By the age of 50 you will have walked about 75,000 miles, according to the American Podiatric Medical Association (APMA). With each step, one-and-a-half times your body weight comes down on each foot. Start to run and that amount increases to three to four times your body weight (more than 400 pounds!). Your feet have 26 bones, 33 joints, and 100 tendons, muscles and ligaments. Given their heavy use — and potential for injury — it’s no wonder that, according to the APMA, 77 percent of Americans suffer from some sort of foot pain that impacts work, exercise, walking and even interactions with friends and family.
- Genetics: Certain foot characteristics, like high or flat arches, and deformities like bunions and hammertoes are all largely genetic. “People are living longer, more active lives so foot deformities have more time to cause problems,” says Lowell Weil, Jr., DPM, president of Weil Foot & Ankle Institute.
- Excess body weight: Carrying around extra body weight adds additional strain to feet, especially when any of the above genetic characteristics or deformities are present.
- Overuse from exercise: The push to get people exercising has led to overuse injuries from too much too soon, or too little time allowed for tissues to recover between activities.
- Age-related foot changes: Aging causes a loss of elasticity in muscles, which can lead to strains and tears. Diminished bone density also often accompanies aging and can result in stress fractures in the feet.
- Poor footwear: Women are particularly guilty of forcing their feet into narrow-toed, high-heeled, or ill-fitting shoes, all of which can create an array of issues and injure the feet.
- Previous injury: Past injuries can leave ankles weak, with little flexion, or cause tight muscles of the lower leg, all of which can lead to strain further down in the feet.
Now that you know which factors most often contribute to foot pain, here are the most common foot injuries and ailments and what you can do to prevent or alleviate them and the pain they cause.
“Plantar Fasciitis is becoming an epidemic,” Weisman says. It is estimated that 10 percent of the population suffers from the condition. The plantar fascia is a ligament on the sole of the foot that supports the arch and connects the toes to the heel. Inflammation of this ligament can cause moderate to debilitating pain when standing and walking. “The pain is most noticeable in the morning or after a period of sitting, when the ligament is short and tight,” Weisman says. He attributes the increase in cases of plantar fasciitis to overuse, inappropriate footwear, tight muscles of the lower leg and excess body weight. Weil notes greater incidence of plantar fasciitis in patients with flat feet and those with high arches. When your arch is working properly, it works to distribute weight throughout the foot with each strike. When the arch is not supported properly, the foot rolls too far inward, or “overpronates,” which can lead to plantar fasciitis.
Recommended treatment options:
- Warm the feet and lower legs before getting out of bed or after periods of sitting. Practice plantar flexion and dorsiflexion before you stand.
- Wear shoes that support your arch at all times, even in your house. Flat shoes like flip-flops aggravate plantar fasciitis as the arch collapses inward with each step.
- Choose non-weight-bearing exercise like swimming, biking or lower-impact elliptical running.
- Work to stretch tight muscles in the lower leg and improve ankle flexion.
- Consider wearing a night splint, which keeps your foot in dorsiflexion as you sleep, preventing the shortening of the ligament.
- Consider purchasing over-the-counter orthotics or a prescription version from your physician or physical therapist.
- Physical therapy may help you strengthen and stretch muscles higher up the chain that are causing your plantar fasciitis.
Check out this four-minute video for some great suggestions for preventing and treating plantar fasciitis:
“Bunions (hallux valgus) are a structural deformity of the first metatarsal, usually caused by a genetic predisposition,” explains Weisman. A bunion is an enlargement of the joint of the big toe, which starts to lean towards the second toe, eventually leading to a bony prominence that is very apparent, and often times, inflamed and painful. Bunions can get progressively worse, aggravated by standing for long periods and narrow-toed shoes. Bunions may cause other issues like corns, calluses, ulcerations and infection as the bunion creates friction with your shoe. Compensating for the bunions may cause soft tissue injuries and bursitis.
Weisman recommends the following strategies to alleviate bunion pain:
- Avoid wearing high-heeled shoes, or shoes with narrow toe boxes that aggravate bunions.
- Choose shoes with a wide toe box and soft uppers like Birkenstocks.
- Unload the bony prominence with arch supports provided by a shoe or orthotic.
- Utilize pads specifically made for bunion pain to eliminate friction and unload the bunion when wearing shoes.
- Avoid long periods of standing when possible.
- Consider surgery when your bunion begins impacting your daily life. Weisman notes that bunion surgery has improved dramatically, resulting in an 85 to 95 percent satisfaction rate.
Morton’s neuroma is a thickening of the nerve tissue between the third and fourth toes of the foot. The pain the condition creates in the ball of the foot can be debilitating and has been described as feeling like a rock is in your shoe. “Morton’s neuroma is often caused by narrow-toed, high-heeled shoes, and is preventable,” Weisman says. For those with other foot problems like bunions and hammertoes, a Morton’s neuroma may develop. The condition is often cured with a simple switch to lower-heeled shoes with a wider toe box, though more involved treatment is needed for persistent cases.
“Pain in the ball of the foot is often misdiagnosed as Morton’s neuroma,” Weil explains. “Deformities of the bones in the ball of the foot are sometimes the actual problem. An overly long second metatarsal bone (one of the five long bones in the middle of the foot) may cause pain, damage to a ligament, a change in toe position and even dislocation of the toe joint,” Weil says. The Weil Osteotomy is a surgery to treat metatarsalgia. During the osteotomy procedure, the bone is cut and moved to a correct position. Ligament repair is also completed, if necessary. Patients are generally back to walking, in running shoes, within a week of the surgery.
Stress fractures are very small fractures in the foot that are often not visible on an X-ray. “Stress fractures in the foot are caused by repetitive, small traumas to the foot,” Weisman explains. They are most commonly experienced by walkers, runners and those new to exercise, as well as by people with lower bone density like older women or younger athletes. Most stress fractures are caused by overuse during weight-bearing activities. The pain is usually felt during activity, but can become constant. Rest is the first course of treatment, which may also involve a walking boot to unload the foot.
Preventing a stress fracture is key:
- Check with your physician to ensure your intake of calcium and vitamin D are adequate for optimal bone health.
- Keep your body weight at a healthy level.
- Wear supportive footwear, appropriate for the activity, i.e., running shoes for running.
- Always warm up and cool down before workouts.
- Increase your activity level gradually, allowing bones and muscles to adapt.
- Include non-weight-bearing activities in your exercise routine.
- Make sure to include stretching and strengthening of the muscles of the foot, ankle and lower leg in your routine.
Toenail Fungal Infection
Toenail fungus is at best unattractive, and at worst will cause pain and even spread to other nails and the skin of your feet. Toenail fungus appears as a thicker, yellowing, brittle nail that may separate from the nail bed, and may even give off a foul odor. Warm, moist environments, like showers, swimming pools, or sweaty shoes, can cause fungal infections. Weisman suggests genetics may make you more susceptible to experiencing toenail fungus. Those with weaker immune systems are also more likely to contract it. Topical, over-the-counter treatments can be successful for those with a mild infection; Weisman has also found the prescription Jublia to be effective in about half of cases.
To avoid nail fungal infections:
- Wear protective shoes at all public pools or showers where your feet might come in contact with an infection.
- Wash and dry your feet thoroughly, including between all toes.
- Wear breathable shoes and socks whenever possible. Change out of wet socks quickly.
- Allow your feet time to breathe each day.
- Keep toenails trimmed to the edge of each toe.
- Use sterile instruments on your feet.
- Ensure the tools used at your salon are sterile. Consider bringing your own.
Plantar warts are caused by a viral infection and impact the bottom of the foot. More apparent when wet, they look like a small hole in your foot. When dry they appear flatter and less noticeable. Plantar warts can spread and become painful, especially if located on the heel or ball of the foot. Many go away on their own, especially in youth, but over-the-counter and prescription treatments can also be effective. Mild cases can be treated by placing duct tape overnight on a wart that has been soaked in water. Pull the duct tape off in the morning and file the wart down. Repeated treatments may result in elimination of the wart.
For optimal overall foot health, Weil recommends wearing running shoes whenever practical. “Running shoes put your foot in the best mechanical position possible,” he says. Weil particularly likes Hoka shoes, which are light, but offer a supportive, firm sole.