Sunday, March 18, 2018

What causes foot pain and how to deal with it

Imagine walking around the earth — about 25,000 miles — four times. That's how many miles the American Podiatric Medical Association estimates the average person puts on his or her feet in a lifetime.

But most of us don't pay much attention to our feet until they hurt — and sometimes we wait until they really hurt.

That's too bad. Because if you seek help early, "most people can be treated with conservative measures," said Dr. Heidi Stephens, a foot and ankle surgeon and associate professor of orthopaedic surgery at USF Health.

Address your foot pain early, and you'll likely relieve it with simple measures such as bracing, taping, padding, stretching, changing shoes, placing orthotic inserts in shoes, taking anti-inflammatory medication or steroid injections.

If all that fails, then "we talk about surgical options," Stephens said.

Most foot problems can be prevented, and the ones that can't — bunions, for example, may be genetic — can at least be minimized with commonsense measures.

And that doesn't mean being sentenced to life in ugly shoes.

"We know we're fighting a losing battle on that one," said Dr. Timothy Runyon of St. Anthony's Hospital and the Tampa Bay Sports Medicine Center in St. Petersburg.

"Women love their high heels. Instead, I try to educate women and help them at least find the appropriate high-heeled shoes and make sure they fit properly."

More on that later. First, take a load off your feet and read about the most common foot problems and how to deal with them.

1. Bunions

Bunions are those bony bumps on the side of the foot at the base of the big toe. As they grow, they cause the toe to turn in, toward the second toe.

Causes: Genetics, foot shape, flat feet and wearing tight shoes all put too much pressure on the big toe joint.

Symptoms: Pain, redness and swelling at the base of the big toes; other toes may become painful as the big one crowds them.

What to avoid: High heels, narrow shoes and shoes with a pointed toe box.

What to do: Anti-inflammatory medication, orthotics in shoes to improve arch support and relieve pressure on toes, wearing a foot splint at night.

Next steps: When other toes become painful, you can't find comfortable shoes or daily activities are disrupted, you might consider surgery. Most procedures involve shaving down the bump and realigning the bones of the big toe; usually outpatient. Recovery varies depending on procedure chosen. "The one I like has you walking without crutches in two or three days," said Stephens. "You can do low-impact exercise in two months and high-impact in three months. No shoe shopping for six months."

2. Heel pain or plantar fasciitis

Plantar fasciitis strikes along the bottom of the foot, the ligament that supports the foot arch and connects the heel bone to the toes.

Causes: A weak arch that allows the foot to roll inward, or pronate; flat feet; tight calf muscles or Achilles tendons; running, walking or standing for long periods especially on hard or irregular surfaces; aging; being overweight; wearing shoes that don't fit well, are worn out or are poorly cushioned.

Symptoms: Pain while walking or standing, especially with first steps of the day or after rest. You may find pain improves with activity, then worsens as the day progresses. Foot pain while climbing stairs or standing on toes (to reach high, for example) also is a sign to watch for.

What to avoid: Don't go barefoot; take a break from pounding exercise like running and jumping rope.

What to do: Stretch the foot and calf muscles with simple exercises throughout the day. Wear shoes with good arch support and well-cushioned soles. Try orthotics to improve arch support and cushion the heel. Lose weight. Try anti-inflammatories. In severe cases, steroid injections, physical therapy or wearing a walking cast to force the foot to rest can be tried.

Next steps: Only about 5 percent of people may need surgery, which usually involves cutting the plantar fascia ligament to release tension along the bottom of the foot. According to Stephens, patients can be up and walking within a couple of days and must wear a protective boot for two to three weeks.

3. Neuroma

Also known as Morton's Neuroma, this is a swollen, thickened nerve in the ball of the foot that can feel like your foot's on fire.

Causes: Toes squeezed together because of tight, narrow shoes, especially high heels.

Symptoms: Sharp, shooting, burning pain in the ball of the foot (usually between third and fourth toes) that worsens with walking.

What to avoid: Tight, high-heeled and/or pointed shoes. Sports and activities that put pressure on the toes.

What to do: Get shoes with lots of toe room; use ice and anti-inflammatories. Get pads for the ball of the foot. Use a device that spreads the toes so they don't squeeze the nerve. Try steroid injections.

Next steps: "This is one you want to treat early to prevent chronic inflammation and swelling, which can cause a wad of scarring around the affected nerve," said Stephens. If it gets too severe, surgery can be performed to remove the affected nerve through an incision on the top of the foot.

4. Achilles tendon problems

Also known as tendonitis, this involves the tendon that connects the calf muscle to the heel bone and allows you to stand up on your toes or push off from your toes when you walk or run. Overuse and abuse, such as during sports, can cause tiny tears in the tissue around the tendon. In severe cases, the tendon can tear or rupture completely.

Causes: This can happen to athletes who engage in repeated pushing off or stop and go movement. But it also happens to out-of-shape middle-aged people who suddenly put a lot of stress on the tendon, or who fail to warm up before exercise. Shoes with poor arch support can be a factor. But an actual rupture usually only happens during vigorous exercise or sports.

Symptoms: Swelling in the ankle area, mild to severe pain that may come on gradually or occur only with walking and running. Athletes notice weakness, less foot strength or less movement in the ankle. A rupture of the tendon usually causes a sudden, sharp pain, a popping sound and collapse.

What to do: Rest — for weeks or even months. Anti-inflammatories, stretching, well-cushioned shoes, shoe inserts such as a wedge-shaped heel lift. Immobilizing the ankle with a walking boot or a lace-up brace. "For many athletes, the ankle brace is all they need to continue their sport," said Stephens. Physical therapy may be prescribed.

Next steps: In severe cases, surgery can be performed to repair the tears or reattach the ruptured ends of the tendon.

Wait! There's more!

More reasons your feet hurt:

Calluses, corns, blisters: Generally develop from poorly fitting shoes or even socks.

Warts: Caused by a virus and can spread. May need to be professionally removed.

Ingrown toenails: Avoid by keeping nails cut straight across.

Toenail fungus, athlete's foot: Can be addressed by keeping feet dry, changing shoes and socks often, avoiding tight shoes. If you get pedicures, bring your own instruments and sanitize them at home. Medication and laser therapy are available for fungus if it's really bothersome.

Swelling of feet or ankles: Can be caused by poor blood flow, injury, medication side effects, heart, liver, kidney disease. If one leg swells painfully, you may have a blood clot. Seek medical help right away.

Peripheral neuropathy: Poor blood flow to the feet; bumps and sores become easily infected. Caused by diabetes and certain drugs, particularly those for cancer.

Arthritis: May cause painful deformity of the toes.

Gout: Causes pain, redness, swelling in big toe. See your doctor. Medication and diet changes can help.

Heel spurs: A bony growth usually from ill-fitting shoes, standing for long periods or being overweight.

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