With summer on our doorstep, most people are looking to spend more time outside and be more active. This includes more walking, hiking, running and exploring our beautiful landscape and your feet will help you go the distance.
However, an increase or change in activity can lead to pain in the foot and ankle. In fact, some of the most common injuries we see at our practice occur from simple walking and being active.
In general, foot pain is caused by faulty foot mechanics that over time will stress the bones, joints, ligaments, tendons, muscles and even nerves of the foot. It is necessary to treat the mechanical or structural cause of the pain to reduce the chance of permanent damage.
Here are the most common biomechanical foot problems and how you can manage them:
Plantar fasciitis (heel pain)
The plantar fascia is a tendon-like structure that runs from the heel bone all the way into the toes. The force of body weight on the foot can cause the arch to lower and the foot to lengthen, stretching out the plantar fascia. Over-pronation (rolling of the foot towards the center of gravity) or pronating too long during the gait cycle are the most common causes of plantar fasciitis.
Pain will usually, but not always, present itself in the heel first thing in the morning or after some rest. It may also increase with long periods of standing and walking.
Simple treatments such as rest, ice and anti-inflammatories can be helpful in the acute phase. If pain in the heel or arch persists for longer than three weeks, proper assessment is necessary to treat the cause. Long-term therapies include strengthening of the arch, proper shoe gear, custom orthotics, steroid injections, laser and in the worst-case scenarios, surgery.
Prevention of plantar fasciitis is achieved by strengthening the foot’s arch by walking barefoot, toe walking and calf raises. Wearing supportive shoes and arch supports with strenuous activities is essential if you over-pronate or have flat feet.
Metatarsalgia (pain in the ball of the foot)
A common area of pain in the summer is caused by shoes with minimal support such as flip flops and light shoes. Pain in the ball of the foot, under the central metatarsal bones, usually starts as an ache at the end of the day. Pain can increase and affect walking.
The most common cause of metatarsalgia is a collapse of the metatarsal arch, the arch in the ball of the foot, or as a hammertoe develops. Too much pressure under one bone can eventually lead to a stress fracture of the metatarsal bone.
Treatments include more supportive shoes with significant cushioning, arch supports, custom foot orthotics, immobilization and rest. Seeking a professional assessment to determine the structural cause is always important.
If you have structural mal-alignments such as a bunion or hammertoe, prevention of stress to the forefoot is essential. This is achieved with orthotics or corrective surgery.
Bunions
A bunion is a mal-alignment of the big toe joint as it slowly shifts out of the foot. Bunions are very misunderstood as for years people have been mistakenly told these are bumps of extra bone that grow out of the foot.
A bunion needs to be assessed properly with X-rays to evaluate how far the bone has shifted out of the foot. Surgery involves shifting the bone permanently back into the foot, not cutting the bone off. The most modern bunion surgery allows walking in a running shoe two to three weeks after surgery.
The best way to prevent bunions, especially if you have a history of them in your family, is to avoid shoes that compress the toes. Strengthening the arch will help avoid overpronation and decrease pushing the big toe towards the second toe.
If any type of foot pain lingers for more than four weeks, it is best to seek professional help to assess the mechanical cause of the pain.
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