Once the underlying cause of foot pain is diagnosed, the appropriate treatment plan can be developed. The mainstay of most foot pathologies is non-operative measures.
Reducing or modifying activities that exacerbate the pain is often the first step in managing foot pain. Rest allows tissues to heal, reducing inflammation and preventing further damage.
Applying ice to the painful area can help reduce inflammation and numb the pain. Heat therapy, on the other hand, can help relax muscles and improve blood flow. Alternating between ice and heat therapy can provide relief for certain conditions such as plantar fasciitis and tendonitis.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and reduce inflammation. Along with regular paracetamol, these medications are particularly useful for managing mild to moderate pain caused by conditions such as arthritis, tendonitis or minor injuries.
Orthotics, such as shoe inserts or custom-made orthotics, can provide support, improve foot alignment and relieve pressure on certain areas of the foot. They can be beneficial for conditions such as mild pes planus, mild cavus, plantar fasciitis and metatarsalgia. Commonly we see patients that have spent thousands of dollars on orthotics that have never worked. If they haven’t worked for the patient, they likely never will, so refer them to see an orthopaedic foot and ankle surgeon.
Physiotherapy involves exercises and stretches designed to improve strength, flexibility and range of motion in the foot and ankle. A physiotherapist can help develop a personalised treatment plan to address specific issues such as plantar fasciitis, Achilles tendonitis or stress fractures.
For persistent pain, corticosteroid injections may help reduce inflammation and provide temporary relief for conditions such as arthritis or bursitis. However, they are generally not a long-term solution and should be used with caution due to potential side effects and damage to tendons and fascia.
I would caution the prescribing of corticosteroid injections for conditions such as plantar fasciitis and Achilles tendinopathy. For diagnostic purposes of a patient with generalised foot pain, an image guided injection of local anaesthetic may be recommended to an area of interest and potential surgical target.
Surgery is the last resort when other treatments have failed to provide pain relief. Surgical options vary depending on the cause of foot pain. Recovery from foot surgery can also differ, so the decision to undergo surgery should be made in consultation with an orthopaedic foot and ankle surgeon.
Prevention strategies
Preventing foot pain is often easier than treating it. Here are some practical tips for your patients to help maintain foot health and prevent pain:
Choosing the appropriate shoes is crucial for preventing foot pain. Good shoes provide adequate arch support, cushioning, a rocker-type bottom and a proper fit. Avoid high heels and shoes with narrow toe boxes, as they can contribute to conditions like bunions and neuromas. Replace worn-out shoes regularly to ensure optimal support.
Excess body weight puts additional stress on the feet. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this excessive load and prevent conditions such as plantar fasciitis and arthritis. This is one of the most significant modifiable conditions that drastically improve foot pain.
If your patients have chronic medical conditions such as diabetes, arthritis or peripheral vascular disease, work closely with them to manage these conditions effectively.
Incorporate foot stretches, calf stretches and lower limb strengthening exercises into a daily routine to improve flexibility, support, and balance. Exercises such as toe curls, calf raises and ankle rotations can help maintain foot health and prevent injuries.
Proper foot hygiene including washing and drying feet thoroughly, can prevent fungal infections such as athlete’s foot, which can cause discomfort and pain. Regularly trimming of toenails can also help prevent painful conditions such as ingrown toenails. This is especially important for the neuropathic feet and patients with diabetes.
When a patient is starting a new exercise regimen or increasing physical activity, urge them to do it gradually to allow the lower limb muscles and feet to adjust. Avoid sudden increases in intensity or duration, as these can lead to overuse injuries such as stress fractures and tendonitis.
Regularly inspect the feet for signs of injury, swelling, redness or deformities. Early detection of foot problems can prevent deterioration, which is particularly important for individuals with diabetes or neuropathy who may not feel pain or notice injuries.
While many cases of foot pain can be managed with self-care measures, some situations require specialist attention. Referral may be indicated if your patients experience severe pain that does not improve with rest or over-the-counter pain relievers, persistent swelling in the foot, difficulty walking or bearing weight on the affected foot or pain that is affecting their quality of life and activities of daily living
Associated symptoms such as fever, wounds, acute onset of pain and swelling that may indicate an infection or septic joint, requires referral to an emergency department with orthopaedic cover.
Key messages
- Treatment follows accurate diagnosis and is mainly non-operative
- Prevention is easier than cure and there are a number of approaches
- Surgical review/intervention may be needed in severe or persistent pain.
Author competing interests – nil