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Wednesday, May 4, 2022

Wrestling with a Painful Foot: Thoughts on Treatment

I have many rules I use when attempting to help someone with a sore foot, and I also need their cooperation in the treatment. First of all, whereas they say periodic dieting is great for our overall metabolism, periodic levels of increased pain should be avoided. Therefore, after the onset of pain you want to reduce the pain to the 0-2 range (still smiling on the pain scale charts) as quickly as possible. This can be accomplished on one end of the spectrum with complete bed rest, and for some simply not running 5 miles. Get the pain down, and hold it down for 2 weeks for a start. 
     Hopefully, by this time you have a doctor or therapist appointment that can lead you further. But beware, all medical recommendations have to be tried by you, and if they increase your pain, stop doing them until this is reported. Some practitioners will have you continue if they deem the pain as "Good Pain". Good Pain is pain that does not linger for 2-3 days after starting, does not cause you to limp, does not come on during an exercise only after. 
     Now, what types of foot treatment should be done? These are general rules but will apply to most of you. The types of treatment, and I recommend one from each category at least, are Mechanical treatments, Inflammation treatments, and Neuropathic (nerve pain) treatments. Mechanical treatments can be walking casts, changing how fast you run, shoe selection, insert selection, padding, taping, braces, etc. There are so many things that can be tried and can vary from visit to visit. 
     Inflammatory treatments in my practice is typically ice in some form and contrast bathing. I try to avoid oral medications in general, but short periods are fine. If you have any swelling or sudden stiffness or sore muscles and tendons, you should be working on the inflammation daily.
     Neuropathic pain can be from local nerve injury, local nerve hyper-sensitivity, and referred from above the foot. Nerves love non-painful massage, warm, short ice no longer than 5 minutes, motion like walking, neural flossing, but not prolonged stretching. Any injury that still has significant pain after 3 months will develop nerve pain in the form of protective neural tension or just hyper-sensitivity. Nerve pain is more intense than inflammatory pain, but shorter in duration. Patients commonly describe level 10 pain bursts for a minute or less that shuts them down. There is a whole branch of PTs specializing in nerves. 
     Therefore, when you are treating a painful foot problem, think about what mechanical, inflammatory, and neuropathic treatments you are doing daily. If you are missing one, add it in. Or, make changes to each type of treatment if the treatment progress stalls. Good luck!!

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.