A pain in the foot

Rupesh Puna discusses foot pain throughout the lifespan. He uses a case-based approach highlighting four common conditions:

Sever’s disease
Morton’s neuroma
plantar fasciitis
osteoarthritis of the foot.

Take home messages

Taking a history is crucial to making the diagnosis when a patient has foot pain.
Often imaging is required with foot pain - consider a weight-bearing x-ray to exclude and rule out significant other differentials. If unsure about further imaging modality, please feel free to discuss with your friendly orthopaedic foot surgeon
If local anaesthetic or steroid injections are to be used, we would recommend US guidance for accuracy.
Sever’s disease will resolve when the child stops growing.  Ceasing aggravating activities is the key to this.  Heel cups and calf stretching exercises can be of some help but we appreciate compliance can be an issue.
The clue to diagnosis of Morton’s neuroma is asking about footwear and the relief that comes with removing tight fitting foot wear.  Other common symptoms include burning into the webspace (most often the 3/4 webspace) and a sense of walking on a “mass”.
Plantar fasciitis has many options of treatment and all essentially have similar outcomes at one year - if symptoms are still present after a year an orthopaedic opinion may be sought.  First line treatment should involve calf stretching, plantar fascia specific stretching as well as an orthotic or heel pad).
Osteoarthritis of the foot is complex and there are many treatment options other than just fusion for certain joints (1st MTPJ and ankle). Glucosamine may be of benefit early in the disease process. It is worth referring to someone who specialises in the foot and ankle to discuss surgical options when the time is right.