I spend time within each day at the clinic assessing why someone’s feet hurt. What kind of pain they are experiencing; the actual location of the pain; this is sometimes difficult for them to identify; and what I can do to make it better. Hurting feet can be dealt with via padding or orthotics, therapies, injections, or surgery. With the foot, it is important to relate things to patients via body systems. I have found this is an easy way for them to understand what is occurring, and the co-relations. The four main areas through which the body is impacted are vascular, neurological, dermatological, and orthopaedic.

Vascular Conditions

This is the circulation coming down into the foot, known as arterial circulation, and the circulation leaving the foot going back up to the heart, known as venous circulation. Can circulation cause foot pain? Most definitely! If too little blood is getting into the foot, it will cause pain and discolouration; usually most noticeable when the foot is elevated such as during rest. Putting the feet in a dependent position (standing), will reduce the symptoms somewhat. Poor venous return on the other hand will generally cause pain, swelling, and sometimes breakdown of the skin (ulcers), when standing too long. If sitting and elevating your feet seem to make the pain less intense, then there is a possibility that your foot pain is from lack of adequate blood flow back to the heart.

This, of course, is a very broad description of circulation, as the source of why your feet hurt. However, there are many other presentations to the feet and lower leg that will be circulatory related, and need to be evaluated by your doctor or podiatrist. Circulatory problems, unlike most bone, joint or skin problems, have the potential to become very serious with grave implications. In general, if your feet change colour and swell, depending on whether you are standing, sleeping or sitting, you should be evaluated for poor circulation.

Neurological Conditions

This refers to abnormal sensations occurring in the feet, as well as loss of muscle strength. Neurological problems are divided into two basic types, sensory and motor loss. In sensory deficit you may be experiencing things like numbness, tingling, burning, hyper-sensitivity, or a heightened sense of feeling in the feet. This is usually caused by damage to a sensory nerve. The damage can be anywhere; from the lower back down, to one of the local nerves in the foot. If the damage to a sensory nerve is coming from the lower back, often times it will affect both feet in similar locations. Local nerve irritation of a sensory nerve will usually only occur on one foot, and limited to a very specific location, which is generally the affected nerve innervates.

Motor nerve abnormalities will normally adversely affect the ability of the muscles in the foot and leg to function properly. This will result in an abnormal gait (the way you walk), because of loss of muscle strength.
Nerve abnormalities in many instances can be of a worsening nature. This is a cause for concern, when the neurological deficit affects a good portion of the feet, and extends to the legs. Local nerve irritation also has the propensity to worsen, but the damage done is generally local, and with the exception of the pain it may cause.

Dermatological Conditions

Can present as localised skin discolouration either in the form of redness, some sort of oozing, formation of scaling, crustiness, open wound, etc. There may also be nail issues, such as thick discoloured nails, or ingrown nails either with or without infection.

In many cases these skin and nail problems will be the result of some sort of trauma, but in many cases the origin will be insidious; either occurring very quickly or developing over time. I find that most patients will attempt to remedy the problem on their own. They either perform “self-surgery” where they attempt to cut away something; visit the local drug store and get some kind of ointment or cream to apply, to rid themselves of the problem.

Some of the more serious skin and nail problems that may be present include ulcers and infections. Any open wound should not be self-treated, as many simple infections have the potential to become very serious if improperly treated. Individuals may have a thick dark nail and attribute it to nail fungus. In most cases that is all it is, but in rare cases it may also indicate a melanoma of the nail bed or nail growth plate; if left untreated, it can have catastrophic consequences. It is truly best to seek professional help; your doctor, podiatrist or dermatological for a consult. Next week we will look at the Orthopaedic aspect. Until then…Do have a safe and enjoyable Carnival!

Your feet mirror your general health . . . cherish them!