Rheumatism - pain in the foot

Hong Kong Hiking Web: 戶外大夫專欄 Outdoor Doctor Forum: Rheumatism - pain in the foot
   By Outdoor Doctor (Doctor) on Monday, August 10, 2009 - 10:53 pm:  Edit Posted From: 116.48.68.36

Flexible flat feet that are painless do not require treatment. If you have pain due to flexible flat feet, an orthotic (arch supporting insert in the shoe) can bring relief. Many shoe stores stock shoes for flat feet. The shoes designed for flat feet make long distance walking easier and less tiring because they correct for the abnormality.

Rigid or painful flat feet require evaluation by an orthopedic doctor / podiatrist.

   By Eve on Saturday, August 08, 2009 - 2:59 pm:  Edit Posted From: 116.49.137.210

Dear Doctor,
I think i have flat feet. I can't walk for long without the arch of my foot hurting. However, I also wear flats and flip flops a lot when in town. Is this bad for flat feet? What sort of shoes should I stick to and avoid? Should I contact a doctor for shoepads? If so, who should I contact in Hong Kong?
Thanks

   By Nobody on Wednesday, August 28, 2002 - 5:25 pm:  Edit

Dear Doctor,

Lately I've persisting pain in the top of my feet, mostly the right foot. The pain may extend to the brim and part of the sole. A doctor told me it was likely to be reheumatism. The pain comes without warning and sometimes it is so severe that movement is difficult. That being the case, please advise what precaution I should take and what medicine I should have with me before embarking on a hiking trip.Thanks.

   By Nobody on Thursday, August 29, 2002 - 10:23 am:  Edit

Dear Doctor,

Further to my query of yesterday, I wish to add that the pain is in the bones and that the pain, previously persisting, seems all gone after I went swimming last night. But I'm worried it may recur any time.

   By Outdoor Doctor on Friday, August 30, 2002 - 12:13 am:  Edit

Rheumatism is a very vague term. It does not tell you anything about the
cause of your problem.

Based on your description, it sounds like a "neurogenic" type of pain.
(Neurogenic means something related to the nerve). But, even for this
suspicion, there could be many causes.

Sometimes, a disease near the lower spine can cause pain like that. It is
called "sciatica". The nerve is compressed by some sort of abnormality
around the spine (specifically, it is the compression of the nerve root near
the exit opening). This problem can produce a sharp & severe pain on the
foot (at a defined region).

To narrow the possibilities, further information is needed. What is your
age? Any medical history of gout? Any abnormal appearance of the foot when
you are in pain? What about your left foot (pain at the same area or not)?
Did you have any X ray of the foot (showing any abnormality)?

   By Outdoor Doctor on Friday, August 30, 2002 - 12:13 am:  Edit

Your condition is a bit special.
You mentioned that the pain came suddenly and caused severe pain. And now
you also mentioned that the pain had been persistent but swimming last night
completely relieved the pain.
Problems with the muscle/joint/tendon (locally in your feet) or "sciatica"
can all present like that.
Do you feel the pain deep inside (so that you described it is IN the bones)?
What is the character of the pain (burning/needle pricking/ dull/ knife
cut/sharp)?
How long have you got the problem?
Do you think that it is related to your footwear/ frequent walking or
hiking?

   By Nobody on Saturday, August 31, 2002 - 10:57 am:  Edit

Dear Doctor,

Thank you for replying. I provide additional information as follows:

1. I am 40.
2. Blood test has ruled out gout.
3. When in pain, the foot seems red, hot and swollen but not too much. Pain is particular acute when I attempt to turn the foot to the left or the right.
4. The left foot did experience pain before at about the same spot but only very rarely.
5. I have had no x-ray of the foot.
6. The pain occurs under the skin. When I touched the affected area I felt the pain is in the bones but I may be wrong.
7. I'll try to describe the pain the best I can. It is somewhat buring and sharp. The affeced foot is hotter than the normal foot. The heat is local; unaffected area on the painful foot is not hot. The affected area is stiff.
8. I can recall having pain before but it was not until April 2002 that the pain seems to come every now and then.
9. I do not think footwear or hiking is to blame.

Doctor, since you mention sciatica, I wish to add that sometimes my low back does seem powerless with pain after I bend myself prolongedly or repeatedly. I then have to be very careful when bending and returning to straight position. Recovery takes between a few hours and a few days. The low back is otherwise normal.

Sorry to bother you with all this. I'll be grateful for your advice. Thanks.

   By Outdoor Doctor (Doctor) on Sunday, September 01, 2002 - 4:31 am:  Edit

First, a normal blood test actually cannot rule out gout. (many people misunderstood this). A gouty attack can make a joint of the foot swollen, red, hot and painful suddenly.

Based on your further information, your problem is a localized inflammation (Not sciatica). It is unlikely due to bone (bone seldom inflammed, unless being infected). At this stage, I think there are 3 possibilities left: 1) problem of the small joint inside your foot, 2) tenosynovitis (inflammation of the tendon and its sheath), 3) gout.

Is your pain very localized (i.e. less than 1cm in diameter)? Do you feel more pain when you compress the painful site? Are you totally well (for many days) if you are not in pain? If an attack comes, how long does it last (minutes/hours/days)?

   By Nobody on Monday, September 02, 2002 - 9:46 am:  Edit

Dear Doctor,

Thank you again for replying. Your questions are answered below.

1. The pain is usually felt in about two-thirds of the foot.
2. A touch does add to the pain.
3. Before the swimming miracle, the pain was persistent but somewhat latent when there was no attack, i.e. when the foot is not a bit hot, red and swollen. I was never totally well (I had pain upon a touch) before the miracle. A period of no attack can be as long as a month or two.
4. Attacks usually last for hours. The pain subsides very consideraly overnight.

Doctor, what about my low back? Is there another problem?

   By Outdoor Doctor (Doctor) on Wednesday, September 04, 2002 - 6:21 am:  Edit

What I can say is that: your foot problem is unlikely to be due to muscle,tendon or bone problem. I suggest you to see a doctor immediately when you have another attack of red, hot and painful foot in the future. An examination of your foot is important to make a diagnosis. Gout is still a possibility!

Don't worry too much on your back. Many people have backache because of their prolonged standing/ improper sitting/ any other kind of improper posture that strain the back muscle. Try to switch your posture to another one from time to time, so that you can relax the muscle.

   By Nobody on Wednesday, September 04, 2002 - 9:34 am:  Edit

Dear Doctor,

Thank you for the advice.

Does that mean I can put the problem aside as long as there is no further attack? Besides, is there any fast-acting cream/ointment that can help me in case I have a sudden attach when being out in the wild?

   By Outdoor Doctor on Wednesday, September 04, 2002 - 10:43 pm:  Edit

If you are very concerned about the cause of the foot problem, you should
see a doctor. Proper examination and further investigation (e.g. X ray,
blood test to rule out other rheumatological disease) are essential. What I
meant is: If you see a doctor during an active phase (i.e. red, hot, swollen
foot), it would be easier for a doctor to make a diagnosis.
I don't think ointment/ cream really help in an attack. Paracetamol may be
too weak to stop your pain (inflammatory in nature). If you have no peptic
ulcer and no history of drug allergy to painkiller, you can try aspirin or
ibuprofen (should be available in pharmacy store) to decrease the
inflammation. Eat some food before taking either of them.

   By Nobody on Thursday, September 05, 2002 - 9:27 am:  Edit

Thank you, Doctor.

   By Ho (61.92.23.144) on Friday, October 14, 2005 - 1:16 am:  Edit

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