Foot pain

Many of the conditions discussed below can be accompanied by foot pain. Other causes of foot pain are listed below.

Stiff big toe. This condition is caused by arthritis of the metatarsophalangeal joint. Movement in this joint is limited and painful. A ring of osteophytes may develop on the dorsal side of the joint. Treatment is with arthrodesis or the Keller procedure.

Foot pain in children

Children rarely complain of foot pain. If they talk about pain in the sole, then one should think first of all about a splinter. Pressure from shoes on the protrusion of the navicular bone (or on the accessory bone) or on the posterosuperior protrusion of the calcaneus may require surgical alignment of the bone. The cause of foot pain may be osteochondritis of the bones of the foot - the diagnosis is established radiologically.

In Köhler's disease, the navicular bone is affected; in Freiberg's disease, the heads of the metatarsal bones are affected; in Sever's disease, epiphysitis of the heel occurs. The pain can be reduced by using shoe inserts (in some cases, plaster forms).

Ingrown nails. This condition occurs in both children and adults. The big toe is most often affected. Incorrect nail trimming and pressure from tight shoes predispose the lateral edge of the nail plate to sinking into the soft tissues of the nail bed, which responds to this by swelling and growth of "wild flesh". Then an infection usually sets in. Conservative treatment consists of placing cotton wool soaked in surgical alcohol under the corners of the "wild flesh" and waiting until the nail grows, which is then cut straight, but so that its edges protrude slightly above the edges of the nail bed. If an infectious process reoccurs in the area of the "ingrown nail", then surgical intervention may be required - wedge resection of the nail, removal of the lateral edge of the nail, as well as interventions aimed at inhibiting nail growth - removal of the nail bed (surgical or with phenol), sometimes it is necessary to remove the entire nail.

Forefoot pain in adults (metatarsalgia)

Increased pressure on the metatarsal heads causes pain. Treatment consists of using supportive insoles. Surgical intervention in such a condition, unless it is rheumatoid arthritis, is considered unpredictable.

March fractures. Usually occur in the diaphyses of the 2nd and 3rd metatarsal bones after a very long march. The treatment tactics are expectant. If the pain is very sharp, then a plaster cast is applied to the foot and they wait: the healing of the fracture can relieve the patient of pain.

Morton's metatarsalgia. The pain is caused by pressure on the interdigital neuroma located between the metatarsal bones. The pain usually radiates to the space between the third and fourth metatarsal bones. Treatment consists of excision of the neuroma.

[ 1 ], [ 2 ]

Examination and examination of the ankle joint

The normal range of motion in the ankle joint is considered to be extension (dorsal flexion) of 25° and flexion of 30°. Inward (inversion) and outward (eversion) movements occur due to movements in the subtalar and midtarsal joints. Extension of the toes should be within 60-90°. Pay attention to any calluses you find on the foot. Trace the arches of the foot. Notice how the toes lift off the floor and what position they are in when the patient stands on tiptoe. Observe the patient's gait and examine his shoes (normally, the rise of the arch of the foot is located medially, and the depression from the heel is posterolateral).

[ 3 ], [ 4 ], [ 5 ], [ 6 ]

Flat feet (pes planus)

In this case, the arch of the foot is low. At the same time, valgus deformity of the foot and some eversion outward may also be observed. Most often, this condition is asymptomatic, but pain in the foot may also be noted. This occurs with the so-called peroneal spastic flat foot, in which the heel is slightly turned outward, and the medial edge of the foot is pressed flat to the floor. An attempt to turn the back of the foot inward causes a painful spasm of the peroneal muscles. In such cases, special exercises, stimulation of the foot with faradic current and medial insoles inserted closer to the heel end of the shoe can help. With the spastic type of flatfoot, arthrodesis of the back of the foot may be needed to eliminate pain.

[ 7 ], [ 8 ], [ 9 ]

Concave foot (pes cavus)

The accentuated longitudinal arches of the foot may be idiopathic, associated with spina bifida or poliomyelitis. In this case, the toes may become claw-like, since the body weight during walking mainly falls on the heads of the metatarsal bones. Conservative treatment consists of placing soft pads under the heads of the metatarsal bones to reduce the pressure on them. Surgical treatment involves dissection of soft tissues to eliminate tension (some ligaments are separated from the calcaneus, the arch of the foot is formed, and it is placed in a cast) or arthrodesis is performed to straighten the toes. If the cause of foot pain is osteoarthritis of the metatarsal bones, arthrodesis of the corresponding joints can be performed.

[ 10 ], [ 11 ], [ 12 ], [ 13 ]

Hammertoes

In this case, the toes are extended at the metatarsophalangeal joints, hyperflexed at the interphalangeal joints, and extended at the distal interphalangeal joints. The second toe is most affected. Arthrodesis at the interphalangeal joint usually straightens such a toe, and dissection of the extensor tendon allows it to lie flat on the surface.

Claw-like fingers

Such toes are extended at the metatarsophalangeal joints and strongly flexed at the middle and distal interphalangeal joints; such a deformity may be caused by an imbalance between the flexors and extensors of the toes (for example, after polymyelitis). If the toes still retain mobility, then a Girdleston operation is necessary, in which the flexor and extensor tendons are crossed.

[ 14 ], [ 15 ], [ 16 ]

Hallux valgus

In this case, there is a lateral deviation of the big toe in the metatarsophalangeal joint. Apparently, such deformation of the toe is facilitated by wearing pointed-toe shoes with heels. In this case, there is increased pressure of the shoe on the metatarsophalangeal joint of the big toe, which contributes to the formation of bursitis in this area. Arthritis in this joint develops secondarily.

Soft pads in the area of the bunion and plastic "pegs" inserted between the first and second toes can relieve the pain, but severe deformity requires surgical intervention. Various types of operations are used. Thus, the medial part of the metatarsal head can be cut off or the Keller operation can be performed, in which the proximal half of the proximal phalanx is removed (excision arthroplasty), the toe is formed in the shape of a flail. Other surgical interventions are also used: osteotomy with displacement of the metatarsal bone, the Mayo operation (arthroplasty with excision of the distal head of the metatarsal bone) and arthrodesis of the metatarsophalangeal joint.