Degenerative Joint Diseases
Our feet are constantly under stress. The load carried by the heel accounts for approximately 85% of body weight during slow walking (68 kilograms for an 80-kilogram person) and increases to about 260% of body weight during running (208 kilograms for an 80-kilogram person). Eighty percent of us experience foot problems at some point in our lives, and these problems are commonly associated with systemic diseases.
In the practical management of foot pain, what do we, as Physical Medicine and Rehabilitation Physicians, do?
- First and foremost, a diagnosis must be established through history-taking, physical examination, and the necessary tests. It is crucial to differentiate the type of pain. Is the pain mechanical, or is it inflammatory?
- After evaluating the complaints and obtaining the patient’s history, a foot examination and shoe examination are performed. Selecting the right shoes and examining worn areas in shoes are essential for individuals with foot problems.
- In addition to this, an assessment of foot joint mobility, musculoskeletal system evaluation, assessment of vascular structures in the foot, and evaluation of neurological structures (nervous system structures responsible for foot sensation and function) are necessary. In other words, the examination is not limited to the foot just because there is foot pain. Sometimes, foot pain can be a sign of vascular blockages, while other times, it can be an indicator of diseases affecting our nervous system, such as multiple sclerosis or stroke. Furthermore, conditions like diabetes and clotting disorders can also lead to foot pain. Therefore, when patients come with foot pain, a comprehensive evaluation of all body systems is necessary.
Common Complaints In The Foot And Ankle
- Heel pain
- Pain in the forefoot
- Ankle pain
- Numbness/burning sensation
- Tingling/electrifying sensation
- Swelling in the ankle
- Redness around the foot
How Do Patients Describe Their Foot Problems?
- I used to walk from Fatih to Eminönü without any pain. Why do I experience pain when I walk now?
- Pressing my feet in the morning is torture!
- My foot suddenly swelled, and I can’t put any weight on it.
- The pain is so severe that I can’t sleep at night…
What Clues Do I Prioritize In The History?
- Any past injuries?
- Engaging in a specific activity regularly?
- Recent use of new shoes?
- Engaging in a new sport or activity outside of the usual routine?
- Sudden increases in walking distance?
- Prolonged periods of exercise or work without breaks?
- Significant weight gain?
- Diagnosis after patient history and examination
- If the patient has
◦ a history of trauma
◦ been exposed to repetitive stress
◦ inflammatory events are suspected, advanced tests are necessary
Foot disorders come in various forms.
- Pes planus (Flat feet)
- Pes cavus (Excessive arch height)
- Plantar fasciitis
- Calcaneal spur (Heel spur)
- Bunion
- Osteoarthritis
- Hallux rigidus
- Hammer toe
- Metatarsalgia
- Sesamoiditis
- Neuroma
- Stress fractures
- Tendinitis
- Tarsal tunnel syndrome
- Arthritis
- Ulcers
- Corns
- Infections…
After diagnosing foot pain, we proceed with our treatment plan. While treatment varies from patient to patient, I will mention some of our fundamental treatment methods below:
- In pain management
- Physical therapy modalities, manual techniques, education
- In increasing joint mobility
- Physical therapy modalities, manual techniques, exercise programs
- In muscle strengthening programs
- Exercise routines, establishing home exercise programs, and patient education
- In improving functional levels
- Assistive devices, shoe modifications, addressing the disorder
What Are The Physical Therapy Modalities Used In Foot Disorders?
Cold - Hot Applications
- Surface applications
- Cold packs
- Hot packs
- Infrared
- Ultraviolet
- Contrast baths
- Paraffin
- Deep heating agents
- Ultrasound
- Shortwave diathermy
Electrotherapy Applications
- TENS (Transcutaneous Electrical Nerve Stimulation)
- Diadinamic current
- Interferential current
- FES (Functional Electrical Stimulation)
- ESWT (Shockwave Therapy)
- Magnetic field therapy
- Manual techniques
- Mobilization
- Manipulation
- Chiropractic care
- Bandaging/Kinesiotaping
Massage Applications
Injections
- Local injections: Ozon, PRP (Platelet-Rich Plasma), Cortisone injections, etc.
- Acupuncture
- Neural therapy applications
Use of assistive devices: cane, orthotics, slippers, walker, crutch, etc.
Exercise
- All treatments should be complemented with the right exercises. Starting with stretching exercises to elongate shortened muscles and strengthen weak muscles is essential for eliminating improper loading on the foot.
Patient Education
- Being aware of pain: Identifying factors causing pain
- Ensuring active participation in treatment
- Gradually regaining normal daily activities
- Education to prevent the problem from recurring after pain relief
Patient compliance is crucial because failure to follow our recommendations inevitably leads to treatment failure.
- Weight control
- Regular and consistent exercise
- Activity restriction
- Adherence to treatment modalities
- Compliance with medical or drug therapy
- Adaptation to the use of devices or orthotics
I provide my patients with…
My Recommendations To Patients
- Don’t push through your tasks without breaks.
- Constantly putting weight on your feet delays the resolution of the existing problem and prolongs the healing process.
- Not taking the initial pain seriously can lead to it becoming chronic and an unsolvable issue.
- Active participation in treatment is crucial; otherwise, we’ll be paddling in vain.
My Weight-Related Recommendations:
Excess weight puts excessive strain on the feet.
Losing weight is important.
However, excessive exercise to lose weight can lead to foot pain.
Take proper care of your feet: cleanliness, moisturizing, nail care, shoe maintenance.
Be aware of age-related changes.
- Choose shoes that fit your feet.
- Provide the necessary support for your arches.
- If you wear high heels, avoid standing for extended periods and wear them for short durations.
- Be cautious when walking barefoot.
- Don’t walk or run barefoot.
- Always walk or run with the appropriate footwear and on the right surface.
- Remember that a hard surface puts more strain on your feet.
How My Patients Respond to Pain Treatment Recommendations:
- I’m very active; I can’t have arthritis.
- I don’t have five minutes to sit down.
- My day is filled with hustle and bustle.
- I’m very particular; everything has to be just right.
- I don’t have time to rest.
- I can’t seem to lose weight.
- My shoes are very comfortable; it can’t be because of them!
- I’m used to wearing high heels/flat shoes; I can’t change my shoes!
Important Reminders:
Stay in communication with your doctor.
After answering the question “Why is this happening?” together, we should seek answers to “What can I do for my treatment?”
Saying “I can’t do it” or “I don’t have time” to treatment recommendations won’t solve the problem.
We should ask “How can I do it?” or “Which treatment can I participate in more easily?”
Without active participation in treatment, the healing process will be prolonged.
