miércoles, 31 de octubre de 2018

Foot Pain Management

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By Yolanda Smith, B.Pharm.Reviewed by Liji Thomas, MD

The management of foot pain can vary significantly for each patient as the best course of action depends on the cause of the pain. In most cases, patients will combine non-pharmaceutical therapy with medication to provide adequate relief of foot pain.

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Physical therapy

Physical therapy is an important part of foot pain management. For pain caused by inflammation following a physical injury to the foot, an ice pack applied immediately after the incident can help, as it brings down the inflammation. Heat packs can be used to reduce swelling and pain for patients with arthritis and similar conditions.

Massage and acupuncture therapy both offer a benefit in the management of foot pain. Massage encourages healing of the muscles and connective tissue in the feet. Acupuncture uses needles that are inserted into certain points in the body to reduce the sensation of pain.

Additionally, there are certain stretches and exercises that can help to increase or maintain the strength and flexibility of the muscles that support the foot. This is very important to prevent future injury to the foot.

Podiatry care

As specialists in the health of feet, a podiatrist often plays a central role in the management of foot pain.

For some patients, orthotics can help to support the feet properly. They are inserted inside shoes to improve the kind of foot pain that occurs when walking, running, or doing other movements with the feet. These insoles are created by the podiatrist, who molds a cast of the patient’s foot which is then inserted into the shoes. The orthotics may be constructed to be rigid, semi-rigid or soft, depending on the specific case.

Medications

There are various types of medications that may be used to relieve the pain and inflammation of the feet, or to address a specific cause that may be causing the pain.

Oral analgesic medications such as acetaminophen (paracetamol) or aspirin are often the first line choice for quick relief of foot pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are also often recommended and can help to reduce inflammation at the same time. Topical formulations of some NSAIDs such as diclofenac may be preferred in some cases, as they help to reduce inflammation with a lowered risk of systemic side effects.

A local corticosteroid injection into the foot can help to control inflammation that is causing foot pain. Alternatively, an oral corticosteroid medication may be prescribed for more general pain that is part of a condition that also affects other areas of the body.

For patients with foot pain due to arthritis, disease modifying anti-rheumatic drugs (DMARDs) may be recommended. This class of drugs works to modify the course of the disease and slow the progression of pain severity. Alternatively, biologic response modifiers are a newer class of medication that can help to slow the disease progression by inhibiting the immune system, which is involved in causing rheumatoid arthritis.

For patients with foot pain due to gout, preventative medications such as allopurinol can control the concentration of uric acid in the body. As a result, the crystals that are responsible for causing a gout attack are less likely to be formed.

Surgery

Surgery may be required for some patients with severe foot pain, particularly if it inhibits them from walking or other activities. Surgical procedures that may be recommended include:

Fracture repair
Arthroscopic debridement
Joint fusion
Osteotomy

The appropriate procedure will depend on the specific case and the nature of the foot pain. It is important for rehabilitative care to follow the surgical procedure and support the patient into recovery. A follow-up appointment several weeks after the procedure is usually needed to check on the progress and recovery of the foot.