Pain in the feet: Common causes and how they are treated

The foot is the part of the foot that takes the most load. At the same time, it is subjected to pressure both internally from bony bumps, such as the heel bump and metatarsal heads, and externally from the ground.

From these it is protected by a tissue of fat and fibrous connective tissue, which have a cohesive, insulating and anti-vibration role, holding and distributing loads, as well as providing insulation from cold and heat.

The heel and the heads of the metatarsals are under the most pressure and show the most problems.

Diseases of the metatarsals

Metatarsalgia is the strain on the metatarsals and pain in the plantar surface of the forefoot, especially in the area under the metatarsal heads.

It is very often accompanied by hyperkeratosis (calluses) under the heads of the metatarsal heads.

Metatarsalgia is divided into:

- Mechanical (from finger deformation, instability of the metatarsophalangeal joint, etc.)

- Arthritis (due to joint conditions such as degenerative osteoarthritis, rheumatoid arthritis, inflammatory and gouty arthritis).

- Nervous (interdigital neuromas are often a cause of metatarsalgia, with neuroma being very common

Morton's). It is common in road, jumping and team sports athletes due to injury or chronic stress.

- Idiopathic (it is common in athletes, workers with long periods of standing and women who wear high heels

shoes for many hours). Older people have metatarsalgia due to atrophy of the atrophy of the

fatty body of the heads of the metatarsal heads and due to the degeneration and imbalance of the muscles of the

forefoot. This combination leads to metatarsal drop. The heads are left uncovered and are painful when walking.

Heel spur

The most common and painful condition of the heel is acantha, an inflammation at the plantar fascia of the plantar fascia of the heel. The plantar fascia is a thick, fibrous band that runs along the length of the foot and extends from the germs of the heel to the heads of the metatarsals.

It acts as a platform that stabilizes the foot and maintains the arch of the foot during loading. This area receives the greatest stresses on the medial aspect of the heel. The term plantar fasciitis denotes a chronic degenerative progression that is caused by repeated excessive loading. This is why it is common in overweight people, as well as in those who are very active, such as long-distance athletes and middle-aged people (the most common age of onset).

Other predisposing factors include tummy ache, flatfoot, flat Achilles tendon, acute injury, type of patient's footwear, walking surface and work environment.

The most important symptom is pain, which is usually located in the medial gum of the heel, where the plantar fascia is attached. Most patients describe a gradual onset of pain, over weeks or months, with acute episodes of pain often occurring in runners.

The pain is most intense after waking up in the morning and decreases after a few steps and is the main feature of plantar fasciitis.

Address

Conservative treatment consists of specially shaped orthotic insoles after podiatry,

cortisone infusion with local anesthetics, growth factor injections (PRP);,

special stretches and physiotherapy or ice therapy.

The majority of cases of these patients improve satisfactorily with the above conservative means.

In persistent conditions, surgical repair is recommended. With modern surgical methods, the patient does not need to be admitted to hospital, as it is performed under local anaesthesia, with the nerves of the foot blocked, without bandaging and with incisions of no more than two millimetres.

The patient walks immediately after surgery with the help of a special shoe.