Will My foot pain last forever?

Treating foot pain can be a little tricky. The foot is challenging because it is a weight bearing structure that is influenced by multiple factors. Foot pain can be caused by a local problem in the foot or it may be due to something more distant from the foot itself.

The foot is a complex structure of 26 bones and 33 joints layered with an intertwining web of 126 muscles, ligaments, and nerves. The average person spends four hours on their feet and takes between 8,000 and 10,000 steps each day. The feet are very small relative to the rest of the body, and the impact of every step exerts tremendous force upon them -- about 50% greater than the person's body weight. During an average day the feet support a combined force equivalent to several hundred tons. In addition to supporting weight, the foot acts as a shock absorber and as a lever to propel the leg forward, and it serves to balance and adjusts the body to uneven surfaces. It is not surprising, then, that about 75% of Americans experience foot pain at some point in their lives. According to a recent study, chronic and severe foot pain is a serious burden for one in seven older disabled women. To compound problems, the lower back is often affected by injuries or abnormalities in the feet.

Foot pain is generally defined by one of three sites of origin: the toes; the front of the foot (forefoot); or back of the foot (hind foot). Toe problems most often occur because of the pressure imposed by ill-fitting shoes. Pain originating in the front of the foot usually involves the metatarsal bones (five long bones that extend from the front of the arch to the bones in the toe) and the sesamoid bones (two small bones imbedded at the top of the first metatarsal bone, which connects to the big toe). Pain originating in the back of the foot can affect parts of the foot extending from the heel, across the sole (known as the plantar) to the ball of the foot.

In understanding and treating foot pain successfully, it is essential to understand the musculoskeletal mechanics of the body, particularly the lower extremities. Podiatrists call this biomechanics. No other medical specialty studies biomechanics of the lower extremities in the depth as that taught to the podiatric specialist. Nerve compression in the back, hip or knee can cause foot pain. Muscle imbalances in the leg and skeletal alignment problems cause foot pain, and metabolic disorders such as diabetes or gout can cause foot pain. Foot disorders can also contribute to pain in the leg, knee, hip and back.

There is little if any evidence supporting any premise that the actual treatment of foot pain differs that much from the treatment of other pain, but understanding the underlying cause or mechanics associated with the foot pain is the key to successful treatment. For example, a very common complaint of foot pain is heel pain. This pain occurs in the bottom of the heel and tends to be worse first thing in the morning or after getting up from sitting. One of the key elements contributing to this condition is an imbalance in the muscles in the leg. In this instance, the calf muscles are overly tight. A x-ray may demonstrate a spur on the heel and many might consider this spur to be the cause of the pain. In fact, the spur has very little to do with the pain. It is a secondary reaction to the effect that the calf muscle may have on the foot.

Rarely will doctors remove this spur to permanently cure their patient from heel pain, they generally address the tight calf muscle by teaching proper calf stretching exercises. On occasion patients have done better with doing nothing more than knowing how to properly stretch calf muscles. Understanding the nature and origin of pain is the key to successful treatment.