Foot pain, Ankle aches and rheumatic disease 4/5 (18)

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Pain in the ankles and feet in children and adolescents most commonly occurs during sports and injuries. Childhood arthritis (juvenile arthritis) is also possible. For foot pain among adults over the age of 50 is Osteoarthrtitis (often in the big toe) most common cause. Pain in the foot or ankle is less often a symptom of a more serious illness. Rheumatic inflammation and other underlying diseases are less common causes. Side effect of cortisone (osteonecrosis), antibiotics (tendon injuries) and some medications are assessed for prolonged and otherwise unexplained symptoms.

Achilles tendon inflammation (tendinitis)

The condition often causes pain along the Achilles tendon behind the heel. Typical is acute severe pain in the heel and calf, and the pain increases with strain. Achilles tendonitis is one of the most common running injuries and is seen with overload or pressure with unsuitable shoes. Rare damage to the tendon is less common. Spondyloarthropathies as enthesitis related JIA (a type of juvenile arthritis often attacks the Achilles tendon attachment on the heel. ciprofloxacin is an antibiotic for infection. A side effect is tendonitis which can cause the Achilles tendon to rupture (late rupture). Cortisone injection into the tendon increases the risk of injury. Also high doses of cortisone in the form of tablets (for example Prednisone) or intravenously also increases the risk.

Arthritis (arthritis of the foot)

Arthritis is characterized by stiffness, pain, increased heat over joints. Various diseases cause arthritis, such as child joints (JIA), most often with discomfort under the toe pads in the forefoot ("Feeling of walking on pads"), the joints of the foot root or ankles. Rheumatoid Arthritis (Arthritis) can attack the same areas as juvenile arthritis. Spondyloarthropathies in the form of Ankylosing spondylitis (ankylosing spondylitis), Psoriatic arthritis, reactive arthritis or rheumatic manifestation in Crohn's disease or ulcerative colitis can cause foot pain with symptoms from the ankles, under the feet (plantar fascia) and ankle joints. Gout causes acute, very severe pain, most often in the big toe / gout or in the ankle, so that you can almost not load the foot.

Illustration: Hallux valgus (Osteoarthrtitis) in big toe. From fr.wikipedia to Commons., CC BY-SA 1.0,

Osteoarthritis and foot pain

Often the base of the big toe is attacked and then after the age of 40, most often somewhat later. Typically, stabbing pains are during and after walking. The joint may swell and become hot, but to a lesser extent than in arthritis or gout. Osteoarthritis with stiff big toe osteoarthritis is called hallux rigidus. Skewed axis may occur in the form of hallux valgus (see photo).

Stress fracture

Fractures are seen in the form of stress fracture among athletes who run long distances. Acute foot pain that increases with exertion is typical. The location of the pain suggests the starting point. Several of the bones can be attacked, including the heel bone. X-rays do not always reveal the damage at an early stage. In case of suspected stress fracture, but normal X-ray, CT or MRI examinations are recommended, which reveal almost all cases (Andersen Ø, 2022). Bone density measurement to reveal osteoporosis. as a predisposing factor may also be relevant. Treatment is especially relief for a sufficiently long time, often 6-12 weeks. One avoids NSAIDS such as Ibux, naproxen and Voltaren because the drugs can reduce the healing process (Zilener JL 2010).

Mucositis of the foot

Bursitis (mucositis) proven at the Achilles tendon behind the heel (retrocalcaneal bursitis). Pain and strain may be topical symptoms.

Tendonitis and foot pain

Entesitis / entesopathy (tendonitis) felt by pain and swelling at the Achilles tendon (heel) or under the foot (plantar fascia). Tendonitis: Please see below.

Erythromelalgia and foot pain

Erytromelalgia is a rare condition with severe burning pain in the feet and legs, so one will cool down with ice cold water or ice (which is not recommended)

Athlete's foot

Athlete's foot appears by cracking, itching of the skin between the toes.

Foot warts

Foot wart gives a limited thickening of the skin in the form of warts under the feet. The condition is separated from the corn (see below).

Osteonecrosis of the foot

Freiberg's disease (Köhler II, see also below) is due to cartilage inflammation and reduced blood circulation with tissue death (osteonecrosis) in the skeleton within the toes (metatarsal heads). Young women are attacked in 80% of cases. The cause is unknown, but hard physical exercise can be predisposing. Symptoms include pain in the forefoot when walking and other strain. Treatment includes relief over 4-6 weeks.

Foreign bodies in the foot

Foreign bodyr such as shards of glass, thorns and other sharp objects in the soles of the feet cause sharp pain during exercise and can be a cause of inflammation.

Haglund's heel

Haglund's heel is a calcification / protrusion starting from the skeleton (exostosis) at the back of the heel, above attached to the Achilles tendon. Most of those attacked are between 15 and 35 years old. The reason is unclear. Haglund's heel is usually visible as a bullet. There will then be little strain before mucositis (bursitis) and Achilles tendonitis also occur in the same place. Custom shoes and preventative exercises are recommended. Inflammation and pain can then return. In some cases, the calcification is surgically removed.

Worm bite

Adder bite can go unnoticed for up to 15 minutes (latency time before pain and swelling).

Hollow foot and foot pain

Hollow formed fot (pes cavus) appears at high arches so consists of load. The condition is often congenital and does not cause any symptoms. Others notice strain-related pain under the forefoot. In some cases, hollow foot is associated with neurological disease in the form of hereditary motor and sensory neuropathy type 1 (Charcot-Marie-Tooth disease) and Friedreich's attack.

Hæspore

Heel spurs is a calcification at the attachment of the Achilles tendon. It is located lower down towards the sole of the foot compared to Haglund's heel. Ultrasound and X-ray examinations can show calcifications both at Haglund's heel (see above) and heel spurs.

Heel spurs with development from normal X-ray (A) to calcification under the heel (B) and also in the Achilles tendon behind the heel (C) (Menz HB, Zammit GV, Landorf KB, Munteanu SE - Journal of foot and ankle research, 2008. CC BY 2.0)

Ingrown nails

Ingrown nail causes inflammation and pain along the toenails.

Köhlers

Köhler disease due to reduced blood circulation and tissue death in the midfoot (os navigate) form of osteonecrosis with pain and swelling. Boys are most often attacked at 6-9 years of age. The triggering cause is unclear. X-ray or MRI examination of the foot reveals the skeletal changes.

Corns in the foot

Corns recognized as a restricted area with thickened, painful skin 20% among adults. The condition may be similar to foot warts (see above), but grows to a greater extent inwards.

Morton's nerve pain

Morton's metatarsalgia is due to painful thickening of the nerve, most often between toe 2 and toe 3. After pressure from shoes, you can feel pain and numbness in the forefoot with radiation to the toes.

Osteoporosis and fracture of the foot

Osteoporosis (osteoporosis) can cause pain due to fractures even with minor injuries. Prolonged cortisone treatment (prednisolone) is available and women in old age are also at risk.

Osteonecrosis of the foot

Osteonecrosis due to failure of blood circulation so that bone tissue is damaged. Boys aged 3-10 can be attacked by Köhler I where the navicular in the metatarsal becomes painful and injured. In Köhler II (identical to Freiberg's disease, see above) The triggering cause is often unknown. Køhler's disease I is the bone os navicular which is affected, while in Køhler II it is the second, third or fourth metatarsal head within the towers that is attacked.

Inflammation under the foot

Plantar fasciitis is among the most common running injuries. Symptoms are pain under the feet and heel, especially with pressure and strain (walking). Typically, the first steps after being at rest trigger the pain.

Illustration. Plantar faciit causes foot pain. Wikipedia. Public domain

Infection of the foot is rare, but often causes a general feeling of illness with night sweats, fever, pain and on examination feels increased heat and the foot is red and swollen. Prior injury with foreign bodies can be the triggering cause.

Cerebrovascular disease

Plantar Fibromatosis (Ledderhose Disease) is a rare, non-painful thickening under the foot, along the plantar fascia. The condition corresponds Dupuytren's contracture in hands and Garrods pads over knuckles on fingers.

Flat feet and foot pain

Flat feet is indicated by the arch of the foot becoming flat when the foot is loaded. Some are generally hypermobile. The condition can cause foot pain with prolonged exertion.

Polyneuropathy in the feet

Polyneuropathy causes decreased sensation or pain, usually in both feet. The symptoms can spread upwards towards the legs and some also get it in the hands.

Tendonitis in the foot

Tendinitis in the foot may be due to tibialis posterior inflammation. Symptoms include foot pain inside the ankle and below the heel (reference: Julie Kohls-Gatzoulis, 2004)

Sever's disease of the heel

Severe's disease is a common cause of heel pain in younger athletes. The cause is repeated overloads and small injuries (microtrauma) with pulls from the Achilles tendon. Severe disease is only seen in younger people before the bone tissue is fully mature (Ogden JA, 2004).

Illustration: Stress fracture (fracture) towards toe 2. (metatarsal). Personal, Wikipedia. CC BY SA 3.0

Accident

Accident may cause breakage by osteoporosis or stress fracture breakdown after prolonged overload for ex marathons.

Spondyloarthritis

Spondyloarthropathies can cause chronic stiffness, pain and rheumatic inflammation in tendon attachments, under the feet, in the back and large joints are mentioned under «arthritis» above. Most people get the symptoms from adolescence and early adulthood. Ankylosing spondylitis/ ankylosing spondylitis, Psoriatic arthritis, reactive arthritis, rheumatic manifestation in Crohn's disease or ulcerative colitis.

Stress fracture; Please see Fracture above.

Tarsal tunnel syndrome

Tarsal tunnel syndrome is nerve entrapment with stabbing and radiating pain with numbness in the ankle and foot pain. The location is mostly on the inside (media) below en of the feet (usually one-sided) and out into the big toe is typical. The causes can be several, such as calcification, injury, inflammation or overload / exercise.

Posterior tibialis

Tibial posterior dysfunction (see also tendonitis above) causes foot pain on the inside of the foot (medial) and tendency to flat foot (sunken foot arch). Women from the age of 40 are most at risk.


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