Foot Pain: When to See a Specialist for Relief

Toe pain and forefoot pain?

Hello, Doctor.
I have been experiencing pain, tightness, soreness, numbness, and weakness in my foot for the past two years.
I have undergone 12 sessions of shockwave therapy, each with 10,000 pulses, but the symptoms remain the same, although there has been a 60% improvement due to the therapy.
Today, on August 26, 2022, I visited the orthopedic department at Kaohsiung Chang Gung Memorial Hospital.
An X-ray showed that my foot bones are normal, but I have a slight case of high arches.
Should I continue to see a doctor? Which specialty should I consult? If it's a neurological issue, should I see an internist or a surgeon? What kind of treatments might be offered? Alternatively, should I consider trying acupuncture? If there is nerve damage, is there still hope for recovery? Can I return to my previous condition?

Yang Meimei, 40~49 year old female. Ask Date: 2022/08/26

Dr. Jiang Junyi reply Neurology

Dear Ms.
Yang,
You mentioned experiencing "foot pain, tightness, soreness, numbness, and weakness for the past two years, despite having undergone 12 sessions of shockwave therapy, each with 10,000 pulses, and still feeling the same after two years." I recommend that you visit a rehabilitation medicine clinic for an evaluation and follow-up to identify potential musculoskeletal causes.
It may also be beneficial to improve your lifestyle habits, such as your walking posture, among others.
Peripheral nerve injuries typically have the potential to heal.
For nerve repair, I suggest considering supplementation with B vitamins.
Thank you for your inquiry, and feel free to discuss any related questions further!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Hospital

Reply Date: 2022/08/26

More Info

When dealing with persistent foot pain, especially after two years of experiencing symptoms such as tightness, soreness, numbness, and weakness, it is crucial to take a comprehensive approach to diagnosis and treatment. Given that you have already undergone shockwave therapy with some improvement, it indicates that you are on the right track, but further evaluation is necessary to address the remaining issues.

Understanding Your Symptoms
Your symptoms suggest a possible combination of musculoskeletal and neurological issues. The tightness and soreness could be related to conditions such as plantar fasciitis, tendonitis, or even issues stemming from your high arch (cavus foot). The numbness and weakness, on the other hand, may indicate nerve involvement, such as tarsal tunnel syndrome or peripheral neuropathy.

When to See a Specialist
If your symptoms persist despite treatment, it is advisable to consult a specialist. In your case, you may consider seeing a podiatrist or an orthopedic surgeon who specializes in foot and ankle disorders. They can provide a thorough evaluation, including a physical examination and possibly additional imaging studies (like an MRI) to assess soft tissue structures and nerves.

Choosing the Right Specialist
1. Podiatrist: A podiatrist specializes in foot and ankle conditions and can provide a comprehensive evaluation of your symptoms. They can offer treatments ranging from orthotics to physical therapy and, if necessary, surgical options.

2. Orthopedic Surgeon: If your condition is more complex or if there is a need for surgical intervention, an orthopedic surgeon specializing in foot and ankle surgery would be appropriate. They can address structural issues and provide surgical solutions if conservative treatments fail.

3. Neurologist: If there is a strong suspicion of nerve damage or neuropathy, consulting a neurologist may be beneficial. They can perform nerve conduction studies to assess the function of your nerves and determine if there is any nerve damage that could be contributing to your symptoms.

Treatment Options
Depending on the findings from your specialist, treatment options may include:
- Physical Therapy: A physical therapist can help you with exercises to strengthen the muscles in your foot and improve flexibility. They can also provide modalities such as ultrasound or electrical stimulation to alleviate pain.

- Orthotics: Custom orthotics can help correct biomechanical issues associated with high arches or flat feet, providing support and reducing pain.

- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. If nerve pain is a significant issue, medications such as gabapentin or pregabalin may be prescribed.

- Injections: Corticosteroid injections can provide relief for inflammation in specific areas of the foot.

- Acupuncture: If you are open to alternative therapies, acupuncture may help alleviate pain and improve function.

Prognosis and Recovery
Regarding your concern about nerve damage, the prognosis largely depends on the extent of the injury and how long it has been present. Nerves can regenerate, but the process can be slow, and full recovery is not always guaranteed. Early intervention is key, so seeking the right specialist promptly can significantly impact your recovery.

Conclusion
In summary, given your ongoing symptoms, it is advisable to see a podiatrist or orthopedic surgeon for a comprehensive evaluation. If nerve involvement is suspected, a neurologist may also be necessary. With the right diagnosis and treatment plan, there is potential for significant improvement in your condition. Don't hesitate to explore various treatment options, including physical therapy, orthotics, and possibly acupuncture, to find what works best for you.

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