Persistent foot and toe pain affects an incredibly large part of our population. We spend hours on our feet every day, working, playing, and engaging in everyday activities. Some may be pounding their feet running marathons, while others try to reach that goal of 10,000 steps a day. Each of those steps generates a force on the foot. Add to that, activities like jumping and running, and the force placed on the foot increases that much more. During an average day, the feet support a combined force equivalent to several hundred tons. It is not surprising, then, that the majority of us experience foot pain at some point in our lives.
We can compound our problems of foot pain by our choices of footwear. Improper foot mechanics with walking, running and intense training can cause problems with our feet too. Various physical conditions such as high arches, fallen arches, degenerative arthritis, bony abnormalities, flat-footedness, inflammatory joint diseases and excess weight also predispose us to foot pain.
The foot, if we include the toes and ankle, contains 26 bones. All of those bones make up 33 joints supported by more than 100 muscles, tendons and ligaments. Any of these structures can become weakened or injured, which will then destabilize the foot, due to insufficient ligament and tendon support for proper motion in those joints. The result is foot pain due to the joints of the foot becoming weak, lax, and unstable.
Instability in any joint typically begins with an injury to the ligaments and tendons which support the joint. Because the joint is no longer held in place by healthy ligaments and tendons, abnormal joint motion develops. This abnormality in the movement of the joint results in a greater amount of pressure being exerted on the different parts of the joint. All of the structures of the joint can become damaged, including the cartilage. When cartilage degenerates, there will be a crunching and grinding in the joint. With time, the body reacts to this instability by contracting the muscles in the area. You’ll experience that as muscle spasms. Eventually these tense muscles will fatigue and lose their strength. Then the ligaments and tendons will try even harder to stabilize the joints, but they will become damaged further. That is the cycle of abnormal joint motion will degenerate the joint. The body responds to the failure of these various soft tissue structures by increasing bone mass in an attempt to stabilize the joint. One result is arthritis, a frequent diagnosis related to foot pain.
Instability of the joints of the foot can also result in a number of forefoot conditions. These include Morton’s Neuroma, bunions (hallux valgus), and a stiff, degenerated, big toe called hallus rigidis. The origin of these conditions can be traced back to an original ligament injury or weakness.
Morton’s Neuroma refers to a fibrous tissue formation around nerve tissue in the spaces between the toes and results in symptoms that include sharp pains, burning sensations, and paresthesias (abnormal sensations). This condition is not traditionally thought of as being an instability problem. However, injury to ligaments of the foot can cause excessive motion between the bones of the toes, causing irritation of the bursa or a nerve, and can result in a significant enlargement of the nerve. This enlargement can cause further trauma and worsening of the symptoms, which can be quite severe. Morton’s Neuroma most often affects women who frequently wear pointed, high-heeled and close-toed shoes, the mechanics of which transfer body weight to the toes, placing undo force on the toes and their ligaments.
Bunions are another widespread, persistent foot complaint, also commonly seen in women. This growth in boney tissue occurs mainly on the medial side of the foot, producing the characteristic bump or bunion. Joint instability here causes the bones of the toes to move in an abnormal fashion with this shift leading to the formation of this boney projection on the medial side of the toe in an attempt to stabilize joint motion.
Hallux rigidus is a disorder of the joint at the base of the big toe, which causes pain and stiffness in the toe. Over time, the toe becomes increasingly more difficult to bend. Hallux refers to the big toe, and rigidus means the toe is rigid. The condition is caused by degenerating cartilage in the metatarsophalangeal (MTP) joint of the big toe, which will eventually lead to the formation of bone spurs that form around the joint—a last ditch effort of the body to recover joint stability and stabilize the joint. The underlying condition of both bunions and hallux rigidus is instability that causes arthritis of the MTP joint.
Abnormal joint shifts are what precipitate the pathological bone growth associated with bunions, reducing movement in both flexion and extension, and leading to hallux rigidus and to a potentially frozen joint.
Standard treatment for foot pain is generally conservative, beginning with choosing properly fitting shoes. NSAIDs are often prescribed along with physical therapy. When foot and toe pain continue, surgery is frequently considered. In fact, surgery on the first metatarsophalangeal joint is amongst the most common surgery performed.
Despite the commonality of these treatments, a large percentage of people continue to suffer with foot and toe pain. An effective alternative treatment for reduction and elimination of this pain is Regenerative Orthopedics, because it addresses the underlying cause of the problem, the joint instability caused by ligament and tendon injury. By strengthening ligaments and tendons, Regenerative Orthopedics can stop the pathologic cascade causing these persistent foot conditions, stabilizing the joint and bringing pain relief.