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Got an ache or pain? Have a question about a prescription or over-the-counter drug? Looking for some FREE medical advice?
Question:
About a month ago I started to have a problem with my left foot. A soreness started up when I was doing more walking than usual daily, and then has been a bother since. I thought it would just go away of itself, a bruised muscle or slight sprain.. but the pain persists and every home remedy I try (soaking daily in hot water, new soft shoes, etc) doesn't seem to help. What is the most normal cause of persistent (nerve?) pain in the lower foot / heel area? What can one do?
DJ
Answer:
Several problems come to my mind when I see the below mentioned complaints. Of course, it would be great to get some additional information about you like age, what kind of job you do, whether you have any history of shoulder traumas, how active are you in sports, for how long you have been having the problem, whether the motions of your shoulder are restricted or not, is the pain better with rest and worse with activities. The first reason which can cause this pain is arthritis of the shoulder. This condition is characterized by destruction of joint cartilage with loss of joint space. Pain and stiffness develop as a result. Arthritis of the shoulder is more common in patients older than age 50 years. Patients principally report pain around the shoulder and upper arm (sometimes in the forearm and around the top of the shoulder). The usual complaint is night pain that interferes with sleep. Progressive loss of motion in the shoulder is the second most common complaint. In this case radiographs can show certain signs of arthritis and prove the diagnosis. Patients may have chronic shoulder pain and loss of strength and motion. Conservative treatment is recommended initially, including use of NSAIDs (nonsteroid anti-inflammatory drugs), application of heat and/or ice for relief of symptoms) about 15 minutes each time), gentle stretching exercises to preserve motion, and/or injection of corticosteroids. The second possible reason is frozen shoulder or adhesive capsulitis. It is characterized by insidious onset and decreased active and passive motions; while the cause is unknown, there is most likely an underlying inflammatory process. Pain and progressive loss of motion without any known injury are the classic signs and symptoms. Usually at risk are women between ages 40 and 65 years. In this case radiographs are indicated as well, though they are usually normal. MRI scan is indicated in patients whose pain and motion do not improve after 3 months of treatment. NSAIDs and physiotherapy with a home exercise program are indicated. Patients who fail to regain motion after 3 months of conservative treatment need further evaluation. The third possible reason is impingement syndrome or shoulder bursitis. It is impingement of the acromion, coracoacromial ligament, acromioclavicular joint, and the coracoid process of the underlying bursa, biceps tendon, and rotator cuff. This syndrome may be caused by inflammation of any of these structures; commonly, all are affected. Gradual onset of anterior and lateral shoulder pain is characteristic. Night pain is common. Radiographs are usually normal. Several exam tests should be performed to prove this problem. Treatment should include NSAIDs combined with rest. Exercises to stretch the posterior capsule of the shoulder should be done 4 times a day. These 3 conditions seem to be the most common reasons of shoulder pain, though it can be also caused by certain conditions of the cervical spine, which require radiographs and further evaluation. What you should do: If you have a possibility to see a doctor and get a full evaluation - it is the best step. If you do not have this possibility, you may continue taking NSAID and use applications of heat and/or ice (for 15 min each). You mentioned that the Ibuprofen is not very effective. You can make the dosage higher - max is 800 mg three times a day after a meal for an adult. If that does not work you can try Celebrex 100 mg or 200 mg twice a day after a meal. I mentioned the exercises which should be done, if you e-mail us your fax number I can send you a copy of the necessary home set. Alcohol will not effect this problem much, unless you are taking muscle relaxants (like Serdalud) or other drugs which can not be combined with it. You may take NSAIDs with alcohol. But a real examination done by a physician will be the best option. Best regards, A. Korchagin MD.
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