Foot Pain

The foot has a complicated anatomy of 26 bones and 33 joints, layered with a web of 126 muscles, ligaments, and nerves. It serves the following functions:

• Supports weight.
• Acts as a shock absorber.
• Serves as a lever to propel the leg forward.
• Helps to maintain balance by adjusting the body to uneven surfaces.

Since the feet are very small relative to the rest of the body, the impact of each step exerts tremendous force upon them. This force is about 50% greater than the person’s body weight. During a typical day, the average person spends about 4 hours on their feet and takes nearly 10,000 steps. This means that the feet support a combined force equivalent to several hundred tons every day.

Given what the foot must endure, it is not surprising that about 75% of Americans experience foot pain at some point in their lives.

Foot pain is generally defined by one of three sites of origin:

1. The toes. Toe problems most often occur because of the pressure imposed by ill-fitting shoes.
2. The front of the foot (forefoot). Pain originating in the front of the foot usually involves one of the following bone groups: the metatarsal bones (five long bones that extend from the front of the arch to the bones in the toe); or the sesamoid bones (two small bones imbedded at the top of the first metatarsal bone, which connects to the big toe). Foot pain in the “ball of your foot” is generally called metatarsalgia (met’-a-tar-sal’-gee-a).
3. The back of the foot (hind foot). Pain originating in the back of the foot can affect parts of the foot extending from the heel, across the sole (known as the plantar) to the ball of the foot.

There are many diverse causes of foot pain:

• Callus that forms on the bottom of your foot. A callus is a build-up of skin that forms in response to excessive pressure over the bone. By itself a callus is not painful, but the build-up of skin can increase the pressure and making walking uncomfortable.
• Shoes that are too tight or too loose. Tight shoes squeeze the foot and increase pressure; loose shoes let the foot slide and rub, creating friction. High-heeled shoes concentrate pressure on the toes and are major culprits for aggravating, if not causing, problems with the toes.
• A torn ligament or inflammation of the joint in the foot. It is best assessed by an orthopedic doctor.
• Temporary Changes in Foot Size and Shape. Temperature, and therefore weather, affects the feet: they contract with cold and expand with heat. Feet can change shape and increase in size by as much as 5% depending on whether a person is walking, sitting, or standing.
• Poor Posture. Improper walking due to poor posture can cause foot pain.
• Medical Conditions. Any medical condition that causes imbalance or poor circulation can contribute to foot pain, including diabetes, arthritis, osteoporosis, many disorders of the nervous system.
• Inherited Conditions. Inherited abnormalities in the back, legs, or feet can cause pain.
• High-Impact Exercising. High-impact exercising, such as jogging or strenuous aerobics, can injure the feet. Common injuries include corns, calluses, blisters, muscle cramps, acute knee and ankle injuries, plantar fasciitis, and metatarsalgia.

Risk factors for developing foot pain include:

• Gender
• Occupational hazards
• Sports and dancing
• Medical and physical conditions
• Smoking

Prevention:

• If the pain persists, do not ignore it, see a podiatric physician.
• Inspect feet regularly. Pay attention to changes in color and temperature of the feet. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet could indicate athlete’s foot. Any growth on the foot is not considered normal.
• Wash feet regularly, especially between the toes, and dry them completely.
• Trim toenails straight across, but not too short. Cutting nails in corners or on the sides increase the risk for ingrown toenails.
• Wear shoes that fit properly. Purchase new shoes later in the day when feet tend to be at their largest and replace worn out shoes as soon as possible.
• Select and wear the right shoe for specific activities (i.e., running shoes for running).
• Alternate shoes. Don’t wear the same pair of shoes every day.
• Avoid walking barefoot, which increases the risk for injury and infection. At the beach or when wearing sandals always use sun block on the feet.
• Be cautious when using home remedies for foot ailments; self-treatment can often turn a minor problem into a major one.
• It is critical that people with diabetes see a podiatric physician at least once a year for a check-up. Persons with diabetes, poor circulation, or heart problems should not treat their own feet, including toenails, because they are more prone to infection.

Skin creams can help maintain skin softness and pliability. Taking a warm footbath for 10 minutes two or three times a week will keep the feet relaxed and help prevent mild foot pain caused by fatigue. Adding 1/2 cup of Epsom salts increases circulation and adds other benefits. Pumice stone or loofah sponge can help get rid of dead skin.

Reflexology is an Eastern massage therapy that manipulates hands and feet. A pleasant exercise using this method can be done while taking a bath. Use the thumb, index, and middle finger to rotate each toe in a circular motion. Then, make a fist and rotate it slowly around the bottom of the foot. Finally, gently twist each foot as if wringing wet clothes, moving the top and bottom in opposite directions.

Gentle stretching and heel lifts after warm-up and before running can help prevent Achilles tendonitis and heel pain.

A person should prepare for long hikes by putting moleskin pads on the heel and other parts of the foot that might be rubbed by the shoe. At the end of a hike, the foot should be checked for irritation and redness. Antiperspirant spray on the feet before a long hike can help prevent blisters.

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat mild pain caused by muscle inflammation. Aspirin is the most common NSAID. Others include ibuprofen (Motrin, Advil, Nuprin, Rufen), ketoprofen (Actron, Orudis KT), naproxen (Aleve, Naprelan), and tolmetin (Tolectin). A gel containing ibuprofen can be applied to sore joints. Acetaminophen (Tylenol) is not an NSAID, and although it is a mild pain reliever, it will not reduce inflammation. It is important to note that high doses or long-term use of any NSAID can cause gastrointestinal disturbances, with sometimes serious consequences, including dangerous bleeding. No one should take NSAIDs for prolonged periods without consulting a physician.

Treatment:

• Shoe inserts (orthosis) as a kind of shock absorber may alleviate pain.
• Sometimes, simply buying shoes that fit properly can solve the problem. Shoes should have a wide toe box that doesn’t cramp your foot.
• Soaking your feet to soften calluses, then removing some of the dead skin with a pumice stone.
• Occasionally, surgery may be necessary to remove a bony prominence or correct a deformity.