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Could your feet be the sole cause of your problems?
by James Wilson BSc (Hons) Ost Med. DO - find out more about James.
Our foot and ankle complex is clever: mobile enough to allow us to walk over rough ground yet strong enough to propel our whole body weight thousands of times per day. Unfortunately despite this essential role, our feet can become a bit ignored – sure there are plenty of people who regularly take care of the cosmetic side of things (like nails and hardened skin) but how many of us would regularly do specific exercises which would aid strength and mobility of the feet and ankles?!
Each foot and ankle complex involves some 28 bones which are supported at their joints by numerous thick strong ligaments. The ligaments also help form the two arches of the foot (one on the sole of the foot and one at the front of the foot.) The shape of these arches aids in both shock absorption and the transmission of force between the ground, the foot and the spine. For the purpose of this topic we will concentrate on two of the main supporting structures which regularly present a problem; the Lateral Collateral Ligaments and the Plantar Fascia.
Ankle Sprains
Almost all of us have done it at some point: you’re happily walking along, minding your own business when your foot disappears into a rabbit hole, your ankle goes over and you know immediately you’ve damaged it! This is termed an inversion sprain and will always effect the Lateral Collateral Ligaments:
These ligaments are positioned in three bands on the outside of the ankle. Their job is to prevent the ankle moving excessively outwards (called inversion,) although they do have to be lax enough to allow some movement for foot adjustment as we walk over uneven surfaces. The problem with this is that when we do turn our ankle over a bit too far there is frequently a lot of momentum produced before the slack in the ligaments is taken up which all too frequently leads to some of the ligament fibres being damaged as they absorb the force. This will cause inflammation, swelling and pain. In more severe cases some of the small muscles of the foot may be torn as well causing some impressive bruising.
Treatment of inversion sprains of the ankle (dependant on grade of strain):
- RICE: Rest, Ice, Compression, Elevation. Immediately and several times per day for the next 2 days at least.
- 48 hours after injury start some gentle non-weight bearing exercises, such as pointing the toes and circling the foot clockwise then anti-clockwise.
- At this point unless things are already feeling dramatically better see an Osteopath or Physiotherapist: physical assesement will determine the extent of damage and treatment can aid in clearing bruising and inflammation.
- When to start weight bearing is dependant on the degree of strain, and broadly you will know by the amount of pain as to whether you should be standing. As a guide don’t push it for at least the first 4 days; a little at a time is key.
- Exercise should gradually be increased over the next 2-3 weeks, ideally guided by your therapist. Exercises such as rolling your foot over and around a football whilst sitting can progress to standing with more weight on the foot and gradually increasing the range of movement you put the foot through.
- As the ability to bear weight and mobility improves simple strength exercises can be started. An example could be to start with simple balance exercises such as standing on one leg, progressing through standing on tip-toes to one leg squats and then one leg squats on tip-toes.
Above all please remember that ligaments have a poor blood supply and therefore their healing time can be prolonged. Tears (sprains) to ligaments will take a minimum of 6 weeks and more likely 8-12 weeks to heal fully! Keep at your exercises and try to be patient; your hard work will be rewarded in the end result.
You must seek advice for any strain that is still causing significant pain or restriction 7 days after the accident that damaged it.
Plantar Fasciitis
Do you get recurrent heel pain or do you struggle to put weight on your feet when you first get out of bed in the morning? An inflamed Plantar Fascia may well be the cause.
The Plantar Fascia is a thick membrane on the sole of the foot running between the heel and the toes. Normally we are never aware it exists, but problems such as dropped arches, poor movement in the mid-foot, tight calves and dysfunction around the pelvis can lead to the Plantar Fascia becoming torsioned and inflamed.
What can be done for Plantar Fasciitis?
Foot function must be assessed, as must spinal and pelvic function. Osteopaths are very skilled in this area and can advise on the most appropriate course of action. Treatment from a good Podiatrist may also be invaluable in solving the problem.
Additionally two things you can start yourself before seeing anyone are:
1. Cold Packing; either with an ice pack or putting the foot/feet into very cold water will help reduce inflammation. 5minutes, twice per day.
2. Tennis Ball; roll your foot (gently at first!) on the ball to help massage and soften the Plantar Fascia. Do at least 2 minutes, twice per day.
A few other things to contemplate!
Footwear
Much of what we choose to wear on our feet is far from ideal, by that I mean we can often find something more practical and supportive for the job in hand! Wellingtons and high heels (not necessarily in combination!) spring to mind.
Wellie boots have changed a lot over the years. The newer types with a more solid sole, rather like that on a walking boot, not only help provide better grip and fit but essentially they support the foot and ankle so much better than the old types. Most of them really are worth the premium, especially when you think of how long many of us are in our wellies each day.
High heels really have one purpose and that is to look good. By walking (and sitting) with your foot in essentially a tip-toes position, the calf will shorten thus exerting stress on the heel and forefoot. This can cause mechanical problems in the foot and knee but also can be a strong contributor to lower back and pelvic pain. The big toe joint will also be placed under strain increasing the risk of issues such as bunions. Regular calf stretches will help, but ideally you must vary the type of footwear you wear.
Regular Stretching
At least a few times per week we would all benefit from 3 simple stretches. Spend a few minutes on each.
1. Roll your foot on a tennis ball for a few minutes, work especially on the bits you can feel are tight.
2. Stand with feet facing directly forwards. Keep the heel on the ground as you gently bend the knees, taking care to keep the knee in line with your feet. You should feel a stretch low in the calf near the heel. Slowly release and repeat.
3. Stand on the bottom step facing upstairs, support yourself on a rail for balance. Stand with the balls of the feet on the edge of the step, and keeping the knee straight, gently let your heel drop down toward the floor. You should get a stretch through the whole calf area. Slowly release and repeat.
Other pains
There are a lot of other reasons why you could get foot or ankle pain, and this is in no way intended to be an exhaustive list. However some other reasons for pain:
- Fractures or bruising of the bone itself
- Referred pain from the low back (nerve compression or irritation)
- Nerve problems such as those caused by diabetes
- Vascular problems
- Swelling due to systemic illness, such as heart problems
Above all the motto has to be look after your feet and they will look after you by giving you years of trouble free service!
Further information is available on our website www.molfordhousesurgery.co.uk. Alternatively I am always pleased to answer any questions you may have. You can call me at Molford House Surgery on 01769 574830.
The information provided on these pages is intended as a general guide only and in no way constitutes a complete service for diagnosis or treatment. You must not rely solely on this information and it is therefore your responsibility to seek a professional opinion should you be concerned about your particular case.
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