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My Feet Hurt: What Could It Be?*
By Laurence J. Kinsella, M.D., F.A.A.N.

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).

 

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