Most Common Syndromes
Foot and ankle pain can come from very different structures and have several etiologies, some of the most common are described here.
Achilles tendon can suffer from diverse but associated conditions such as degenerative changes, inflammation and rupture. Most frequently, it happens to unconditioned male individuals who suddenly perform an intense physical activity or to athletes of running sports. If there is only tendonitis, the main symptom will be pain at the Achilles region, and conservative treatment is indicated. If the tendon ruptures, depending on severity and activity level of the person, it may be better to try conservative treatment or go immediately to surgery.
An avulsion fracture is characterized by a bone fragment that tears away from the main bone at the ligamentous or tendinous attachment as a result of exaggerated stretch or contraction. Most avulsion fractures can be treated conservatively.
Gout results from an accumulation of uric acid crystals inside a joint resulting in inflammation. The most common sites where it happens are the first toe, the midfoot and the ankle joint. Treatment must address the flare-up phase and then the maintenance phase, usually with medication and rest plus ice in the acute phases.
Hammertoe and mallet toe are deformities where the toe is bent at the interphalangeal joints (either the proximal or distal), creating pressure points susceptible to induce pain and/or callus. Initially the deformity is flexible but can become rigid and lead to difficulties walking. Changing the footwear is important and using an insole to help distribute the weight on the foot. Exercises to stretch and strengthen the foot muscles may help as well as medication. Definite treatment will be surgical.
Morton’s neuroma is a benign thickening of the plantar nerve in the foot, and it is most common in the third intermetatarsal space. The main symptom is pain during walking activities, usually with a burning or numbness sensation that can radiate to the toes. Initial treatment includes changes in the footwear, using an appropriate insole and possibly a local injection. It this does not help, surgery may be considered.
Plantar fasciitis is the most common cause of heel pain and is characterized by inflammation and sometimes degenerative or calcific changes of the plantar fascia, mainly in its calcaneal insertion. One of the most important predisposing factor is excessive weight, but also spending much time on the feet or practicing repetitive impact activities (eg. Running). Pain is usually described as stabbing and the first steps in the morning are the worst. Treatment is mostly conservative with footwear changes, use of an insole, exercises to stretch the plantar fascia and strengthen foot muscles, physiotherapy, or infiltration.
Rheumatoid arthritis is a chronic, inflammatory disease which affects predominantly hands and feet. In the foot it leads to severe joint destruction and marked deformities, such as bunions, hammertoes, claw toes, ulnar deviation, subluxations, flatfoot and others. Treatment with chronic medication to control disease activity is of utmost importance and approach of acute phases with physiotherapy might be helpful. As disease progresses foot orthosis to correct imbalances and ultimately surgery can correct some deformities.
Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve as it passes through the tarsal tunnel at the hindfoot. The main symptom is pain, which can be burning or sharp in natures and is usually worsen by prolonged standing or walking. It can be associated with a tingling or numbness sensation radiating in the plantar foot. Initial treatment includes biomechanical corrections, medication, physiotherapy, and a steroid injection. Surgery is indicated is conservative treatment fails or if a definite cause for entrapment is identified.
Ankle sprains are one of the most common sports-related injury and while they tend to have a positive evolution, many people remain with residual complaints and possibly with chronic instability leading to recurrent sprains of the same structures. Lateral ligament complex is most frequently injured and as such, pain, swelling and ecchymosis will be present at the lateral aspect of the ankle. In mild cases, conservative treatment is usually enough but in more severe ones surgery may be needed at some point.
A stress fracture is a small crack in a bone, usually caused by repetitive trauma and overuse of a particular structure, commonly in athletes of running sports. In the foot the most frequent location for these fractures are the second and third metatarsal bones and occasionally the calcaneus, the talus or the navicular. Majority of stress fractures can be managed nonoperatively with rest, ice, medication, protective footwear and sometimes casting of the foot. In some cases, surgery might be necessary.
Corticosteroids medications are used to reduce pain and inflammation and can be taken oral or through an injection.
Peripheric Nerve Block
This minimally invasive procedure, as radiofrequency ablation and cryoablation, should be guided for ultrasound or fluoroscopy.
Cryoablation uses cold temperatures and is a minimally invasive procedure guided for ultrasound or fluoroscopy.
Radiofrequency ablation is a minimally invasive procedure guided for ultrasound or fluoroscopy.
PRP (platelet rich plasma) contains 2-5 times the usual number of platelets and have a regenerative effect on the tissues.
Pharmacological management pain is commonly part of the treatment and a wide range of drugs can be used to manage pain.
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