by Eric Winder, DC   

Feet are the body’s foundation, but they are often taken for granted—until they hurt. When feet are painful, it’s hard to give them a break. After all, we need them to move. Let’s examine some of the main causes of foot pain, as well as the solutions that can provide relief. 

Types of foot pain range from plantar fasciitis or metatarsalgia to Achilles tendonitis or Morton’s neuroma. Some painful feet are arthritic, while others might be painful due to a chronic ankle sprain. These are all different problems, but they share one common thread—the inability to handle the normal forces we subject our feet to on a daily basis. Causes of this failure include wearing shoes, prior injuries, and hereditary problems such as flat feet or high arches.   

Many of us are aware the wrong type of shoe can cause foot problems. Long-term wear of high heels often leads to bunions, hammer toes and fallen arches. On the other hand, slip-on shoes or flip flops frequently cause toe clenching to keep them from slipping off, which can lead to plantar fasciitis. However, what many don’t know is that just wearing shoes of any kind for an entire lifetime can lead to foot problems.   

 Three Causes of Foot Pain 

Three research studies in various parts of the world compared barefoot-living villagers with shoe-wearing relatives in cities. The research showed that those who live barefoot have almost no structural foot problems such as those listed above. As it turns out, walking barefoot uses a lot more muscular strength in the lower leg. This helps to maintain more structural support from tendons that attach from those muscles to the foot.   

It also follows that people who are inactive or sedentary can be more prone to foot problems due to not maintaining sufficient strength in their lower leg muscles. Another significant problem for many is past trauma to either the leg or foot. Physical injuries can leave residual stiffening or distortion in the connective tissue called fascia.  

This, in turn, can cause muscular imbalance and weakness that leads to pain—whether it is located the plantar fascia on the bottom of the foot, the pad at the ball of the foot, or the tendon attachment at the back of the heel. In the specific case of chronic ankle sprain, the original injury can cause the ankle to remain weak, so that a person might repeatedly “turn” their ankle and reinjure it.  Of course, for some, the only cause of their foot pain is their inherited flat feet or abnormally high arches, both of which can lead to extra stress on the foot.  

With hereditary flat feet, the foot never develops a full arch, which deminishes the spring action that the arch would normally provide. Less spring means less foot protection from the stress of walking, running, jumping or standing. You might think that someone with high arches would have opposite issues of flat feet, but actually, a high arch tends to be more rigid (and less springy) than a normally shaped arch. This puts more stress on the feet when they bear weight.  In the end, both problems tend to create arch pain. 

 Answers to Foot Pain 

When we look at solutions to foot pain, we should start once again with shoes (or the alternative of not wearing shoes at all). While a lifetime of walking around barefoot is ideal for foot health, switching over to barefoot will not necessarily help someone who has worn shoes all their life.  First, it takes time to build the leg muscles to tolerate a lot of barefoot walking. A second issue is the hard surfaces that most people tend to live on today. Wood or tile floors, cement sidewalks and asphalt roads are not what feet are built for.   

For someone with foot pain, walking on hard surfaces will likely worsen the discomfort.  While there are some instances where barefoot walking is helpful—such as on sand or soft earth—most of us need shoes for support and protection. The key is to wear the type of shoe that will be most beneficial for your feet. 

While choosing the correct shoe can involve many considerations, certain basic features are important. The arch should roughly match the shape of your foot. Most of us should have at least moderate arch support. However, those with flat feet should not try to use too much arch support, although a minimal amount is still important.   

On the other hand, those with high arches usually benefit from a fuller arch support. In many high arch cases, a shoe that is otherwise well built might need either supplemental support or replacement of the built-in support with a more robust arch insert. 

Shoes with a sole that is too rigid do not encourage as much leg muscle activity. An optimal shoe should allow flexibility where the toes bend with some back-and-forth twist at the arch. Also, the heel cup should align vertically and not tilt inward—otherwise the shoe will encourage pronation of the foot, thus exacerbating foot pain in the long-term.    

Fascia and Feet 

Past physical trauma can leave restrictions in the fascia (connective tissue) of the leg and foot, leading to pain. Manual therapy treatments that release fascia restrictions can help to restore muscular balance and joint stability, relieving foot pain. Fascia release is a focus of my practice, and I have helped many people experience relief from foot pain with this type of treatment. In addition to releasing restrictions of the foot tissues, it is also important to release restrictions in the lower legs, thighs and even hips to restore foot function.   

It is worth emphasizing how much fascia can be involved in foot pain. Even when there are physical changes to the foot, such as bunions or arthritis, much of the pain is often caused by fascia distortion. Stiffening of this connective tissue can alter muscle tension and joint stability, which could contribute to structural changes in the first place. Treating these restrictions can relieve pain, even though it usually cannot reverse the structural distortion. 

Those with naturally high or low arches can develop restrictions in fascia more easily, due to greater stress on their feet. Therefore, wearing optimal shoes with the right arch supports is critical. When necessary, custom orthotic inserts can also be relieving, and fascia release therapy is almost always helpful. 

Each case of foot pain is unique, and there is no one-size-fits-all solution.  Understanding both shoe type and arch support is important. In many cases, expert help with fascia release therapy and specific exercise programs can also make a significant difference in pain relief.  For those afflicted with pain in their feet, I recommend seeking out a healthcare practitioner experienced in all of the above issues. 

 Dr. Eric Winder has been practicing chiropractic for 25 years. His practice emphasizes relieving pain and restoring alignment and motion with gentle fascia release therapies. For more information, call 941-957-8390 or visit Gentlebay.com.