It’s everybody’s problem Foot pain is a common problem. In fact, a recent report in the New York Times states that 75 percent of Americans experience foot pain at some point in their lives. Unfortunately, the fact that everybody has it doesn’t make it any less troublesome when yours is the painful foot. As providers of specialized foot and ankle care, the team of physicians, nurses, physical therapists, orthotists, and prosthetists at the Orthopaedic Associates of Michigan Foot & Ankle Center see their fair share of foot pain, including complex cases that have been referred by other physicians. In this post, Robert S. Marsh, DO, specialist with the OAM Foot & Ankle Center, explores a few of the most common types and causes of foot pain, as well as ways to prevent it. Later this month, OAM Foot & Ankle Center specialist Donald R. Bohay, MD, FACS, will discuss treatments for foot and ankle pain and problems. Why do my feet hurt? Perhaps foot pain is so prevalent because so many things can cause it — anything from physical activity, to chronic disease like diabetes, to the shoes we wear can play a role. “The kinds and causes of foot pain are as varied as the people who experience it,” says Dr. Marsh. “But the most common kinds of foot pain we see are plantar fasciitis, which causes pain in the arch and heel, and metatarsalgia, which is pain and inflammation in the balls of the feet.”
Plantar Fasciitis According to the American Academy of Orthopaedic Surgeons, about 2 million people are treated for plantar fasciitis each year. Dr. Marsh points out that this condition crosses all population boundaries —adolescents, older adults, athletes, and couch potatoes are all candidates. Plantar fasciitis comes on when the ligament that supports the arch of your foot — or the plantar fascia — develops tiny tears and becomes irritated and inflamed. “Many people notice the pain when they get out of bed in the morning and take their first steps,” says Dr. Marsh. That pain typically subsides after walking for a few minutes, but can return after prolonged walking or exercise. “Others notice a deep ache in their arch or sharp heel pain or tenderness after exercise.” Advanced cases can feel more like needles pricking the bottom of the feet or can result in prolonged pain, even when resting. While the general population is at risk, Dr. Marsh cites a congenital condition called gastrocnemius contracture, or tightness of the outer calf muscle, as a common contributing factor. “People who have this condition are particularly prone to getting plantar fasciitis, especially when they alter their activity level, over train or start exercising when they haven’t exercised for a long time, repeatedly stand for long periods, or change the type of shoes they’re wearing.” Dr. Marsh offers these tips to help prevent plantar fasciitis or lessen its symptoms:
- Wear supportive shoes with well-cushioned heels and good arch support. Avoid highly flexible footwear like flip-flops or “barefoot” shoes.
- Warm up and stretch calf and foot muscles. Start with a light walk followed by gentle stretching before more rigorous exercise.
- If you’re a runner, choose natural, softer running surfaces like grass or a running track rather than asphalt or concrete.
- If your foot hurts, pay attention. Rest and ice sore feet and lighten up on sports and high impact exercise temporarily if you notice continued pain or tenderness in your arch and heel.
- Keep your weight in check — excess weight adds stress to your feet. “Patients with plantar fasciitis often want to know if an orthotic can help,” says Dr. Marsh. The simple answer is, sometimes. “Orthotics may be beneficial, but they’re not a solution to all foot problems,” he explains. “You can try an over-the-counter orthotic first to see if the added support helps relieve the pain. If you get some relief, then talk to your doctor about pursuing a custom orthotic.”
Metatarsalgia Another type of foot pain that affects men and women, young and old, is metatarsalgia. “Metatarsalgia is pain at the heads of the metatarsal bones, or the area just behind the toes in the ball of the foot,” explains Dr. Marsh. Typical symptoms include:
- Sharp ache or burning pain in the ball of the foot, just behind the toes
- Pain in the ball of the foot that worsens when walking barefoot or on hard surfaces
- Shooting pain or tingling sensation in the toes Like plantar fasciitis, metatarsalgia can be brought on by a variety of factors. Shoes that don’t fit properly, high impact exercise, excess weight, natural loss of padding in the foot as a person ages, and high arches are typical contributors. Stress fractures, or tiny breaks in the toe bones or metatarsals, can also contribute to the problem. “We can see metatarsalgia in runners and athletes when they make a change in their shoes or their running surface, or they alter their activity in some way and get stress fractures,” says Dr. Marsh.
Your doctor is the best person to diagnose both metatarsalgia and stress fractures and, based on the cause of the problem, can prescribe treatment that best fits your situation. Fortunately, you can take steps to prevent these conditions:
- Wear proper footwear. It’s a common theme when it comes to foot health, but supportive, well-cushioned, proper fitting shoes can help prevent metatarsalgia.
- Maintain a healthy body weight. Excess weight puts excess pressure on the feet.
- If you have high arches, consider an arch support. This may help prevent metatarsalgia in certain cases. As with plantar fasciitis, Dr. Marsh recommends trying an over-the-counter orthotic first. If it is helpful, you can talk to your doctor about a custom orthotic.
- Give yourself time to heal. If you’ve had an injury to your foot or leg, follow your doctor’s orders. Resuming normal activity too soon can lead to further injury.
Foot Injuries While it would be impossible to discuss all the types and causes of foot injury, it’s helpful to keep a few injury prevention tips in mind, particularly if you’re an athlete or if you have diabetes. Let’s start with athletes. Injuries to the foot and ankle are the most common types of sports injury. With that in mind, Dr. Marsh has some advice about footwear. “I’m a big fan of wearing a lace-up ankle supports in volleyball, basketball, and football,” he says. “For runners, I typically recommend shoes that are supportive and that have low miles. If you’re a heavy runner, you should switch your shoes about every four months. Recreational runners might get six months out of a pair of shoes.” He also advises all athletes to pay attention to core strength. “Whether you’re a runner or you’re engaged in contact sports,” he says, “you should add a good core routine. This will help with balance, it will help reduce excess bouncing and swaying when you run, and it will help prevent twisting and falling.” Diabetics are also prone to foot injuries, particularly in the more advanced stages of the disease. That’s because diabetics can develop a condition called Charcot neuropathy, or lack of sensation in the bottom of their feet. “People with neuropathy tend to put too much pressure on certain areas of their feet and can develop calluses and, eventually, ulcerations of the foot,” explains Dr. Marsh. “Also, because they can’t feel the bottom of their feet, they can cut their foot without knowing.” Dr. Marsh says the best and simplest advice for diabetics is:
- Wear comfortable, proper-fitting shoes that will protect your feet from injury and won’t cause calluses and ulcerations.
- Check your feet every day. Look for blisters, calluses, nail deformity, ulcers or open wounds. If you see callus formation, nail deformity, or have an open or draining wound, seek medical attention as these can lead to more serious problems.
General Advice Be sure to watch for our post from Dr. Bohay later this month when he talks about treating foot and ankle pain. Until then, be good to your feet and follow this general advice from Dr. Marsh: “I usually give people three general rules for buying shoes: You can afford them. They’re comfortable. And they’re supportive and not flexible, like a flip-flop or ‘barefoot’ shoe.” The other advice that applies to everyone is to maintain a healthy weight and stay active. “Your feet will do better when you keep the excess weight off and stay active versus being sedentary,” points out Dr. Marsh. “I always tell people that every pound you carry over your ideal body weight is like 10 pounds on your feet. Every pound makes a difference.”