What To Do Do About Foot Pain?
Most of us don’t appreciate our feet. We use them for the majority of our daily and physical activities yet we don’t reciprocate with adequate maintenance. Then when our feet eventually complain in the form of pain we spend a lot of money searching for the solution in the form of new footwear, orthotics or injections. Our feet, like any other part of the body, require proper synergy between joints, connective tissues and muscles to function properly. It makes sense then to ensure the parts of the feet are working correctly before seeking expensive quick fixes.
Before listing off a bunch of do’s and don’ts for foot exercises it is important to have a basic understanding of the structures in the foot. There are 26 bones and over 100 soft tissue structures (ligaments, tendons, muscles ect) in a human foot. They all work together in such a way that forms arches. These arches are what allow the feet to support our body weight and also act as springs that are important for propulsion as we move our bodies. If any one of the bones or soft tissue structures is not functioning properly, then it can impair the entire foot and ultimately result in dysfunction and pain. Like any other body part we want to ensure that the foot has proper mobility (range of motion) before we should move forward with building strength.
Let’s start with some things to avoid as your first intervention:
- Complete rest is likely not best. A reduction in offending activity is most likely needed to calm down irritated tissues but too much rest can delay recovery and cause additional problems. Soft tissue requires a certain amount of stress to prevent loss of strength and muscle atrophy. Maintaining a healthy amount of stress through targeted exercise is ideal for proper recovery.
- Orthotics, over-supportive footwear or heavy taping. It is the same concept as too much rest, if there is no stress placed on the foot structures because the footwear, orthotics ect are doing all of the supportive work, then those muscles will lose their strength, balance, endurance ect. These have a time and place but be aware that they can mask the source of dysfunction.
- Ignore your pain. This is one of those instances where “No Pain, No Gain” likely does not apply. If activity is exposing dysfunction in the foot resulting in pain, more activity will likely result in more irritation of those tissues and ultimately more pain.
- Anti-inflammatory pills, creams, and/or injections as a primary treatment. Let’s say, for example, that you are over pronating, which places too much stress on the mid foot and leads to inflammation of the surrounding tissues. Taking some form of anti-inflammatory medication will likely help reduce the inflammation (temporarily) but the cause of the problem is not corrected and your symptoms will return. This temporary reduction in pain may allow you to resume the activities that caused injury in the first place and risk more damage.
So what to do?
Restoring proper function of the joints and muscles is important. It can help correct the root cause of symptoms and allow for additional interventions, such as orthotics, to be utilized more effectively.
The first step is to reduce the offending activities and replace them with targeted exercises to place a healthy dose of stress on the structures of the feet. Try these mobility drills and stretches to help ensure that the joints in the foot and ankle are moving properly.
Plantar rolling: This can help relieve tension in the bottom of the foot and even up the back of the leg.
Foot and Ankle mobilizations: Passively moving the joints can help reduce tension in the joints and joint capsules and improves range of motion.
Calf stretching: Introducing some length to the calf muscles (gastroc and soleus) will not only loosen those muscles, but reduce tension on the Achilles tendon.
Active range of Motion: Actively taking your joints through their full range of motion (with control!!) will incorporate the nervous system to improve the function of the foot and ankle.
Eccentric calf raises: This is an effective way to build up strength in the calf muscles and has been shown to reduce pain in the Achilles tendon.
Single leg balance: Beneficial to improve balance and proprioception (how our brain knows where our joints are in space)
-Orthotics: Orthotics can be a powerful intervention to help support the foot when prescribed properly. They are often over prescribed and can potentially prevent/delay recovery if they are not the proper intervention. If symptoms persist once full ROM and strength is restored, then a referral to a professional, such as an orthotist, should is warranted.
-Injections: Ah the quick fix injection. Again there is a time and a place for everything but masking symptoms with a steroid injection can result in problems down the road. If injection therapy is warranted, recent research has shown that Platelet Rich Plasma (PRP) is a more effective option for conditions such as plantar fasciitis when compared to steroid injections 1,2 . Put in the work to improve strength and mobility as injection therapy, which is comparatively more invasive, can be considered later on.
-Footwear: Footwear is an in-depth and controversial topic that can easily take up an entire blog on its own. There is also not a blanket answer that applies to everyone. Each person’s feet, arches, pain and activities are all different, and thus require different footwear. A couple tips when it comes to footwear:
- Utilize at least 2 different sets of shoes for you activities
- If you make any changes be sure to ease into your new style of footwear
- Don’t wear worn out shoes.
-Maintenance! Don’t wait for the feet to ache, show them some TLC by frequently rolling, stretching and spending time barefoot. Your feet will thank you!
- Kowshik, J et al. 2015. Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study. The Foot, Volume 25, Issue 4, page(s) 235-237.
- Rocco Monto, R. 2014. Platelet-Rich Plasma Efficacy Versus Corticosteroid Injection Treatment for Chronic Severe Plantar Fasciitis.. Foot and Ankle International. Volume: 35 issue: 4, page(s): 313-318