Foot pain

Dr. Karpati on Foot Care

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1. Question:
My sister-in-law has problems with her feet. We can be walking in the mall less than 1 hour and her feet start to arch with instant pain, plus drenched socks. What can she do to prevent this from happening? The pain has her in tears every day and night.

Dr. Karpati's Answer:
This does sound very distressful for your sister-in-law. Unfortunately, without a proper examination, I do not feel it is appropriate to try and guess as to what this could be. Is there some neurological component that causes her "feet to arch" or is this purely biomechanically induced? Is the sweating more of a direct response to the pain or independent of it? There are many questions to be asked by a professional to get to the root of her problem. Please refer to the "Find a Podiatrist" tab on the www.apma.org website to find a podiatrist in your area who can help.



2. Question:
What causes and how do you treat a stinging sensation in your feet? My husband is 52, he complains daily of a severe burning or stinging in both feet. Mostly in areas that are calloused i.e. the ball, heel, bottoms of toes and across the top of the foot, near the toes. We have used everything that we can imagine to comfort him. It seems to worsen at night, although he does have the sensation during the day.

Dr. Karpati's Answer:
My first question would be whether or not he or a relative is diabetic. Many diabetics experience the sensations you are describing. If he has been tested for this and is not diabetic then he does seem to have similar nerve type pain. He may have compression of the nerves in the lower extremity. This may be due to binding of a certain nerve from, let’s say, a flat foot type, or if he is athletic, this could be due to the chronic jamming of the foot forward in a shoe with exercise. In either case, the next best course of action is to seek a neurologist who can perform nerve conduction velocities (NCV) and Pressure Specified Sensory Devise (PSSD) testing to help narrow the cause down. A podiatrist will help eliminate abnormal biomechanics as a cause. There are medications that can help reduce these sensations. Your neurologist and podiatrist will help you find the right medication combination if need be.



3. Question:
I have very narrow feet and often feel like I am walking on my bones, my feet hurt most of the time, is there anything I can do?

Dr. Karpati's Answer:
It sounds like you need a good pair of functional orthotics. These devices are custom-made for your foot and their job is to help realign the osseous and soft tissue structures, providing optimal alignment and function during stance and ambulation to help alleviate discomfort. You will need to see a podiatrist to have these made and to find out insurance coverage for these and there will more then likely be a waiting period to have these made. These are truly the ones that our custom to your foot (rather than shoe size) You may find a podiatrist in your area by visiting www.apma.org.



4. Question:
I've lived in cheap rubber flip-flops for at least seven summers and generally wear cheap shoes year-round. I have pretty flat feet and am relatively sure I over-pronate. But I have been blessed to avoid foot pain, so I generally never thought about the importance of "good shoes." I have had just a little occasional arch pain lately, though, and as I prepare to have a baby and anticipate carrying a little one a lot, I thought I would invest in a good pair of shoes. I bought a pair of Chaco's after hearing them so highly recommended as healthy for your feet, but when I tried them on, I found them pretty uncomfortable. The arches were so high that my feet were hurting after standing and walking in the Chaco's for just half an hour. I was relieved to put the flip-flops back on! What I'm wondering is, do my feet NEED this kind of support and they'll just get used to it and stop hurting in the Chaco's if I keep wearing them? Or will they always hurt, and I just need a different kind of shoe for my flat feet? I don't want to keep and wear such an expensive shoe if it's just going to be painful all the time, but I'm willing to pay the money and undergo temporary pain if this is really so much better for my feet (and back, shoulders, etc.) long term.

Dr. Karpati's Answer:
There is no question that podiatrists see an increase in foot pathology, including heel/arch pain, during the summer months since it is during these times when people are wearing flip-flops/sandals the most. Increased weight from your pregnancy is putting increased pressure on your arches. This, combined with a flatfoot type, is what I believe is giving you arch pain. There is no question that you need more support. Just because a shoe is expensive does not mean that your foot will accommodate to the arch in the shoe. I recommended you keep trying to find shoes with good support that are comfortable. It will take six months for your feet to return to their pre-pregnancy state and it is at this time that I recommend you see a podiatrist to get casted for functional orthotics. These are custom-made inserts which replace the factory inserts in your shoes. Their job is to help realign the osseous and soft tissue structures, providing optimal function of your feet which will help alleviate discomfort and help prevent future pathology. Please go to www.apma.org to find a podiatrist in your area.



5. Question:
Here is my story/problem: First of all, this is who I am...
Age: 15
Gender: Male
Weight: 165
Height: 6 feet, 2 inches
Sports: Swimming in the winter, Track (distance) in the Spring, Swimming again in the Summer, and Cross Country in the Fall.

So basically, when I run, the 1st mile in I'm fine. But then gradually a pain that wraps around both my ankles develops, and it gets worse and worse until I can't tolerate it and I start to walk. The pain continues when I begin to walk, although 30-60 seconds later it usually wears off to a point where I have no pain. Then when I try to run again, the pain develops within a minute and I have to walk again. But the weird thing is, it happens on some days, and not others. I can go through a whole week of running with my track team with no ankle pain, and then that Saturday when I go out for a run, my ankles kill me as I just described. The running conditions are equal, same surfaces, etc.

I went to the podiatrist and they at first thought it was shin splints (which I knew it was not, because I've had them before), but then when I said that pain is on my WHOLE ankle, including the back of the foot and all the way around, they concluded that it was pain from my growth plate that has not completed fusing. On both feet, he took a total of 6 x-rays. But I don't know how much I believe him.

I've had the pain before. I had it during the Fall, during Cross country. But in the Fall, I had the problem where my ankles would hurt so bad, only if I didn't run the day before. But it was the same pain I have been feeling recently, except recently it has been worse than ever.

The doctor pressed around my whole leg/ankle/foot area, and could not reproduce the pain, as I expected. The pain ONLY occurs after running for more than 10 minutes without stopping. Usually I go for 40+ minute runs, which I have not been able to do recently because of this problem.

The first day of track and field in the Spring, my distance coach made everyone run way too much, and the same went for the first week of practice. Instead of gradually working our way up to our target workout and running time, he jumped right in, more or less, with us running 4-6 miles the first week of practice. I had to skip a few days because I almost couldn't walk after the workouts he gave us, because I hadn't ran since the Fall. Maybe because he started me off to rough, it caused this problem? I thought it could be a stress fracture, although the doctor said it probably wasn't.

Now let me describe the pain. It doesn't feel like muscle pain or bone pain. It's just really hard to explain. It seems like the pain (same in both ankles) radiates from the center of my ankle until it becomes so intense where I can't run anymore. It almost feels like what sore muscle would feel like, except it is condensed in a smaller area (around my ankle) and is much more intense and intolerable.

The doctor told me not to run (ugh...) for 7-10 days, and after that, go back out and run and see if it still hurts. If so, come back and I'll see a foot doctor who is a runner, so knows more about running than he did. Overall, I spent over an hour in the exam room between getting the x-rays, and the doctor and his intern discussing what it might be. They looked pretty clueless to me. Does do you have any ideas?

Dr. Karpati's Answer:
Wow! You have really had time to think this through and I am impressed by your eloquence! I am curious as to what foot type you have. Most people I see (and I see a lot of runners and used to run myself!) with ankle pathology have a flat foot type. Now let me tell you, not all flat feet look flat when you look at them and people will swear to me they don’t have one when they do. It is not necessarily how the foot looks when you look at it, rather it is more what the foot does to compensate for how the foot functions that matters. It is key that your physician watch you walk and run. It is key that she or he evaluates the forefoot to rearfoot to leg relationship when your foot is placed in neutral. It is key that she or he looks at the bones and joint structure and alignment on X-ray. Only then can the best course of conservative treatment be made. With out having done so myself, I can only guide you so far.

First and foremost, most of my athletes do better with their respective problems in a functional orthotic. A functional orthotic is a device that replaces the factory insert in your athletic shoes and works by realigning the boney and soft tissue structures, thereby improving foot function. Placing your foot in proper alignment removes much of the excessive strain that leads to various pathologies. Mind you, I am not talking about an orthotic that is made off of a mold of you stepping into a foam box (impression type mold) or walking across a plate. A true functional orthotic is one that is made by molding a fiberglass type slipper or plaster type slipper onto your foot while the foot is PLACED in neutral position by a trained podiatrist. (I do not know of an orthopedic specialist that do what podiatrists do in this respect.) We are trained to be able to do this in medical school and residency. If the skill is not kept up with (a podiatrist who won’t take the time to do this method), however, the technique will be lost. Now there are many podiatrists who will disagree with this “orthotic casting” view point, but there are many more who swear by it, and if you think about it, it just makes more sense.

Once your foot is placed in proper alignment, and the running is resumed, we can have a better idea of where we can go with you. Unfortunately, having a custom orthotic made will take time as the mold is sent to a lab where the orthotic is made according to your specifications based on your symptoms and foot/ankle type. In the mean time, it is important to have something better that what you have in your shoes, and the arch supports you find in stores will not cut it. Not as good as custom, but better than store bought, are inserts sold to professionals, such as Orthofeet BioSole-Gel Self Forming Orthotics Sport. Work your way into them. Do not run in them until you are 100% comfortable in them. (If your feet or ankles get sore wearing them, take them out and let them rest, putting them back in when you feel better.) When they are comfortable, work your way up in mileage with them in your shoes. Yes, this does absolutely mean cutting back on your running. It is hard to heal a hurt ankle when you are pounding on it. I say run for ¼ to ½ the time you normally run and stop. Work up adding another ¼ to ½ every 3 days depending on your symptoms. You may also want to wear a lace up ankle brace if the insert alone does not cut it. Try this in conjunction with the insert, not to replace the insert.

Also while you wait for your orthotics to come in, please get some physical therapy, not from your high school, but by a physical therapist. This can help in many ways.

Last but not least, consider getting an MRI if these simple things don’t work. There are things that can show up on MRI that are not seen on X-ray. Remember, having not seen your ankle, this is about the best advice I can give you unseen. Any further advice or treatment must come from a podiatrist who has evaluated you and whose advice you trust enough to follow. You can go www.apma.org to find podiatrists in your area. Very best of luck to you!



6. Question:
My feet feel like they are sweating but there is no moisture on my feet. My toes hurt and cramp sporadically. I have been researching tarsal tunnel because until January of this year I transcribed information using a dictaphone using my right foot constantly. I have orthotics, they have helped some but have not cured the hot feeling feet nor sore toes and now my left foot has started hurting in the same manner. My sister was diagnosed with diabetics last year, but according to my recent test results 6 months ago there were no signs of diabetics. I have no idea why this starting two months after I no longer used a dictaphone.

Dr. Karpati's Answer:
You may be right on with this one as your symptoms are in sync with Tarsal Tunnel. You may have quit what caused it but now you sound chronic. Please gather a "team" (podiatrist and neurologist) and get a good work up done which should include nerve conduction velocities and EMG. If theses are negative, get an MRI. Ask about Lyrica to help with your symptoms in the mean time.



7. Question:
I am otherwise a healthy woman, except on the soles of my feet I constantly experience burning sensation. I am not in the pain. I am able to exercise, do cross country skiing, hiking, etc. I do not have a problem sleeping. It is just this constant burning sensation or like ants walking on the soles of my feet when I walk or sit. I try exercising my feet to get the blood moving, put ice pack on my feet whenever I can, I am massaging bottom of my feet but nothing seems to help. Can you recommend something else I can try? Do you have an experience with the leg and foot massaging equipment for around $400? Are they any good? My calves get sometimes very heavy and tired. I can't sit for a very long time. Flying in an airplane or going to a theater makes my legs very restless. Is this a circulation problem? Any recommendation what could I try to relieve these problems? I forgot to mention that I have flat feet and I use inserts all the time.

Dr. Karpati's Answer:
If you have a history of diabetes in the family, I would get checked yearly. This presents very much like diabetic neuropathy. Assuming you have recently been checked for diabetes and you do not have this, and the fact that you have flat feet, you may be experiencing Tarsal Tunnel Syndrome. Flat feet put excessive strain on the nerve that supplies sensation to the bottom of your feet. When this nerve gets compressed, it results in the symptoms you are describing. Over the counter inserts may not support your arches enough. The best thing you can do immediately is get functional orthotics to reduce the biomechanical strain. Please get these from a podiatrist who will actually get a cast molding of your foot (not handed to you by shoe size, not by scanning your feet and not getting a mold of your foot by stepping in a foam box.) Your podiatrist can also evaluate your condition. You may also need to see a neurologist who can do tests to check for nerve entrapment. There is medication that can help in your symptoms. I do not like medicating, but if an orthotic doesn't cover it, sometimes meds are necessary to alleviate these symptoms. Do not waste your money on foot massaging equipment (put it towards the orthotics instead).



8. Question:
My almost 15 year old daughter has bunions on both large toes. We've read in a medical book about this and know it can be hereditary; what can be done for such a young one? (I always thought this came as are result of wearing heels a lot and being on our feet, etc.)

Dr. Karpati's Answer:
Bunions are very much a hereditary condition in a juvenile patient. She may also have flat feet. Orthotics can to slow down the progression of her condition, but if she is already having pain and the orthotics do not work, then surgery is the most likely answer.



9. Question:
I am a 42 year old woman who jogs about 5 miles a day. I just noticed a soft bump on top of my left foot. It is the size of a golf ball and it is painless. How can I get the swelling to go down or what can I do?

Dr. Karpati's Answer:
Sounds like you have developed a cyst. If it is soft, they you can inject it with cortisone and sometimes get it to shrink. Yours is quite large and definitely worthy of a visit to your podiatrist to have it checked out.



10. Question:
To start, the inside of the heel on my left foot is painful if you put pressure on it. Not at the base but starting right above the bone and continuing for about an inch up from that point. I'm not sure if this is related or not to what I'm actual asking about so I thought I'd mention that. It's been about, 3 months with that heel pain.

My real problem: I have been having pain in my toes with certain foot movements for about a month or so now. If I try to curl my toes they can only get about halfway before it starts to hurt, if I try to go all the way it's extremely painful! I have a bump on the top of my foot, not noticeable unless you touch it. If you look at the top of both my feet the left one is noticeable a bit higher as a whole, not just the bump area. If I press down on the small knot it sends a tingle from that place all the way down to my toes, kind of like an electrical current is the best I can describe it. No pain. Pushing harder this sensation turns to pain running down my foot. Basically the same feeling as when I curl my toes hard only starting from the middle and going down. Do you have any idea of what this might be or anything I can do to aleve this?? A lot of times after I have been walking/running it just has a dull pain to it which is quite annoying. I've taken to putting a bag of ice on the top of my foot just to numb it and make it feel normal briefly.

Dr. Karpati's Answer:
The bump you are describing seems to be putting pressure on the nerve that provides sensation to the top of the foot and when you compress it, you get tingling and pain. This is called "neuritis". If the bump is from a cyst, then sometimes we can inject it with cortisone and shrink it. If it is caused by bone, then things get more complicated. You can try skipping the laces in your shoes over the area or wearing orthotics to try and change the position of your foot in your shoe. If neither helps, you may have to resort to having your podiatrist shave down the bump surgically. The other pain to the heel, called "plantar fasciitis" can extend up the inside of the heel because there is a nerve that innervates the inside of the heel in that area which can worsen the condition. If the pain is more along the ankle bone, then that could be tendonitis or another nerve problem known as Tarsal Tunnel syndrome. Hope that helps! Now get to your podiatrist and get better already!



Medical conditions are fact-dependent, so in addition to Dr. Karpati's insights, it is important you consult with your personal physician before undergoing any footcare treatment.

Dr. Adriana Karpati is a trusted Summer Soles Advisor and frequently tests Summer Soles products before they are brought to the public. Over the years, she has answered countless footcare and podiatry-related questions – many of which are posted here. Her practice is located in Grapevine, Texas. Her office can be reached through www.faant.com, for medical appointments and established patients only please.