and Managing Severe Foot Pain in the Elderly

Q: and Managing Severe Foot Pain in the Elderly

Hello, Sisi： According to the information provided, it seems that you are currently experiencing pain near the left foot's dorsum close to the ankle. <br>An orthopedic examination with X-rays indicated that the bones appear normal, but there is some degeneration. <br>Additionally

Grandfather's foot pain issue?

Hello doctor, I would like to ask about my grandfather who has been experiencing severe foot pain recently.
Initially, he mentioned that his foot had been hurting for a month, and he thought he could just endure it.
Eventually, he couldn't take it anymore and told the family.
I first took him to see a traditional Chinese medicine practitioner for acupuncture for about half a month.
At that time, he said both feet hurt; the left foot had noticeable swelling and some warmth, while the right foot hurt at the sole.
The doctor diagnosed the left foot with edema and the right foot with plantar fasciitis.
At the beginning of the treatment, my grandfather said he felt a bit better and the pain in his right foot subsided, but after a few days, he started crying again, saying his left foot hurt.
As a result, we also tried massage and applied traditional Chinese medicine ointment for trauma, which seemed to help a bit.
However, we felt this was not a long-term solution, and the Chinese medicine doctor also suggested we go to a hospital for further examination.
So yesterday, I took my grandfather to the hospital to see an orthopedic specialist for an X-ray.
I informed the doctor about his condition, mentioning that the area near the ankle on his left foot was painful, and that he had been in so much pain he couldn't walk.
The doctor said the bones looked fine, just some degeneration, and suggested I consider a referral to a rehabilitation specialist or continue with acupuncture.
He prescribed pain medication and sent us home, but that night my grandfather was in so much pain he couldn't sleep and was crying.
What should I do? He said it hurts to turn over as well.
Which specialist should I take him to for further examination? My grandfather has high blood pressure and is taking medication for prostate issues, has an enlarged heart, and also has respiratory problems.
He previously had surgery on his lower back after a fall, but the doctor said it shouldn't be a spinal issue.
Recently, he has also been experiencing leg tremors, and the medication hasn't improved this.
Could these symptoms be affecting his foot pain?

Si Si, 20~29 year old female. Ask Date: 2023/06/15

Dr. Liu Hongxiang reply Family Medicine

Hello, Sisi: According to the information provided, it seems that you are currently experiencing pain near the left foot's dorsum close to the ankle.
An orthopedic examination with X-rays indicated that the bones appear normal, but there is some degeneration.
Additionally, the persistent shaking of the foot may contribute to the worsening of the pain.
To address the issues of foot pain and tremors, it is recommended to return for a follow-up appointment (with either a neurologist or orthopedic specialist) to adjust medications for pain management.
Wishing you good physical and mental health.

Dr.
Liu Hongxiang

Reply Date: 2023/06/15

More Info

Understanding and managing severe foot pain in the elderly can be a complex issue, especially when multiple underlying health conditions are present. Your grandfather's situation, characterized by significant pain, swelling, and previous medical history, requires a comprehensive approach to diagnosis and treatment.

Firstly, it’s essential to recognize that foot pain in the elderly can stem from various causes, including degenerative joint diseases like osteoarthritis, inflammatory conditions such as gout or rheumatoid arthritis, peripheral neuropathy, and even vascular issues. Given your grandfather's age and medical history, including hypertension, heart issues, and previous surgeries, a multifaceted evaluation is necessary.

From your description, it seems that your grandfather has been experiencing pain for over a month, with symptoms that include swelling and heat in the left foot and pain in the right foot's plantar fascia. The initial diagnosis of plantar fasciitis (inflammation of the tissue that runs along the bottom of the foot) and edema (swelling due to fluid retention) is a good starting point. However, the persistence of pain despite various treatments suggests that further investigation is warranted.

Recommended Steps for Management:
1. Follow-Up with a Specialist: Since the orthopedic evaluation did not reveal any significant bone issues, it may be beneficial to consult a rheumatologist. They can assess for systemic inflammatory conditions that may not be evident on X-rays but could be causing joint pain and swelling.

2. Physical Therapy: If the orthopedic doctor suggested physical therapy, this could be a valuable option. A physical therapist can provide tailored exercises to strengthen the muscles around the foot and ankle, improve flexibility, and reduce pain. They can also teach your grandfather how to manage his pain through proper body mechanics and gait training.

3. Pain Management: Since your grandfather is experiencing significant pain that disrupts his sleep, it may be necessary to revisit the pain management strategy. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can be effective, but they should be used cautiously, especially considering his heart condition. Discuss with his physician about the best pain management plan, which may include prescription medications or topical treatments.

4. Investigate Vascular Issues: Given your grandfather's history of heart problems and the swelling in his left foot, it might be prudent to evaluate for potential vascular issues. A vascular surgeon can assess for conditions like peripheral artery disease (PAD) or venous insufficiency, which can contribute to pain and swelling in the extremities.

5. Consider Neuropathy: The mention of leg shaking and previous falls raises the possibility of peripheral neuropathy, which can cause pain, tingling, or weakness in the legs. A neurologist can perform nerve conduction studies to evaluate for this condition, which may be related to his diabetes or other systemic issues.

6. Lifestyle Modifications: Encourage your grandfather to maintain a healthy weight, as excess weight can exacerbate foot pain. Additionally, proper footwear is crucial; shoes should provide adequate support and cushioning to alleviate pressure on painful areas.

7. Monitor and Document Symptoms: Keep a detailed record of your grandfather's symptoms, including when they occur, their intensity, and any factors that seem to alleviate or worsen the pain. This information can be invaluable for healthcare providers in diagnosing and managing his condition.

In conclusion, managing severe foot pain in the elderly requires a thorough evaluation and a collaborative approach among various healthcare providers. Given your grandfather's complex medical history, it is crucial to address not only the foot pain but also any underlying conditions that may be contributing to his discomfort. Regular follow-ups and open communication with his healthcare team will be key in finding an effective management strategy.

Similar Q&A

Effective Treatments for Plantar Fasciitis in Older Adults: Recovery Options

How can my elderly mother be treated for her condition to recover, or will she need to take medication and undergo rehabilitation for the rest of her life?

Dr. Shi Guozheng reply Orthopedics
The causes that need to be identified include: standing for too long, excessive walking, uneven surfaces, and inappropriate footwear. Insufficient cushioning in the shoes can lead to inflammation of the plantar fascia. The first step in treatment is to eliminate the underlying ca...

Understanding Severe Hallux Valgus in Elderly Patients: Treatment Options

My father is 84 years old and has had hallux valgus (bunion) for a long time (since he was young), but recently the condition has suddenly worsened to about 45 degrees (it was previously around 30 degrees), and it is pressing against his index finger, making it difficult for him ...

Dr. Wang Shouji reply Orthopedics
Age is not the only criterion for considering surgery. However, the success rate and risks of the procedure must be taken into account to provide the most appropriate recommendations. Medications and physical therapy can alleviate symptoms to some extent. If these options do not ...

Effective Pain Relief Strategies for Elderly Arthritis Patients

In recent months, my grandmother has frequently complained of knee pain. After going to the hospital, she was diagnosed with arthritis. She has previously experienced joint effusion and had it drained. Recently, she fell and got injured, and the pain has become unbearable. How ca...

Dr. Liang Yinpan reply Geriatrics
Dear Ms. Cheng, You should take your grandmother to an orthopedic specialist for a detailed examination to determine if there are any fractures or ligament injuries, so that appropriate treatment can be administered to alleviate her pain. Wishing your grandmother a speedy recov...

Rehabilitation Options for Seniors with Severe Diabetes Complications

Hello Doctor: My father has had diabetes for over ten years, and now it has progressed to the point where he has almost no sensation in his feet. He often bumps into things and gets injured. The doctor mentioned that he might need an amputation. He is a 70-year-old man and is ver...

Dr. Chen Xianchang reply Rehabilitation
Hello: Thank you for your inquiry. I would like to address your questions and provide the following suggestions: 1. Dietary and medication management for diabetes is very important. 2. If there is an injury to the foot, immediate wound care is necessary. 3. When selecting shoes, ...