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Introduction
Foot pain refers to experiencing pain in various parts of the foot namely: toes, forefoot, nails, arch, ball, heel, and the hindfoot. Foot pain is a common occurrence in many people. Foot pain significantly affects a person’s normal daily routine, body balance increases vulnerability to falls, and generally lowers the quality of life (Hill et al., 2009 p.1). Foot pain is common in older than young people (Hill et al., 2009 p.2). Pain may range from mild to sharp with fluctuating occurrence or may be chronic. Foot pain may be caused by a number of factors such as poorly fitting shoes, medical conditions, or a high impact activity (Simon & Zieve 2009).
Medical conditions that may cause foot pain include a number of arthritis conditions the significantly, including osteoarthritis, gout, and rheumatoid arthritis. Others are flat foot, diabetes, Morton Neuroma, and Sesamoiditis. Ill-fitting shoes may put a strain on toes and foot muscles, bones, and joints leading to pain. High impact activity such as jogging and strenuous aerobics (Simon & Zieve 2009) may cause foot injuries or injury to other parts of the legs which may be felt in the foot. Hill et al. (2009) found out foot pain can be associated with increased age, female sex, obesity, and pain in another body region.
Treatment may involve a number of measures such as wearing proper-fitting shoes and avoiding high-impact activities. In some cases simply sitting down may relieve the pain. Severe foot pain conditions may require the use of orthotics, insoles molded from a plaster cast of the patient foot (Simon & Zieve 2009).
Causes
The causes most significant to foot pain are related to medical conditions. Chief among them are the chronic types of inflammatory arthritis namely: osteoarthritis, rheumatoid arthritis, and gout.
Arthritis refers to inflammation of joints that result in pain, swelling and stiffness (Australian Institute of Health and Welfare (AIHW) 2009, p.4). Hundreds of various types of arthritis have been identified. More than 3 million Australians are affected by arthritis and its prevalence has risen in recent years (AIHW 2009, p.3). With regard to foot pain the three significant arthritis are Osteoarthritis, gout and rheumatoid arthritis. The arthritic foot may also develop as a result of injury such as sprains or fractures. This may happen years later if the injury was not properly treated.
Osteoarthritis (OA) is the most common form of arthritis. It is characterized by destruction of bone cartilage resulting in pain, swelling and stiffness at the joints. OA is common in the elderly as the body naturally loses its ability to replace worn out cartilage with new one in old age. Rheumatoid arthritis is the most severe. Its causes are not really known but it is characterized by the body immune system attacking its own cells and tissues (AIHW 2009, p.4). It is systemic and apart from the characteristic swelling, inflammation and pain at joints affects many parts of the body such as lungs, eyes, mouth, skin, heart. With regard to foot pain, the forefoot especially the Metatarsophalangeal (MTP) joints at the base of the toes are most affected during a rheumatoid arthritis attack (AIWH 2009, p.4). Gout on the other hand results from deposition of uric acid crystals (Monosodium Urate) in tissues and fluids within the body (CDC 2010). Foot pain related to gout is due to the destructive effect of urate on cartilages. Acute gout is characterized by pain, swelling and warmth that are evident on the great toe (CDC 2010) while in chronic gout, urate crystals may be deposited in soft tissues such as elbow, ears, distal finger and joints (CDC 2010). Orthoses are common in treatment and management of inflammatory and reactive arthritis described above. Custom-foot orthoses have been reported to effective in treatment of hind foot-rheumatoid arthritis (Hawke et al 2008, p.1).
When posterior tibial tendon that supports the foot’s arch is ruptured, overstretched or inflamed the condition is referred to as pronation/ acquired adult foot/posterior tibial tendon dysfunction (PTTD) (Lotke 2008, p.162). An acquired flat foot is common in adult and occurs progressively (Kulig et al 2006, p.1). Stage I of PTTD is characterized by mild swelling. In stage II the feet is still flexible but the tendons are extensively damaged. Stage III is characterized by permanent deformation of the foot. Flat feet affects people of all ages and may be either be flexible or rigid. It should however be pointed out that babies are born with a natural flat feet that persists up to the age of seven after which a normal arch develops (Houghton 2008, p.7). Inflexible flat foot the arch is only observed while toe-standing or sitting while in rigid flat foot, there is no arch formation during toe-standing or sitting (Houghton 2008, p. 7). Children with rigid flat feet may complain of pain during and after active physical activity while their flexible flat-feet counterparts complaint is usually due to parental concern as there are no clear symptoms (Houghton 2008, p. 7). Rigid flat foot is first marked by pain and swelling at the medial foot which may later result in a flat foot deformity when the medial longitudinal arch collapses (Parvizi 2010, p.396). It mostly affects a single foot and geriatrics will complain prolonged pain and discomfort over one foot (Lotke 2008, p.162). Other symptoms include pain during heel rise in addition the “too many toes” sign whereby anterior view of the feet gives an impression of more lateral toes on the affected foot (Lotke 2008, p.162). Orthotic intervention is based on the stage of progression and is mainly geared towards preventing pronation which is evident during quick movement. Orthotic therapy involves UCBL orthoses in adults or heel wedges to counter hyperpronation. In pediatrics, flexible flat feet can be treated with insoles while for severe cases hinged casts may be used to reposition soft tissues (Stein, Taylor & Taylor 2004, p.85). Orthotics casts may also be used to treat acquired flat feet in children.
Foot pain at the forefoot caused by inflammation of the tendons around the two small bones (sesamoids) beneath the end of the first metatarsal bone is known as sesamoiditis (Stein, Taylor & Taylor 2004, p.87). The tiny sesamoid bones act as the main shock absorbers at the ball of the foot when walking in addition to aiding forward propulsion. The inflammation can be caused by sustained stress on MTP or by direct impact on the sesamoids which may fracture them (Browner 2003, p. 2474).Other contributing factors include a high-arched foot and bony foot that lacks enough fat to protect the tiny sesamoids from shocks. These contributing factors coupled with activities that exert much pressure on the forefoot may greatly accelerate the development of sessamoiditis. It is common in physically active children and requires medical examination for confirmation. The dislocation of the sesamoids or injury to tendons surrounding them is accompanied with pain which is may be constant or severe when pressure is directed towards them. Swelling around the balls of feet, which is contributed by continued physical activity of the feet may further aggravate the pain. This swelling may extend to cover much area of the forefoot. It is common in people with active lifestyle although adults in sports such as running, dancing, soccer or with deep feet arch are also susceptible. Victims, both young and old may complain on pain emanating from the balls of the feet that intensifies with increased activity or is strongly felt afterwards. Children may however, learn to shift their weight without any complaint and therefore parental examination and further action is necessary. Treatment usually focuses on relieving and reducing pressure on the areas beneath and above the affected sesamoiditis. This may involve rest or orthotic intervention to keep off stress from the affected areas. Orthotic treatment is carried out by placing a soft pad underneath the arch that extends to fore metatarsals after which the foot remains casted for a number of weeks. Another approach may involve placing crescent-shaped pads behind the sesamoids to prevent reaction pressure from the ground. Arch support insoles may also be used to surface stress in addition to metatarsal pads to balance pressure in the forefoot.
Conclusion
Orthotic therapy (OT) presents medical practioneers with a safe and less painful non-invasive alternative to treat foot pain and resultant foot deformations from medical and traumatic conditions. Both custom-made orthoses and prefabricated orthoses are always a significant option in the treatment of foot problems. Orthotic therapy may require lengthy care under a qualified physiotherapist but is considerably less costly and life-stagnating than invasive options. Although few studies have been undertaken to verify the efficacy of orthoses in treating such problems their credibility arises from long years over which they have proved to significantly aid in relieving foot pain and better the lives of foot patients. This may even be the reason for little interest in research works pertaining to them. The application for OT is not generic as foot pain presents in different ways that may require unique orthotic devices and additional treatment measures such as drugs or surgery. Foot pain in children should be viewed from a different angle to that of adults. While adults foot problems can be attributed to natural degradation of the body, in children immature structures coupled with an active lifestyle is largely to blame. This difference calls for a special approach in the treatment and management of foot problems in both subjects.
References
Australian Institute of Health and Welfare. (2009). A picture of rheumatoid arthritis in Australia. Arthritis series no. 9. Cat. no. PHE 110. Canberra: AIHW. Web.
Browner, B. J. (2003) Skeletal Trauma: Basic science, management and reconstruction. Amsterdam: Elsevier Health Sciences.
Center for Disease control and Prevention (CDC). (2010). Gout. Web.
Hawke, F., Burns, J., Radford, J & Du, V. T. (2008) Custom foot orthoses for treatment of foot pain. systematic review.146(6). Web.
Hill C, L., Gill, T.K., Menz., H.B., & Taylor, A.W. (2008)
Prevalence and correlates of foot pain in a population-based study: the North West Adelaide health study. Journal of Foot and Ankle Research 2008, 1(2). Web.
Houghton, K. M. (2008). Review for the generalist: evaluation of pediatric foot and ankle pain. Pediatric Rheumatology, 6(6). Web.
Kulig, K., Pomrantz, B.A, Burnfields, M.J, Reisch, S.F., Mais-Requejo, S., Thordarson, D.B & Smith, W.R. (2006) Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial.
BMC Musculoskeletal Disorders, 7(49). Web.
Lotke, P. A. (2008). Lippincott’s Primary care orthopedic. Philadelphia: Lippincott Williams and Wilkins.
Parvizi, J. (2010). High yield orthopedics Amsterdam: Elsevier Health Sciences
Simon Harvey & David Zieve (2009). Foot pain_ introduction. Web.
Stein, M.C, Taylor, G & Taylor, M.G (2004).The Encyclopedia of Arthritis. New York: InfoBase Publishing.
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