Foot Pain - First Things First

I try to give a straightforward response to the person with a chronic foot problem...

You're going to consider months of medication, injections, various diagnostic tests (MRI, CT Scan, etc) and surgery, without trying much simpler things first?

What about the basics?

What about a solid and consistent short-term effort of (relative) rest of the foot, working on movement related issues like inflexibility or weakness, and getting into the most appropriate shoe for your situation?

The basics are not rocket science. The basics are somewhat inconvenient. The basics, while not a miracle cure, will often take you a long way. And they are a necessary foundation. Even if you do ultimately need surgery or other more invasive treatments, the basics will need to be in place in order for the "non basic" to be effective over the long term.

I understand that the various treatment options and guidance can be confusing and seem complex. But here I lay out a path for you. Though you probably will not fit perfectly into this as a protocol, it should serve well as a general guide for you to know what pieces of the puzzle may need to be addressed.

Get (relatively) off your feet for a while. 

There is absolutely no substitute for a period of rest from the offending activity. And when you have a sensitive foot, even one step of supporting your body weight can flare things up. Two or four weeks in a walking boot may be in order. It will be at least that long should you elect for surgery.

I realize that taking some time off work or fitness and athletic activities can cause various hardship. But if your feet remain painful despite various treatments, and you're running out of options, do not neglect this step in the process!

Treat the symptoms.

While you're off your feet, you can still use modalities like ultrasound and electric-stim, massage, and other passive treatments to help restore normal soft tissue tone and sensory input to the foot. Many people try new shoes, new orthotics, exercises, and other modification before they first (including pain medications) simply manage the symptoms. Most of the time, you can successfully implement these strategies while you're on rest from the offending activity (see step one above).

Stretch and strengthen.

The time of relative rest is also a great opportunity to work on select stretching and strengthening exercises. This is a critical step in the process, but by no means the only step. If you don't address movement related problems to the best of your ability, steps one and two above are likely to help you feel better only until you attempt to resume your normal activities. For example, people with a neuroma or metatarsal (ball of foot) pain can usually stretch their toes and hips to help avoid twisting off the ball of the foot when they walk.

The therapeutic exercises may feel uncomfortable but they should not hurt. If they cause the same symptoms, you are doing something wrong and need further guidance. For example, people with plantar fasciitis can and should stretch their calves, and when done properly, this does not irritate the symptoms.

Put time and money into the best shoe for you.

There is no "best shoe for plantar fasciitis." The best shoe for you may be different than for someone else with the same diagnosis, and depends on your foot structure, walking or running style, and activity level.

Expect to pay more for a well constructed shoe. For example, the Asics that you buy on sale for $40 at Kohls are absolutely not the same as the Asics that you buy for $100 in a shoe store.

As compared to the shoe store, you can probably find the same quality shoe for $10 less on-line. But then you miss out on the expertise of shoe service staff, and the ability to try multiple shoes on at once. When the size 9 fits good in length but not width, you can immediately try the 9.5, the 9-wide, and a comparable shoe that possibly suits your needs better. Try doing that on-line.

Consider an appropriate off-the-shelf or custom orthotic (inserts).

Soft gel insoles rarely fix the problem. If all of your problems are solved with a $15 gel inlay from the grocery store, then truly good for you! But most people with chronic foot problems need something that provides contoured support to the arches of the foot and facilitates a change in the mechanics of the foot/ground interface.

Do not expect a custom orthotic to magically address all factors above. They always...ALWAYS work much better when you have given your foot relative rest, have managed the symptoms, and have addressed biomechanical issues with the lower extremity.

If you do obtain a rigid or semi-rigid device, be prepared to gradually taper into full time use of them. Be prepared to have them revised to fine-tune the fit and function as needed.

S L O  W   L    Y  return to full activity.

In my experience, this is where many clients miss the boat, whether or not they successfully completed any of the above or even had a favorable response to injections and medications.

The person who works 10-hour days standing on cement, returns to 10-hour days standing on cement. That's simply a case of too much, too soon, and most of the population without foot problems would struggle with that.

Also, the person who loves to walk or run, simply returns to their former exercise routine, when they should have undergone low impact weight bearing strengthening exercises with a very light start to their walking/running progression (adding less than 10% distance or duration per week).

Helpful...help for foot problems-

I would strongly suggest that you find a health care professional with the appropriate clinical expertise who will also be an advocate for you, and help you find context and perspective.

-Did the professional examine your foot flexibility and strength in both weight bearing and non weight bearing positions?

-Did the professional examine your general movement patterns - how you walk or run, squat down, balance, etc?

-Did they comment on the status of your current footwear, athletic and casual shoes?

-Did they offer means to manage the symptoms?

-Did they offer means to restore proper function prior to resuming your typical activity level? Did they offer guidance on a reasonable plan for getting back to what you want to do?

-If they construct orthotics, did they offer a compatible shoe suggestion, activity modification, and easy follow-up for making revisions as needed?

If you get the feeling that a professional is attempting to push you into their own "mold" of treatment; only injections, or surgery, or shoes, or orthotics, or exercise, and it's not working...move on.