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Researchers Continue to Investigate Fibromyalgia-Foot Pain Correlation

February 23, 2020
A clear quality of life impact calls for more clinical attention to tender points in the plantar region.

with Gary W. Jay, MD, and Don L. Goldenberg, MD

 

Emerging studies show a growing correlation between fibromyalgia syndrome and foot pain, especially among women, with symptoms representing one or more causes for a worsened quality of life among patients.

“It is important to remember that pain is the hallmark of fibromyalgia,” said PPM editorial advisor Gary W. Jay, MD. According to Dr. Jay, swelling, irritation, and inflammation of the tissues within the foot and heel may induce significant pain. For those with a heightened sensitivity to pain, which is inherent in this syndrome, this pain can be severe, he noted.

Two Sample Studies

Worsened General Foot Health

One study led by Patricia Palomo-López, PhD, at the University Center of Plasencia in Spain, found significant differences in foot health compared to healthy controls.1 The trial compared foot wellbeing and quality of life in women (n = 208, divided into equal groups) with fibromyalgia (FM) and their healthy counterparts.

Their findings, published in the Archives of Medical Science, showed that women with FM were found to have overall worse foot health and needed extra pain medication. Specifically, women who suffered from FM had lower foot-related quality of life compared to healthy matched women (P < 0.001) including for general well being (eg, general health, physical activity, social capacity and vigor) as well as for specific foot domains (pain, foot function, foot health, and footwear).

The team used the Foot Health Status Questionnaire (FHSQ), which they noted had not been applied to women with FM pain in trials to date. The domains of the FHSQ scores as well as demographic data were registered, and other health-related quality of life questionnaires were applied as well.

However, whether the subjects’ pain heightened response was specific to the feet, to trigger points, or just a generalized pain from FM, it might still be early to detect. According to Dr. Jay, “Many people who suffer with FM experience pain in their feet, but medical doctors do not feel foot pain is specifically symptomatic of fibromyalgia,” which tends to present with muscle and soft tissue pain rather than joint and bone pain. “This is not to say that the foot muscles can’t be affected.”

According to fibromyalgia expert Don L. Goldenberg, MD, also a PPM editorial advisor, “Most experts would think foot pain in FM represents generalized pain sensitivity with nothing specific to the feet.”

In fact, Dr. Goldenberg noted that Dr. Palomo-López’s study found no anatomic abnormalities in FM patients with foot pain versus controls. “My suspicion is that you could find similar hypotheses with any body part,” he said, mentioning increased FM elbow and shoulder pain as examples.

While the jury is still out, Dr. Palomo-López’s and coauthors encouraged the clinical community to “pay more attention to improving the general and foot-specific health-related quality of life in women with fibromyalgia.” They noted that pregabalin, orthotics, and trigger points dry needling (see more below), may benefit these patients.

Trigger point dry needling, orthotics, and pregabalin may help to reduce chronic foot pain. (Image: iStock)

Trigger Point Foot Pain

Another related study led by Maria C. Tornero-Caballero, PhD, at the International Doctoral School, also in Spain, investigated the presence of trigger points in the muscles of the feet and sensitivity to pressure pain.2 Specifically, they examined the relationships between trigger points, pressure pain maps, and clinical variables in women affected by fibromyalgia, ultimately linking FM foot pain to active myofascial trigger points. Fifty-one women with fibromyalgia syndrome and 24 comparable healthy women participated in the study. Sixty percent of women with FM in the sample reported foot pain.

According to the findings, differences in sensitivity were noted in topographical pressure pain maps of the foot. Another finding revealed that women with fibromyalgia and from foot pain demonstrated higher pressure pain hyperalgesia in the plantar region compared to women with FM without any foot pain. Overall results supported assumptions that regional pain in individuals with fibromyalgia may be related to active trigger points, and that overall fibromyalgia-related pain may not be widespread, but rather, located in specific areas of the body, supporting the hypothesis that treatments to reduce FM pain should focus on specific trigger points.

Despite this study, trigger points are also controversial, said Dr. Goldenberg, again pointing to localized peripheral sources of pain, such as myofascial trigger points, as a likely possibility.

Dr. Jay weighed in as well: “Foot pain may also come from an overlapping pain condition such as rheumatoid arthritis, lupus, or Raynaud’s syndrome.” He noted that fibromyalgia can be a primary or secondary syndrome, and when the latter is the case, treating the primary condition may help to treat the fibromyalgia.

Potential Solutions

There is some agreement, however, when it comes to pain control for patients with FM suffering from foot pain. Atrial published in Clinical Rheumatology showed that customized foot orthotics demonstrated a level of effectiveness for foot pain for patients with the syndrome.According to lead author Robert Ferrari, orthotics are widely prescribed for patients with “chronic, non-specific low back pain and lower limb pain,” but effectiveness had not yet been demonstrated for patients with fibromyalgia. “As part of a complex intervention, in a cohort-controlled trial of primary care patients with fibromyalgia, the addition of custom-made foot orthotics to usual care appeared to improve functioning in the short term,” he wrote in his paper.

Says Dr. Goldenberg about certain cases, “If I thought there was localized pathology, I would refer the patient to a foot specialist and consider orthotics,” he says. 

Last updated on: May 11, 2020
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