Over the course of an average lifetime, our feet help us walk 110,000 miles, which is more than four revolutions around the Earth. They do this because they are a true anatomical marvel: they have an impressive 28 bones, 33 joints, and more than 100 tendons, muscles, and ligaments.
And yes, the way all those joints and muscles wear and tear can greatly affect your lifestyle. “Foot problems affect the quality of life, whether it’s going out at night or playing a round of golf,” says Alan Bass, a New Jersey podiatrist who is also a representative of the American Podiatric Medical Association (APMA).
It should come as no surprise that they hurt sometimes, and even more so as we get older. A study published in the European magazine Maturitas in 2016 found that one in four people aged 45 or over have pain in their feet, especially in the front part and in the toes, which can affect mobility and balance and even be a risk factor for falls. So, what exactly is the cause of these pains, and when should you see a doctor?
“The most common foot problems, regardless of age, are generally the result of overuse and the shape and structure of the foot, the surface they stand on, the level of activity, the weight they carry and the shoes we wear,” says Alex Kor, an Indiana podiatrist who is also an APMA representative.
An MRI foot scan which is also known in the medical language as MRI for feet is a painless diagnostic test that uses powerful magnets and radio waves to create detailed images of the bones, muscles, and ligaments in the foot. It can help diagnose a wide range of conditions such as fractures, muscle tears, infections, and tumors.
If you see a podiatrist because of foot pain, Bass says, “First we look at the structure of the foot and the way the person walks and stands, and then we may recommend the treatment. However, the treatment is tailored to each individual patient.” With that in mind, these seven ailments are the ones you are most likely to be diagnosed with as the cause of your problem:
This inflammation of the plantar fascia ligament, which runs from the heel to the ball of the foot, can cause pain in both the heel and arch and is sometimes associated with heel spurs (calcium deposits under the heel bone). “If you talk to 10 podiatrists, they will all tell you that plantar fasciitis is the most common problem they see in their office every day,” Kor says. “I’ve seen it in everyone from teen athletes to 95-year-olds.” He points out that a common cause is wearing the wrong shoes, no matter what you do. “Your feet don’t know the difference between walking on a track, running on a treadmill, or standing at home for eight to 10 hours a day.”
Almost all cases of plantar fasciitis resolve in 8 to 12 months, says Pedro Cosculluela, an orthopedic surgeon at Houston Methodist Hospital who specializes in foot and ankle problems. He says some doctors treat the problem with cortisone injections or platelet-enriched plasma. Outside of that, Kor recommends never buying shoes without seeing and trying them on first. “You have to pick up the shoe, whether it’s a gym shoe, a running shoe or a dress shoe, and fold it up. If it bends in the arch, it’s generally poor quality and you’ll be more likely to have overuse problems like plantar fasciitis.” Shoes that have good support don’t have to be expensive, adds Kor, who recalls a recent patient who bought a proper pair of shoes for $14 and within a month felt great pain relief.
“As years go by, joint problems come along,” says Bass, “because we don’t walk on sand, we walk on cement and asphalt.” This often leads to osteoarthritis, which is a painful, degenerative disease of the articular cartilage and adjacent bone. “We see arthritis in the ankle, the joint below the ankle, the center of the foot, the big toe, and in many other areas,” says Cosculluela.
What can you do? Limit foot activity, lose weight, wear proper shoes, add cushioning, and physical therapy, take anti-inflammatories, get steroid injections, and limit yourself to non-impact exercises. “I always tell people that if they’ve had foot pain for a year, running, walking, or jumping probably aren’t the right exercises to do,” Kor says. “Instead, it’s better to do exercises like pedaling on a stationary bike, swimming, water aerobics, using the elliptical machine or rowing machine, that is, do activities that do not affect the feet,” says Kor. “If you’re overweight, losing 20 pounds might ease the pain when you walk.”
Technically known as hallux valgus, it’s a common and painful condition that manifests as a bony prominence in the big toe joint, sometimes causing the big toe to drift toward the smaller toes. The causes? For example, the hereditary factor can be aggravated by years of wearing too-narrow shoes or very high heels. “And people who have a lower arch or flatter foot are more prone to bunions,” Bass notes. “Other than surgery, there’s not much we can do to cure a bunion,” says Cosculluela. “However, unless it causes pain and limits activity, we do not operate.” Regardless of whether you have surgery or not, you have to deal with biomechanics, which means you have to wear orthotics. A podiatrist can take a mold of your foot to make them custom, which can be expensive. Bass also recommends the Powerstep brand, which is readily available.
This happens when one of the smaller fingers flexes up. Sometimes it’s due to wearing tight-toed shoes, as you suspected, and sometimes because people with very flat feet don’t get adequate support over time. According to Kor, “If the tendon and soft tissue structures are not supported enough, the tendons leading to the fingers start to pull, which can cause hammer toe.” What can you do? Wear shoes with a wider toe whenever you can. He points out that “like bunions, hammertoes are deformities of the foot and there is no device that will cure them permanently,” although small protectors worn over the toes can reduce friction against the shoe.
Just as you notice that you are losing collagen in your face, you may also be slowly losing it in your feet. “On the ball of the foot and on the heel are fat pads that sometimes atrophy with age,” says Kor, who sees this problem, particularly in smokers. As with other ailments, it is advisable to use orthopedic insoles, over-the-counter inserts and shoes with a lot of support. Bass favors the brands New Balance, Brooks and Clarks.
Morton’s neuroma, an uncomfortable condition that occurs as a result of swelling or inflammation of a nerve, affects the ball of the foot and generally between the smaller toes. It can feel like you have a pebble in your shoe, and it almost always affects women who have worn shoes that are too narrow or have high heels. The solution is to wear shoes with a wider toe or add specially designed insoles for this problem, either with or without a prescription.
The skin of the feet, like all skin, becomes drier with age, which is why cracks can form. “These fissures can be dangerous,” Kor notes, “, particularly in people who are neuropathic, meaning they have no feeling in their feet. Cracks are breeding grounds for bacterial infections. People often soak their feet in the water, but that dehydrates the skin and makes cracks worse.” Instead, he points out, moisturizes your skin after you shower with Eucerin, Aquaphor, or Lac-Hydrin, the latter on prescription.
Swelling in the feet and ankles can be caused by many things, including poor circulation, diabetes, and a sedentary lifestyle. “A disorder called venous insufficiency, in which the veins stop working properly can cause fluid to build up in the feet at the end of the day,” Kor says. “This can cause a condition called venous stasis where blood pools, breaks through the skin, and forms an open wound that we call a venous stasis ulcer.” His advice is to elevate your feet above waist level for 20 to 30 minutes at least twice a day, wear compression stockings, and ask your doctor if you should also take medication.