Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Foot Pain

Posted by CPeters on 3/07/01 at 13:25 (040712)

I have had foot pain in the arch of my right foot for over 3 weeks now. It began a day after I ran 3-4 miles-didn't hurt while I was running or that day. It was so painful that I was unable to walk in the heel of the foot (walked on the ball instead)the following days. The majority of the pain is in the outer side and heel. I have continued with my training program for a 10 mile run, but my foot often hurts daily. I think I may have plantar fasicitis, but am not sure. Ice and heat both make it feel better, but only offer temporary relief. I have not tried any other treatments other than asprin/ibprophin. Any advice?

Re: Foot Pain

Dr. Zuckerman on 3/07/01 at 17:29 (040744)

You need to find out if your have torn the posterior tibial tendon. This is a very important tendon that attaches to the arch area. If it is torn and not treated could lead to chronic long term pain. I know you love to run but this isn't the best option at this time. See a doctor and have him examine the Post Tib tendon

Re: Foot Pain

Dr. David S. Wander on 3/09/01 at 21:38 (040920)

You mention that your foot pain is at the outside aspect of your heel. You also mention that you have difficulty walking on your heel, and must walk on your toes. This would indicate that there is NOT involvement of the posterior tibial tendon. This tendon is on the inside or medial aspect of your foot. Additionally, if there was a tear or rupture of the posterior tibial tendon, you probably would not be able to stand on your toes. One way that we test for a tear of the posterior tibial tendon, is to ask the patient to raise on his/her toes. If the tendon is torn or not functioning, the patient will not be able to stand on his/her toes. If the pain is on the outside of the foot (lateral) and the pain goes under your foot toward the arch, you may have injured your peroneal tendons. Regardless, I would rest the area and seek medical advice before resuming any strenuous activity, to avoid additional injury.

Re: Foot Pain

Dr. Zuckerman on 3/09/01 at 22:21 (040922)

Thanks for the additional clarification . I miss you today in my office.

Re: Foot Pain

Scott R on 3/09/01 at 22:27 (040923)

I have seen a patient or two with heel pain who walks on their toes. If tension in the fascia is the cause of the pain, then walking on the toes maximizes this tension, so I don't understand those cases and wonder if they are plantar fasciitis. How do we know it's not a stress fracture?

Re: Foot Pain

Dr. David S. Wander on 3/10/01 at 12:28 (040948)

Scott,

As you're aware, there are a plethora of conditions that can cause heel pain. It is unlikely that a patient with traditional plantar fasciitis would walk on his/her toes to compensate. As you correctly stated, this would place more tension on the fascia, and should actually increase the symptoms. Usually, patients will compensate by supinating or inverting the foot to decrease tension on the fascia. If the heel pain is posterior toe walking may be due to a tight or short Achilles. A stress fracture is also a possibility, with walking on the toes as compensation for a sore heel. Obviously, there are numerous scenarios from a tight Achilles, to a stress fracture or other bone or muscle pathology. This patient would need a thorough evaluation and any necessary radiographic studies.

Re: Foot Pain

Barbara TX on 3/10/01 at 16:55 (040959)

Dr. Wander - Do you mean rise up on the actual toes to test the PT Tendon, or do you mean rise up on the ball of the foot? Thanks! B.

Re: Foot Pain

Dr. David S. Wander on 3/10/01 at 19:53 (040975)

Barbara,

If the posterior tibial tendon is not functioning, it will be difficult to raise up on the 'ball' of the foot. There are other muscles that are also active in rising on your toes such as the posterior calf muscles/'Achilles' tendon. There is a condition called posterior tibial tendon dysfunction that can manifest with pain at the medial (inside) of the foot and/or arch. Additionally, there is often difficulty rising on the ball of the foot and some patients notice a flattening of the foot. This can be progressive and can occur slowly over time, or can be acute. There are several manual tests to test the integrity of the posterior tibial tendon, including resistance applied against the tendon when muscle testing. MRI's are also very useful in determining if there is a pathology of the tendon and the 'stage' of the pathology if it exists. Additionally, a portion of the population may have an accessory bone at the area of insertion of the posterior tibial tendon, causing discomfort in the area of the medial foot/arch. A thorough examination should lead
your doctor to an accurate diagnosis.

Re: Foot Pain

Dr. Zuckerman on 3/11/01 at 00:25 (040994)

I see alot of patients that try to walk on their toes to avoid the heel completely due to the severe heel pain. The cause could be pf , heel spur pain etcd. If you watch this pateint it is usually first step pain and they are walking and not placing the heel down. In addition they are placing very little weight on the foot period. Is this the toe walking patient you you are talking about.

So the patient is in so much pain that they avoid all weight on the heel and very little is palced in the toe area. It is sore of a balancing act with all the weight on the opposite foot. It is a a heel migrane.

Re: Foot Pain

Julie on 3/11/01 at 01:27 (041003)

I agree with that description, Dr Z. When my first-thing-out-of-bed pain was at its worst I kept my right heel off the floor, but put almost no weight on the toes: they merely grazed the floor to keep me balanced while my left foot moved forward. It was a maneuvre just short of hopping (which would have woken husband up).

Re: Foot Pain

Dr. Zuckerman on 3/07/01 at 17:29 (040744)

You need to find out if your have torn the posterior tibial tendon. This is a very important tendon that attaches to the arch area. If it is torn and not treated could lead to chronic long term pain. I know you love to run but this isn't the best option at this time. See a doctor and have him examine the Post Tib tendon

Re: Foot Pain

Dr. David S. Wander on 3/09/01 at 21:38 (040920)

You mention that your foot pain is at the outside aspect of your heel. You also mention that you have difficulty walking on your heel, and must walk on your toes. This would indicate that there is NOT involvement of the posterior tibial tendon. This tendon is on the inside or medial aspect of your foot. Additionally, if there was a tear or rupture of the posterior tibial tendon, you probably would not be able to stand on your toes. One way that we test for a tear of the posterior tibial tendon, is to ask the patient to raise on his/her toes. If the tendon is torn or not functioning, the patient will not be able to stand on his/her toes. If the pain is on the outside of the foot (lateral) and the pain goes under your foot toward the arch, you may have injured your peroneal tendons. Regardless, I would rest the area and seek medical advice before resuming any strenuous activity, to avoid additional injury.

Re: Foot Pain

Dr. Zuckerman on 3/09/01 at 22:21 (040922)

Thanks for the additional clarification . I miss you today in my office.

Re: Foot Pain

Scott R on 3/09/01 at 22:27 (040923)

I have seen a patient or two with heel pain who walks on their toes. If tension in the fascia is the cause of the pain, then walking on the toes maximizes this tension, so I don't understand those cases and wonder if they are plantar fasciitis. How do we know it's not a stress fracture?

Re: Foot Pain

Dr. David S. Wander on 3/10/01 at 12:28 (040948)

Scott,

As you're aware, there are a plethora of conditions that can cause heel pain. It is unlikely that a patient with traditional plantar fasciitis would walk on his/her toes to compensate. As you correctly stated, this would place more tension on the fascia, and should actually increase the symptoms. Usually, patients will compensate by supinating or inverting the foot to decrease tension on the fascia. If the heel pain is posterior toe walking may be due to a tight or short Achilles. A stress fracture is also a possibility, with walking on the toes as compensation for a sore heel. Obviously, there are numerous scenarios from a tight Achilles, to a stress fracture or other bone or muscle pathology. This patient would need a thorough evaluation and any necessary radiographic studies.

Re: Foot Pain

Barbara TX on 3/10/01 at 16:55 (040959)

Dr. Wander - Do you mean rise up on the actual toes to test the PT Tendon, or do you mean rise up on the ball of the foot? Thanks! B.

Re: Foot Pain

Dr. David S. Wander on 3/10/01 at 19:53 (040975)

Barbara,

If the posterior tibial tendon is not functioning, it will be difficult to raise up on the 'ball' of the foot. There are other muscles that are also active in rising on your toes such as the posterior calf muscles/'Achilles' tendon. There is a condition called posterior tibial tendon dysfunction that can manifest with pain at the medial (inside) of the foot and/or arch. Additionally, there is often difficulty rising on the ball of the foot and some patients notice a flattening of the foot. This can be progressive and can occur slowly over time, or can be acute. There are several manual tests to test the integrity of the posterior tibial tendon, including resistance applied against the tendon when muscle testing. MRI's are also very useful in determining if there is a pathology of the tendon and the 'stage' of the pathology if it exists. Additionally, a portion of the population may have an accessory bone at the area of insertion of the posterior tibial tendon, causing discomfort in the area of the medial foot/arch. A thorough examination should lead
your doctor to an accurate diagnosis.

Re: Foot Pain

Dr. Zuckerman on 3/11/01 at 00:25 (040994)

I see alot of patients that try to walk on their toes to avoid the heel completely due to the severe heel pain. The cause could be pf , heel spur pain etcd. If you watch this pateint it is usually first step pain and they are walking and not placing the heel down. In addition they are placing very little weight on the foot period. Is this the toe walking patient you you are talking about.

So the patient is in so much pain that they avoid all weight on the heel and very little is palced in the toe area. It is sore of a balancing act with all the weight on the opposite foot. It is a a heel migrane.

Re: Foot Pain

Julie on 3/11/01 at 01:27 (041003)

I agree with that description, Dr Z. When my first-thing-out-of-bed pain was at its worst I kept my right heel off the floor, but put almost no weight on the toes: they merely grazed the floor to keep me balanced while my left foot moved forward. It was a maneuvre just short of hopping (which would have woken husband up).