Can Changing How We Walk Alleviate Our Aches and Pains?

We all want good health. . .   We want to be lean, strong, and free from pain, especially pain in our back, neck, hips, knees, shoulders, legs, ankles, and feet. Beyond good health, we want to live life with energy, confidence, and exuding youth. At one time in our lives, we had this pain-free vitality and more. For many of us, the day-to-day grind wore down our bodies, leading to sore, achy and perhaps arthritic joints, weak muscles, more fat, greater fatigue, and even depression. 

Walking—when done optimally and correctly—can give you all this. But, before we discuss that, we need to understand how we came to walk poorly and how improper walking patterns can lead to pain, disability, increased risk of injury, lack of fitness and muscle strength, and most importantly, a lack of spiritual vitality.    

“You Walked Into Pain” — Sherry Brourman, PT, Walking Instructor

Humans have always walked. With the recent discovery of the oldest known human skeleton, Ardipithecus ramidus, nicknamed “Ardi,” we now know we have been walking for at least 4.4 millions years. It is our most natural and most common physical activity.

Yet, walking is not innate. It is learned, through trial and error, in a haphazard way. The infant, toddler, and young child learns to walk by watching his or her parents or caretakers. The child’s ”adult pattern” of walking locks into place by age 8. Don’t believe me, go to the local shopping mall and watch children walk with their parents. More often than not, the child will walk like one parent or a combination of both.

(As a podiatrist, I recently saw a 10-year-old girl who limped for no apparent reason. In talking with her mother, the mother related that she had the same limp due to a hip that she injured in a car accident a decade earlier. The child had taken on her mother’s limp, even though she had no pain or injury.)

Herein we find the first problem with walking: we may be learning to walk by mimicking parents who are not walking correctly. I can hear some of you now: Wait a minute, Dr. Nirenberg, my parents walk just fine! They may, but it is much more likely they do not. Optimal walking is a combination of proper positioning of our joints, correct breathing, coordinated movement of our extremities, torso and pelvis, and good posture. 

The fact is, most people walk wrong. Yes, they get from point A to point B, but they are moving their joints and muscles in a way that will likely exacerbate or eventually lead to muscle-skeletal pain somewhere in their body (i.e. knee, hip, back, neck or shoulder pain). Likely, they have poor posture, and more likely, their body will be asymmetrical. That is, one shoulder may be lower than the other, one hip higher than the other, one hip more anterior, one foot flatter etc. 

Every Step We Take

So we learn to walk by picking up the bad habits of one or both parents. As youngsters, we can run, jump, even bungee jump, and we feel invincible. Slowly though, due to poor walking patterns or an outright injury, or our activities (or much more often our lack of activity), or habits, aches develop. We may strain a muscle here, twist an ankle there, or just get a slow gnawing discomfort in our back, neck, knee, hip, ankle, foot, or shoulder. 

By the way, when I say habits, I am talking about such things as repetitive strain activities (carrying a knapsack, purse, briefcase, or baby or a specific activity that creates wear and tear on the body), diet (obesity or in rare cases malnutrition), and worse of all, poor footwear, which can put the whole body in poor alignment and/or distort and alter foot function (and altered foot function will alter our entire body!).

It Only Takes One Injury. . .

It only takes one injury to one joint, muscle, or ligament to worsen our walking pattern. Our body is a incredibly inter-related functioning unit and a simple knee problem can quickly lead to back, neck and foot problems.Even if the painful knee subsides after a few weeks, problems with your alignment and the way you walk can remain. For example, let’s say you hurt your knee and for a few days you are miserable. So you begin putting most of your weight on the other leg. When our body makes these kinds of adjustments, we call it a compensation. However, shifting our weight in this manner will often lead to additional compensations throughout your body, and these will further alter the way you walk. Over time, the knee pain may go away, but now, your walking pattern has changed—for the worse—and it is unlikely you are going to return completely to the old pattern.  

We Break Down Slowly (aka You Don’t Know What You’ve Got Until It’s Gone)

As we age, we may start having a pain here and there, and as a result, we may avoid certain activities, perhaps we stop skiing, or playing racquetball or even just stop taking the stairs. We soon find ourselves moving less, sitting more and quickly gaining weight. More weight strains our body more, leading to more aches and pains and even less exercise. Our walk might become further limited and stiff because we are worried about another fall or injury, and in effect we begin walking worse. Ironically, for many of us, lack of exercise and movement was probably one of the big factors that contributed to our problems in the first place. Yet, REST is touted as a good treatment for what ails us. Perhaps it is for an acute injury, but 6 months after an ankle sprain, if you’re still resting, you’re in big trouble!  

Worse, when your body isn’t moving as well as it should it is at even more risk for injury. People often think injuries are random. But, when a person has a poor walking pattern, they are much more likely to become injured. The person may slip on the ice, twist an ankle on the front lawn, or even throw out their back bending down to pick up a quarter. When this happens, they may blame the injury, but the injury is just the symptom of an underlying problem: the person’s misaligned, weak, worn out body.    

Keep in mind: The part of the body that hurts may not be the problem.

For example, in my practice I see many people with back pain due to severly flat feet. Once we get these people into orthotics (custom made, medical grade arch supports) their back pain goes away. 

Some people in pain seek help: they may see their doctor, or a chiropractor, or some cases, a surgeon. But even if they have a back fusion, knee replacement or pop pills to mask the pain, if their poor walking pattern continues, their problems will continue, or worse, new problems or injuries will occur. By now, some of you might be saying, I know how to walk. Of course you do, and if I gave you a golf club and no instructions on how to tee off, you could probably manage to hit the ball. But, your swing would be average to horrible.  Perhaps, your walk is too?

There is poor walking and there is walking well—walking optimally. Correct walking positions your bones and joints in their best alignment, which in turn stimulates muscles that were not moving much to not only move but work well.   

Further, if we are not walking correctly, over time we will see an increased strain on our joints, muscles, and ligaments. This strain is actually micro-trauma.  Microtrauma is very insidious, but when it goes on step after step, mile after mile, its damaging effects can add up.

Are You in Symmetry?

Regardless of the mechanism of injury, our body will lose symmetry. Lack of symmetry or lack of alignment, will lead to some muscles contracting or tightening and others weakening or shortening. That is, every joint in our body is able to function or move because the muscles around joints oppose and balance each other. For example, in simplistic terms, our middle toe can bend upward (extend) or bend downward (flex), the muscle that flexes the toe is opposed or balanced by the muscle that extends (these muscles are for obvious reasons called extensor and flexor muscles).

When a joint in our body is out of alignment or out of its correct anatomical position, there is a lack of equal and balanced muscle tension on the joint. Thus, one or more muscles will become looser and weakened and their opposing muscles will become tense and tighter.  Muscles under tension, become tired and may go into spasm, and at some point pain sets in. Further, these muscles–already strained–are at risk for injury as soon as you they try to do an activity out of their normal routine. This is often how people end up with the good old “pulled muscle.”

The activity that pushes these already tensed, tired muscles to the breaking point does not have to be something radical like suddenly going for a run on the treadmill or doing a kick-boxing class. It could be as simple as bending down to pick up the newspaper or reaching high up to clean a window.

It does not always have to be a misaligned joint that starts the cycle of muscle imbalance. Muscle imbalances can cause the joints to BECOME misaligned. For example, a body builder may work his abdominal muscles more than their opposing back muscles. This would lead to imbalance affecting numerous joints, including the spine and pelvis.  

Even one joint out of balance (out of position) can potentionally lead to pain and problems anywhere else in the body.   

Modern medicine likes to break up the human body into its component parts or pieces. There are back doctors, foot doctors, hand doctors etc. The reality is the human body functions as a whole unit. For example, a foot that is out of position can affect the hips as easily as a hip joint that is malaligned can affect the feet. Cause and effect go up and down the body, and to an extent in other directions, too.

Now, you might be saying, I feel fine—I don’t have any hip, knee or back pain. And you may not. But, if you are walking incorrectly, you are likely heading toward some kind of loss of function, decreased flexibility and ultimately, pain. Your body just isn’t at the breaking point yet.

Even if your body never reaches the point of giving you pain, incorrect walking diminishes the effect of walking on many of your muscles, leaving them weaker and flabbier.   

Can We Walk Better?

Yes! Walking is a skill, just like golfing, but even better: recall that walking is our most common and most NATURAL activity. Because it is natural, we can improve on it–easily–to the point where it can be extremely beneficial.

I can hear some of you now going through all the reasons that you cannot change the way you walk: “it runs in my family”, “I’m too old to change”, “I have bad genes”, “I was born with curve in my back” and on and on.

Listen up! Your body and its muscles are under YOUR control. You can change the way you walk once you understand how to do it. You learned how to walk wrong without any help; now, with proper instruction, you can learn how to walk correctly.  

Right now, there are only a few people in the world teaching correct walking. One of the foremost experts on walking correctly is Sherry Brourman. Recently, I spent a three days studying with her at her Santa Monica studio.  Brourman, or “Sherry” as she likes to be called by her patients,  is author of the book Walk Yourself Well. She is also a Physical Therapist and Registered Yoga Teacher, and super dedicated to helping people walk better. 

When treating a new patient, Sherry will take a thorough history, observe how the patient stands and then she will watch them walk. Often, within seconds of the patient taking a few steps, she will point out the patient’s main walking problem. 

At that point, she would recommend ways for the patient to make small adjustments and often some basic exercises and stretches that will target the patient’s specific walking problem.  

Essentially, walking correctly involves a combination of optimal, unique joint and muscle movement, body posture, and breathing, and most importantly, a new and heightened awareness of your body.   

Developing an awareness of your body is key, and this is why it is  important to work with a good teacher. Often, we can’t see our abnormal walking pattern or our compensations because we are so use to them.  For example, when I first  met Sherry, she immediately spotted my left knee hyperextending. Despite having read her book and studying the science of walking and biomechanics for years, I had never noticed my knee hyperextending until she pointed it out.

Now, I am much more tuned into listening to my body, and I have learned that our bodies, in a sense, “talk” to us.  We just have to listen.

Many of the people who I saw going to Sherry for help were at the end of their medical rope. They had tried everything else modern medicine has to offer, and then–out of desperation–went to her. Sadly, some of these patients went through surgery or even surgeries, and they are still in pain.  As I watched Sherry work with them, I often found myself wondering how much better shape many of them would have been in, had they come to her earlier, perhaps, even before they had surgery.

In fact, from observing Sherry work with her patients, I have come to believe that there are few people who cannot be helped with these walking techniques. Further, I believe millions of surgeries could be avoided, if people first tried to walk correctly.  

Lastly, having spent a lifetime trying to alleviate pain for patients, I want to emphasize how impressed I was with Sherry. She brings an intuitive brilliance to training people to walk. Perhaps, this is because of her understanding of traditional medicine and yoga—a great mix! If you have structural pain and can get to the Santa Monica area, I would highly recommend seeing her for a few walking sessions.  

“Walking is man’s best medicine.” — Hippocrates

After studying with Sherry, I slowly began using her techniques with a handful of my patients who had muscle-skeletal pain and problems throughout their body.   

My most successful walking patient to date is a woman who complained of back pain to the point that every morning she needed to use a heating pad for 30 minutes. She also had another unusual problem: the seam of her pants or skirts always rode up on her left butt cheek.  

This patient constantly would have to pull the seam back into place. Now, after only working with her for 4 sessions, she no longer has a problem with the seam of her pants and more importantly, her morning back pain is gone!  

Further, all the patients who I have been working with are doing better to varying degrees. Of course, a handful of patients walking well and getting well is not scientific proof that walking better makes your body better, but it is very encouraging.   

(By the way, if you step into my common sense chamber for a moment, you would have to admit that it seems logical that walking better will make your mind and body feel better.)   

For now, I am continuing to study, explore, and learn new ways to help people walk better. I am meeting with various holistic and biomechanic experts and seeing what I can learn from them. Ultimately, I believe if  people walk better, they will not only experience increased weight loss and fitness and pain relief, but spiritual vitality. That is, beyond the physical effects that walking well bring, people often find that good, whole-body walking has a very beneficial effect on their emotional state. It can lessen anxiety, alleviate depression or just clear their minds–briefly–of psychological woes.

We should never forget that our mind and our body are tightly linked. Each  affects the other, and walking well will lift your spirits and when done regularly can become meditative and rejuvenating.   

“It is impossible to walk rapidly and be unhappy.” — Mother Theresa

“Everyday I walk myself into a state of well-being and walk away from every illness.” — Soren Kierkegaard

If you are in the Chicagoland or Northwest Indiana area and are interested in learning to walk better, please contact my office – Friendly Foot Care.     

Final Thoughts on Walking Better

Most exercise and fitness programs require a conscious decision to do them each day. When it comes to walking, you already are doing it. The average person walks 10,000 steps a day. Now, you can just do it better.

How do you walk? Do you walk well? Or poorly? I would love to hear your comments on walking!      

References:

Brourman S. Walk Yourself Well. Santa Monica, CA. 1998.  

Kendal FP. Muscles: Testing and Function, with Posture and Pain (5 ed). Philidelphia, PA: Lippincott Williams & Wilkins, 2005. Klenerman L, Wood B. The Human Foot. London: Springer, 2006.  

Kirtley C. Clinical Gait Analysis: Theory and Practice. London: Churchill Livingston, 2006.  

Kou AD, Donelan JM. Dynamic Principles of Gait and Their Clinical Implications. Phys Ther. 2010 Feb;90(2):157-74. 

Neumann DA. Kinesiology of the Musculoskeletal System: foundations for rehabilitation (2nd ed). St. Louis: Mosby, 2010.   

Oatis CA. Kinesiology: The Mechanics and Pathomechanics of Human Movement (2nd ed). Philadelphia, PA: Lippincott Williams & Wilkins, 2009.  

Perry J, Burnfield JM. Gait Analysis: Normal and Pathological Function (2nd ed). Danvers, MA: Slack Incorporated, 2010.  

Rose J, Gamble JG. Human Walking. Philadelphia, PA: Lippincott Williams and Wilkins, 2006.  

Sahrmann S. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby, 2001.  

Subotnick SI. Sportsmedicine of the Lower Extremity (2nd ed). Philadelphia:Churchill Livingstone, 1999.  

Zajac FE, Neptune RR, Kautz SA. Biomechanics and muscle coordination of human walking. Part I: Introduction to concepts, power transfer, dynamics and simulations. Gait Posture 2002; 16: 215-232.  

Links:

Sherry Brourman 

About.com Walking  

The Walking Site  

Walking on Wikipedia  

AARP – The Numerous Benefits of Walking  

Active.com – Walking  

Walk About Magazine

EroFit 

Marathon Walkers 

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Recently, EmpowHer invited me to write a column – here it is!

Pain and problems in the female foot are common—four times greater than for men. One study found that eighty-two percent of U.S. women report having foot pain, seventy-two percent have a foot deformity, and of all foot surgeries in the U.S., women undergo ninety percent of them.

Incredibly, it isn’t just the woman’s foot that leads in pain and problems. Females suffer with more ankle, leg, knee, hip, back, and neck problems. Clearly, when it comes to pain, this is one place women have too much equality!

Don’t despair! You can do simple things to prevent and alleviate pain now. Before I get to that, I want to explain why women are more prone than men to experience muscle-skeletal pain and ailments.

The Feet Are Our Body’s Foundation

Feet are your foundation—whether you are man, woman or child. Strong, well-functioning feet and ankles are essential for support and balance. Working in unison with the body, your feet rapidly adapt to maintain balance over a variety of surface, whether you are running, walking, jogging, carrying a backpack, baby, purse, or all three, or even recovering from a sudden stumble. Feet do it all.

Having incredibly dynamic feet is great until something with them goes wrong. The smallest imbalance in your feet shows up as larger problems up above—in your knees, hips, back, and/or neck. Thus, a misaligned foot leads to a misaligned hip and/or back and/or neck.

Our body depends on agonist-antagonist muscles pulling against each other around our dozens of joints, and any joint imbalance will cause weakness of the muscles on one side of the joint and tension and strain of the muscles on the other side. The result is pain.

Further, these muscle-skeletal misalignments are more likely to occur due to the unique shape of the woman’s “normal” foot.

How is Woman’s Foot Unique?

Compared with males, the female’s foot is generally shorter, narrower, and the length of instep is not as long. The average woman wears a size 8.5 (her foot is approximately twenty-four centimeters or 9.5 inches in length, about an inch shorter than the foot of the average male). The woman’s heel is narrower when compared to the ball of foot, which is wider and has a larger girth relative to the rest of the foot. 

Overall, the woman’s foot is flatter than the male foot. This lower (or more pronated) foot is the root cause of the many of the body’s structural problems.

When feet flatten more than necessary (or over-pronate), the legs compensate by rotating excessively inward. This increased internal rotation creates abnormal stress on the knees causing them to become painful and deteriorate (osteoarthritis). With the knees now strained and out of alignment, a “ripple effect” can occur, causing imbalances, pain and arthritis in the hips, back and neck  Since a woman’s foot is already on the flat-side, she is more predisposed to this painful cascade of events. (For those people whose feet are high arched (or supinated), a similar cascade of joint misalignment occurs leading to pain, imbalance and osteoarthritis.)

To make this chain-of-events even worse, a foot—male or female—that is on the flat side (excessively pronated) is more prone to become even weaker through a vicious downward foot-flattening cycle. Ultimately, this progressive flattening of the foot results in even more foot problems and more muscle-skeletal problems throughout the body.

What You Can Do About Foot, Knee, Hip, Back and Neck Pain

To restore normal alignment to your body, you need to restore balance. The best way to do this is by strengthening agonist and antagonist muscles around your major joints with the goal of improving posture.

This sounds complicated, but there is a very simple way to start: walk barefoot. Shoes act as braces for your feet, altering the alignment of your body and negating the need for many muscles to work at all. Walking barefoot or in minimalist footwear (very flexible shoes such Terra Plana’s Vivo Barefoot), allows your body to “feel” the ground. Do as much walking barefoot as safely possible.

Barefoot activity allows your body’s muscles to develop and remarkably, an innate biofeedback system kicks in that tells your body how to make subtle, unconscious adjustments in the way you walk (your gait). To walk correctly takes a lot of work and study, and is beyond this article, but barefoot walking is a great way to start.

When you must wear shoes, less is more. As mentioned, wear minimalist shoes or very flexible, thin shoes that provide basic protection but still let your feet sense the ground beneath them.

Final Thoughts on Muscle-Skeletal Pain

Now, you can begin to understand the effect of foot misalignment and other joint imbalances on your body. The simplest way to start to strengthen your muscles and rebalance your body is through your feet, and how by losing your shoes, you will be on your way to losing the pain.

If you have any questions or foot, ankle or walking-related topics you would like to learn about, please post in our Forum Section.

References:

Bingefors K, Isacson D. Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain–a gender perspective. Eur J Pain. 2004 Oct;8(5):435-50.

Stubbs D, Krebs E, Bair M, Damush T, Wu J, Sutherland J, Kroenke K.Sex Differences in Pain and Pain-Related Disability among Primary Care Patients with Chronic Musculoskeletal Pain.

Khang YH, Kim HR. Gender differences in self-rated health and mortality association: role of pain-inducing musculoskeletal disorders. J Womens Health (Larchmt). 2010 Jan;19(1):109-16.

Terrier P, Dériaz O, Meichtry A, Luthi F. Prescription footwear for severe injuries of foot and ankle: effect on regularity and symmetry of the gait assessed by trunk accelerometry. Gait Posture. 2009 Nov;30(4):492-6. Epub 2009 Aug 25.

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Could improper shoe fit be the cause of runners' ailments?

I received a large and diverse response to my last post on the potential benefits of running barefoot. I will not bore you with the gory details, but suffice to say barefoot running stirs up more emotion than the last Presidential election.

Most runners, at some point, sustain injury. One of the most common is knee injury/pain, followed by achilles tendon/calf problems, metatarsal problems, toenail problems, hip/groin pain, plantar fasciitis and heel pain, ankle pain/sprains, shin splints, nerve injuries, quadriceps, hamstrings and back problems.

Could Improperly Fitted Running Shoes Be the Problem?

A survey of 1200 runners by the American Orthopedic Foot & Ankle Society found that almost two-thirds of runners sustained injury that they believed shoe related. In analyzing the survey, the American Orthopedic Foot & Ankle Society implied that it was necessary to have the shoe broken in and stressed the importance of “proper fit” and “comfort.”

Achieving “proper fit” as a runner can be laborious process, and perhaps NOT achievable.

The Running Advisor has a detailed process on How to Choose a Running Shoe, which is good and worth a read. One problem is, there is no consensus on what exactly the definition of proper or perfect shoe fit is. Numerous “experts” have guidelines, but no definition exists. Worse, even if a definition existed, meeting it would rarely be possible.

A 1982 survey by the Prescription Footwear Association found that all people have “mismatched” feet. Keep in mind this is looking at the foot in three-dimensions. Even if both feet have approximately the same shoe size, their structure (arch height, ball width etcetera) will differ. It would be extremely rare for someone to have two feet with same size, shape, proportions, and biomechanics.

Further, feet change shape. Four factors must be considered when sizing shoes to feet. These factors are dependent on activity and external factors.

The Four Shoe-Fitting Factors No One Tells You

At rest, the foot has a STATIC shape, when standing the foot’s 26 bones shift position creating a WEIGHT-BEARING SHAPE, under walking or running the foot will change shape again (FUNCTIONAL SHAPE), and lastly, the foot will change shape in response to temperature and humidity (THERMAL SHAPE).

Not to complicate the matter but the newest literature shows that our diet and our body’s hormonal fluctuation can affect foot shape and the way we walk. Machado has shown that plantar pressure distribution under the feet of young women varies with the woman’s menstrual cycle.

Further, throughout the day, as we walk, our feet swell. William Rossi in his book Professional Shoe Fitting claims that this swelling is approximately 5%, and he says during exercise, such as jogging, our feet can expand as much as 8% or a one and a half shoe size difference. Let’s repeat that: during jogging your foot could expand one and a half shoe sizes. Therefore, a runner who bought their running shoes in the morning, before much activity, and then went for a run on a hot day potentially could find their foot squeezed into a shoe one and a half sizes too small!

Proper Running Shoe Fit is a Myth – It’s Never Happened!

How can running shoes perfectly (properly?) fit non-expanded feet in the morning (or at the start of a marathon) and expanded feet at the end of the day (or 12 miles into a marathon), combined with the fact that each of our feet (left and right) are different? They can’t. Like the Loch Ness Monster, proper shoe fit does not exist. Sure, some salesman may tell you your shoe fits, but ask him about Static fit, Dynamic fit, and how the shoe will fit your foot after you run five miles in the heat.

On the Runner’s World forum, Barefoot TJ wrote: “Doc, I have Morton’s Neuroma (2 in each foot).  The pain became so unbearable that I could no longer run in those over controlling, so-called, high-tech running shoes; I was in crippling pain by 1 – 3 miles feeling like I had fractured my toes.  Running barefoot allows me to run farther, much farther before that horrible pain comes on, and I’ve been doing this for a while now.”

Morton’s neuroma causes cramping, tingling (a feeling of pins and needles), burning, or shooting pain in the toes or ball of your foot. A neuroma is a painful growth on a nerve that forms when the nerve becomes irritated.

In TJ’s case, once you understand correct shoe fit—or more importantly, lack of correct fit, one can understand how TJ’s shoes were, while running, becoming too snug and compressing the forefoot (and the nerve) and aggravating her Morton’s neuroma. Now, she could buy larger shoes, but that could lead to the foot moving too much and cause other problems, such as blisters.

All runners are compromising on shoe fit. For some, this may be fine. For others, it may be contributing to injury.

The American Orthopedic Foot & Ankle Society recommends proper fit as a recommended solution. Could the 2/3 of runners surveyed who are injuring themselves and blaming their shoes all not be wearing properly fit shoes? Or are other forces work?

Coming Soon:  Could Running Shoes Themselves Be the Cause of Runners’ Injuries? 

Resources on Shoe Fit and Sizing:

Zappos Running Shoe Fit Guide

Runner’s World Right Shoe Fit Guide

Asics Shoe Fit Chart

Cool Running Shoe Guide for Dummies

Dick’s Running Shoe Fit Guide

Sierra Trading Post Shoe Fit Guide

Wiki How to Choose Running Shoes

Running Shoes – Finding the Right Fit

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Ask the Foot Doctor Your Questions

Today we start a new feature: the chance to ask Dr. Nirenberg a foot or ankle question.

The Internet has changed how we learn and understand our world, and our medical problems and conditions—especially our foot and ankle problems. Information is now literally at our fingertips! I firmly believe knowledge is power. However, due to legal issues and restrictions on physicians practicing telemedicine, answers to questions are strictly for informational purposes. Readers will still be able to learn much by asking questions, but the answers are not a substitute for medical care (for a more medical detailed disclaimer read this site’s Terms of Use).

As for your questions, we are looking for great, fascinating foot and ankle questions that our readers will find interesting.

The questions can concern anything related to our feet and ankles, from simple warts or corns to arthritic or weak ankles, and everything in-between. Questions do not have to be strictly medical related. (For example, I was recently asked why our feet are ticklish, and soon I will post an entire article on this fascinating question.)  

So start asking your questions right now! Click Ask a Question.

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Madonna with Ice Pack and Bandaged Ankle

Madonna limped off the stage yesterday after injuring her ankle during a concert in France. Reporters spotted her with a big wrapping around her ankle. From these reports and photos, it seems she is treating her ankle sprain (ankle injury) wrong. But, before I get to that, we need to understand a little about ankle sprains.

If You Dance, You Must Pay the Piper

Dancers may not be considered athletes, but the one’s at the top of their game—such as Madonna—are just as athletic as the top basketball or football players, albeit in a different way.

Madonna (and other dancers) often do complex dance moves for which our feet and ankles were not designed. Specifically, these dancers move sideways with a lot of sudden stopping and going. These abrupt sideways (or lateral) movements strain the ligaments—the thin fibrous bindings–that hold our ankle securely to our foot. (One can only begin to imagine the incredible strain Madonna’s fantastic dance moves puts on her ankles!)

Dancers Are at High Risk to Injure The Ankle's Ligaments

Doing these sudden, quick moves once or twice is one thing, but Madonna and other dancers do these repeatedly, and as a result, the strain on the ligaments accumulates.

Over time, the ligaments weaken, and eventually they SNAP—giving out. You may see a simple ankle strain or ankle injury, or a severe ankle sprain or even a ankle fracture.

The Best Treatment for Madonna’s Sprained Ankle

Madonna with her Ankle Bandaged Incorrectly

In the photo above, Madonna has wrapped a big bandage AROUND her ankle. This type of wrapping is a start. A sprained ankle needs rest, ice and immobilization.

The reason for immobilization is to allow the frayed, sprained, or even torn ankle ligaments to heal. And not just heal enough for the pain to go away, but they should heal up as snugly and tightly as possible.

When ankle ligaments do not heal correctly, the person has doomed their ankle to weakness and instability for the rest of their life.

A weak ankle is more prone to further ankle sprains, ankle injuries, ankle pain and even ankle fractures. A vicious cycle ensues. People with weak ankles may eventually develop ankle arthritis due to repeat sprains. Ankle arthritis can lead to chronic pain with each and every step.

Madonna has several options to allow the ligaments to heal—casting the ankle, a walking boot, an ankle brace or wrapping up the ankle. She may also need physical therapy or other measures.

Madonna has started treating her ankle sprain with wrapping the ankle, but to do it right she needs to have the wrapping pull the ligaments tight (pull them together) The wrapping should go under the heel or arch and pull the foot up to the ankle and immobilize the entire foot/ankle complex.

The Right Way to Tape a Ankle Sprain

Depending on the severity of the sprain, Madonna may find herself with a lifetime of ankle weakness. I hope she heeds this warning and promptly sees a podiatrist!

Sources: Radar and The London Paper

To Learn More about Taping Up an Ankle Sprain visit Sports Medicine International

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Now that your car has an airbag to protect your head, neck, spine and torso, doctors are seeing car accident victims sustaining more foot and ankle fractures. Let me rephrase that: now that people are surviving their car crash, doctors need to treat more foot and ankle fractures.

In the old days, before air bags, a fractured ankle did not matter if you were dead. Now, a fractured ankle is nowhere near as serious as a fractured skull, but it can leave you with chronic arthritis, weakness and deformity. These people can be left with foot pain or ankle pain or problems for the rest of their life.

The solution is simple: another air bag for our feet and ankles. We have the technology, so why not add another airbag?

Of course, once our feet are safe, someone is going to want an airbag for their hands.

Source: Medical News Today

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Is Dr. Nirenberg a real doctor? Hear what Seinfeld has to say:

Podiatrists, or Doctors of Podiatric Medicine (DPM), are, in fact, real physicians.

Podiatrists specialize in treating foot and ankle problems. Podiatrists treat all problems related to the foot or ankle, and the variety of cases is endless. However, the most common problems I see are:

• Heel and/or arch pain

• Ingrown toe nails

• Bunions (bumps on the inside of the big toe)

• Hammertoes (bent toes)

• Flat feet

• Foot or ankle arthritis

• Fungal toenails

• Sores (ulcers)

• Infections

• Sprains and fractures

• Ankle pain or weakness

• Nerve problems and neuropathy (numbness, burning, or tingling)

• Shin splints

• Gout

• Athlete’s foot

• Sports medicine and diabetics foot problems

• Children’s foot problems

• Swelling or discoloration

• Plantar warts

• Arthritis of foot and ankle

• Heel spurs

• Arthritis

• Tendonitis

• Blisters

• Corns and Callouses

• Moles, cysts, tumors or lesions

When to Call a Podiatrist:

1. You Have Foot or Ankle Pain

Some aches and pains in our feet or ankles may go away in a day in a two; others do not, and that is when you need to go to a podiatrist.

Many people who see me for a painful foot or ankle have had pain for several days or weeks, but some have been limping around for several months or even over a year!

Pain is the body’s way of telling us something is wrong. Don’t ignore it.

However, not all people with foot or ankle problems have pain. For example, diabetics who have neuropathy (a deterioration of the nerves of their feet) may fracture a bone or develop an infection or sore on their foot and not have any pain.

Recently, I had a patient with diabetes come to see me complaining of a small sore on the bottom of their foot; an x-ray revealed a needle inside the foot.

Because the patient had very little feeling in her feet she didn’t know she had stepped on anything sharp.

In all patients, foot and ankle problems can quickly become serious, but diabetics are especially at risk.

Diabetics who don’t seek podiatric care promptly often develop gangrene and need a toe or the whole foot amputated.

Prompt treatment is essential. All diabetics or anyone else with decreased feeling in their feet need to have any foot or ankle problems checked by a podiatrist immediately.

2. You Notice Changes in Your Feet

Some people may notice one foot swelling or flattening.

Diabetics and others with neuropathy may not have pain, however these are the people most at risk for a particularly serious problem called charcot arthropathy.

In charcot arthropathy, the bones of the foot weaken and slide out of position, and may actually break through the bottom of the foot, leading to infection and even amputation.

For other patients, a rapid flattening of one foot may mean the main tendon holding up their foot has torn.

It is a good guideline for anyone who notices swelling, redness, increased warmth, or a change in the shape of his or her foot or ankle to see a podiatrist promptly.

3. You Find Something Abnormal On Your Foot or Ankle

A podiatrist should check any lumps, bumps, cysts, tumors, or moles on your foot or ankles. These problems are usually harmless, but occasionally they can be cancer and life threatening.

Final Thoughts on Foot and Ankle Problems

If you have a foot or ankle problem or pain, the best advice I can give you is: Don’t wait for it to go away—it may not.  

If you experience persistent pain, notice changes in the shape or color of your feet, or find an abnormality, then see your podiatrist right away. To learn more about podiatry, podiatrists, and podiatric medicine, visit the website of the American Podiatric Medical Association

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Bunions, Flat Feet & Weak Ankles

Most of us don’t think about our feet until they hurt.

Even then, we limp around hoping the pain will go away. But with two to three times our body weight pushing down on each foot with every step, it usually doesn’t.

Fortunately, you can do a few things for relief.

1. Wear Only Great-Fitting Shoes

In one study, 88% of women admitted that at some point they knowingly squeezed their feet into shoes that were too small.

Further, as we age, our feet tend to become larger, but most people insist on wearing the same shoe size they wore years ago.

In addition to making sure your shoes fit properly, make sure they have a good arch support and that the heel counter—the area that wraps around your heel—is firm and strong.

2. Feet Need Exercise, Too

I can hear the couch potatoes now:  “My feet get enough exercise.”  Perhaps, but walking to the fridge or standing in line at McDonald’s isn’t exactly exercise.

Most people agree our entire body needs exercise, but few people think about keeping their feet in shape.

Yet, with the average person walking over a hundred thousand miles in their lifetime, feet need all the help they can get.

Foot exercises tone, stretch, and strengthen feet, while alleviating fatigue, soothing soreness, and increasing blood flow.

3. Take the Plunge

Nothing soothes sore, aching feet more than a relaxing footbath.

You can use a bathtub or plastic basin, or for some serious relief, I recommend buying a massaging footbath.

Make sure the water is warm, not hot (I’ve seen patients soak in water so hot they received second-degree burns).

Add good quality bubble bath to the water; and for those who are not diabetic or have poor circulation, adding Epsom salts is great, too.

4. Moisturize Your Way to Healthier Feet

Good moisturizers can sooth dry, irritated skin.

The secret to finding a good moisturizer for your feet is not by price; more expensive doesn’t mean better.

Read the ingredients and avoid products with alcohol or alcohol derivatives—the best dry-skin products tend to be creams without alcohol.

These are gooier and absorb slowly, so I recommend applying them just before going to bed.

5. Nailing Down Nails

Caring for your nails will go a long way in helping to alleviate foot problems.

Long, jagged, and thickened toenails can catch on socks or pantyhose, dig into adjacent toes, or suffer injury by pressing against the inside of our shoes.

In my practice, I have seen unkempt nails lead to blisters, infections, ingrown toenails, and even gangrene.

When trimming your toenails, follow the contour of the toe and avoid cutting into the corners. Smooth any rough edges with a nail file.

Final Thoughts on Aching Feet

Caring for your feet is your responsibility. However, when problems don’t go away, become serious, or if you have diabetes or poor circulation, get professional help and see a podiatrist.

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Painful Hammertoes & Fungal Toenails

Eighty percent of people, at some point in their lives, have a foot problem that requires medical care.

However, many people let their problems persist and worsen untreated.

Here is a list of the most common foot problems I see in my practice that you can watch for to ensure the health of your feet.

Heel Pain

Heels get a bad rap. The dictionary defines a heel as a dishonorable person, and the term “Achilles’ heel” refers to a fatal weakness.

The reality is your heels are quite strong, though no other part of your foot malfunctions more. Heel pain is the number one reason people come see me.

Heel pain can be very complicated and may have a variety of causes, including a stress fracture, pinched nerve, bone cyst, or tumor.

Most patients with heel pain believe they have a heel spur.

This may be part of the problem, but the most common cause of heel pain—whether or not a heel spur is also present—is inflammation of the largest ligament in our foot, the plantar fascia. In doctor-speak, this problem is called plantar fasciitis.

 Treatments for plantar fasciitis range from custom-made arch supports (called orthotics), to simple stretching exercises, to the revolutionary, high-tech shockwave treatment. 

Nerve Problems

 Burning, numbness, tingling, or shooting pain in your feet or ankles often means something is wrong with a nerve.

Nerve problems are common in feet, so if you have one, don’t get nervous. Most of the time, the treatment is relatively simple.

The main nerve problems I see are:

• Morton’s Neuroma

Not to be confused with Morton’s Steakhouse—which may cause a full stomach—Morton’s neuroma causes cramping, tingling (a feeling of pins and needles), burning, or shooting pain in the toes or ball of your foot.

A neuroma is a painful growth on a nerve that forms when the nerve becomes irritated.

Treatment for neuromas consists of using a special arch support, called an orthotic, and sometimes injections are needed. Surgery is rarely necessary.   

• Tarsal Tunnel Syndrome

Almost everyone has heard of carpal tunnel syndrome in the hands, but few people realize the same problem occurs in our feet.

Tarsal tunnel syndrome may cause burning, tingling, shooting pain, or a cramping sensation in your foot.

The good news is that there is a light at the end of this tunnel. Tarsal tunnel syndrome is often easily treated with orthotics, injections or a short, outpatient procedure.   

• Neuropathy

Neuropathy literally means a “disease of the nerves,” and it affects millions of people each year. Persons with neuropathy often experience loss of sensation, burning, tingling, or shooting pain.

The number one body part affected by neuropathy is the feet. Persons with diabetes are those most afflicted with neuropathy, but it also occurs in people with thyroid problems, vitamin deficiencies, alcoholism, and some types of arthritis.

Neuropathy has many treatment options and some people might opt for a new, somewhat controversial, procedure that involves surgically freeing up the nerves to restore normal sensation to their feet.

Arthritis of the Foot and Ankle

Degenerative joint disease, osteoarthritis, or just plain old “Arthur” is a deterioration of the joints between our bones.

When Arthur visits people’s feet or ankles, many believe they just have to live with it. This is far from the truth. The reality is podiatrists have many techniques to alleviate arthritis, including a high-tech, tiny arthroscopic camera that can remove arthritis from sore ankles.    

Nail Problems

I am not talking about rusty nails on your garage floor, but ingrown toenails and fungal toenails. Ingrown toenails occur when the edge of the nail grows deep into the flesh of the toe.

These are painful and can become infected. Fortunately, a brief, in-office technique can alleviate ingrown toenails, often permanently.

Fungal toenails are another story, and usually require a long course of medication.

Bunions

These are protrusions of bone or bumps that form on the inside of the foot at the joint at the base of the big toe.

If you wear ill-fitting shoes, don’t blame them for bunions—blame your parents. Bunions are inherited. However, poor footwear can contribute to the formation of a bunion.

Numerous conservative treatments, such as trying wider shoes or foot soaks, can alleviate painful bunions, though getting rid of them requires a short, outpatient surgical procedure.

Other Big Toe Problems

• Hallux Rigidus

With hallux rigidus, the big toe may look normal; however the inside of the joint at the base of the big toe is deteriorated and painful.

Sometimes the big toe won’t bend. Like bunions, simple treatments can lessen the pain, but in on some cases surgery is necessary.

• Gout

Known as the “rich man’s disease,” gout doesn’t just affect the rich. Gout is a type of arthritis that most often occurs in the joint at the base of the great toe, causing redness, swelling, and pain.

Some patients have said the pain was so severe that they couldn’t stand the bed sheet resting on their toe. Other patients describe less intense symptoms.

Gout occurs when too much uric acid is present in your body. Uric acid is a natural chemical that your body manufactures, and you ingest in certain foods, like pork, beer, or liver.

Treatment consists of altering your diet to limit the amount of uric acid you ingest, and if that isn’t enough, medication is prescribed.

Corns and Callouses

Corns have nothing to do with plants that grow ears. Painful corns (and callouses) are a build-up of hard, dead skin that often occurs due to an abnormal bony prominence or a bone out of position.

Corns occur on toes and callouses are found on the bottom of the foot.

Contracted toes (hammertoes) cause corns to form, and callouses form when a bone or bones are out of position. Treatment of a corn or callous depends on what is wrong with the bone underneath them.

Final Thoughts on Common Foot Problems

These are the top foot and ankle offenders, but the list of problems I see in my practice is endless. If you have foot or ankle pain or another problem, the best thing you can do is have it checked by a podiatrist.

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