There are different types of pain in the sole of the foot but, simplifying, we can differentiate between two large groups. One of them is "mechanical" pain, which only appears when we put our feet on the ground when walking, especially barefoot, and which corresponds to an area with increased pressure or increased muscle tension that the patient notices as something that is it sticks into the plant. The second type corresponds to a "neuritic" pain (caused by inflammation of a nerve), which can occur even at rest, as well as walking, and typically appears with the foot shod, especially if it is tight. The patient notices a kind of ramp in the fingers or even that they fall asleep, and many times the pain is accompanied by burning, stinging or numbness.
which corresponds to a callus or hyperkeratosis (thickening of the outer layer of the skin, composed of keratin), due to an increase in skin pressure in that region of the sole of the foot.“Plantar fasciitis can become a worrisome problem, especially for an athlete, since in 10% of cases it perpetuates and becomes chronic”
Without Undoubtedly, the most frequent condition is the one that occurs due to excessive pressure in the plantar area; the patient has a painful callus that corresponds to an increase in pressure due to having an excessively long or inclined metatarsal. There are two particularly typical cases in athletes: the first is a stress fracture, which is caused by multiple low-intensity repeated traumas to a bone predisposed to being overloaded; a clear example would be a stress fracture in an excessively long metatarsal or bent over in a marathon runner; and, the other, is heel pain, plantar fasciitis (what is more widely known as heel spurs), here the fact of having short calf muscles is very involved. Finally, one of the most frequent "neritic" plant pains is Morton's Neuroma.
Plantar fasciitis can become a worrisome problem, especially for an athlete, since in 10% of cases they perpetuate and become chronic, and are difficult to treat in this type of such functionally demanding patients. Something similar happens with stress fractures, which can become a recurring problem, which is repeated despite correct treatment on some occasions.
Causes of pain in the sole of the foot
The foot is a complex biomechanical system and is usually connected to the ankle and calf muscles. The most common is that the patient feels a very localized pain in the sole, but that the cause of this pain is often found in the ankle and/or calf.
There are multiple causes of pain in the sole of the foot, among those that cause “mechanical” pain, the most frequent is due to an alteration in our shape or arrangement of the metatarsals. In other words, an increase in the length of the metatarsals or an increase in their inclination can produce areas of hyperpressure that translate into very painful calluses for the patient. As for "neuritic" pain, the most common cause is the presence of a tumor on a sensitive nerve in the toes (the plantar digital nerve). In this case, the most frequently affected toes are the 3rd and 4th. This tumor corresponds to the diagnosis of “Morton's neuroma”.
Other causes should be sought in locations far from the foot. Having short calf muscles can be a cause of mechanical pain, this is one of the most important causal factors for plantar fasciitis or, for example, if the patient suffers from diseases in the lumbar spine (such as herniated discs or wear of the lumbar spine that affects the nerve roots that come out of it), can result in pain with “neuritic” characteristics on the sole of the foot.
The influence of footwear
The type of footwear greatly influences the pain in the plant. It is necessary to differentiate the cause of each pain and individualize each patient, but in a generic way the characteristics of the footwear to improve or avoid the pain of the plant should be the following: a heel of between 2 or 3 centimeters, a sole that is not hard and that absorbs the impact of our steps, a wide anterior chamber (the part of the shoe where the fingers are housed) and a buttress (the most posterior part of the shoe) high that collects the heel well. When the pain in the sole is disabling for activities of daily living and/or sports activity and lasts for more than 2 or 3 weeks, you should see a doctor.
How to diagnose a problem on the sole of the foot
The initial tests that we perform on our patients consist, first of all, of a good anamnesis (asking the patient what type of pain he has, its characteristics, when it is triggered and if it has any relationship with the type of footwear or with any specific activity) and a physical examination. It is mandatory to perform a frontal and profile X-ray of both feet "in load", that is, of the patient standing. If with this we do not manage to establish a diagnosis and an effective treatment, other complementary tests can be considered, such as Magnetic Resonance Imaging (NMR), computed tomography (CT) or even a gait study.
Treatment and prevention
The main treatment for pain in the sole is conservative. It consists of the modification in the footwear and, when this is not enough, a second line of treatment is to adapt personalized insoles to the footwear, made by a podiatrist. On this basis of treatment, conventional analgesics for pain can be added, and sometimes an infiltration can help us, especially if it is a Morton's Neuroma.
We must be cautious with infiltrations with corticosteroids in the sole of the foot, because poorly indicated or applied excessively can cause severe complications. On very few occasions we immobilize pain in the sole of the foot, unless it is caused by a bone fracture and we reserve surgery as the option to consider when conservative treatment fails.
Footwear, essential to avoid pain
The best way to prevent pathology or injuries to the sole of the foot is to wear correct footwear on a daily basis or when doing sports and consult to an orthopedic foot and ankle surgeon when shoe modification does not work. The orthopedic surgeon will make a correct diagnosis of the problem, determining the cause of the pain in the sole and will establish treatment guidelines. In this, it is common for several specialists to participate, such as the podiatrist, who will be in charge of making personalized insoles, or the physiotherapist to, for example, establish a calf stretching guideline, very useful in patients with plantar fasciitis. It must be considered that insoles and footwear are the foundations of all treatment of pain in the sole of the foot.
At first, no sport is discouraged. When a patient has pain in the sole of the foot, that pathology should be treated so that the patient can continue practicing their favorite activity. But it is true that, depending on the cause of the pain in the plant, there will be sports that will be more harmful. Thus, for example, a running sport with continuous impact will be a risky sport for a patient with plantar fasciitis.
Another important decision in this sense is knowing how long you should stop your sporting activity to cure the pathology, which will depend fundamentally on the type of injury and the sporting discipline to be performed. Good communication between the athlete and the orthopedic surgeon is key (especially in the first weeks) and strictly follow the guidelines established by the latter.
About the author
We are talking about Dr. Albert Ginés, traumatologist at Clínica CorachanInstagram: @clinicacorachanWeb: https://corachan.com/
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