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Foot pain assessment should also look at hip and knee, experts say

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A new study has found a significant association between foot pain and knee or hip pain, suggesting that people with foot pain should also be assessed for hip and knee pain.

Researchers at Hospital for Special Surgery (HSS) and Harvard Medical School analysed information from a database of 2,181 people who had participated in the Framingham Foot Study between 2002 and 2008.

Participants completed a questionnaire evaluating foot pain, pain location (including side of pain) and severity. They also indicated whether they had experienced pain, aching or stiffness in the hip or knee and specified the side of any reported pain. In the study, 16% of participants reported bilateral foot pain, 6% right foot pain only and 5% left foot pain only. Slightly more women than men reported foot pain.

According to HSS, reporting on the findings, the researchers found that foot pain was associated with bilateral and same-side knee pain in men and women. For example, men with right foot pain compared to those with no foot pain were five to seven times more likely to have pain in their right knee or in both knees.

Foot pain was also associated with hip pain on the same side in men. In women, bilateral foot pain was associated with hip pain on both sides, on the same side or on the opposite side.

The association between foot pain and knee or hip pain may be due to an individual modifying their movements and postures when experiencing pain. This can result in malalignment and other problems.

The challenge for medical practitioners is to develop a treatment plan that addresses all issues, according to the study authors.

“The study shows that a physician evaluating a patient for foot pain should also ask about possible hip or knee pain, and vice versa, so we can address all of a patient’s issues,” said Dr Brian Halpern, a sports medicine physician at HSS and co-author of the study. “In medicine, many times it comes down to ‘what does your MRI look like or what does your x-ray look like?’ But it’s really important to conduct a thorough medical history and physical exam.

“A comprehensive orthopaedic evaluation may prompt a broader treatment strategy and possibly a referral to another specialist.”