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Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 7552
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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What are the causes of foot pain?

Resolved Question:

Dull pain in right foot sole of foot. In the middle of sole a small nodule underneath skin, sore to the touch when pressed. Pressure irritates foot when walking. Not always painful to walk.

Submitted: 7 years ago.
Category: Medical
Expert:  Dr Uzair replied 7 years ago.

Hi.
Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.

Q. Is the pain more pronounced during the first few steps of the day?

Q. Do you do a lot walking or running recently or in the past?

Q. Any pain in the knees?

Customer: replied 7 years ago.
Is the pain more pronounced during the first few steps of the day?

Not really

Q. Do you do a lot walking or running recently or in the past?

Yes, and carrying heavy objects in high heels.

Q. Any pain in the knees? No

Expert:  Dr Uzair replied 7 years ago.

Hey there,

Thanks for the details.

Your symptoms seem consistent with plantar fasciitis.

This is due to the inflammation of the plantar fascia. The pain begins in the sole of the foot and remians dull and aching but tender to touch most of the times especiallu after walking.

The diagnosis of plantar fasciitis is usually made by clinical examination alone. The clinical examination may include checking the patient's feet and watching the patient stand and walk. The clinical examination will take under consideration a patient medical history, physical activity, foot pain symptoms and more. The doctor may decide to use Imaging studies like radiographs, diagnostic ultrasound and MRI.

An incidental finding associated with this condition is a heel spur, a small bony calcification, on the calcaneus (heel bone), in which case it is the underlying condition, and not the spur itself, which produces the pain.

Sometimes ball-of-foot pain is mistakenly assumed to be derived from plantar fasciitis. Some current studies suggest that plantar fasciitis isn't actually inflamed plantar fascia, but merely an inflamed Flexor digitorum brevis muscle belly. Ultrasound evidence illustrates fluid within the FDB muscle belly, not the plantar fascia.

Treatment options for plantar fasciitis include rest, massage therapy, stretching, night splints, motion control running shoes, physical therapy, Cold therapy, orthotics, anti-inflammatory medications, injection of corticosteroids and surgery in refractory cases. Studies have also shown, throwing away your running shoes and running barefoot or with a minimalist shoe can help.

Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure to improve the pain.

Traditional surgical procedures, such as plantar fascia release, are a last resort, and often lead to further complications such as a lowering of the arch and pain in the supero-lateral side of the foot due to compression of the cuboid bone. This will allow decrompression of the nearby FDB muscle belly that is inflamed, yet doesn't fix the underlying problem. This basically allows more space for the inflamed muscle belly, thus, relieving pain/pressure.

An ultrasound guided needle fasciotomy can be used as a minimally invasive surgical intervention for plantar fasciitis. A needle is inserted into the plantar fascia and moved back and forwards to disrupt the fibrous tissue.

For now I suggest that you give your foot some rest with restricted movements and avoid wearing heels. Instead wear a padded foot wear, you can find this kind of foot wear at departmental stores and pharmacies, especially made for patients with plantar fasciitis.

An anti-inflammatory like tylenol 2 tablets 4-6 hourly daily or Naproxen 550 mg, a tablet every 8 hours will be helpful in reducing the inflammation.

Cold compresses of the foot.

Dicloran or ibuprofen liquigels for local application will have a soothing effect and reduce the inflammation locally more effectively and efficiently.

--Hope this helps--

Best wishes.

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