Foot Pain and Treatment:
Foot pain afflicts a majority of people in the world. 100 million Americans suffer from chronic foot pain and 75% of the people in the United States experience foot pain at one point or another in their lives. There are many different types of pain that exist or are likely to occur in the foot. Some foot pain arises from everyday experiences that can happen to anyone such as in the case of accidents like stumping your toe on household furniture or creating a stress fracture or sprain on the top of your foot while competing in an athletic event. Then, there are more long-term or chronic foot problems. Occupations that require a person to be on their feet, day after day, will most commonly lead to foot pain at some point in their lives unless preventative steps are taken. Athletes are highly susceptible to foot pain. In Fact, 25% of athletic injuries are foot and ankle related.(1) Athletes are highly familiar with not only accidental foot pain, but long-term pain stemming from years of over-usage. Those who suffer from some sort of foot-pain in their lives is constantly growing. This is because our feet do so much for us on a daily basis.
Everyone knows that our feet give us balance when we are standing, walking, or running. However, did you know how many parts of your feet operate at the same time to provide this balance? The toes are providing stability so that you don’t fall forward and land on your face. The tendons and muscles on the sides of your feet provide balance from side-to-side. The structure and functionality of our feet is intricate! All of these parts work constantly everyday as a lever that supports the weight of your entire body and attaches to your ankle while it serves as a movable fulcrum. Typically, some injuries in the foot can lead to other problems if not treated immediately. The foot contains many movable, working parts; damage to one area in the foot can lead to problems in other areas like the leg and ankle. There are a multitude of causes that lead to foot pain. Some of them are more preventable or treatable than others. Foot pain caused from everyday use or medical reasons may be a result of improper foot wear. Other types of foot pain may be injury-related, or stem from overuse in a physical activity. Foot pain may also be related to improper running or walking, which can alter an individual’s gait or proper walking form. As inevitable as foot pain may seem, there are many different ways of preventing certain types. There are also a variety of different treatments and other options to reduce the symptoms of foot pain. Information is power, so it is essential to research the type of foot pain that is specific to you. Understanding the way the foot moves and operates, as well as how to prevent soreness or injury, is the first step in alleviating pain in the feet and reducing foot injuries altogether.
Stress, Injuries, and Other Common Pains in the Bones of the Feet.
There are different types of fractures in the feet. Nondisplaced fractures refer to when the bone cracks or breaks but remains in place. Displaced fractures are bones that do not stay in the same place and are in separate pieces. Comminuted fractures mean that the bone is broken in several places and open fractures, are open enough to see the bone sticking out of the skin. Stress fractures, also known as hairline fractures, happen when a particular bone in the top area of the foot has a small crack due to overuse and repeated stress. These tiny cracks in the bones can create inflammation, swelling, and debilitating pain. They commonly occur in athletes who spend a lot of time on their feet. However, it can also occur to those whose occupations require long hours on their feet. Nobody is resistant to accidents, and work-related injuries are quite common in producing stress fractures to the feet. Runners, hikers, and other athletes that spend long amounts of time on their feet are susceptible to a stress fracture related injury. When we are running or jumping, the impact we create when we land puts a significant amount of stress on many areas of the foot. It is inevitable that, over time, this pressure can create small cracks in the supportive bones of our feet. The bones that support a great portion of our weight are the metatarsals. Theses bones are the ones that you can feel on the top of your foot. They connect the toes, or phalanges, to the rest of your foot. In the majority of cases, the most afflicted area is the first metatarsal head, which is just behind the big toe. Any type of injury or condition that affects the metatarsal area is known as metatarsalgia. Conditions that lead to problems in the metatarsal bones can also stem from medical reasons. If the metatarsal bones are uneven or not aligned properly, it can create problems and create unnecessary stress to other metatarsal bones.
Another set of bones that are susceptible to fractures are the sesamoid bones. These “jelly-bean”(2) shaped bones come in pairs in each foot, and are located just behind the big toe on the bottom of the foot. Sesamoid bones basically function as a fulcrum to help flex and move your big toe up and down. Sometimes these bones are fractured due to stress, overuse, or injury, and the area becomes swollen and inflamed. This type of injury is common among athletes. Dancers may experience a sesamoid fracture by landing improperly during training or performance. Baseball catchers commonly report having sesamoiditis, most likely due to the amount of time they spend resting on these particular bones in their feet.
Stress fractures, metatarsal fractures, and sesamoiditis can happen to anyone at any age and can be so painful that it may be difficult to even walk. When inflammation occurs, it can take a long amount of time (depending on the type of injury) for the swelling to go down. Most stress fractures are fairly treatable at home, however, they should be examined immediately by your doctor after they occur. Treatment includes:
- Hot and cold applications (warm water/cold water/ice packs)
- Boots or temporary supportive footwear to reduce stress
- Topical analgesics to reduce inflammation and pain
- Adequate amounts of rest to allow the bone to heal and reduce the swelling
- Applying ice packs is a must during periods of rest, as you can battle inflammation at both angles.
- Pain in the Toes
Corns are hard spots of thickened, dead skin that can occur on the top or sides of the feet, as well as in between the toes. This “thickened” skin is also known as Hyperkeratosis. This thickening is a defense mechanism to strengthen the skin when there is excessive friction or pressure. Hammertoe and Claw toe can also lead to corns on the feet. Seed corns are tiny, discrete calluses that can be more painful if they are located on load-bearing spots of the foot. Corns are typically the result of repeated pressure or friction on a specific area of the foot. This pressure will cause the outer skin layer to die and what results is a hard, protective surface. Sometimes this is an issue related to the shoes we wear. If our shoes trap moisture they are more likely to create bunions. If they are worn down, and misaligned, they can create unnecessary friction on certain areas of our feet. Some corns are the result of toe deformity like hammertoe and clawtoe. It is typical to find corns in people who suffer with toe deformities because the toes bend in positions that create corns on the sides and ends of the toes. Soft corns are corns that are known to form in areas where sweat is often trapped, like in between the toes.
- Corns can be treated with products that include salicylic acid, an ingredient commonly found in wart-remover. These types of products can come in the form of applicators, drops, pads, or plasters and moderately inexpensive. They can be found in the pharmacy section of many department stores and have a fairly high success rate.
- Never try to remove a corn or callus at home! This can lead to infection in the tissue area. If a corn needs to be removed, it should be surgically removed by a podiatrist or medical professional.
Another common toe pain is caused by an ingrown toenail. Ingrown toenails are highly common in those who wear ill-fitting shoes with toenails that are not properly trimmed. This most often happens to the big toe. The skin along the edge of the toenail becomes red and can lead to infection. Any shoe that is too small or too big creates unnecessary pressure on the toe and nail which can lead to the toenail growing inward or downward. This can most likely happen to those who trim their toenails too short. Another trimming mistake that many people make is to round the edges instead of cutting them straight across. If the edges are rounded, it can cause the toenail to grow downward into the skin. An infected, ingrown toenail should immediately be looked at by a podiatrist. If an ingrown toenail is not infected, there are many home remedies that can help treat the symptoms.
- A 15 minute foot soak in warm water can relieve the pain and minimize the swelling
- During the day, keep your foot dry as possible
- If your feet sweat a lot, consider changing your socks twice a day or more to keep the area where the ingrown toenail is dry.
- If your ingrown toenail is between toes, you can place a cotton ball in between them to provide comfort and prevent further irritation to the area.
- Keep the area clean and apply antibiotic ointment to the area to prevent any infection.
- It is important not to irritate the area around the ingrown toenail, but gently pulling the skin away from the nail can relieve some of the pressure and pain.
A bunion is an aberrant, bony bump which appears on the base of the big toe. When the big toe deviates toward the little toes, its base pushes outward on the first metatarsal bone (the bone behind your big toe) and forms a bunion. Bunions occur at the joint where the toe moves back and forth. This area is crucial when it comes to walking, and every step you take will place pressure on the bunion. Those who have stiff joints or arthritis typically experience the pain of bunions more than those with flexible joints. There are preventative steps to take in order to avoid a bunion forming altogether. Once a bunion forms it is permanent unless it is surgically removed. The pain can be minimized fairly easy and treated with shoe inserts or corrective shoes.
- Moleskin or gel-filled pads have been known to have a high success rate in reducing the pain of bunions as well as arch supports.
- Warm soaks and/or ice packs can help relieve the pain of bunions
- Foot massages are also capable of relieving some of the pain
Common Injury and Overuse Related Foot Pains
Morton’s Neuroma is a condition that affects the ball of your foot and the area between the third and fourth toes. With Morton’s neuroma, the tissue begins to thicken around the nerves that lead to your toes. This foot issue is often described as a feeling of something stuck in your shoe near the ball of your feet. It may also feel like you are stepping on a folded sock. Patients may feel a stinging or burning sensation as well as numbness. Morton’s neuroma can be extremely painful and can be debilitating when the pain becomes too great. Morton’s neuroma is fairly serious since long-term compression of this nerve may lead to permanent damage. The symptoms of this condition are often gradual and occur mostly in those who wear narrow-toed shoes, high-heel shoes, or shoes that have a tapered box toe. Individuals with specific foot deformities like hammer toe, flat feet, or bunions are at higher risk of developing this foot pain than other people without these factors, although Morton’s neuroma can also be the result of an injury from athletics or an occupation. Diagnosis of Morton’s neuroma will be performed by your physician through a series of foot and ankle tests.
- Changing footwear may dramatically reduce Morton’s neuroma before it becomes a more serious condition. A prospective clinical series enrolled 115 subjects out of 340 consecutive patients who attended a private orthopedic clinic with a diagnosis of Morton’s neuroma. Out of 57 patients treated only with foot wear modifications, 47 had improvement and required no further treatment.(4)
- You can protect your feet from developing Morton’s neuroma by increasing the padding in specific areas in your shoes. Insoles that help pad or support the metatarsals are ideal in preventing Morton’s neuroma and are inexpensive and easy to find in many stores.
- Topical analgesic creams that carry anti-inflammatory properties can also be beneficial and may reduce the pain of Morton’s neuroma.
- Medical/Orthotic devices can also help prevent and reduce the symptoms of this condition.
- Ice packs can be used to lower inflammation and reduce swelling.
Plantar Fasciitis is a very common form of heel pain and is often described as a “stabbing” pain that is felt most in the mornings. It refers to inflammation in the thick band of tissue that runs along the bottom of your foot (the plantar fascia) and connects the heel to the toes. When this ligament is strained, it becomes swollen, weak, inflamed, and hurts with any pressure. Plantar fasciitis is a very common form of heel pain and is often described as a “stabbing” pain that is felt most in the mornings. For most feet, it takes a while for them to adjust to the pressure that is placed on them in the first moments of the day, but after a while they become accustomed to the exertion and stop hurting. However, the pain commonly returns after long periods of standing or walking throughout the day. When the pain returns, inflammation sets in and the feet become swollen. This condition “occurs in as many as 2 million Americans per year and 10% of the population over their lifetimes.”(5) Plantar fasciitis is common in old age and usually develops between the ages of 40 and 60. Weight can play an important factor as the added pressure creates more stress. If your weight is a concern of yours, it may be important to talk with your doctor about a nutritional plan. This is a great investment in taking care of our feet in the long run. Eating healthy is probably one of the most underlying treatments in battling foot-related pains. Maintaining a healthy weight is a longitudinal treatment for a majority of foot pain. Athletes who place a lot of stress on the heel and surrounding tissue can also develop this condition. Having flat feet or high arches can also lead to plantar fasciitis, as well as incorrect foot mechanics during movement. If your occupation requires you to stand on your feet for long periods of time, there is greater risk of this band of tissue stretching or becoming damaged. Treating plantar fasciitis may be as simple changing the mechanics you use while walking because it will cause less stress on the afflicted area. Other treatments include orthotics or simply a change to more supportive foot-wear or arch support insoles.
Achilles Tendonitis happens when the tendon that is attached to the back of the leg and heel becomes inflamed. This typically occurs at the bottom of the foot and creates significant amounts of pain during walking and/or running. The Achilles tendon attaches these two muscles in the calf area to the heel. They create the power needed to push off the ground or stand on your toes. Long-term stress to the tendon creates tendonitis. Achilles tendonitis is rarely caused by an injury and is usually the result of overuse. Some typical causes are:
- Sudden increase in activity (like running more than usual)
- Jumping a lot (as in volleyball or basketball)
- Not wearing supportive foot-wear
- Tight calf muscles
- Running or walking on hard surfaces
- Many athletes experience damage to the Achilles tendon. One particular study found that out of 331 patients with damage to their Achilles tendon, 275 of the participants reported that the injury was sports related. (6)
Treatment and prevention for this type of tendonitis involves:
- Decreasing the activity that aggravates your symptoms
- Proper shoes that fit correctly
- Walking and running on softer surfaces
- Building strong calf muscles, that help support the tendon
Tarsal Tunnel Syndrome occurs when there is compression on the tibial nerve, which travels along the tarsal tunnel. Tarsal Tunnel Syndrome is severely debilitating because the tibial nerve splits into three sections that connect to the heel and continue at the bottom of the feet. When this nerve is compressed, it creates inflammation and also creates a neural pathway block. This pain can arise due to the following:
- Having flat feet or low arches can compress the tibial nerve.
- Certain diseases like arthritis or diabetes can also produce swelling, which adds stress to the tibial nerve.
- Ailments such as bone spurs, inflammation of the tendon sheath, cysts, nerve ganglions, or typical swelling that would arise
- from a sprained or broken ankle, also compress the tibial nerve.
- Numbness in the foot between the big toe and the middle three toes
- Pain around the ankles and heel
- Swelling is likely to occur
- Burning or stabbing sensations
- Pain may also travel up and down the leg where the nerve is present and is typically present when walking or even standing.
Treating TTS may be as simple as:
- Resting the afflicted foot
- An orthopedic “boot” may also be prescribed to prevent further stress of the Tarsal Tunnel.
Deformities can occur when we spend lengthy hours on our feet wearing tight shoes that bind the toes and feet in abnormal ways. Squishing the toes into abnormal or uncomfortable positions for long periods of time results in improper circulation, swelling and inflammation, and the inability to walk correctly without the sensation of pain. Another typical cause is from walking improperly because it places stress on the toes. However, not all deformities are foot-wear or improper walking related: “Certain diseases affecting muscle and nerve function can cause ligaments and tendons to tighten leading to a deformity. This can occur with Diabetics, alcoholics, stroke victims, and patients with osteoarthritis and rheumatoid arthritis.”(3) These deformities are not only very painful, but can often prevent everyday mobility and sometimes even total immobilization. One known deformity is called Hammertoe. Hammertoe is a painful foot condition that often occurs simultaneously with bunions and is usually created by improper walking or footwear. Hammertoe typically affects the second toe in the middle of the joint and causes it to rise up while forcing the rest of the toe to bend down toward the floor. This is most likely due to the fact that it puts pressure on the middle of the joint. This pressure can add more stress and friction to the middle of the toe which can result in bunions or calluses. When the toe bends down at the joint closest to the ends of the foot, this is when Mallet Toe can occur. Mallet Toe is extremely painful as it puts pressure on the ends of the toes which are highly sensitive. Calluses form at the ends of the toes and can be quite debilitating. Mallet toe can happen in any of the toes but is most commonly found in the second toe. Clawtoe can occur when the toes bend up at the joint where they attach to the foot. This usually affects the four smaller toes simultaneously. The way the toes bend down at the base joint gives the toes their “claw” like shape. Clawtoe is extremely painful and affects multiple toes simultaneously.
Most of these deformities can be prevented by wearing the proper footwear. If you have changed footwear and still seem to see the same symptoms of these deformities, it is advisable to consult an orthopedic specialist so that you can find what best works for you. The symptoms of deformities in the phalanges are often identifiable, so the first sign of immediate pain or appearance of deformation should be examined by your physician. Deformities can happen to anyone, but are most likely found in individuals who are on their feet several hours a day while wearing ill-fitting shoes. Consult with your physician or a podiatrist to decide on what kind of shoes may be right for you. Your physician may prescribe orthotics or an assistive device to help you return to pain-free mobility. Toe deformities can be genetic but are usually identifiable at a younger age. However, if they are a result of years of improper walking or running in ill-fitting shoes, they may be harder to detect or diagnose. At the first sign of irregularity or pain, you should consult your physician, so that the minimum amount of damage is done. Time is of the essence and those who may be “used to” the chronic pain, may be unaware that anything is really wrong at all. The longer it takes for an individual to see the doctor and treat their condition, the worse the disorder can become, affecting other areas of the body like the leg and ankle.
Genetic Foot Conditions:
Flat Feet (or posterior tibial tendon dysfunction) is a condition where the arches of the foot are so low that a majority of the sole of the foot touches the floor. Flat feet can be caused by the arches not developing as a child, an injury, or general wear from age. An estimation of 20-30% percent of the world’s population has flat feet. (7) Although having flat feet is not necessarily a painful issue in the foot itself, problems may arise in the ankles and knees due to the misalignment that flat feet create. Pain is usually experienced after long days on the feet. Without a proper arch there to support the placement of the foot, the amount of pressure placed on the bottoms of the soles can create soreness. Another disorder involving the arches, is cavus foot. Cavus Foot, also known as high-arch foot, is a disorder where the arch of the foot is abnormally high. Pain is usually the result of excess pressure on the ball of the foot, heel, and metatarsals. Having high arches is less common than flat feet (low arches) and is reportedly more painful. Fitting in to the right kind of shoes is quite difficult with this disorder and most sufferers require arch support insoles in their shoes. In most cases, Cavus foot is a result of having a neurological disorder or other similar medical condition like cerebral palsy or muscular dystrophy, however other genetic abnormalities may be also be a factor. Having this condition may even lead to hammertoe. Painful calluses may also form on the ball or sides of the feet. A review of your medical history by a physician would be needed to successfully diagnose cavus foot.
Taking care of our feet in order to prevent foot pain is one of the best investments we can make in our lives. As age plays a critical role in certain types of foot pain, it is important to be proactive and start the process of caring for your feet early. Foot injuries are never to be taken lightly, as these injuries can affect other parts of the body like the ankle, leg and even the functionality of the knee. Our feet transport us everywhere we venture throughout our entire lives; this should be enough motivation to take care of them while we still have the opportunity to ensure a life free of foot pain. The following tips are a great way to care for your feet:
- Maintain a healthy weight: As we get older, we often put on more weight. This added weight can create unnecessary stress and pressure on the tendons, bones, and joints that work inside our feet.
- Eating healthy is one of the most common and successful path to preventing and treating foot pains and disorders, because it not only keeps our weight managed but there are also foods out there that help reduce inflammation in joints and muscles.
- Foods that are high in omega-3s are a great example of an anti-inflammatory food. There are also a variety of fruits that contain anti-inflammatory ingredients, but also contain healthy antioxidants as well. It is always a good idea to consult your doctor before beginning any sudden diet or nutritional plan.
- If there is general swelling, inflammation and soreness, consider your type of foot-wear. Maybe you need to find a better pair for your unique feet.
- Search for orthotics or foot-wear that meet your specific requirements and decide if you need insoles that support or raise the arch or soles of the feet.
- You can treat the pain and swelling with ice packs which will reduce inflammation and minimize the pain.
- A warm soak can also relieve the pain for general soreness in the feet.
- Topical analgesics that contain anti-inflammatory properties can also be applied.
- You and your doctor may decide on specific assistive devices if the pain in your feet becomes too chronic and severe. Walker, canes, braces (or boots), and orthopedic shoes may be prescribed by your physician to help keep you mobile if your foot pain becomes debilitating.
- Remember the importance of rest when it comes to reducing inflammation and giving fractured bones a chance to heal.
- Whenever you experience an injury in your feet, seek the attention of a medical professional immediately.
- Holmes, George B M.D., Lin, Johnny M.D., Lee, Simon M.D. Garras, David N M.D., Foot and ankle injuries in athletes, Midwest Orthopedics, 2004.
- Truven Health Analysis, Foot fractures in adults, Allina Heath, 2014.
- Your Practice Online Presents: Common toe deformities, multimedia health education, Nov 2008. (8)
- Bennett GL, Graham CE, Mauldin DM. Morton’s interdigital neuroma: a comprehensive treatment protocol. Foot Ankle Int.1995; 16:760-763.
- Bronner, S. 6 Physical therapist guide to plantar fasciitis, Move Forward Physical Therapy; Nov 28: 2011.
- Raikin S., et al. Achilles tendon injuries in a United States population. Foot Ankle Int. 2013 Apr; 34 (4): 475-80.
- Franco, Abby Herzog. Pes cavus and pes planus analyses and treatment. Physical Therapy; 67 (5): 688