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Foot Pain

foot bones
Looking at the illustrations below from Gray's anatomy, you can only begin to appreciate the complexity of your feet and why taking good care of them.
Ligaments
foot ligaments
Nerves
fot nerves
Muscles
foot muscles
foot-tendons

Foot pain is a broad subject and can be caused by a multitude of problems, so for this to be helpful, we’ll need to be more specific.  As with all kinds of body pain, defining your pain issues - where, how and when is clearly the first step to a successful resolution.

Foot pain can originate with pressure, stressed ligaments sore muscles and tendon attachments, so we need to be specific.  What’s tricky is that foot pain may not even originate in the feet but are referred from other muscles like the calf muscle.

Metatarsalgia

The most common pressure related pain is also the most prevalent and related to the body weight being focused on the second metatarsal head.  This is called Metatarsalgia, and stems from the fact that weight that should be supported by the full width (all five metatarsals) of the foot is concentrated right behind the second toe.  It hurts not only because of the pressure, but because the foot usually twists externally with every push off, so in addition to the pressure, the second metatarsal is ground into the shoe.  It will be red, tender and often cause a callus right behind the second toe. 

Plantar Fasciitis

This nasty heel pain is a good contestant for first place when it comes to foot pain.  The heel pain occurs when the fascia under the foot that attaches the metatarsal heads to the heel bone becomes stretched.  The pain is most often focused right where the fascia attaches to the heel bone.  The fascia is literally trying to tear away from the bone and the microtears becomes very painful.  In extreme cases a bone spur may develop. The pain is usually sharp and focal and felt in the forward lateral portion on the bottom of the heel bone.   Plantar Fasciitis can be misdiagnosed because trigger points in the calf muscles can refer pain to the back and bottom of the heel, but it is usually less focused. 

Hammer Toes

When the toes try to grip the floor, you get hammer toes.  Usually the second through the fourth toes.  Mallet toes are just a variation on the same problem where the last toe bone remains flat on the ground but the first knuckle is elevated and is often rubbing on the shoe upper.  Mallet toes may also produce ingrown toenails by exerting greater pressure on the toe nail.  Deformation of the toes often goes along with excessive weight carried on the outside of the feet, instability and even metatarsal fractures if you are a runner.  Hammer toes are not necessarily a painful condition, and if you experience pain, it may often be from putting too much pressure on the lesser metatarsals. 

Neuroma Pain

Lots of people have neuroma pain and it is a boon for doctors who love needles and knives.  The nerve between the 3rd and 4th metatarsal heads, which is also where the most pain is felt, is being squeezed between the metatarsals and responds by building a protective layer of scar tissue which makes the pain worse. If you tend to walk on the outside of your feet (check the bottom of your shoes) you are a more likely candidate for this pain. 

Bunions

Bunions start slowly with the medial side of the first metatarsal (big toe joint) becoming tender and red.  The tender area starts swelling so you develop a bump on the inside of the foot.  As the big toe joint becomes inflamed which is usually the source of the pain.  Motion aggravates the pain.  When the joint capsule breaks the big toe responds to the external pressures which will push it over toward the second toe.  Bunions may be surgically corrected and often develop again. 

Arch Pain

Most often complaints about arch pain stems from tendons and ligament attachments being subjected to too much stress.  The pain may be felt at the back of the arch where a ligament attaches the heelbone to the first articulating bone (Navicular) in the arch.  Two significant muscles (Tibialis Posterior and Anterior) also attaches their tendon in this area, to the two bones distal to where the above ligament attaches (Cuneiform and First Metatarsal).  There is ample opportunity for significant pain in this region from too much tension in the ligaments and tendons.

Calluses

Calluses are the result of pressure and friction, so obviously calluses are related to foot mechanics, but may often be related to improper footwear.  These days, the shoe industry is promoting a little extra width in the shoes for the “feet to have room to spread”.  That sounds much like getting out of the dress garb and into a comfortable pair of shorts and sandals doesn’t it?  Well that may work for your clothing, but not so much for your feet because they move as you walk.  As they move calluses start appearing especially under the second metatarsal head, on the inside bottom corner of the first metatarsal head and big toe and often on the outside of the little toe joint.  This is usually all from excessive motion of the feet inside those “extra wide” comfort shoes.  As you wouldn’t dream of wearing shoes that are too long or short, it pays to stick with the correct width too – a nice snug fit that prevents your feet from flopping around. 

Stress Fractures

Short of an injury, stress fractures usually happen in the lesser metatarsals because of excessive weight bearing on the outside of the feet. The First and second metatarsal bones are designed to support most of the body weight while the lesser metatarsals contribute to improved balance. People who has a tendency to supinate will place excessive pressure on the lesser metatarsals and are more likely to suffer from stress fractures.

Possible Causes

plantar fasciitis imposter
You may think and even be told you have Plantar Fasciitis, but it could be an imposter - pain referred from the Soleus Muscle to the heel.

When you look at all the above problems, you should realize that some of these symptoms are sometimes confused even by medical professionals.  A more thorough examination may for example reveal that you suffer with Metatarsalgia - not Neuroma pain.  Pain in the heel is often Plantar Fasciitis, but it could also be referred pain from trigger points in your Soleus muscle.  Steriod injections, while temporarily helpful  for Neuroma pain, will not do much for Metatarsalgia. If your heel pain turns out to your Soleus muscle, the various treatments for Plantar Fasciitis will only drain your wallet, so as always we encourage you to really define the symptoms and when and when they occur.  Plantar Fasciitis is often referred to as the "First Step Pain" because as the foot pronates when weight bearing, the tension in the fascia attachment in the heel is instant.  If you have a bad case, the pain will be to.  A trigger point will behave differently.  

Mostly foot pain is caused by improper weight bearing and mechanics that leads us to compensation that when combined with improper shoes makes the problem even worse.  If you really dig to the bottom of it, we have created ourselves an environmental problem by making everything we stand and walk on flat.  Look at all the insoles offered.  They have beautiful shapes to support your feet.  On the bottom they are flat, just like the inside of your shoes.  Our feet just aren’t compatible with "FLAT", and it causes widespread problems from head to toe. 

As is the case with Metatarsalgia, aren't you curious why almost all the weight land on the second metatarsal head and you constantly have to remove caluses. Clearly a mechanical problem.  Plantar Fasciitis is caused by the foot lengthening when fully weight bearing increasing the distance between the  facia attachments.  The pain goes to the heel attachments which takes the stress from all five attachments to the base of the first toe bones.  It’s a mechanical problem.  Bunions develop in response to people rotating their feet out.  Instead of pushing off with the first and second metatarsal in a straightforward motion, walking on the inside of your feet makes you push off with the second metatarsal obliquely across the big toe trying to push the big toe into the second toe with every step.  You're catching on.   At first the joint becomes inflamed.  Ultimately, as the joint becomes damaged, your big toe is resting on top of your second.   Hammer toes are usually a response to the instability that occurs when you try to balance on the outside of your feet.  Why do so many people walk on the outside of their feet?  It’s compensation to prevent a postural collapse of the arch from over-pronation..

How to eliminate the pain

Most foot problems are considered to be mechanical.  Visiting the average podiatrist, you’ll get steroid shots to kill the pain by reducing swelling and/or custom arch support orthotics.  These solutions are but temporary because they do not address the root cause.  What if we could make the weight bearing in the forefoot distribute more evenly across the full width of the foot?  What if we could naturally prevent the foot from lengthening because the first metatarsal was not fully supporting of our weight when it needs to be?   What if….

If the root causes are mechanical, and the feet are controlled by the central nervous system and the brain, wouldn’t it make good sense if we can get the brain to do something different.  If the real cause is standing and walking on flat surfaces, and the brain getting lacy because one step is like the last which was like the last, what if we could at least make the brain do something different that will cause less problems even if repeated over and over again.