Current and future advances in practice: mechanical foot pain

Mechanical foot pain affects similar to 20% of the UK population >50 years of age, with similar to 10% reporting disabling pain that impacts daily activities. For most people, foot pain improves over time, but for some this can become chronic and disabling, affecting physical activity, participation, mental health and work capacity. Mechanical foot pain can present as localized pain, but more often the pain presents in multiple structures. Traditional treatments for mechanical foot pain are largely based on self-management that includes pain control, reassurance of healing trajectory, and activity or footwear modifications. Randomized controlled trials support the short-term use of exercise and foot orthoses for some foot conditions; however, accessibility can be limited by regional variations in procurement compounded by a lack of long-term trials. The roles of weight loss and strengthening of the foot and leg muscles offer new avenues to explore. Lay summary What does this mean for patients? One in five middle-to older-aged adults report foot pain that occurs during weight-bearing movements, such as walking and standing. Foot pain can present with weakness, symptoms of stiffness and changes in movement, all of which can limit daily activities and occupational duties. Owing to the complexity of the foot anatomy and loads placed on the foot, there are many musculoskeletal foot disorders to consider. In this review, we have presented the common causes of foot pain and separated these into the forefoot, midfoot and hindfoot regions for quick reference. Regarding treatments, changing the demands and loads placed upon the foot is a key strategy. This can be achieved by using appropriate footwear, limiting or changing activities that cause excessive loading, weight loss and wearing insoles inside shoes called orthoses. Maintaining muscle strength is also important, because weakness of the foot and lower leg muscles is found in many cases of foot pain. At present, we do not know how effective other treatments for foot pain are, such as pain medications and injections, hence more research is needed.