Fibromyalgia is a syndrome that causes chronic pain throughout the body as well as other symptoms, such as sleep disturbance and depression, with a higher occurrence in women. According to 2018 data, the condition affects up to 2.10% of the global population, with 4.7% prevalence in Europe and 5% in the United States.
Researchers are now analyzing a possible correlation between fibromyalgia (FM) and foot pain, adding to the nearly full bucket of symptoms that impact these individuals’ quality of life.
“I went to multiple doctors trying to figure out what was wrong. One doctor told me I was just an 'overactive mother,'” says Karisa Sikora, a teacher from Maryland who was diagnosed with fibromyalgia about 6 years ago. According to Karisa, it takes “mental gymnastics” to get out of bed in the morning, which is a constant struggle.
“Sometimes my feet feel like they are on fire. A lot of times, the discomfort travels into my ankles and toes, which often feel stiff, “ describes Karisa, who says she feels exhausted and discouraged easily.
However, when it comes to foot health, Karisa did not find the answers she was looking for when she visited her rheumatologist. “I complained about my feet hurting, asked about better shoes, but didn’t get anywhere with that so I dropped it,” she says, figuring the foot pain could be related to her FM.
To date, researchers have found significant differences in foot health among different patient populations. In one study led by Patricia Palomo-López, PhD, at the University Center of Plasencia in Spain, individuals with FM were found to have overall worse foot health and needed extra pain medication.
The team studied just over 200 women, comparing foot wellbeing and quality of life in those with FM and those that were otherwise healthy. They started with the hypothesis that women with FM might have a lower degree of quality of life linked to foot and overall health. Their findings, published in the Archives of Medical Science, confirmed this theory, finding several areas of significant impact in the wellbeing of women compared to the healthy group, including: general health, physical activity, social capacity and vigor, as well as for specific foot domains such as pain, foot function, foot health, and footwear.
However, whether this difference in pain is specific to the feet, to trigger points (sensitive areas) within or near the feet, or just a generalized pain from the syndrome, is still in question.
Pain expert and PPM advisor Gary W. Jay, MD, explains: “Most commonly, the pain we associate with fibromyalgia is the kind of muscular pain that is found in the shoulders, back, neck and larger muscle groups of the legs. There can also be pain in the hands, arms, and feet that are equally distressful.” Individuals with fibromyalgia syndrome often experience a heightened sensitivity to pain, known as allodynia, so when pain occurs in a particular part of the body, this pain can be severe.
Dr. Jay adds, “Foot pain may also come from an overlapping pain condition such as rheumatoid arthritis, lupus, or Raynaud’s syndrome.” He explained 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.
Fibromyalgia expert Don Goldenberg, MD, also a PPM advisor, agrees, pointing out that, “Most experts would think foot pain in FM represents generalized pain sensitivity with nothing specific to the feet.” He notes that the researchers found no anatomic abnormalities in fibromyalgia patients with foot pain compared to healthy women. “My suspicion is that you could find similar [results] with any body part,” he says, mentioning increased elbow and shoulder pain among those with FM as examples.
While more research is needed to confirm the foot pain source, Dr. Palomo-López and team recommend that, “health authorities should pay more attention to improving the general and foot-specific health-related quality of life in women with fibromyalgia.”
Another 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. They were able to link fibromyalgia-related foot pain to myofascial trigger points – these are essentially irritable tight nodules in muscles that become painful when pressed on and can cause pain to be projected or “triggered” in specific muscle patterns.
According to Dr. Tornero-Caballero’s research team, key differences in sensitivity of the foot were noted. “…The prevalence of foot pain in our sample of women with FMS was as high as 60%,” they wrote in their published study.
Their results supported some experts’ theories that regional pain in those with FM is related to active trigger points and that overall FM pain may not be widespread, but rather, located in specific areas of the body. If these findings are repeated in other large-scale studies, it could suggest that FM treatment approaches focus on specific trigger points in order to reduce overall pain.
However, trigger points are also controversial in the medical community, notes Dr. Goldenberg. He believes it is unlikely that myofascial trigger points are part of a specific peripheral pain phenomenon. (The peripheral nervous system affects the nerves beyond the spinal cord and brain, the latter of which are known as the central nervous system.) Thus, the jury is still out.
While the scientific and medical community continue to hack out the root cause of this complicated condition, what Karisa and other patients suffering from fibromyalgia and foot pain really want to know when it comes to pain control and management, is how to reduce the discomfort and improve their quality of life, which is unquestionably lower with constant pain. The good news is that there is some agreement when it comes to foot pain control. Current best practice based on a trial published in Clinical Rheumatologya few years back is that customized foot orthotics can be very effective in patients with both FM and foot pain.
According to the original trial lead, 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 FM patients. “The addition of custom-made foot orthotics to usual care appears to improve functioning in the short term [for patients with FM],” Ferrari stated in his published study.
The bottom line? It is important to speak with your doctor if you are experiencing pain in your foot. Since the pain may be a symptom of your fibromyalgia or of another painful condition, such as plantar fasciitis or rheumatoid arthritis, it is vital to insist on a search for an appropriate treatment, which may include over-the-counter pain relievers, physical therapy, orthotics, or surgery in extreme cases. Trigger point dry needling (a more modern, evidence-based approach to acupuncture that involves inserting a solid needle into a trigger point) may also be beneficial.