Feet are arguably the most frequently used parts of the musculoskeletal system. We need them for standing, walking and running on a daily basis. However, we do not think about them much until they start to hurt. Foot pain can be excruciating and warrants getting the right diagnosis and appropriate treatment.
The most common problems in the feet that people usually encounter originate from the plantar fascia (Plantar Fasciitis) and Achilles tendon problems (Achilles Tendinosis and Achilles Tendonitis). If you are experiencing foot and ankle problems, get in touch or book an appointment in one of our clinics in Kent.
What is Plantar Fasciitis?
Plantar fasciitis is inflammation of the plantar fascia, which is a thick band of tissue that runs across the sole of the foot and connects the heel bone to the toes (plantar fascia). It is a common cause of heel pain.
It frequently creates stabbing pain with your first steps in the morning. The discomfort usually subsides as you get up and move, but may return after long periods of standing or when you stand up after sitting.
What is Achilles Tendonitis and how is it different from Tendinosis?
Achilles tendonitis and Achilles tendinosis, on the other hand, are two prevalent heel cord disorders. Achilles tendonitis is a condition in which the Achilles tendon becomes inflamed. This inflammation is usually temporary, however, if not treated, the problem may progress to tendon degeneration (Achilles tendinosis), in which the tendon loses its organized structure and is prone to microscopic tears. The region where the Achilles tendon joins the heel bone is sometimes affected by degeneration. Chronic deterioration with or without pain may culminate in tendon rupture in rare circumstances.
Non-surgical Treatment Options for Managing Foot Pain
Non-surgical treatment options that can help treat the cause of foot pain include;
Physical Therapy and Home Exercises
Rest, Ice, Compression, and Elevation (RICE)
For several weeks following the diagnosis of your condition, we recommend a combination of rest or immobilization, ice, compression, and elevation, hence the RICE regimen. Depending on the nature and stage of your condition, we can advise how long you should participate in a RICE treatment.
A walking boot may assist you in keeping your foot stationary while your foot pain improves. Following the diagnosis of your foot condition, you may be advised to reduce activities that bring up the pain for a few weeks. Appropriate footwear like trainers could also help.
Applying ice to your Achilles injury 2 to 3 times a day for 5 to 10 minutes at a time will help relieve pain and swelling. Wrapping a flexible bandage around the heel and ankle area may help minimize swelling in the first few days following the injury. Elevating the foot for 15 minutes three times daily can also help with swelling.
In more severe cases like Achilles tendon rupture, it is usually required to immobilise the foot and ankle for 10-12 weeks in a special boot with wedges. For the best possible healing potential, the ends of the cut tendon must be appropriately positioned soon after damage. This can be confirmed with the help of an ultrasound scan of the tendon.
Physical Therapy and Home Exercise
Stretching the plantar fascia, Achilles tendon, and calf muscles are the mainstay of treatment if performed correctly. Similarly, strengthening exercises for the foot and calf muscles are also effective. The physical treatment schedule is tailored to your specific condition and stage of recovery.
A specialist would work with you to adapt your physical activity to lessen stress on the foot's sole. For example, if you engage in a high-impact activity such as running; in that case, we may propose that you switch to lower-impact sports, such as cycling and swimming for a period of time. Orthotics in the form of insoles or custom made inserts into shoes could also help in relieving pain.
Shock Wave Therapy
Shock wave therapy, also known as extracorporeal shock wave therapy, may benefit your condition. It is performed using a handheld device to deliver ultrasonic waves to the target tissue to stimulate healing. This method typically requires five 15-minute treatments spread out over several weeks.
Depending on your condition, we might use several injections to avoid invasive treatments like surgery.
The injections normally used to treat foot conditions like plantar fasciitis and Achilles tendonitis include:
Platelet-Rich Plasma Injections
Botulinum Toxin Injection
Corticosteroid Injections Corticosteroids, also just known as steroids, are potent anti-inflammatory drugs that relieve pain and reduce inflammation.
Corticosteroids may be combined with a small amount of anaesthetic. The anaesthetic can provide immediate pain relief but only lasts a few hours. Two to three days after the procedure, the corticosteroids begin to work. This method is particularly effective if combined with an appropriate physiotherapy programme.
Most people return home or to work immediately following the injection. To relieve pain and reduce swelling, your doctor may advise you to apply ice to the bottom of your foot two or three times per day or to take an over-the-counter medication.
Platelet-Rich Plasma Injections
If corticosteroid injections did not relieve your condition, platelet-rich plasma injections may work for you. Platelet-rich plasma (PRP) is composed of platelets, which are blood cells. Platelets secrete substances known as growth factors, which promote healing.
During the procedure, first, a small amount of blood from a vein in your arm is drawn and then separated into the platelets and growth factors, and other blood components using a centrifuge machine. The entire procedure takes about 15 minutes. The doctor then injects this platelet-rich liquid, known as plasma, directly into the plantar fascia, guided by ultrasound imaging.
Botulinum Toxin Injection
Botulinum toxin, also known as Botox, is a protein produced by a bacterium called Clostridium botulinum.
According to emerging evidence, this injection may help relax the muscles and fascia of the foot, thus relieving foot pain.
Depending on your situation, we may advise you to use nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen or naproxen, to reduce inflammation and relieve discomfort. These drugs are often prescribed for a few weeks to allow the body to heal and recuperate.
If you have foot pain that is not getting better, get in touch
About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.