Adam Sewell MD


Foot pain is a very common complaint. Because the foot is comprised of so many tiny and intersecting bones and ligaments (26 bones and 33 joints, and hundreds of ligaments, muscles, and nerves), there are many places where injury can occur.  Bone spurs, stress fractures, Achilles tendinitis, bursitis, neuropathy,

osteoarthritis, neuromas, and tarsal tunnel are all frequent causes of foot pain and they can be divided into two categories, structural, or neuropathic.

Structural Foot Pain

Structural abnormalities of the foot include bone spurs, Achilles tendinitis, osteoarthritis, rheumatoid arthritis, and stress fractures. Bone spurs, or osteophytes, are bony projections that can develop along the edges of the bones in the feet, and they are typically the result of arthritis. They can be highly irritating to surrounding nerves, and cause a significant amount of pain. Just above the heel, is the Achilles tendon, which can become inflamed, resulting in tendinitis. Achilles tendinitis is usually the result of a sports injury, where the ankles and calf muscles are significantly overused. Osteoarthritis is caused by the breakdown and loss of cartilage in the joints. It is most often seen in older adults. Rheumatoid arthritis is a severe autoimmune disease. In RA, the body’s immune system attacks normal joint tissues and organs, resulting in severe pain and deformities. Stress fractures are tiny fractures that occur in the bones of the feet. They are typically caused by overuse, or improper physical training. Some treatments for structural foot pain include:

  • Non-steroidal anti-inflammatories (NSAIDS)
  • Opioid medications
  • Physical therapy
  • Splinting/casting
  • Steroid injections
  • Surgical intervention
  • Neuropathic Foot Pain

Foot pain can, also, have a neuropathic source, and stem from Morton’s neuroma, peripheral neuropathy, RSD, and lumbar radiculitis. A Morton’s neuroma is a swelling and nerve irritation between the third and fourth toes. Peripheral neuropathy is an inflammation of the peripheral nerves in the lower extremities, and can stem from multiple things. Some of these conditions are: Diabetes Mellitus, infections, and vitamin deficiencies. RSD is an abnormal neuropathic response to injury and is characterized by redness, swelling, and temperature changes. Foot pain can also be caused by nerve root impingement at the lumbar spinal level. Some treatments for neuropathic foot pain include:

  • Medications like Lyrica (pregabalin), Neurontin (gabapentin) and Cymbalta (duloxetine)
  • Lumbar epidural steroid injections
  • Lumbar sympathetic blockade
  • Physical therapy
  • Neuromodulation via TENS unit or spinal cord stimulation

Spinal Cord Stimulation (SCS) is often described as a “pacemaker for pain”. It works by introducing an electrical current into the epidural space near the source of chronic pain impulses. Under a local anesthetic, and some minor sedation, your doctor will place the trial SCS leads into the epidural space. The trial stimulator is typically worn for 5-7 days and connected to a stimulating device, which is taped to your skin. If the trial successfully relieves your pain you can decide to undergo a permanent SCS if desired. With both neuropathic and structural foot pain, the utilization of multiple treatments increases the chance of improvement in pain and quality of life


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