Foot and Ankle Pain Treatment in Philadelphia

Many conditions cause foot and ankle pain. In addition, low back conditions can cause sciatica, which results in leg and foot pain. The foot is composed of 26 bones and 33 joints. These structures are covered by an intertwining web of approximately 120 nerves, muscles, and ligaments. Foot pain can be caused by ill-fitting shoes, high-impact exercise, and certain medical conditions, as well as back conditions.

What is the purpose of the feet?

The feet support the body’s weight, act as shock absorbers, maintain balance, and serve to propel the leg forward. The feet are small when compared to the rest of the body, and each step exerts a serious force upon them. During any typical day, a person spends around 4 hours (or more) on his/her feet.

What is sciatica?

The sciatic nerve is composed of five nerves that joint at the lower portion of the spine. This nerve extends down the back region of each leg, and it runs all the way down to the toes. The sciatic nerve connects the spinal cord with the muscles of the foot and leg. When this nerve is inflamed, it can lead to pain that radiates down the leg and into the foot, which is called sciatica.

What spinal conditions cause referred pain in the leg and foot?

Several conditions cause foot/ankle pain. These include:

  • Lumbar spinal stenosis – With this lower back condition, the spinal nerve roots are compressed (pinched), which leads to foot symptoms of tingling, pain, and weakness.
  • Herniated lumbar disc – When the disc’s inner gel-like core pushes through the outer core, it can cause pressure on a nerve root. This produces pain that radiates down the sciatic nerve and into the lower leg and foot.
  • Spondylolisthesis – If a vertebra slips over the one below it, this compromises a portion of the spine segment, and results in pain down the leg and foot.

What are other causes of foot pain?

Pain occurs in the foot from a variety of conditions. These include:

  • Corns, calluses, bunions, and bunionettes – These occur around the toes and can be treated with wide toed shoes, soft heel cushions, and use of shields and splints.
  • Morton’s neuroma – This is inflammation of the nerve between the third and fourth toes and the bottom of the foot. It creates a burning, cramping pain. This condition is aggravated by prolonged standing and ill-fitting shoes.
  • Metatarsalgia – This chronic condition produces pain at the ball of the foot, and is treated with box-toed shoes, gel cushions, and orthotics.
  • Plantar fasciitis – This condition causes pain of the arch and front of the heel. It is treated with medications and orthotics.
  • Ankle bursitis – This produces pain of the heel, as well as joint stiffness.
  • Achilles tendonitis – This pain worsens with physical activities. The Achilles tendon runs along the back of the heel. When injured or inflamed, pain results.

What treatments are used for foot and ankle pain?

Treatment depends on the underlying cause. Options include:

  • Cortisone injections – The doctor can inject the painful joint with a steroid agent to decrease inflammation, swelling, and pain.
  • Medications – Most foot pain can be treated with anti-inflammatory agents, such as naproxen and ibuprofen. For severe pain, analgesics are used, such as codeine and hydrocodone.
  • Shoe inserts and orthotics – To alleviate the pain associated with foot deformities, special shoes can be used, as well as orthotics, heel lifts, and special padding. The doctor will use computer technology to construct a personalized set of orthotics.
  • Epidural steroid injection (ESI) – The epidural space is between the spinal cord and the surrounding epidural layer. With ESI, the doctor injects this space with a long-acting steroidal agent, and sometimes, an anesthetic drug. According to studies, ESI is 80-90% effective for nerve pain relief.
  • Facet joint injection (FJI) – The doctor can inject the tiny facet joints along the back of the spine with an anesthetic agent. This is done using x-ray guidance for correct needle placement. According to a recent research report, FJI is around 85% effective for sciatica and nerve-related pain.
  • Extracorporeal shock wave therapy (ESWT) – With this procedure, the doctor uses intense quick energy waves to treat Achilles tendonitis and plantar fasciitis. Based on a recent clinical study, ESWT has an 80% efficacy rate.

Resources

Falco, FJ, Manchikanti, L, Datta, S, et al. (2012). An update of the effectiveness of therapeutic lumbar facet joint interventions. Pain Physician, 15(6), 909-953.

Thomas MK, Roddy E, Zhang W et al. (2011). The population prevalence of foot and ankle pain in middle and old age: a systematic review. Pain, 152(12), 2870-2880.