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A pain in the foot

Rupesh Puna discusses foot pain throughout the lifespan. He uses a case-based approach highlighting four common conditions:

  1. Sever’s disease
  2. Morton’s neuroma
  3. plantar fasciitis
  4. osteoarthritis of the foot.

Take home messages

  1. Taking a history is crucial to making the diagnosis when a patient has foot pain.
  2. Often imaging is required with foot pain - consider a weight-bearing x-ray to exclude and rule out significant other differentials. If unsure about further imaging modality, please feel free to discuss with your friendly orthopaedic foot surgeon
  3. If local anaesthetic or steroid injections are to be used, we would recommend US guidance for accuracy.
  4. Sever’s disease will resolve when the child stops growing.  Ceasing aggravating activities is the key to this.  Heel cups and calf stretching exercises can be of some help but we appreciate compliance can be an issue.
  5. The clue to diagnosis of Morton’s neuroma is asking about footwear and the relief that comes with removing tight fitting foot wear.  Other common symptoms include burning into the webspace (most often the 3/4 webspace) and a sense of walking on a “mass”.
  6. Plantar fasciitis has many options of treatment and all essentially have similar outcomes at one year - if symptoms are still present after a year an orthopaedic opinion may be sought.  First line treatment should involve calf stretching, plantar fascia specific stretching as well as an orthotic or heel pad).
  7. Osteoarthritis of the foot is complex and there are many treatment options other than just fusion for certain joints (1st MTPJ and ankle). Glucosamine may be of benefit early in the disease process. It is worth referring to someone who specialises in the foot and ankle to discuss surgical options when the time is right.


Mr Rupesh Puna

Orthopaedic Specialist


Rupesh graduated the New Zealand Orthopaedic surgical training program in 2015.

He has recently returned from two years of fellowship training in Canada with a practice solely dedicated to disorders of the foot and ankle. He also has a public hospital appointment at Auckland City Hospital.

He is a Fellow of the Royal Australasian College of Surgeons and member of New Zealand Orthopaedic Association, New Zealand Orthopaedic Association Foot and Ankle Society and the American Orthopaedic Foot and Ankle Society.

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