Some possible conditions â˘Â  Foot Pain – Top of Foot – Midfoot
Arthritis is a common inflammatory condition that affects bony joints. The most common type of arthritis is Osteoarthritis (OA). It occurs when the cartilage, which acts as a cushion between the bones of the lower limb wears down over time. As the cartilage deteriorates, the bones begin to rub against each other causing pain and inflammation. While it is most common in older adults, osteoarthritis can occur at a younger age. Other types of arthritis include psoriatic arthritis, rheumatoid arthritis and gout.
The most common symptom of foot arthritis is pain, which can range from mild to severe. Depending on the affected joint, pain can be felt throughout the foot. Psoriatic and rheumatoid arthritis primarily affect the toes and cause changes in shape, alignment, and may cause swelling. Along with pain, people with foot arthritis may also experience stiffness, as well as decreased range of motion. These symptoms may be worse after sitting or standing for long periods of time, or with physical activity. Gout can be acute or chronic, but when it first presents, pain, swelling and redness of the joint are the primary indicators.
Osteoarthritis is caused by a combination of genetic and environmental factors. With age comes the natural breakdown of the cartilage. The most common joint in the foot to be affected by OA is the big toe joint. Biomechanics play a significant role in the development of osteoarthritis because the position of our foot joints and how they move can cause increased pressure throughout the area affected. Previous foot injuries or surgeries can cause damage to overall joint structure/cartilage, which can be another factor. Overuse of certain joints is another cause of foot osteoarthritis as the more we work our foot joints, the faster cartilage breaks down. This is why jobs that involve a lot of walking and kneeling will have higher rates of workers with foot osteoarthritis. Psoriatic and Rheumatoid arthritis are a by-product of the disease processes, and have genetic and auto-immune causal factors. Gout is primarily precipitated by diet but ultimately, is a by-product of faulty handling or producing of uric acid by the body. These crystals build up within a joint and are very painful.
Treatment for foot arthritis begins with non-surgical approaches, such as medication, physical therapy, weight loss, bracing/splinting, orthotics and well-fitted shoes. Physical therapy can help to reduce pain and improve function by strengthening the muscles around the joints. Weight loss is also an important aspect of treatment as it can help to reduce the pressure on the foot joints. A brace, splint, orthotic or shoe with a forefoot rocker may be recommended to offer support and aid in pain reduction.
A high-arched foot, also known as a Cavus foot, is less common than a flatfoot, but it can cause more pain and trouble walkingâparticularly if itâs connected to a neurological problem. A high arch on the inside of your foot creates a âhigh instep.â This can make fitting shoes difficult. It can also lead to other concerns because most of your body weight is loaded on to your heels and the ball of your foot, rather than be distributed evenly over your entire foot.
With time, the uneven distribution of body weight heavily concentrated on the heel and forefoot that we see with a Cavus foot, can lead to a number of symptoms. The most notable symptom is pain. The pain typically is felt in the heel, ball of the foot or on top of the foot â the instep. As a result, you may have trouble fitting into some shoes and notice redness on top of your feet after wearing shoes. Additionally, you may notice, your toes start to change shape (hammer toes/claw toes are common), and calluses/corns may appear under the feet or on the tops or tips of toes. Sometimes the foot tilts to one side, too, which destabilizes the limb and may increase the odds of spraining your ankle. Frequent ankle sprains may be related to your high arches!
Cavus high-arched feet can be your natural foot shape that youâre born with, but often it is the result of a neurological disorder. Cerebral palsy, Charcot Marie Tooth disease, polio, muscular dystrophy, and spina bifida are all conditions that may cause your arches to develop higher than normal. Although most often hereditary, there are number of reasons why your arches may seem excessive, such as having the following shape / biomechanical pathology -
⢠Metatarsus adductus (âC-shapedâ foot)
⢠Forefoot valgus
⢠Plantarflexed first metatarsal
⢠Excessive curvature of the external arch (pseudoequinus)
⢠Excessive inclination of the heel bone
A thorough biomechanical exam by a Canadian Certified Pedorthist or Registered Chiropodist is important to better understand the biomechanics of your lower limbs. Your primary care professional may also order x-rays. Treatment depends on if the arch is rigid or flexible but focuses on addressing any biomechanical pathology through functional correction or accommodation. This can be done with Orthotics and appropriate shoes. Shoes that are easy to get into and accommodate for a higher instep are ideal. However, no off-the-shelf shoe has an insole that can properly address or support an excessively high arch. This is where orthotics are key. Also, any calluses or corns need to be trimmed and offloaded by a Chiropodist or Footcare Nurse. Finally, stretching and strengthening with physical therapy can help address balance issues and some gait disturbances.
Extensor tendonitis refers to inflammation of the extensor tendons, which run past the front of the ankle and along the top of the foot inserting into the toes. It is an overuse injury that is common in active individuals, especially if your shoes do not fit properly, or are laced too tight.
The main symptom of extensor tendonitis is pain on the top of the foot. It is often described as an aching pain or soreness, which increases with wearing shoes or exercise, in particular, running. Symptoms are likely to develop gradually over time, becoming progressively worse.
You may have some swelling over the top of your foot. And very rarely, some mild redness from shoe irritation. Curling the toes may trigger pain because this places stress on the tendons by stretching them.
Extensor tendonitis refers to the inflammation of the extensor tendon and implies a more acute injury. Overuse or repetitive strain is likely the cause. Repetitive strain causes the tendons to become inflamed and eventually degenerate. However, there are a number of factors that may increase your chances of injury. These include:
- Tying shoes too tightly or having a high instep where shoes fit tightly
- Running uphill or on a treadmill incline for extended periods
- Running on slippery surfaces
- Pathological biomechanics
The term extensor tendinopathy is probably a more accurate description of most injuries. This is because it also describes the degeneration of the tendon.
Pain from most long-term, chronic injuries is likely to be degeneration from wear and tear, not tendonitis. Studies have shown that long-term injuries usually do not have inflammatory cells present.
The best treatment is to cease the behaviour that caused the concern, while you let the tendons heal. If you were tying your laces too tightly or incline/uphill running, youâll want to stop. Training can continue once the inflammation has subsided and you begin to feel better. But easing back into training must be slow. Additionally, ice and anti-inflammatory medications can help when it is acute and newly painful. Once the pain subsides, heat is a better option than ice. Elastic laces may be a great investment as they expand with walking and take the pressure off. Finally, if you are active or walk or stand throughout your day, having a Certified Pedorthist or Registered Chiropodist examine your lower limb mechanics is important. You may be at further risk for injury if a biomechanical condition is contributing to your problem.
