Title : Neuropathic foot pain: Therapeutic insights from a biomechanical perspective
Abstract:
Neuropathic foot pain is a significant clinical issue, as its persistent and distressing nature severely impacts patients' quality of life. Neuropathic foot pain arises from damage or dysfunction within the somatosensory nervous system, leading to pain that is often disproportionate to the initial injury. The etiology of this condition is multifactorial, encompassing various systemic, local, and iatrogenic factors.
A leading contributor is diabetic peripheral neuropathy, which occurs as a result of prolonged high blood sugar damaging small blood vessels that supply nerves. Peripheral nerve compression disorders like tarsal tunnel syndrome and Morton's neuroma involve mechanical pressure on nerves in the foot, producing symptoms such as sharp, burning, or tingling sensations. These symptoms often worsen with physical activity or prolonged standing. Traumatic injuries to the nerves, whether from accidents, sports injuries, or surgical procedures, can result in persistent neuropathic pain. This may occur due to improper nerve healing or the development of neuromas—tangled masses of nerve tissue at the injury site. Infections, such as herpes zoster, may also trigger neuropathic foot pain. Another increasingly common cause is chemotherapy-induced peripheral neuropathy, particularly in cancer patients receiving neurotoxic agents. This condition frequently leads to numbness, tingling, or pain in the feet, and significantly diminishes patients’ quality of life.
Biomechanical strategies are fundamental in managing neuropathic foot pain without medication, focusing on decreasing abnormal mechanical loads and enhancing movement capabilities. A key method includes orthotics that help redistribute pressure across the sole, improve foot positioning, and support fragile tissues. These devices help to relieve nerve pressure and lessen repetitive injury, which are common causes of neuropathic pain . Adjustments to gait and posture are also critical elements of biomechanical treatment, as improper walking mechanics can worsen nerve irritation. Physical therapy with therapeutic exercises aimed at correcting biomechanical dysfunctions, strengthening muscles, and stabilizing joints. Furthermore, tools such as specially designed shoes and braces provide passive assistance to reduce mechanical stress during walking. Preventative measures, including ongoing biomechanical evaluations and timely interventions, are vital to slowing disease progression and enhancing patient well-being. Together, these biomechanical interventions work alongside medical therapies by targeting the mechanical origins of neuropathic foot pain.
