In this issue of HEALTHbeat:
  • 9 ways to fix foot pain
  • Foot massage


Harvard Health Publications -- Harvard Medical School HEALTHbeat
July 28, 2009

9 ways to fix foot pain

Pain is a symptom common to many foot conditions, and pain medications are a good solution for most types of foot pain. You also can try other approaches, either before resorting to pain relievers or in conjunction with them. For example, you can try an ice pack or a warm foot soak before reaching for the pain pills. In general, if your skin feels warm to the touch (indicating that your foot is inflamed and possibly swollen), apply ice. Don’t apply warmth to an inflamed area because it will only increase the blood flow and make the inflammation worse.

If your feet are tired and sore and your skin feels normal or cool to the touch, try soaking your feet in a warm bath to relax and soothe them. Pharmacies sell gel packs that you can either freeze or heat in the microwave, then apply to your feet. You can also try massage (see “Foot massage,” below). Gently rubbing sore muscles and joints can often provide needed relief. But don’t massage a foot that is inflamed or that you think might be injured.

When it comes to pharmaceutical treatment, there are a number of different options. Some medications are topical — that is, you apply them to the skin. Others are systemic; these are usually taken in pill form. A summary of the major categories of pain relief medications follows.

  1. Analgesics. This class of medications encompasses pain relievers, such as acetaminophen (Tylenol), which relieve pain without relieving inflammation. Be aware that doctors caution people who drink regularly against using acetaminophen because alcohol can combine with this drug to cause liver damage.
  2. Topical analgesics. Topical pain medications are available in lotion, cream, or gel form. They are spread on the skin and penetrate inward to relieve some forms of mild foot pain. Some topical preparations — such as those containing menthol, eucalyptus oil, or turpentine oil — reduce pain by distracting the nerves with a different type of sensation. Another group delivers salicylates (the same ingredient as in aspirin) through the skin. A third group counters a chemical known as substance P, which is a neurotransmitter that appears to transmit pain signals to the brain. These creams contain a derivative of a natural ingredient found in cayenne pepper. For that reason, they may burn or sting when first used.
  3. Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are available both with and without a prescription. Popular over-the-counter NSAIDs include aspirin (Bayer, Bufferin, others), ibuprofen (Advil, Motrin, others), and naproxen (Aleve). If you are taking an NSAID solely to relieve pain, expect to take a low dosage for a limited amount of time — usually until the pain is gone. If you have a condition that involves inflammation as well as pain, such as Achilles’ tendinitis or a sprain, your doctor may advise you to take an NSAID at a higher dose and for a longer period, sometimes as much as several weeks. Why the difference? You can feel the pain-relieving effects of NSAIDs almost immediately, but you do not experience the full anti-inflammatory effects until a sufficient amount of the medication builds up in your bloodstream. Be aware that NSAID medications have a variety of side effects, so it is important to discuss your personal health risks with your doctor when considering their regular use.

    If these over-the-counter options don’t solve your foot pain problems, your doctor can prescribe a variety of prescription medication and treatment options, as described below.
  4. COX-2 inhibitor. A type of prescription NSAID known as a COX-2 inhibitor — such as celecoxib (Celebrex) — relieves pain and inflammation and may reduce the risk for gastric ulcers and bleeding, which sometimes make older NSAIDs difficult to tolerate. COX-2 inhibitors have their own side effects, though, so it is important to discuss your personal health risks with your doctor when considering the long-term use of these medications.
  5. Opioid analgesics. Prescription drugs that contain opioids such as codeine are useful for pain that can’t be relieved by analgesics or NSAIDs. They provide stronger pain relief because they block certain chemical pathways that send pain signals through the central nervous system. Many of these medications also cause drowsiness.
  6. Nerve pain medications. Pain caused by nerve damage may not respond well to opioids, so doctors rely on other medications. Two mainstays in treating nerve pain in the feet include the antidepressant amitriptyline (Elavil), which increases the levels of brain chemicals that ratchet down pain signals, and the anticonvulsant gabapentin (Neurontin), which apparently works by interfering with nerve signaling involved in pain as well as seizures. In December 2004, the FDA approved a medication for nerve pain relief, pregabalin (Lyrica), which also doubles as an antiseizure medication.
  7. Nerve blocks. A nerve block is an injection that numbs a particular nerve to prevent pain signals from reaching your brain (much as lidocaine does in a dentist’s office). It’s effective for severe pain or for use during a surgical procedure.
  8. Corticosteroids. These medications are synthetic forms of naturally occurring hormones produced by the adrenal glands. Corticosteroids may be given in the form of pills or injections to decrease inflammation and thus relieve pain. Topical corticosteroids, applied directly to the skin, are useful only in treating rashes, not for pain due to musculoskeletal injuries.
  9. Ultrasound. This is not a medication, but rather a treatment in which high-frequency sound waves are directed at an inflamed area to speed healing and reduce inflammation. It works best on soft tissue injuries.

Foot massage

When you think of massage, you may think of a neck or back rub. But your feet also benefit from a regular rubdown. And you may even be able to do it yourself. Massage improves circulation, stimulates muscles, reduces tension, and often alleviates pain. It also provides a time for you to examine your feet, giving you the chance to notice a problem before it gets worse. To do a massage:

  • Sit in a comfortable chair. Bend your left leg and rest your left foot gently on your right thigh.
  • Pour some skin lotion or oil into your hand. Rub it gently into your foot and massage your whole foot — toes, arch, and heel.
  • Do a deeper massage. Press the knuckles of your right hand into your left foot. Knead your foot as you would bread. Or work the skin and muscles by holding a foot with both hands and pressing your thumbs into the skin.
  • Using your hands, pull the toes back and forth or apart. This gently stretches the muscles underneath.
  • Repeat on the other foot.

To enhance your massage, you can buy massage devices in local drugstores or health stores. Look for foot rollers; these can provide fast foot massages at home or at work — take off your shoes and roll your feet over the massagers for a quick pick-me-up.

FEATURED CONTENT:
  • The fantastic foot
  • Keeping your feet healthy
  • Heels that hurt
  • Arches that ache
  • Tormented toes
  • Skin and toenail problems
  • Foot surgery
  • Treating foot pain

Reprinted from Foot Care Basics — A Special Health Report from Harvard Medical School, Copyright © 2009 by Harvard University. All rights reserved.

** Get your copy of Foot Care Basics: Preventing and treating common foot conditions

Foot Care Basics: Preventing and treating common foot conditions provides information about your feet and how they function. This report describes the major causes of aching feet and what you can do about them. It will also help you recognize and treat common skin and nail ailments and discusses circumstances that require special care, including diabetes, vascular problems, and nerve disorders.

Click here to read more or buy online.