Treating Chronic Foot Pain

Ask anyone who has ever suffered foot pain, either from something as simple as a pair of ill-fitting shoes or from a disease such as diabetes, and they will tell you that painful feet can severely impact one’s quality of life.

This is especially true for those who suffer from chronic foot pain that is not due to structural conditions such as flat feet, bunions, hammertoes, etc.

Why Do My Feet Hurt?

Podiatrists are specialists who care for the feet and ankles. They are well-versed on treatments that can resolve many of the common anatomical conditions that cause foot pain, such as fallen arches, bunions and bone spurs. But they also recognize that there may be underlying conditions that contribute to chronic foot pain, such as:

• Arthritis: There are more than 350 joints in the human body and arthritis can affect any one of them. Osteoarthritis occurs when the cushioning cartilage between the joints breaks down and the bones begin to rub against each other. Although we often think of arthritis affecting the body’s larger joints, such as the hips and knees, it can also affect smaller joints, including those of the ankles and toes. 
• Diabetes: Left untreated, diabetes can damage the nerves in the feet, leading to a condition known as peripheral neuropathy. This may cause anything from numbness in the feet to sharp pain or extreme sensitivity to the lightest touch.
• Complex Regional Pain Syndrome (CRPS): More than 90 percent of CRPS cases are triggered by some kind of injury or trauma, such as a bone fracture and casting, sprains/strains or surgery. Even after the initial trauma or injury is healed, the CRPS patient continues to experience chronic pain in their extremities (arms, hands, legs, feet). Research has shown that the body’s immune response is what causes CRPS-related inflammation, but more work needs to be done to understand why it develops.[i]

Non-surgical Interventions to Treat Chronic Foot Pain

Podiatrists can address many causes of pain that affect the feet. But when that pain persists, they may refer their patients who suffer from moderate to severe cases of non-structural chronic foot pain to pain medicine specialists. These physicians have specialized training in understanding the source of a patient’s pain as well as the latest advanced interventions that may provide much sought-after pain relief.

The pain medicine specialist may start with a conservative approach that includes over-the-counter anti-inflammatories, perhaps in combination with prescribed medications that were initially developed to treat seizures or depression but which have also proven to be effective for treating neuropathic pain.[ii] They may also recommend physical therapy to improve blood flow, strength and flexibility.

If these treatments fail to bring relief, a board certified pain medicine specialist can perform minimally-invasive interventions that may provide long-term pain relief. These include:

• Sympathetic Nerve Blocks: The sympathetic nerves are found along the front of the spine and control many involuntary bodily functions such as sweating, digestion and blood flow. Initially, the pain medicine physician injects a numbing medicine around the sympathetic nerves in the low back or neck. If this leads to significant pain relief, additional blocks may be performed to further reduce the pain.
• Dorsal Root Ganglion (DRG) Stimulation: This procedure, which was approved by the FDA in 2016, involves implanting a tiny neurostimulator in the patient’s dorsal root ganglion. The dorsal root ganglion contains cells of sensory neurons that bring information from the body’s periphery to the spinal cord. With spinal stimulation, that patient can activate a mild electrical current to interrupt pain signals from the extremities before they reach the brain.

Never Ignore Chronic Foot Pain

Pain is the body’s way of telling us that something is wrong. Therefore, pain in any part of the body that lingers even after attempts at rest and self-care should be evaluated by a physician.

Chronic foot pain may also be a sign of an underlying disease or condition. Left untreated, this pain—and its underlying cause—can intensify and become increasingly difficult to treat effectively. That’s why those with chronically painful feet should take a step in the right direction and seek the care of a qualified pain medicine specialist.

Dr. Ioannis Skaribas is fellowship-trained and double board certified in Anesthesiology and Pain Medicine. He has extensive experience in using interventional treatments to address chronic pain from conditions such as diabetic neuropathy and complex regional pain syndrome (CRPS). He is a clinical assistant professor in pain medicine at The University of Texas Health Science Center at Houston and has contributed his expertise to several textbooks and professional journals.

Resources

[i] https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet

[ii] https://www.mayoclinic.org/diseases-conditions/crps-complex-regional-pain-syndrome/diagnosis-treatment/drc-20371156