Chronic Foot Pain|Chronic Leg Pain
 

Foot & Leg Pain

What is it?

Pain in the feet or legs is common. It can be caused by a number of different conditions. The most common conditions that cause pain in the feet and/or legs are the following:  

  • Plantar fasciitis

  • Arthritis

  • Neuropathy

  • Sciatica

Some of these conditions are commonly short-lived, while others are chronic.

 

If you have a new onset of pain in your legs or feet, it is important to have it evaluated by a healthcare provider. Many acute conditions, such as sprains, bone fractures, or blood clots, can be successfully treated. Some conditions, however, are chronic.

 

Plantar fasciitis

Plantar fasciitis causes pain in the heel and bottom of the foot. It is due to inflammation of the plantar fascia. The plantar fascia is a muscle-like connective tissue at the bottom of the foot.

 

Plantar fasciitis is associated with overuse, such as with runners, or in cases of obesity.

 

Treatments are anti-inflammatory medications, heel stretches, supportive footwear, and weight loss.

 

With treatment or on its own, plantar fasciitis usually improves within months to a year or two.

 

Arthritis

Arthritis is a common pain condition marked by inflammation of the joints. The inflammation causes pain, swelling, and stiffness. Arthritis can occur in any joint of the body.

 

There are different types of arthritis. The two most common are osteoarthritis and rheumatoid arthritis.  

 

Osteoarthritis might best be considered the result of general wear and tear. It can occur from traumatic injuries, overuse, and age. It results from a loss of cartilage, which ordinarily provides cushioning for the bones in the joints. With the loss of cartilage, the bones can rub together in the joints, causing inflammation. In turn, the inflammation leads to pain, swelling, stiffness, and tenderness. Osteoarthritis most commonly occurs in the hips, knees, ankles and feet.  

 

Common treatments for osteoarthritis are anti-inflammatory medications, physical therapy, cortisone injections, arthroscopic and joint replacement surgeries, and chronic pain rehabilitation programs.  

 

Rheumatoid arthritis is the result of the immune system mistaking healthy cartilage for being diseased, and consequently it attacks the cartilage of the joints. Over time, the immune system erodes the cartilage. The subsequent loss of cartilage causes inflammation when the joints are used. In turn, the inflammation causes pain, joint stiffness, and swelling. In advanced stages, the joints become deformed. Rheumatoid arthritis most commonly occurs in the hands and feet.  

 

Common treatments for rheumatoid arthritis are anti-inflammatory medications, chemotherapies, physical therapy, and chronic pain rehabilitation programs.  

 

Neuropathy

Neuropathy is damage to nerves and causes pain, numbness and/or tingling. While technically many conditions are a form of neuropathy, the term ‘neuropathy’ usually refers to peripheral neuropathy.  

 

Peripheral neuropathy is nerve damage in the peripheral nerves. It usually starts in the hands or feet as numbness or tingling. Over time, these symptoms can progress to pain. Patients most often describe the pain as a burning type of pain.  

 

The most common cause of peripheral neuropathy in the hands or feet is diabetes. It is then commonly referred to as ‘diabetic neuropathy.’ Other causes can be kidney disease, HIV, or alcohol dependence. It can also occur for unknown reasons. In the latter case, it is called ‘idiopathic peripheral neuropathy.’

 

If the cause of neuropathy is diabetes, therapy involves aggressive treatment of diabetes. In such cases, treatment consists of medications to control glucose, dietary changes, exercise, and weight loss.  

 

In all cases of neuropathy, therapies also focus on symptom management. Common symptom management therapies include antidepressant medications, anticonvulsant medications, opioid medications, mild aerobic exercise, cognitive behavioral therapy, and chronic pain rehabilitation programs.

 

Sciatica

Sciatica is a common pain condition marked by pain, numbness and/or tingling, beginning in the buttock and oftentimes extending down the leg, all the way to the foot and toes.  

 

The vast majority of acute cases of sciatica resolve on their own within a few weeks to months. Sometimes, it continues and becomes chronic. It’s considered chronic when lasting longer than six months. 

 

Sciatica is the result of either inflammation or irritation of the sciatic nerve. The sciatic nerve is a nerve which starts at the spinal cord in the low back, extends through the piriformis muscle in the buttock, and branches down the back of the leg, and into the foot. Causes of sciatica are disc herniations or other forms of degenerative disc disease in the lower part of the spine, piriformis syndrome, and, rarely, tumors along the spine. Stress can also play a role, particularly in exacerbations of sciatica.

 

The cause of sciatica is often difficult to identify in actual practice. The use of MRI’s to identify the cause is common, but problematic in many cases. While tumors are typically readily seen on an MRI, it is often difficult to identify degenerative changes of the spine that might cause sciatica. Some patients will have MRI’s that show, for example, a disc herniation and nerve root irritation that is consistent with their symptoms. Many patients, however, have sciatica without any objective findings on MRI. Still others commonly have findings on MRI that are inconsistent with their symptoms. For these reasons, providers often pursue epidural steroid injections and nerve blocks in an attempt to identify the cause of sciatica. However, these procedures can also provide unreliable results. As such, with the exception of tumor-related sciatica, healthcare providers typically presume the cause of the condition without ever obtaining definite confirmation. 

 

Common therapies for sciatica are the following:

  • Surgeries:  laminectomies, discectomies, and fusions

  • Interventional procedures:  epidural steroid injections, nerve blocks, rhizotomies, and spinal cord stimulator implants

  • Physical therapies:  stretching and strengthening exercises, mild aerobic exercises

  • Chronic pain rehabilitation programs

Last Updated on Friday, 01 February 2013 02:31

Published on Friday, 27 April 2012 13:37

Written by Murray J. McAllister, PsyD