By Dr Suhel Kotwal, MS (Orth)
Treatment for various problems of the foot
Pain in the ball of the foot
In general, the goal of treatment is to relieve the pain and improve the ability to walk. Usually, the initial treatment is conservative, such as appropriate footwear, physical therapy, and weight loss for people who are overweight. Most people can be treated initially with simple soft pads in their shoes designed to transfer weight to areas of the foot that are not painful. If this doesn’t work, special devices or special shoes may be necessary. For example, a ‘metatarsal bar’ is a bar placed across the sole of the shoe to transfer weight over a wider area.
Corns and calluses that rub on the shoe can be trimmed and padded (with materials such as lamb’s wool, silicone, or foam) to reduce pressure. Ulcers related to corns and calluses usually heal after surgical cleaning (ie, debridement) and appropriate management. However, they may come back unless pressure in the area of the ulcer is reduced and underlying problems (eg, diabetes) are managed.
Analgesics and anti-inflammatory drugs (eg, acetaminophen, aspirin, ibuprofen, naproxen sodium) or corticosteroid injections can often relieve the pain from foot problems. Surgery should be considered only when more conservative treatments have not been effective.
Heel pain
Plantar fasciitis is a common cause of pain in the sole of the foot. The plantar fascia is the long, flat ligament on the bottom of the foot. It can become inflamed from the chronic wear and tear caused by walking, and bone spurs may develop. Pain in the heel is usually caused by stress or tearing where the plantar fascia attaches to the heel bone.
Heel pain can also be caused when the shoe rubs on the back of the heel because of bone spurs, poor-fitting shoes, or other conditions. For example, bursitis and bone spurs can develop where the Achilles tendon rubs against the back of the shoe.
Treatment: Heel pain is often relieved by placing a pad or a special insert called an orthotic into your shoe to take weight off the heel. Footwear that provides a lot of ‘cushion,’ such as shoes with rubber soles, is useful. Pain relievers are also helpful. Sometimes, it is necessary to receive an injection of corticosteroid in the area, which often provides relief for many weeks. Surgery is rarely needed.
Diseases associated with foot problems
Diabetes
The most important disease affecting foot health in older adults is diabetes. Diabetes causes blood vessel and tissue problems that increase the risk of infection and slow wound healing. Vision and nerve complications associated with diabetes also make it more difficult for older adults to see problems before they become serious, or to feel the pain associated with them.
Many amputations in people with diabetes could be prevented by regular evaluation, early treatment, and education on foot health. If you have diabetes, you (or your caregivers) should examine your feet every day. Proper medical management of diabetes (ie, proper diet, exercise, frequent testing of blood sugar, medication, etc) and proper footwear are essential. Professionally developed programmes on foot care and the management of diabetes are available through diabetes associations.
Foot ulcers are important problems for older adults with diabetes. The most common causes are pressure (eg, from shoes), blood vessel problems, nerve damage, and improper foot care. The feet may appear pale or swollen. Pain is common, especially at night.
Treatments for foot ulcers include surgically removing any infected or dead tissue, relieving pressure points, and properly managing wounds with foot soaks, dressings, etc. Many different dressings and medications to use on the wound are available depending on the type of ulcer and its complications. Weight can be shifted away from the affected foot by using crutches, walkers, wheelchairs, and bed rest. Casts, special shoes or boots, braces, or orthotics may be needed.
Antibiotic therapy should be started early to avoid serious infection that can threaten the limb. If infection becomes severe (affects the bone), hospitalization and intravenous antibiotics are usually needed.
Gout
Although gout is most common in middle-aged men, it can develop at any age. In women, gout most often appears after menopause. Usually a painful large joint in the foot or lower leg develops suddenly. Gout tends to flare up from time to time.
Gout is usually associated with a high level of uric acid in the blood, which can lead to uric acid crystals being deposited in joints and body tissue. Alcohol use may increase the chance of getting gout. People taking diuretics (ie, ‘water pills’), heavy drinkers, and people who have recently had a serious illness or surgery are more likely to develop gout.
To diagnose gout, healthcare providers use a needle to draw a small sample of fluid from the swollen joint. Needle-shaped uric acid crystals can be seen in the fluid under the microscope.
Treatment: There are many effective methods for treating an episode of gout. In most cases, nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen sodium, etc) can reduce the pain and swelling. Colchicine is a drug that helps to prevent the uric acid from forming the crystals that cause the swelling and pain associated with gout. Colchicine can be given intravenously (IV) to treat sudden flare ups and then taken orally to help prevent future episodes of gout.
Special shoes and orthotics
Appropriate footwear can prevent serious complications from developing in many disorders of the feet. Various types of shoes and shoe inserts (ie, orthotics) can help relieve pain, and restore and maintain function. Special footwear and orthotics aim to do the following:
• reduce impact and other forces
on the foot
• transfer weight from painful
areas
• correct or support deformities
• control or limit joint motion
Depending on the specific problems, shoes can be specially ordered. Just modification of the footwear alone may be the solution to the problem. After a certain age and after the onset of medical conditions like diabetes, it’s a good practice to visit a podiatrist once in a while to get your feet examined professionally.
