In your FEET, the most common problem is osteoarthritis. There are 26 bones in your foot, and they are all linked together by a system of ligaments which keep them tracking straight. With age, or with overuse, these ligaments get loose and they no longer track straight. This causes wear and tear of the cartilage between the bones of your foot. You can look up the cause and the treatment of this in the osteoarthritis section.

At times you will feel pain on the outside of your foot over the bump of the base of the fifth metatarsal. This is usually due to tendonitis of your peroneus muscle. This muscle which starts in the fibula and travels behind the lateral malleolus pulls your foot down and out. One of the best ways to treat this problem is to move your foot down and out with orthotics, which provide a lift for your heel on the side of your foot. Dr. Bertrand can fit you with a guaranteed pair of orthotics.

Many doctors recommend the use of anti-inflammatory medications (see Nonsteroidal anti-inflammatory references) and, if the problem is severe, steroid injections (see Steroid References). All of these can interfere with the healing of this tendon. To help rebuild the attachment of this tendon on the head of the fifth metatarsal, you can use prolotherapy which has shown its ability to strengthen the attachment of tendons on bones. (See Prolotherapy References)

Conditions that affect the front of the foot

If you have pain at the level of the joints between your metatarsal bones and your phalanges, and numbness between your toes, you may be suffering from a Morton’s neuroma. The nerve that travels to the sides of your toes has to pass between these joints and if it is squeezed between them, the squeezing action will give you pain and numbness and it will react by developing a protective sheath around itself. If you put too much strain on the front of your foot, such as if you are wearing high heels, or shoes that squeeze your foot, you’re more likely to develop this problem. Make sure your shoes don’t have high heels and have a large toebox. The way to treat Morton’s neuroma is to separate the metatarsophalangeal joints to allow the nerve to travel freely. To do this, use an orthotic with a lift between the joints to separate them and an arch support to prevent the pronation which is often a cause of this problem. Dr. Bertrand can supply you with a guaranteed orthotic. Cortisone injections have been used to reduce the inflammation of the nerve. Unfortunately, they do not get to the root of the problem and, as their effect wears off the symptoms will recur. If other treatments are ineffective, you may need surgery which may destroy the nerve and cause numbness between your toes.
If you have pain at the top of your foot where your metatarsal bones are, which is worse when you are weight-bearing, you may have a metatarsal stress fracture. This is a crack in your metatarsal bone caused by over stressing it, such as after prolonged walking or running. It usually affects the three middle metatarsal bones. If you keep stressing the bone, the crack can become a complete fracture, and if that occurs you won’t be able to put weight on your foot. You’re more likely to develop stress fracture if you bones are fragile, such as if you are suffering from osteoporosis which may be due to inadequate vitamin D intake, thyroid problems, menopause, or taking steroids such as prednisone. It is important to keep your bones solid with vitamin D, a good diet, and possibly hormone replacement. Consult your doctor for these and other medical conditions which can affect your bones. To treat this problem, you should rest your foot and avoid weight-bearing. You may need to use a cast if you have a complete fracture. Wearing proper orthotics to avoid stressing the metatarsals can help heal stress fractures as well as prevent them. Dr. Bertrand can supply you with the appropriate orthotics.
If the transverse arch at the front of your foot at the level of your metatarsophalangeal joints is flattened because the ligaments which hold the arch have grown loose, then the joints in the middle of the arch will be hitting the ground too forcefully when you’re walking or running. When this happens, you will often notice calluses underneath these joints on the sole of your foot, and pain in the joints which we call metatarsalgia. Wearing high heels will push these joints into the ground and make it likely you will have pain. Obviously, you need to avoid high heels, but a treatment which will re-create this transverse arch will usually relieve this condition. The best way to re-create the transverse arch is to use orthotics with a metatarsal pad to lift the heads of the three middle metatarsal and prevent the metatarsophalangeal joint from hitting the ground forcefully. Dr. Bertrand can fit you with such an orthotic.

Conditions that affect your TOES:

Bunions often afflict people who wear or used to wear high heel shoes with pointy toes. Other people who get bunions have overpronated feet or flat feet which cause them to put a lot of weight on the inside of their feet, the first metatarsal bone, the one that is attached to the big toe. This weight tends to push the first metatarsal towards the middle. Since people wear shoes, the toe of the shoe tends to push the phalanges (your toe bones) towards the outside. As a result, the line between the phalanx and the first metatarsal is no longer straight but forms an angle which we call a bunion. Hallux valgus (a bunion): this happens because of increased pressure on your big toe when your foot is rolled in (pronated). Obviously, the first thing to do if you have a bunion, is to avoid wearing high heels and wear shoes with a large toebox. Orthotics to support your arch will also help prevent pronation of your foot and stop the progression of your bunion. If it is severe, you may need surgery. If the joint between your first metatarsal and your big toe (the first metatarsophalangeal joint) develops arthritis, it will become increasingly painful and gradually becomes surrounded with excess bone. Little by little, it will become more difficult for you to dorsiflex your big toe (lift it up) until your joint is totally stiff and you are unable to move your big toe. When this happens, you have a hallux rigidus. Anything that prevents this joint from tracking straight will cause it to wear it’s cartilage and develop osteoarthritis (see osteoarthritis). As you get older, your ligaments around this joint become looser and the joint no longer tracks straight, this wears out the cartilage of your big toe.
The same problem happens is you have had a fracture in the area which has not set straight, or if you are overweight and putting a lot of stress on the joint. By the time you have hallux rigidus, it is impossible for you to wear high heels. Choose low heeled shoes with a large toebox and an orthotic which will either leave a space for the first metatarsophalangeal joint or be rigid under the joint. Lose weight. Before the toe becomes totally rigid, prolotherapy can help strengthen the ligaments around the joint and help it track straight. It can also help rebuild the cartilage inside the joint so that the joints can once again glide smoothly. In late stages, surgery may be needed, but the results are mixed. If you wear heels and shoes that squeeze your toes, you can also develop hammer toes. In this condition, the toe looks like a claw. At times, there is a large callous under the tip of the toe. This can also happen if you lose the feeling in your foot, such as if you suffer from a nerve problem. The commonest cause of this would be diabetes, and if you have this, you are at risk for developing an ulcer, which can develop infection which can spread to involve the bone of your toe as well as other bones. Obviously, you want to avoid wearing shoes that crowd your toes together and have high heels. One way to help relieve hammer toes is to wear orthotics which can lift the metatarsals involved, thus relieving pressure on the metatarsophalangeal joint of the toe.

Treatment of painful foot with nerve blocks:

The nerves that supply your foot are essential to keeping it in good working order. If they are injured as a result of faulty gait or footwear or excessive exercise, they will contribute to the breakdown of the foot’s structures. This damage will respond readily to treatments of nerve blocks.


Dr. Bertrand has found that this cream can quickly relieve painful feet. Its active ingredient, mannitol, can shut down the pain signal the body's most common pain receptor sends to the brain. This cream works very well for neuropathic pain, the pain that is due to injured nerves. Many conditions can injure nerves: they include diabetes, cancer chemotherapy, vitamin B12 deficiency and many others. Dr. Bertrand is about to start a research project using this cream to treat the burning feet diabetics can develop called diabetic peripheral neuropathy. Those who will participate in the study will be given at least a three-month supply of the cream and, if it helps them, they will be given more. If you are diabetic and are suffering from burning or feeling pins and needles or other strange sensations in your feet, look at to see if you want to take part in this study.

Prolotherapy References