Time to discuss a clinical topic Section

Mid foot pain and a lump on top of the foot – a patient asks questions

When Irene Perkins* asked about injections and surgery for her painful middle joints of the foot I thought it would be useful to publish her questions and my answers. Rather than using the NHS she wanted to see me privately.

* Not her real name.

‘Is there raised bone in right foot that requires treatment?’
The bone can be treated but generally speaking if this can’t be protected within the shoe it is best to evaluate carefully to see whether reducing the bulk of bone is preferred over carrying out a forced joining (fusion) of that joint. Simple management using bone trimming can be very helpful but also can then lead to instability of the joint necessitating a second surgery.

“I have been told that she will have to point directly to where the pain is when the needle goes in – I am worried that I will be unable to give this information accurately as the pain shifts”.
The joints concerned are very easy to identify and even though you may have pain in different areas the accuracy of the treatment is such that it is very rare to not be able to identify the real source of pain. I hope this gives some reassurance.

“Recently I read an article in the Daily Mail about the risk of injections and heel pain/risk to tendons and soft tissue. Although I know the injection is given under X-ray control, X-rays do not show the soft tissue”.
There is no intention to deal with soft tissue in the case of this condition, mid foot arthropathy. As a consequence no tendons are involved with the injection.

The Daily Mail does carry interesting articles from time to time. However many articles are written by professionals who pay money to try to promote their particular spin on healthcare.

It is true that there has been evidence and suspicions that injections can affect tendons adversely. This means the tendons can in fact tear. This however is more likely to arise where the clinician has not taken sufficient steps to ensure the soft tissue itself is not damaged before the injection is carried out. Again in the case of mid foot arthropathy and the injections used to manage this condition this is not something we need to worry about.

Read more about midfoot arthropathy on www.Consultingfootpain.co.uk. to be published later in the Summer. Also refer to injections of joints factsheet 19 under clinical education.

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