Owww…my Feet Hurt!

July 11, 2016

Do your feet hurt? We don’t think about our feet until they are in pain.  What are the primary causes of foot pain?  What can a sufferer do to get relief?  What is the best footwear to wear to combat foot pain?

Dr. Donald Beck

Dr. Donald Beck

Donald W. Beck, D.P.M., fellow of the American Board of Podiatric Medicine and president of the medical staff at UPMC McKeesport said that “the four most common conditions I see in my practice that cause foot pain are plantar fasciitis, extensor tendonitis, corns and calluses, and halloux abducto valgus commonly referred to as bunions.”

“The plantar fascia is structure in the bottom of the foot that inserts at the heel, travels through the arch, spreads out and inserts at all five metatarsal heads,” says Dr. Beck.  “In most cases, the pain of plantar fasciitis is centered at the heel at the medial and central insertions rarely do you have pain at the lateral insertion.  You can have pain in the arch with this and it is rare to have pain in the metatarsal insertions.”

Richard Sedillo, PT, COMT (Certified Orthopedic Manual Therapist) of Arizona Manual Therapy Centers  says that “foot pain can be cause by problems relating to low back, hip or knee dysfunction. Foot pain often is the result of poor choice of foot wear. All too often females care more about looking good then wearing shoes that fit well.”

“One common problem is that often women wear shoes with a narrow toe box and the toes are pushed inward altering the mechanics of the foot and the gait,” says Sedillo.  “This often causes bunions.”

“High arch or flat feet often results from hip restriction or congenital abnormalities,” says Sedillo.   “Foot pain often is the end result of stiffness in the joints of the lower leg/ankle and foot.  When the joints are restricted, the muscles begin to strain, which cause pain and inflammation and more stiffness.”

Richard Sedillo

Richard Sedillo

How can the pain be treated?  “One way I instruct my patients to manage foot pain is to self-mobilize the foot soft tissues and joints,” says Sedillo.  “Proper shoe insoles will help to support the arches of the feet. Other treatments for foot pain include wearing compression socks, and stretching and icing daily. I always recommend icing feet at the end of the day before bed.”

“There are many treatments for plantar fasciitis:  Stretching exercises, ice, low dye strappings, and NASIDS, arch supports and orthotics, night splints, cortisone injections, and in severe cases there are surgical treatments,” says Dr. Beck.

“The extensor tendons run from the top of the foot and insert on the toes,” said Dr. Beck.  “The treatments for extensor tendonitis are NSAIDs, occasionally cortisone injections, but most importantly the change in shoe wear.”

Corns and calluses are areas of hard skin formed in reaction to pressure on the skin.  Corns are formed on the top of the foot on boney prominences in reaction to pressure.  “You can also get a form of corn called a ‘soft corn’ in between toes where bones rub together,” says Dr. Beck.  “Calluses are areas of areas of hard skin caused by pressure on the bottom of the feet.  The causes can be a structural deformity of the foot or a biomechanical deformity of the foot.  Treatment can be a ‘debridement’ of the area of hard tissue with padding applied to remove areas of pressure and also evaluation of shoe wear to determine if this is the cause of the problem.”

“Hallux abducto valgus (bunion) is a medial deviation of the first metatarsal head with a lateral deviation of the distal aspect of the great toe,” says Dr. Beck.  “Treatment of this could be padding to the area to relieve pressure off the bone, switching to appropriate footwear or surgery.  If the first metatarsal phalangeal joint range of motion is normal and pain-free a surgery procedure is not recommended because you will end up with a straighter toe that will cause you pain for the rest of your life. Conversely, if there is pain on a range of motion, the patient is apt to be satisfied with the procedure.”

Shoe wear can play a role in treating all four conditions.  “In plantar fasciitis, negative heel shoes, i.e., Earth shoes, can bring on bouts of plantar fasciitis,” says Dr. Beck.  “Slip on shoes with no support and especially the habit of wearing no shoes at home seems to bring on this condition.  Surprisingly, high heel shoes will relieve pressure off the plantar fascia and in many patients will give relief.”

“Extensor tendonitis is commonly caused by the tongue of an athletic shoe is too tight on the top of the foot and slip on shoes with elastic at the top of the foot,” says Dr. Beck. “Many people buy these shoes early in the day and don’t realize their feet can be puffier at the end of the day and this helps to bring on this condition.”

Corns especially can be caused by ill-fitting shoes.  “If a shoe is not wide enough at the toes, corms will form on the top of the toes especially if a hammer toe deformity is present,” says Dr. Beck. “Shoes that are not wide enough at the toes may cause soft corns between the toes.  Calluses may worsen by the wearing of high-heel shoes which shifts your weight onto the metatarsal heads and by very thin sole shoes that give no protect to the metatarsal heads.”

“Problems with Hallux abducto valgus (bunions) can be brought on with too narrow of a shoe and high heels which can throw the bunion into the side of the shoe,” says Dr. Beck.

So what is the ‘right’ shoe to wear?  “The proper shoe wear for comfortable feet is a well-fitting, tie shoe with a good built in arch support where the tongue is not snug against the top of the foot,” says Dr. Beck.

“In women shoes, a low broad heel is recommended with wide toe box or a low heeled shoe with a thicker sole.”

REMEMBER, life is short, eat dessert first and it is more enjoyable when wearing comfortable shoes.

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