Being hunkered down at home has the potential to cause two common foot problems in one of two ways: You may have become more sedentary than usual, or if you’re a runner or other sportsperson you may have taken the opportunity to increase your weekly mileage or up your exercise program. In either case, foot pain may be lurking. So, here’s some general advice to keep your most important mode of transportation pain-free and healthy during this difficult time.
Whether you’ve become more active or more sedentary, being at home almost certainly means you’re going barefooted more than usual. Now, for any foot type-- “flat feet” or “high arches”-- being barefoot for long periods of time may lead to two common foot complaints: Plantar Fasciitis and Metatarsalgia. Let’s take a look at these two conditions and discuss what you can do to avoid them; or, if they've already raised their ugly heads, what you can do to ease the pain.
1. Plantar Fasciitis
The plantar fascia is a thick band of tissue that runs along the sole of the foot from the heel to the toes. The role of the plantar fascia is to support the arch. When the foot bears weight, the fascia is placed under tension and stops the arch from flattening out too much. When the fascia is placed under too much tension it becomes inflamed, especially at the point where it attaches onto the heel bone, causing the condition known as Plantar Fasciitis.
The common symptoms of Plantar Fasciitis is pain in the heel and arch on rising from bed, and with weight-bearing following periods of inactivity; a sharp pain in the heel during and after standing on hard surfaces, or going on tip-toe, or climbing stairs. Discomfort often decreases after a few minutes of walking, but gradually returns and worsens throughout the day. Research has shown two primary causes of Plantar Fasciitis are 1) flat feet that causes the foot to lengthen thereby placing too much stretch on the plantar fascia and 2) tight calf muscles, which also stretches the plantar fascia during walking.
Calf muscle issues can occur either because they’re not being used (not being stretched) so they shorten, or because of an increase in exercise, so they tighten up. Either way, contracted or tight calf muscles cause the feet to function in a way that places a higher magnitude of tensile strain through the plantar fascia, which is a common cause of Plantar Fasciitis.
The symptoms of Plantar Fasciitis may become severe and disabling and can sometimes last for months, so to avoid developing this compalint:
1. Avoid walking barefoot. Wear a supportive shoe with a small heel (e.g., a running shoe) around the house. Wearing a small heel actually shortens the foot and takes tension out of the plantar fascia.
2. Perform the following calf muscle stretching exercises 2 x day-- 10-holds for 30-seconds in the morning and 20-holds for 30-seconds in the evening:
· Stand feet 2-3 ft. apart, slightly pigeon toe, 1-2 ft. away from the wall
· Keep your knees straight and heels down
· Bend your elbows to slowly lean your chest towards the wall (wall push up)
· Feel a GENTLE pull in the calf muscle. NO PAIN!
· Hold the stretch for 30-seconds
· Push away from the wall and repeat
If you develop the symptoms of Plantar Fasciitis as described above, do this:
1. No barefoot walking, NOT ONE STEP. Wear a supportive shoe with a minimum heel height of 1 inch. A running shoe will also offer a little cushioning to the heel.
2. Go straight from bed into a house shoe with a heel or running shoe. DO NOT walk to the bathroom barefoot.
3. Perform the calf muscle stretching exercise programme as described above.
4. Avoid doing activities that obviously cause the pain to worsen.
5. If you have arch pain, freeze a water bottle, place the bottle on a towel on the floor in front of you and roll the arch over the bottle for 10-mins twice daily.
6. If the pain becomes severe, book a telemedicine consultation with Ray Anthony to discuss:
a. If a course of anti-inflammatory tablets is required to help settle the inflammation, and
b. If a pair of shoe inserts to take stress of the plantar fascia would help.
"Metatarsalgia" is a non-specific, catch-all term for pain in the ball of the foot-- there are a number of specific conditions that cause forefoot pain. As described above, with either increased sports activity or a more sedentary lifestyle, the calf muscles often tighten up, which affects foot function to cause increased pressure on the balls of the feet. Also, walking barefoot for long periods of time on hard surfaces such as tiles may cause inflammation of the soft tissues beneath the forefoot. My patients describe the pain of this condition as "walking on pebbles," or "bruised," or "like treading on hot coals." Excessive foot pronation or “flat feet” has also been shown to increase pressure beneath the forefoot.
To prevent metatarsalgia, avoid too much barefoot walking, wear a supportive shoe with a soft sole, and keep your calf muscles flexible by doing the calf muscle stretching exercise described above. Do not stretch your calf muscles by standing on a step and letting the heels drop down as this will increase the pressure beneath the forefoot and may worsen the symptoms.
If the balls of your feet begin to feel a little sore and the above advice does not settle the pain, you may need a shoe insert. Research on the treatment of this condition recommends a shoe insert with three specific design features to reduce the pressure on the ball of the foot:
1) cushioning material beneath the forefoot, 2) a metatarsal pad, and 3) a firm arch support — all components incorporated into Spenco insoles, available at Helix Healthcare.
So, in conclusion, if you’ve become more active or more sedentary, and you're spending much more time at home walking barefoot, watch out for the symptoms of these two common, often painful and debilitating foot complaints that could easily take you by surprise.
Please do all the right things to stay safe and healthy as we work through the Covid-19 pandemic. If you need to discuss a foot or leg problem, book a telemedicine consultation with me using Skype, WhatsApp, or ZOOM at www.helix.ky
Ray Anthony, FCPodS, DPodM