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Forefoot Pain

Innovation Podiatry  >  Conditions  >  Forefoot Pain

Common forefoot pain conditions, symptoms and treatments are outlined below:

Bunions (click to open/close)

Overview

The medical term for a bunion is hallux abducto valgus (hallux = big toe). Often hereditary, they can lead to pain and stiffness in the big toe joint. There may also be redness and swelling around the joint and/or bony prominences at the top of the joint.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Joint mobilisation, strapping, dry needling/western medical acupuncture, exercises and functional foot orthoses can all be useful in helping to reduce bunion pain. We can also advise on footwear and stock a small supply at our clinic.

Hammertoe
Overview

A toe that does not bend normally at the middle joint and points down in the shape of an upside down ‘V’ is called a hammertoe. Usually seen in the second toe, at first, it will keep some of its flexibility and lie flat when barefoot, only appearing as a hammertoe when wearing shoes. After a while, the toe will not be able to lie flat at all.

While anyone can get hammertoe, women tend to suffer from it more than men. Age plays a part – hammertoe is the type of injury that may follow repeated damage to the toe and so, becomes more common with age. It is also common in people with nerve damage (e.g. from diabetes, stroke, or heart disease) and in those with second toes that are longer than the big toe, as the second toe is forced to bend in order to line up with the shorter toes next to it.

Wearing high-heeled shoes and certain injuries – such as a stub or a break – can make toes more vulnerable to hammertoe. This is especially true if the injury is not treated properly when it happens.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).
Treatment

Your podiatrist may advise you to wear wide, comfortable shoes that allow the toes to lie flat, and to steer clear of high-heeled shoes. In some cases, prescription orthotics can be effective to correct the misalignment and allow the toes to lie flat. In extreme cases, where the tendons of the toe have contracted and stiffness or pain affects movement, surgery might be needed.

Stress fracture
Overview

Stress fractures are an injury to bone caused by unaccustomed stress from running, marching or walking. They are often seen in military recruits or athletes as they increase their training. They may also be seen in people with hormonal imbalances, low bone mineral density or prior surgery that has altered the way their foot or ankle functions.

Stress fractures may feel like an ache in the foot or ankle, or like a sharp pain when a lot of stress is placed on the foot or when doing heavy physical activity. Swelling often occurs around the site of the pain, but usually no bruising is present.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).
Treatment

By taking an x-ray or obtaining a bone scan, your podiatrist can determine if there is a break or crack in the bone. If stress fractures are present, you will need to stop whatever exercise you are doing that has resulted in your foot or ankle pain. You may self-treat with ice, over-the-counter pain medications, and comfortable shoes. If there is no decrease in pain over several days, you should see your GP.

After making the diagnosis of stress fracture, your doctor or podiatrist will tell you to decrease activity levels. You may either be instructed to wear athletic shoes, or a stiff-soled shoe, to reduce bending motions of your foot when you walk. Depending on the location and severity, your doctor may recommend a cast and crutches. As the pain becomes less intense, you may gradually resume your activity level.

First Metatarsophalangeal Joint pain
Overview

The first metatarsophalangeal joint or ‘MTPJ’ is the joint between the big toe and the first metatarsal bone of the foot. This joint plays an important part in foot function and can be a common area for pain. Causes for this pain can be joint capsulitis, muscle strain or inflammation, inflammation of the sesamoids or ‘trigger toe’.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).
Treatment

When other diagnoses are ruled out such as Morton’s neuroma or sesamoiditis, your podiatrist will look at potential causes for the pain. The best time to treat this pain is in the early stages and your podiatrist will stabilize the joint through padding or strapping to prevent further pain. Your podiatrist may select one or more of the following treatments such as rest and ice, to help reduce the pain and swelling, oral over the counter pain medications, taping or splinting the toe to minimize movement, stretching exercises, shoe recommendations such as a supportive shoe with a stiff sole to decrease and control movement, lessening the pressure on the toe flexing or custom foot orthotics to provide support and re-distribute pressure points away from the affected joint. If the pain does not lessen over several days you should see your GP for further investigation.

Gout

Overview

Gout is an extremely painful form of arthritis associated with elevated levels of uric acid in the blood stream. The area may be swollen, red and warm to touch. If you think you might have gout, it is important to see us to rule out other possibilities. We can refer you for imaging, and to your GP to confirm the diagnosis.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

In the acute stages, your doctor may prescribe various oral medications. In chronic cases, your podiatrist can help treat your secondary foot deformity and assist you with your foot ulceration management.

Hallux Limitus (Functional and Structural)

Overview

In functional hallux limitus, when non-weight bearing, the big toe is able to dorsiflex on the 1st metatarsal. When weight bearing, this functional ability is lost, leading to gait alterations, which can affect mobility and balance, and may possibly cause falls. Detrimental effects can also occur further ‘up the chain’ with reductions to dynamic hip, knee and ankle motion.

In structural hallux limitus, there is a limitation and restriction of big toe joint range of motion at all times, both weight bearing and non-weight bearing.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Functional hallux limitus cannot be seen visually but there are various clinical assessments we can perform to diagnose this condition. Simple design features built into an orthotic device can facilitate desired function.

In structural hallux limitus, physical therapies such as mobilisation, strapping, and dry needling/western medical acupuncture can be helpful. Correct footwear and/or functional foot orthoses can be effective by helping to stop the painful forced flexing upwards of the toe while walking. If indicated, we may also refer you for a corticosteroid injection to reduce joint inflammation. This can provide temporary or permanent relief.

Hallux Rigidus

Overview

Hallux rigidus is the medical term for osteoarthritis or ‘wear and repair’ of the big toe joint where the joint has stiffened and become rigid, unable to be dorsiflexed. Walking can become very painful, as the toe is unable to freely perform its normal function.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Physical therapies such as mobilisation, strapping, and dry needling/western medical acupuncture can be helpful. Correct footwear and/or functional foot orthoses can be effective by helping to stop the foot from attempting to painfully force the upward flexion of the big toe whilst walking.

If indicated, we may also refer you for a corticosteroid injection to reduce joint inflammation. This can provide temporary and sometimes permanent relief.

Sesamoiditis

Overview

The sesamoid bones in the foot are two small bones underneath the head of the first metatarsal. They have an anatomical and biomechanical function, and can become painful with certain activities such as running, netball, dancing and wearing high-heeled shoes. Changes to foot shape, such as can occur with bunions, can also lead to pain in this area due to displacement of the sesamoid bones.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Simple changes to footwear and temporary offloading with padding and strapping can be sufficient treatment. X-rays may be required to check for any fracture or avascular necrosis. If further intervention is necessary, foot orthoses designed to reduce the ground reaction force at the 1st metatarsal head can be prescribed.

Morton's Neuroma

Overview

This painful condition occurs in the ball of the foot, ranging from mild numbness and tingling to a severe burning, stabbing pain. It’s caused by compression of the nerves as they pass between where the long metatarsal bones meet the toes. Repetitive movement, flexible footwear, footwear tight around your toes and/or foot biomechanics are the main causative factors.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

One or a combination of the following may be used:

  • Simple padding and strapping to offload the painful area and reduce pressure on the nerve.
  • Orthotics to address causative biomechanical factors.
  • Footwear modification – avoidance of high heels which increase pressure at the forefoot. Ensure shoes have wide deep toe box to prevent lateral pressure on the nerve. Ensure that shoes have adequate torsional resistance and aren’t too flexible.
  • Activity modification – switching to low impact activity in the short term. It is also worth considering your activities of daily living – are you reaching up on tiptoes a lot, or squatting down onto your toes?
  • Ice therapy to help reduce inflammation.
  • ESWT – extra corporeal shockwave therapy.
  • NSAIDS (non steroidal anti inflammatory medication) under guidance from your GP and pharmacist.
  • Corticosteroid injection under guided ultrasound to help reduce inflammation.

If conservative measures fail, it may be worth seeking a surgical opinion. However, surgery is not normally recommended as a first line treatment.

Bursitis

Overview

This is a painful condition in the ball of the foot, often causing pain, swelling, redness and warmth. It can occur alone or alongside other conditions such as Morton’s neuroma. A bursa is a small fluid-filled sac found near tendons, ligaments, muscles, bones and skin. It cushions and reduces friction between bones and structures that glide over the bones.

Bursitis occurs when these sacs become inflamed and irritated, often through overuse or repetitive movement. This can be from sporting or leisure activities, or purely through certain foot or gait abnormalities. Other factors can include footwear and trauma.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Sometimes a bursa will settle fairly quickly through ice therapy and offloading the affected area. If your symptoms persist, we can discuss other therapies that may help, including shockwave therapy, padding/strapping, western medical acupuncture and foot orthoses.

If conservative measures fail, it may be worth seeking a surgical opinion. However, surgery is not normally recommended as a first line treatment.

Plantar Plate Dysfunction

Overview

The plantar plate is a fibrocartiliginous structure found under the metatarsal heads, attaching to the plantar fascia and the proximal phalanx of the toes. Repetitive overload can lead to pain, which may feel like an ache or bruising to the top and ball of the foot. Swelling may also be present.

You may notice your toe becoming a hammered toe or a floating toe (where the tip no longer touches the ground), and the space between the affected toe and the next toe may also increase (known as a ‘daylight sign’ or ‘victory sign’). The 2nd metatarsophalangeal joint (MTPJ, ball of foot joint) is the most commonly affected. However, it can occur at any of the MTPJs.

Many contributing factors can lead to repetitive overload, including:

  • Increased running or jumping
  • Bunions
  • Long 2nd metatarsal bone
  • High heeled shoes
  • Diabetes
  • Increased squatting onto tiptoes
  • Ballroom dancing, golf and surfing.

A plantar plate injury can range from elongation of the structure, to partial and full tear.

Plantar plate tears can also occur when significant trauma has affected the forefoot.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Early treatment is advised. We will refer you for imaging to gain a clear diagnosis. Strapping, footwear, orthotics and/or protective boot may be required. If surgery is indicated, we work closely with local orthopaedic surgeons, which ensures fantastic multi-disciplinary care for you.

Frieberg's Infraction

Overview

Freiberg’s infraction is an ischemic condition specific to the lesser metatarsal heads, most commonly the second metatarsal. Also known as avascular necrosis or AVN, Freiberg’s infraction results in a focal loss of blood supply to the metatarsal head. Loss of blood supply to the metatarsal head results in collapse of the metatarsal head. Freiberg’s infraction is more common in women than men and has an onset during the second and third decade of life.

Signs and symptoms of Freiberg’s infraction include:

  • Insidious onset of pain with firm swelling in the forefoot
  • Pain increased with the amount of time spent on the foot
  • No history of injury to the foot
  • Swelling and warmth surrounding the metatarsal phalangeal joint
  • No bruising noted

Although there remains no consensus regarding the contributing factors for Freiberg’s infraction, the literature suggests trauma as a contributing factor.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Treatment of Freiberg’s infraction tends to vary based upon the degree of degenerative change in the cartilage and the level of collapse of the subchondral bone. Casting or other methods of immobilization may be used in the early levels to decrease the tendency of the distal bone to collapse. Long-term pain control can be achieved by stiffening the shoe with a carbon plate and anterior rocker sole shoe. Steroid injections may help to relieve pain and reduce inflammation of the joint capsule.

Surgical correction of Freiberg’s infraction may be indicated in more severe cases and there a various different types of surgery available to assist with the treatment of this.

The long-term success of the treatment of Freiberg’s infraction varies. Active patients such as athletes tend to have greater residual disability.

Ganglion's and other deep cysts

Overview

Anytime you notice a lump or mass, you should have it checked out by a doctor as soon as possible, even if it isn’t painful. If the cyst isn’t painful, it may be best to just watch it to see if it changes over time. If you have a painful ganglion, you can try padding the area around the lump or try changing your shoe gear to relieve the pressure.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Your podiatrist will look at and feel the lump and usually organise for imaging to confirm this diagnosis. If it is a ganglion, we will refer you to your GP who may numb the area, then try to pull as much fluid out of the cyst as possible using a syringe. Many GPs will then inject a steroid or hardening agent into the cyst to try to prevent it from filling again. About half of the time, the cyst will fill up again after the treatment. We will then give you the option of having it removed surgically. Throughout this, your Podiatrist will work with your GP to assist with offloading the area and ensuring that you have supportive footwear.

Arthritis of the Toes

Including inflammatory arthritis such as rheumatoid, osteoarthritis and psoriatic arthritis

Overview

Arthritis is a common condition which there is swelling and tenderness in one or more joints. The cause and symptomology can vary depending on the type of arthritis . For example osteoarthritis is due to wear and tear of the joint from activity and age related progression, rheumatoid arthritis is an autoimmune condition. Psoriatic arthritis (PsA), an inflammatory form of arthritis, affects about 30 percent of people with psoriasis. Psoriatic arthritis is a chronic, inflammatory disease of the joints and the places where tendons and ligaments connect to bone. The immune system creates inflammation that can lead to swelling, pain, fatigue and stiffness in the joints.
Risk factors include:
  • Family history
  • Obesity
  • Age – increases with age
  • Gender – Women are more likely to develop arthritis

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

For treatment and more information about Osteoarthritis click here 

Treatments vary depending on the type of arthritis. The treatment focuses on reducing symptoms and improving quality of life. These can range from medication (as below) or surgery or physical therapy such as joint mobilisation, shockwave therapy or orthotic therapy to assist with joint stability and reduction of movement.
Medication
  • AnalgesicsReduces joint pain but does not reduce the inflammation.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)It will help reduce both pain and inflammation.
  • CorticosteroidsReduce inflammation and suppress the immune system.
  • Disease-modifying antirheumatic drugs (DMARDs)The most standard RA treatment helps to slow down the progression of RA.
  • Pain killersIt will reduce the joint pain.
Avascular Necrosis of the Sesamoids

Overview

Avascular necrosis (AVN) of the sesamoid affects the medial or lateral sesamoids of the hallux (big toe) resulting in pain under the first metatarsophalangeal joint. It is often found presenting in young female athletes. There is overlap of stress fracture, nonunion, and AVN that makes defining the diagnosis difficult but the treatment and outcomes are similar. Non surgical treatments are designed to offload the sesamoid, reducing the trauma to the area. The only surgical treatment available is the removal of the bone completely which is often very well tolerated.

Avascular necrosis of the metatarsal sesamoid is an uncommon disorder. It is where the bone dies due to temporary or permanent loss of blood supply to the bones. Often in the early stages there is no symptoms however over time is may cause pain in the big toe joint and limit physical activities.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Nonsurgical treatment for sesamoid injuries of the foot may include one or more of the following options, depending on the type of injury and degree of severity:

  • Padding, strapping or taping. A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension.
  • Immobilization. The foot may be placed in a cast or removable walking cast. Crutches may be used to prevent placing weight on the foot.
  • Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in reducing the pain and inflammation.
  • Orthotic devices. Custom orthotic devices that fit into the shoe may be prescribed for long-term treatment to balance the pressure placed on the ball of the foot.

When sesamoid injuries fail to respond to nonsurgical treatment, surgery may be required.

Chronic Regional Pain Syndrome (CRPS)

Overview

Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. It typically develops after an injury, a surgery, a stroke or a heart attack when the pain is out of proportion to the severity of the initial injury. It is uncommon and is poorly understood, however treatment is most effective when started early and in these cases improvement and remission are possible.

Signs and symptoms include:

  • Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
  • Sensitivity to touch or cold
  • Swelling of the painful area
  • Changes in skin temperature — alternating between sweaty and cold
  • Changes in skin color, ranging from white and blotchy to red or blue
  • Changes in skin texture, which may become tender, thin or shiny in the affected area
  • Changes in hair and nail growth
  • Joint stiffness, swelling and damage
  • Muscle spasms, tremors, weakness and loss (atrophy)
  • Decreased ability to move the affected body part

Symptoms may change over time and vary from person to person. Pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) usually occur first. Over time, the affected limb can become cold and pale and it may undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible. Occasionally it may spread from its source to elsewhere in your body, such as the opposite limb.

In some people, signs and symptoms may go away on their own whereas in others, signs and symptoms may persist for months to years.

The cause isn’t completely understood however it is thought to be caused by an injury to or an abnormality of the peripheral and central nervous systems. Many cases of CRPS occur after a forceful trauma to an arm or a leg. This can include a crushing injury or a fracture. Other major and minor traumas such as surgery, heart attacks, infections and even sprained ankles can also lead to CRPS. It’s not well understood why these injuries can trigger CRPS and not everyone who has such an injury will go on to develop it.

CRPS appears in two types, with similar signs and symptoms, but different causes:

  • Type 1. Also known as reflex sympathetic dystrophy (RSD), this type occurs after an illness or injury that didn’t directly damage the nerves in your affected limb. About 90% of people with CRPS  have type 1.
  • Type 2. Once referred to as causalgia, this type has symptoms similar to those of type 1. But type 2 occurs after a distinct nerve injury.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

There’s some evidence that early treatment might help improve symptoms and outcomes of CRPS. Often, a combination of different treatments, tailored to your specific case, is necessary. Treatment options include:

Medications:

  • Pain relievers. Over-the-counter (OTC) pain relievers may ease mild pain and inflammation. Your doctor may prescribe stronger pain relievers if over the counter ones aren’t helpful such as opioid medications.
  • Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and anticonvulsants, are used to treat pain that originates from a damaged nerve (neuropathic pain).
  • Corticosteroids. Steroid medications, may reduce inflammation and improve mobility in the affected limb.
  • Bone-loss medications. Your doctor may suggest medications to prevent or stall bone loss.
  • Sympathetic nerve-blocking medication. Injection of an anesthetic to block pain fibers in the affected nerves may relieve pain in some people.
  • Intravenous ketamine. Some studies show that low doses of intravenous ketamine, a strong anesthetic, may substantially alleviate pain.

Physical Therapy:

  • Heat therapy. Applying heat may offer relief of swelling and discomfort on skin that feels cool.
  • Topical analgesics. Various topical treatments are available that may reduce hypersensitivity, such as over-the-counter capsaicin cream, or lidocaine cream or patches (Lidoderm, LMX 4, LMX 5).
  • Physical or occupational therapy. Gentle, guided exercising of the affected limbs or modifying daily activities might help decrease pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises might be.
  • Mirror therapy. This type of therapy uses a mirror to help trick the brain. Sitting before a mirror or mirror box, you move the healthy limb so that the brain perceives it as the limb that is affected by CRPS. Research shows that this type of therapy might help improve function and reduce pain for those with CRPS.
  • Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.
  • Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.
  • Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.
  • Intrathecal drug pumps. In this therapy, medications that relieve pain are pumped into the spinal cord fluid.
  • Acupuncture. The insertion of long, thin needles may help stimulate nerves, muscles and connective tissue to increase blood flow and relieve pain.

It’s possible for CRPS to recur, sometimes due to a trigger such as exposure to cold or intense emotional stress. Recurrences may be treated with small doses of an antidepressant or other medication.

Chilblain's and Raynaud's Phenomenon

Overview

Raynaud’s phenomenon is a condition that results in a bluish-white discoloration of fingers and toes, often as a result of exposure to cold. Stress, smoking and certain medications may trigger or worsen symptoms. The color change, which occurs from spasms in small blood vessels, becomes red and then returns to normal when blood flow resumes.

The condition most often affects women, with symptoms varying depending on the severity of the condition.  Because there are no specific blood tests to diagnose this condition, the diagnosis is based on symptoms.

On the other hand, chilblains are itchy, swollen and painful lumps and sometimes blisters on the skin that form after exposure to cold, usually affecting the fingers, and toes but can also appear on the nose and ears. Chilblains do not cause lasting damage and they usually heal in a few weeks. They are different to frost bite, with frostbite being far more serious however they affected area may be more sensitive to the cold after they heal. Similarly to Reynaud’s phenomenon, chilblains are caused by changes in the blood vessels in response to the cold or poor circulation.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Treatment for Raynaud’s phenomenon is aimed at prevention and protection of the toes and fingers. Similarly, to treat chilblains it is advised to stay warm and protect the affected skin.

See your doctor if the symptoms remain or you can’t get the pain under control who might advise

  • cortisone creams to reduce itching and swelling
  • medication or patches to expand the blood vessels and increase blood flow to the affected areas
Charcot's Neuroarthropathy of the Toes and Forefoot

Overview

Click Here 

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Click Here 

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