Background: Body awareness is an expression of the extent of sensitivity and attentiveness to internal bodily signals and sensations. The foot has a critical function in providing interoceptive and exteroceptive information. The purposes of this study were to 1) compare body awareness in individuals with and without hallux valgus (HV) deformity, and 2) investigate the relationship between body awareness and HV-related parameters.
Methods: A total of 129 participants completed the assessments. The severity of the HV was evaluated using the Manchester Scale; pain severity was evaluated using the numeric pain rating scale; and the functional status was evaluated using the Manchester-Oxford Foot Questionnaire. The patients were divided into 2 groups according to the Manchester Scale scores as the presence or absence of HV. The body awareness of the individuals with HV was assessed using the Body Awareness Questionnaire.
Results: Included in this study were 69 participants with HV and 60 healthy participants. There was no difference between groups in terms of demographic properties. Two groups were found different only in pain severity (P < 0.01). The correlation analysis showed that there was a low correlation between the body awareness score and pain severity in both feet (right foot r: 0.306, P = 0.011; left foot r: 0.320, P = 0.007) in individuals with HV.
Conclusions: Participants with HV had higher pain severity and the pain severity was associated with the body awareness. The level of body awareness should be assessed and taken into consideration in the management of pain in patients with HV.
Clinical observations note that foot pain can be linked to contralateral pain at the knee or hip, yet we are unaware of any community-based studies that have investigated the sidedness of pain. Because clinic-based patient samples are often different from the general population, the purpose of this study was to determine whether knee or hip pain is more prevalent with contralateral foot pain than with ipsilateral foot pain in a population-based cohort.
Framingham Foot Study participants (2002–2008) with information on foot, knee, and hip pain were included in this cross-sectional analysis. Foot pain was queried as pain, aching, or stiffness on most days. Using a manikin diagram, participants indicated whether they had experienced pain, aching, or stiffness at the hip or knee and specified the side of any reported pain. Sex-specific multinomial logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals for the association of foot pain with knee and hip pain, adjusting for age and body mass index.
In the 2,181 participants, the mean ± SD age was 64 ± 9 years; 56% were women, and the mean body mass index was 28.6. For men and women, bilateral foot pain was associated with increased odds of knee pain on any side (ORs = 2–3; P < .02). Men with foot pain were more likely to have ipsilateral hip pain (ORs = 2–4; P<.03), whereas women with bilateral foot pain were more likely to have hip pain on any side (OR = 2–3; P < .02).
Bilateral foot pain was associated with increased odds of knee and hip pain in men and women. For ipsilateral foot and hip pain, men had a stronger effect compared with women.
A woman's body undergoes many changes during pregnancy, and it adapts by developing compensatory strategies, which can be sources of pain. We sought to analyze the effects of pregnancy and pelvic girdle pain (PGP) on center of pressure (COP) parameters during gait at different speeds.
Sixty-one healthy pregnant women, 66 women with PGP between 18 and 27 weeks of pregnancy, and 22 healthy nonpregnant women walked at different velocities (slow, preferential, and fast) on a walkway with built-in pressure sensors. An analysis of variance was performed to determine the effects of gait speed and group on COP parameters.
In healthy pregnant women and women with PGP, COP parameters were significantly modified compared with those in nonpregnant women (P < .01). Support time was increased regardless of gait speed, and anteroposterior COP displacement was significantly decreased for women with PGP compared with healthy pregnant women. In addition, mediolateral COP displacement was significantly decreased in pregnant women compared with nongravid women.
Gait speed influenced COP displacement and velocity parameters, and gait velocity potentiated the effect of pregnancy on the different parameters. Pelvic girdle pain had an influence on COP anteroposterior length only. With COP parameters being only slightly modified by PGP, the gait of pregnant women with PGP was similar to that of healthy pregnant women but differed from that of nonpregnant women.
The topic of pain management remains a minor component of the formal education and training of residents and physicians in the United States. Misguided attitudes concerning acute and chronic pain management, in addition to reservations about the legal aspects of pain management, often translate into a “fear of the unknown” when it comes to narcotic prescription. The intentionally limited scope of this review is to promote an understanding of the laws regulating pain management practices in the United States and to provide recommendations for appropriate pain management assessment and documentation based on the Model Policy for the Use of Controlled Substances for the Treatment of Pain established by the Federation of State Medical Boards of the United States. (J Am Podiatr Med Assoc 100(6): 511–517, 2010)
This article defines the three major forms of postamputation sensation: 1) phantom sensation, 2) phantom pain, and 3) residual-limb pain. Proposed etiologies for phantom pain are discussed. The literature on current diagnoses and treatments for each of the three postamputation sensations is reviewed. (J Am Podiatr Med Assoc 91(1): 23-33, 2001)
Background: Heel pain, bunion pain, and other forms of foot pain syndromes are one of the more common reasons a patient visits a podiatrist. Numerous methods are currently available to attempt to achieve pain relief, including pharmaceuticals, magnets, heat, and electrical stimulation. A textile company developed Pain Checker socks (Pain Checker Health Wear, Cresskill, New Jersey), which contains a material that may counter the circuit of pain and oppose the effect, thereby stopping the conduction of pain.
Methods: The purpose of this placebo-controlled, double-blind clinical trial was to evaluate the safety and efficacy of Pain Checker socks in the treatment of mild-to-moderate foot pain. Fifty patients were enrolled, half on active and half on placebo socks. The subjects were evaluated at baseline, 2, 4, and 6 weeks of treatment.
Results: There was no statistically significant difference in disability, pain, or activity scales between treatment groups, although only 5% of the treatment group received no pain relief on visual analog scale during the trial, while 38% of the placebo group received no pain relief.
Conclusion: Although there was no difference in pain relief, the Pain Checker socks were found to be safe and scored high in patient satisfaction. The unique fiber content and construction of the socks may have contributed to the placebo analgesia. (J Am Podiatr Med Assoc 98(4): 278–282, 2008)
The aim of this study was to evaluate the relative contribution of structural foot characteristics and comorbidities to the presence of disabling foot pain in older people. One hundred seventy-two people (55 men and 117 women) aged 62 to 96 years (mean ± SD, 80.1 ± 6.4 years) who lived in a retirement village underwent tests of foot posture, range of motion, and deformity in addition to completing a medical history questionnaire. Disabling foot pain was determined using the Manchester Foot Pain and Disability Index. Thirty-eight subjects (22%) reported disabling foot pain. Subjects with disabling foot pain had a higher body mass index and were more likely to be female; to report osteoarthritis in the spine, hips, hands or wrists, and feet; and to report pain in the back, hips, and hands or wrists. The only significant difference between the groups regarding structural foot characteristics was that those with disabling foot pain exhibited more severe hallux valgus deformity. The strongest determinants of disabling foot pain revealed by a discriminant function analysis were foot osteoarthritis, pain in the hips, and pain in the hands or wrists. These findings indicate that disabling foot pain in older people is more closely related to pain and osteoarthritis in other body regions than to structural characteristics of the foot, and they suggest that more severe forms of foot pain in older people may be a component of a general chronic pain syndrome or a polyarticular form of osteoarthritis. (J Am Podiatr Med Assoc 95(6): 573–579, 2005)
Background: Foot orthoses have been described as a possible intervention for individuals with patellofemoral joint pain. No study has attempted to quantify the perceived comfort and support of foot orthoses when used as an intervention for patellofemoral joint pain.
Methods: A randomized case-control trial with crossover between contoured and flat orthoses was conducted on ten individuals with patellofemoral pain and ten healthy participants. All of the participants completed a comfort-support assessment and had in-shoe plantar pressure data collected before and after 3 weeks of wear. A 1-week washout period was used to minimize any continued treatment effect between orthotics testing. The patellofemoral pain group also completed a numeric rating scale to assess pain reduction after using each orthosis.
Results: All of the participants perceived that greater support was provided by the contoured orthoses in the heel and arch regions. Even with a 30% difference in material hardness between the two orthoses, all of the participants rated cushioning as equivalent. Six individuals in the patellofemoral pain group reported a clinically significant reduction in knee pain as a result of wearing foot orthoses.
Conclusions: A key factor in the selection of contoured foot orthoses versus flat inserts is the amount of support that an individual perceives in the arch and heel regions. In addition, clinicians using foot orthoses as an intervention for patellofemoral pain should expect an individualistic, nonsystematic response. (J Am Podiatr Med Assoc 101(1): 7–16, 2011)
A 66-year-old man was admitted to a hospital rehabilitation unit for the management of chronic groin pain. Since the groin pain began, he had been unable to bear weight on his right foot. During a podiatric examination, the patient reported sharp pain at the apex of his right hallux. A full podiatric assessment was undertaken to evaluate his vascular, neurologic, and biomechanical status. The patient’s ankle-brachial index was found to be 0.34 in the right lower limb and 0.68 in the left lower limb. After vascular assessment, the patient was diagnosed as having chronic ischemia of the right leg. He underwent left-to-right femoral-to-femoral bypass graft surgery to salvage the right lower leg and foot. (J Am Podiatr Med Assoc 97(5): 402–404, 2007)
Foot pain, if not effectively managed, can result in significant disability and loss of function in older patients. This article reviews treatment strategies for acute and persistent pain, emphasizing new pharmacologic approaches. Indications, guidelines, and precautions for acute-pain treatment with acetaminophen, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, and opioids are discussed. Strategies for management of persistent pain using opioids, tricyclic antidepressants, gabapentin, and topical medications are reviewed. Common pain-management and prescribing errors are highlighted. (J Am Podiatr Med Assoc 94(2): 98-103, 2004)