sex, obesity, foot biomechanics and job factors (e.g. job tenure). Two case-control studies and the cross-sectional study found an association with weight bearing, but the assessment of weight bearing varied (e.g. time on feet, time walking or standing). There was low-quality evidence to confirm a causal relationship (Royal College of General Practitioners (RCGP) * grade). This systematic review found low-quality evidence of an association between PF and weight-bearing tasks such as walking and standing on hard surfaces. The only occupations specifically identified as having higher risk were those associated with the engine assembly plant. Further research is required to fully determine the association between weight bearing and PF.

Taping for plantar fasciitis.

Plantar fasciitis is considered the most common cause of foot pain. Numerous non-surgical treatments have been used to relieve symptoms. Taping is one of the most widespread treatments, with several techniques utilized in clinical practice. To evaluate, based on existing literature, the efficacy of different taping techniques in relieving symptoms and dysfunction caused by plantar fasciitis. PubMed, CINAHL, PEDro, ISIWeb of Science, and Google Scholar databases were searched from inception until December 2012, using a predefined search strategy. Controlled trials of any methodological quality were included, without any language restrictions. The methodological quality of interventional studies was evaluated inter alia by the PEDro score. Five randomized control trials, one cross-over study and two single group repeated measures studies met the inclusion criteria. Two studies were high quality; two were moderate quality and four were of poor methodological quality. All eight studies favored the use of different taping techniques. The most common technique was low dye taping. We found that in the short-term, taping is beneficial in treating plantar fasciitis. The best evidence exists for low dye taping and calcaneal taping. More research is needed to investigate long-term effect and effectiveness of specific taping techniques.

Is there an association between clinical features, response to diagnostic analgesia and radiological findings in horses with a magnetic resonance imaging diagnosis of navicular disease or other injuries of the podotrochlear apparatus?

Previous descriptions of the clinical features of navicular disease occurred before the widespread use of magnetic resonance imaging (MRI) allowed a more definitive diagnosis of foot pain. The objective of this study was to compare the clinical features of horses with lesions of the podotrochlear apparatus with those with other causes of foot pain. It was hypothesised that primary navicular bone disease would be associated with more advanced radiological findings than other diagnoses. A retrospective study was performed of all horses examined at a referral centre with a definitive diagnosis of foot pain based on MRI ± post-mortem examination. Clinical examination findings, response to diagnostic analgesia and radiological grading of the navicular bone were compared among five diagnosis groups: (1) primary navicular bone pathology (NB); (2) lesions of the collateral sesamoidean ligament and/or distal sesamoidean impar ligament (CSL + DSIL); (3) primary deep digital flexor tendon injury (DDFT); (4) navicular bone pathology and other lesions of the podotrochlear apparatus ± DDFT (PTA) and (5) Other.There were 702 horses (NB, 62; CSL + DSIL, 180; DDFT, 69; PTA, 92; Other, 299). Horses with PTA injuries were more frequently unilaterally lame than other groups (P = 0.04). Horses with DDFT injury were more likely to exhibit pain on turning than other groups (P < 0.01). There were no associations between response to diagnostic analgesia and diagnostic group, and no association between radiological grade and diagnostic group. Clinical examination findings generally did not discriminate between diseases of the PTA and other causes of foot pain. Overall radiological scores of the navicular bone did not accurately predict navicular bone pathology.

Surgery for Patients With Recalcitrant Plantar Fasciitis: Good Results at Short-, Medium-, and Long-term Follow-up.

Background:Plantar fasciitis is a common cause of foot pain, and although many episodes are self-limiting with short duration, 10% leave chronic symptoms. Recalcitrant cases can be managed surgically, with studies demonstrating good results in the short term but uncertainties over longer term outcomes.Purpose:To assess the outcome following surgical intervention for patients with plantar fasciitis.Study Design:Case series; Level of evidence, 4.Methods:Seventy-nine patients were identified from operative diaries undergoing plantar fasciotomy surgery between 1993 and 2009. They were contacted to investigate long-term results using self-reported outcome measures.Results:Sixty-eight responses were received (86% response rate), with an average of 7 years (range, 1-15 years) of follow-up. Patients reported an average reduction in pain by visual analog scale of 79%, and 84% of patients were happy with the surgical results. Greater success was achieved in patients with shorter duration of symptoms preoperatively. No deterioration in success was seen over time.Conclusion:Plantar fasciotomy surgery for plantar fasciitis remains controversial, with biomechanical arguments against surgery; however, this article reports good success following surgery over a long follow-up period. The results of current operative techniques need to be fully investigated for longer term success, as do the outcomes of newer nonoperative management strategies.

Incremental value of single photon emission tomography/computed tomography in 3-phase bone scintigraphy of an accessory navicular bone.

Accessory navicular bone is one of the supernumerary ossicles in the foot. Radiography is non diagnostic in symptomatic cases. Accessory navicular has been reported as a cause of foot pain and is usually associated with flat foot. Increased radio tracer uptake on bone scan is found to be more sensitive. We report a case highlighting the significance of single photon emission tomography/computed tomography in methylene diphosphonate bone scan in the evaluation of symptomatic accessory navicular bone where three phase bone scan is equivocal.

Effectiveness of Local Tenoxicam Versus Corticosteroid Injection for Plantar Fasciitis Treatment

Plantar fasciitis is one of the most common causes of foot pain in adults. In this prospective study, the outcomes of local tenoxicam injection and corticosteroid therapy for the treatment of plantar fasciitis were compared. Patients were randomly assigned to either the tenoxicam or corticosteroid group. The tenoxicam group (n=31) was treated using a local injection of 1 mL of tenoxicam (20 mg/2 mL) and 1 mL of 2% lidocaine, whereas the steroid group (n=30) was treated with a local 1-mL injection containing 40 mg of methylprednisolone acetate and 1 mL of 2% lidocaine. Clinical evaluations, which were performed before the injection and 6 and 12 months after the injection, consisted of patient-assessed pain using a visual analog scale. In addition, patient satisfaction was measured using the Roles and Maudsley score. Comparison of pre- and posttreatment visual analog scale scores demonstrated a statistically significant difference in both groups (P<.05). Furthermore, no significant difference was found between the steroid and tenoxicam groups in terms of visual analog scale scores measured 12 months after injection (P>.05). The tenoxicam injection was not significantly more effective than the corticosteroid injection. However, both methods were effective and successful in treating patients with plantar fasciitis. Tenoxicam therapy appears to provide pain relief, but its effectiveness in the long term should be explored in additional studies.

Use of Primary Corticosteroid Injection in the Management of Plantar Fasciopathy

Plantar fasciopathy (PF) is characterized by degeneration of the fascia at the calcaneal enthesis. It is a common cause of foot pain, accounting for 90% of clinical presentations of heel pathology. In 2009-2010, 9.3 million working days were lost in England due to musculoskeletal disorders, with 2.4 million of those attributable to lower-limb disorders, averaging 16.3 lost working days per case. Numerous studies have attempted to establish the short- and long-term clinical efficacy of corticosteroid injections in the management of PF. Earlier studies have not informed clinical practice. As the research base has developed, evidence has emerged supporting clinical efficacy. With diverse opinions surrounding the etiology and efficacy debate, there does not seem to be a consensus of opinion on a common treatment pathway. For example, in England, the National Institute for Clinical Health and Excellence does not publish strategic guidance for clinical practice. Herein, we review and evaluate core literature that examines the clinical efficacy of corticosteroid injection as a treatment for PF. Outcome measures were wide ranging but largely yielded results supportive of the short- and long-term benefits of this modality. The analysis also looked to establish, where possible, "proof of concept." This article provides evidence supporting the clinical efficacy of corticosteroid injections, in particular those guided by imaging technology. The evidence challenges existing orthodoxy, which marginalizes this treatment as a secondary option. This challenge is supported by recently revised guidelines published by the American College of Foot and Ankle Surgeons advocating corticosteroid injection as a primary treatment option.

Effectiveness of scalpel debridement for painful plantar calluses in older people: a randomized trial

BackgroundPlantar calluses are a common cause of foot pain, which can have a detrimental impact on the mobility and independence of older people. Scalpel debridement is often the first treatment used for this condition. Our aim was to evaluate the effectiveness of scalpel debridement of painful plantar calluses in older people.MethodsThis study was a parallel-group, participant- and assessor-blinded randomized trial. Eighty participants aged 65 years and older with painful forefoot plantar calluses were recruited. Participants were randomly allocated to one of two groups: either real or sham scalpel debridement. Participants were followed for six weeks after their initial intervention appointment. The primary outcomes measured were the difference between groups in pain (measured on a 100-mm visual analogue scale) immediately post-intervention, and at one, three and six weeks post-intervention.ResultsBoth the real debridement and sham debridement groups experienced a reduction in pain when compared with baseline. Small, systematic between-group differences in pain scores were found at each time point (between 2 and 7 mm favoring real scalpel debridement); however, none of these were statistically significant and none reached a level that could be considered clinically worthwhile. Scalpel debridement caused no adverse events.ConclusionsThe benefits of real scalpel debridement for reducing pain associated with forefoot plantar calluses in older people are small and not statistically significant compared with sham scalpel debridement. When used alone, scalpel debridement has a limited effect in the short term, although it is relatively inexpensive and causes few complications. However, these findings do not preclude the possibility of cumulative benefits over a longer time period or additive effects when combined with other interventions.Trial registrationAustralian Clinical Trials Registry (ACTRN012606000176561).

Entrapment of the Lateral Plantar Nerve Distal to the Tarsal Tunnel: A Case Report

Tibial nerve entrapment is a common cause of foot pain. Identifying the location of the entrapment may be difficult. This case report describes the electrodiagnosis of the lateral plantar nerve branch of the tibial nerve in a 50 year-old woman who failed to respond to the local steroid injection for plantar fasciitis and subsequently a tarsal tunnel release. The etiology of the nerve entrapment is discussed as well as the role of electrodiagnostic studies to locate the nerve entrapment. This case highlights the role of meticulous clinical evaluation and electrodiagnosis for the diagnosis of this challenging condition and a simple in-office treatment to reduce patient’s symptoms.