Here's why your feet hurt — and what you can do about it

0:00You're listening to Life Kit from NPR. Hey everybody, it's Mariel. Alright y 'all, I'm starting this episode with a deep sigh because we are talking about feet. And it's a deep sigh because feet elicit a lot of strong feelings. Everything from the shape of someone's toes, the height of their arch, the skin of their heel, the overall look and smell can provoke insecurity, disgust, even deep fear. And then there's the wiki feet side of the spectrum. If you're not familiar, that is a foot fetish website where people post photos of celebrities' feet and rate them. A couple years ago, the Huffington Post published an article proclaiming that the unruly online culture around feet has made a lot of Gen Zers want to hide their feet away almost entirely.

0:52And let me tell you, I can relate to that. So yeah, we can get weird about the aesthetics of our feet. But let's take a step back, okay? And think about the utility of feet. Oh my gosh, our feet are so amazing. If you just think about the anatomy, we have 26 bones, we have 33 articulations, the six degrees of freedom of motion. And so these feet are complex, but they serve us many functions. Irene Davis really knows feet. She's a professor of physical therapy and rehab sciences at the University of South Florida. And she has spent decades researching the biomechanics of feet and the lower extremities.

1:29They're a base of support. They can become a spring. They become mobile adapters to uneven terrain, and yet sometimes they have to be rigid for push-off. So yes, they're really critical structures, and I think they're very highly underappreciated. That is oftentimes until something goes wrong, she says, like we get hurt or lose function. But we shouldn't wait for the worst to give our feet our full attention and care, because they do a lot for us, starting with the 5 ,000 or so steps that we take on average every day. So there's 5 ,000 repetitions. So it's really the repetitive nature of walking.

2:06And especially if something is not functioning correctly, it can add up. On this episode of Life Kit, everyday foot health, reporter Andy Tegel is going to help us get to know and appreciate our feet. She'll talk with experts about common types of foot pain and what you can do at home to treat them and walk you through the surprisingly complex world of footwear recommendations.

2:34Thank you so much for this education. Yeah, absolutely. We've got a lot of ground to cover, folks, so I'm going to hit the ground running. Literally. Our first takeaway, good footwear is good foot care. Get up to date on basic best practices for sizing up new kicks and tossing out old ones. We're going to go kind of towards the outside of the sidewalk here where it's a little less slanted. And then I'm just going to watch you run down to the end of the block and back closer to the road. It's a brisk Friday morning in the North Park neighborhood of San Diego. I've come to Milestone Running, a specialty running store where co-owner and co-founder Chad Crawford mercifully met with me an hour before opening to demonstrate the shoe fitting process.

3:30Part of it is giving some shoes a spin and watching how you run in them. Whether or not you're actually an athlete. It can be very hard not to be self-conscious of my running. Listen, I walked into this story with a lot of assumptions about what my feet did or did not need. Maybe you can relate. I'm going to have you go ahead and put your right foot on this measuring device. We call this a bronic device. And I'm going to have you go ahead and put all your weight on that foot. It kind of allows the foot to totally splay out. I couldn't tell you the last time I bothered to step on one of those contraptions, for example.

4:04As someone lucky enough to use her feet every day, I figured, surely I already knew everything there was to know about them. So you're actually measuring right at about a six. Yeah. Yeah, turns out even bare bones basics, like my true shoe size, had that wrong. See, you want to get checked every so often because even though generally the bones of your feet stop growing longer when you stop growing in height, your shoe size can still change, famously due to pregnancy, but also from things like weight fluctuations, aging, wear and tear. And that was just a start. Chad says he generally suggests wearing a half size to a full shoe size up in running shoes.

4:45Because your feet often swell when you walk or run for long periods of time. I always think it's like the most important thing here. You know, some people think it's like, oh, what support category do I need to be in? But yeah, I think for general foot health, having enough space in a shoe is definitely going to be like the number one thing. So space is one. Now let's talk about how else to evaluate. if, like me, you might be due for a new pair of walking or running shoes. Oh, man, I can tell you already these are old. You got the foam coming out the back part of the heel. I'm sorry, I know. Treads completely worn off.

5:22How long have you had these, would you say? General guidance says you want to replace your shoes every 6 to 12 months or... We typically will say 350 to 500 miles. Common errors, of course, are that maybe you both run and walk around in the same pair of shoes. Well, all those miles count. Meet Dr. Adam 1040, a former competitive long-distance runner and professor in physical medicine and rehabilitation at Harvard Medical School, where I serve as the director of running medicine and shockwave medicine for Mass General Brigham Healthcare. He says it's important to regularly replace your shoes because, for one, if you're used to a lot of cushion when you exercise, remember, all of that padding will slowly wear away from use, friction with the ground, weather.

6:11And that shoe will start to put more and more demand on your foot and ankle, which can make you more prone to injury. Another piece is that we're asking our foot to be supported by this footwear. And so if other aspects of the footwear are wearing out, it affects our biomechanics with walking and with other daily function. For the front of your shoe or your toe box, you need the rule of thumb. As in... You should have about a half to a thumb's width between the end of the toe and the shoe. And that's your longest toe, to be clear. You need wiggle room. In fact, you want space for your toes in all directions for all types of shoes.

6:46Wearing the heels first, be very judicious when you're thinking about the toe box. That's probably the most important thing. This is Dr. Erica Rowe Urquhart, an orthopedic surgeon who shares a private practice with her husband. Urquhart Orthopedic Associates. Fear not, my fellow high-heeled lovers, she gets it. There are some high-heeled shoes with red bottoms, the name shall remain nameless, that I love and I have a few pairs of that I have no business owning because the toe box is very narrow and they're very painful. But Erica says you can still have healthy feet and wear your favorite fashionable shoes.

7:28You just have to be smart about when and where you wear them. There are time limits. Oh, these are two-hour shoes. These are four-hour shoes. These are six-hour shoes. And then, let's be real, They're those shoes that are strictly for the outfit picture. So bring those backup flats to the party, commute in your tennies, and listen to your body, friend. Pain will help you understand if you're making the right choice. Studies show high heel wearing, perhaps unsurprisingly, can increase your risk for bunions or make matters worse if you have one. And is associated with numerous foot injuries. Ebony Vincent Sleet, a doctor of podiatric medicine, says neuromas, specifically Morton's neuromas, are one particularly painful example.

8:13They're sometimes described as like constantly stepping on a marble and can be caused by compression of the toes, often from narrow, pointy toe boxes. And aesthetically, you look fine. There's nothing wrong with your foot. But inside, your nerve is screaming, you know? So there are consequences to putting your foot into a hostile environment. Ebony is a foot and ankle surgeon in private practice throughout Southern California. You might have seen her on the TLC show, My Feet Are Killing Me. She says it's important to take just a little bit of time to inspect your feet every day. She'll bring us into takeaway two.

8:49Check in with your feet daily. You might be totally missing things. If nothing's wrong with your feet, you should at least get to know them a little bit. I know sometimes people don't look at things that aren't problematic, right? I've had patients who have told me they don't actually scrub their feet in the shower. Like, they just kind of let the soap roll over them, you know? You should actually scrub the dirt off of your feet. Now, this episode focuses mostly on mobility and footwear, not skin and nails, because that's a whole other ballgame. But just note, being conscious of your skin and toenails are a big part of overall foot health.

9:24And problems at the ground level could pretend larger body issues. So they shouldn't be ignored. For just one example, sudden swelling in the feet and ankles could be a sign of cardiovascular issues. So best practice, make sure the skin on your feet is intact. If you do have cuts, sores, or blisters, take extra care to keep your feet clean and dry to avoid infection. And on that note, did you know that you have more sweat glands in the palms of your hands and soles of your feet than almost anywhere else on your body? Excessive sweating is one factor that can put you at high risk for athlete's foot, which is caused by a type of fungus.

9:59It's a super common ailment that Ebony says people misidentify all the time. It looks dry. It's like peeling kind of skin. And so, you know, people come like, I've tried every lotion imaginable. I've tried all kinds of things. But when I see their feet and I'm like, oh, well, it's not going to be cured because this is a fungus. and when you put excessive moisture on fungus, all you're doing is feeding it further. Bothered by corns, cracks, or calluses? Dr. Google doesn't always have the right answer and a pedicure isn't always a solution or even a good idea. Always consult an expert if you have concerns or note any big or sudden changes like swelling or discoloration.

10:41I usually allow patients to send a picture, send a text, you know, making sure that we are not in an emergency. And then at that point, if you still feel like you need to come in, let's have you come in. Another thing to be aware of, the sensations in and of your feet. Like, you know that pins and needles feeling when your foot falls asleep? If you find that kind of thing or something similar, muscle weakness, numbness, decreased feeling is persistent, not just a reaction to an odd sitting position, it might be a sign of peripheral neuropathy. That's nerve damage or dysfunction, which can be experienced on a spectrum and can be caused by a number of underlying health conditions.

11:21It's a common concern for people with diabetes, but it's not exclusive to that condition. So Ebony says, if you're worried about any sensations that arise, persist, or worsen, talk to your doctor. And then, of course, there's how your feet move. Takeaway 3. Get a non-slip grip on foot strength.

11:43if you're listening to this episode i'm guessing it's because you're a person with feet who maybe deals with the odd foot cramp or the every so often foot pain and wants to know hey man what gives well there are a number of common foot ailments caused from stress and overuse of the foot that probably sound familiar namely achilles tendonitis posterior your tibial tendinitis, plantar fasciopathy, or plantar fasciitis. Now, you might not know what exactly you're dealing with because we all cope and compensate for foot pain in different ways. So Adam says in his clinic, he'll sometimes ask patients to just walk and then see what he notices.

12:23A toe pointed out might suggest deficits in the hip, for example, or maybe one ankle doesn't bend as much as the other. But these aren't things you just want to learn to live with. Seeing significant asymmetries where someone can't move normally, that really places people at risk for other injuries. Or as we age, it places people at risk for falls, which, you know, are one of the leading causes of significant morbidity and even mortality. To clarify, that's for adults over 65. Anyway, you get it. Foot pain can significantly impact your quality of life. Not just, you know, how often you can beat your personal record on the treadmill.

13:02But what might surprise you is just how much power you have to curb your own aches and pains. Here's professor and researcher Irene Davis again. I think what people need to realize is that they have these amazing muscles in their feet, and they actually have the ability to increase the strength and capacity of their feet, which can help with the pain. Ever heard of your foot core? There's a whole lot of talk about the importance of core stability when you exercise. You know, all those trunk muscles like your obliques or other abdominal muscles, plus a bunch of tiny muscles that support those bigger ones in keeping you strong and limber.

13:39Your foot core? Less visible, less celebrated, but the same kind of deal. These small muscles of the foot provide the stability so that the larger muscles that move the foot and ankle can do their job. And just like your regular core, you can strengthen your foot core. Regularly going to the foot gym has been proven to help some of those most common foot pains. No gym or athletic footwear required. In fact, Adam says, by all means, practice in little spurts when you're in line at the market or brushing your teeth. Just get into the habit. Like, you might start your day with a little footsie warm-up.

14:15Rotate your ankles, or, Ebony says, simply stretch your toes against a wall. Hold it for 30 seconds. Do that three times, and do it three times a day. Then you might go for 10 reps of short foot exercises, also known as foot doming. You press your toes into the ground. Try not to flex them, but press them into the ground. And then you pull the ball of the foot back towards the arch and squeeze your arch. So the idea is that you're trying to really activate those muscles in the arch to raise the arch. Next up, toe yoga. Or toga. Try lifting up your great toe while leaving the remaining toes on the ground.

14:54Then keep the big toe on the ground and lift the lesser toes off the ground. The muscle that does this to your big toe, it's called abduction of your big toe, is really important for stability as you're pushing off. And then calf raises are a good idea to help you with balance. And not just bouncing up and down on your calves, but really trying to control what we call the eccentric phase, which is lowering the heel gradually to the ground. And one final option I love for warming up or cooling down at the end of the day, hold hands with your feet. To do like a personal massage. So actually sort of interlacing your fingers between the toes and then massaging your foot and rotating the foot and ankle, releasing some of that tension that might be there.

15:39So maybe at this point you're thinking, sure, all this sounds well and good, but couldn't I just opt for some custom orthotics if I'm having foot pain? Short answer, yes, you could. Whether or not you should, well, that's where we need to tread lightly. Takeaway four, aren't you sure you need extra support? Don't just toe the line. Understand the debate around modern footwear before you buy your next pair. So if you've bought a pair of walking or running shoes in the last 50 years or so, you've likely been told it's best to opt for a pair that matches your foot type to avoid pain and injury. And in some cases, that might be the exact right thing to do.

16:22A very advanced foot and ankle condition, or you'll have someone with a neurological injury where they really need corrective footwear long-term. If you suffer from large foot deformities, severe arthritis, or suffer from complications due to diabetes or an injury, for example, custom orthotics or specialized footwear might be best suited to your needs. Or as Erica, an orthopedic surgeon who works with a lot of athletes, told us, she recommends supportive footwear and orthotics as needed to help her patients improve performance and alleviate pain symptoms. Pain will help you understand if you're making the right choice.

16:58One 2022 study on people diagnosed with plantar fasciitis, for instance, showed that more supportive shoes led to less pain. But Adam says for average walkers, people with more or less healthy feet who suffer minor aches and pains. We probably don't need as much cushioning and we don't need as much focus on orthosis to maintain the function of the feet. And we would be better off going back to the basics of looking at strength and function and mobility to have the healthiest feet possible. And from there, figuring out how much support the feet need. The number of times I've prescribed custom orthosis for long term is on one hand.

17:40Irene says if you have average feet and you find yourself experiencing some pain, it's not a bad idea to support those feet temporarily. If you had a back pain and you put a back brace on your back, just to kind of tide you over while you're having that pain, but you wouldn't want to keep that back brace on you for life. Irene says this is her issue with overly supportive shoes and foot orthotics. tools that she once made herself and taught people about early in her career, by the way. You wouldn't want to immobilize the muscles of, say, your neck long term, because that would weaken those neck muscles over time.

18:14And you wouldn't be able to hold your head up. But depending on who your podiatrist is, this sentiment might feel really odd. Counterintuitive, even. Because the prevailing wisdom in most circles is to match the footwear to the foot. And this generally leads people to highly cushioned, highly supportive shoes as a starting point. So if you have a high arch, you probably should be in a more cushioned shoe. And if you have a really low arch, you should be in a more supportive shoe. And for a neutral arch, a neutral shoe, meaning flexible, lightweight, not too many stabilizing elements. And for certain activities, there is definitely good reason to be selective and protective.

18:51One recent study showed orthotics improved comfort while running. Also, specialized shoes for certain sports are a very good idea. Everyone's playing pickleball, and they can play a new sport in the wrong shoes, and I can't tell you the amount of fifth metatarsal fractures and peroneal tendon tears. But one piece of data that really stopped me in my tracks on the promise of supportive footwear was a large-scale study of over 7 ,000 participants across three branches of the military in 2014. Where they tried to match people's foot type to footwear and compared that to people that were just given a neutral shoe and they showed no difference in injury.

19:30That is really the purpose of having that foot type match to the shoe. The idea was that it would help to reduce injuries. There's no reduction in injuries at all. Now, participants were generally healthy, so it wasn't a study of acute foot pain or foot injury, just to note. On the other side of the spectrum are minimalist or barefoot shoes, footwear that doesn't offer much, if any, cushion or arch support. Irene says, basically, you want to be able to roll your shoes up in a ball, which is the polar opposite of what many podiatrists suggest. And yet, she says to date, just about every study she has found looking at minimal shoes, whether it's walking or running, and has looked at the effect of minimal footwear on the size of the muscles or the strength of the muscles or the volume of the muscles has shown that minimal shoes lead to stronger feet.

20:24However, research has also shown that minimal shoes can lead to injury. Irene says that's because making the switch to this type of shoe requires a slow ramp-up period, especially if you're used to a lot of cushion or motion control or you regularly wear orthotics. It's like going to the gym and lifting 100 pounds. When you've never lifted and getting injured, nobody would say don't go to the gym. We know going to the gym is good for you. Just don't do it that way. There isn't a perfect regimen you should follow if you want to make the switch. But if you have inserts, you're going to have to slowly wean yourself off of those first.

20:59And then she suggests slowly starting to incorporate your minimal shoes into your daily routine bit by bit. Maybe for a morning walk to start, then the morning's errands, the pace and rigor of incorporating minimal shoes into your life, she says, will depend on your individual capacity. Someone who's done a lot of gymnastics, for example, where they've actually had to use their feet quite a bit, then they might be able to transition faster. If you have some soreness in your feet, take a day off, come back to it after a day, stay at that level, don't increase, and then just increase a little more slowly.

21:32Minimalist shoes have also been criticized for their lack of shock absorption. But Irene dismisses this too. She says our feet are adapted for all kinds of surfaces. There are plenty of places around the world where barefoot walking is the norm, for example. And it's why with proper conditioning, ramping up, people can run the Boston Marathon, all concrete, barefoot. Fully feeling the surface you're traveling on increases your proprioception or your body's ability to sense its own movement, location, and action without the use of just sight. It's critical and worth mentioning that all of our experts agree it's a good idea for young kids to walk around barefoot or in minimally supportive shoes to develop those sensory skills.

22:15And research shows that kids that use minimal shoes in the long term benefit from them. Investing in your foot health. It's worth considering no matter your age. If you make your feet nice and strong and keep them strong, you're going to have more resiliency against your feet breaking down later. It's like, should you do back exercises or should you keep your core strong if you're not having a problem? I think you should. I think you still should. At the end of the day, of course, we're all walking or running our own paths. So what are you looking for in your footwear? No matter your choice, be thoughtful with how you dress your feet.

22:51We wear shoes for multiple reasons. We wear it for fashion. We wear it for performance. We wear it for general health. But it's recognizing that each type of footwear places different demands for the foot and ankle. And those changes need to be done gradually. And if ever you're not sure exactly what your next move should be, find a provider that you trust. And it just has to be said, take it one step at a time. That's a great pun, but it's well-landed. You need to take it one step at a time. you need to have a systematic approach. Okay, friends, let's walk it back and recap what we've learned.

23:34Takeaway one, good footwear is good foot care. That means replacing your walking and exercise shoes every 500 miles or so and making sure the new ones fit you correctly. And if you're going to wear uncomfortable shoes, make sure to give yourself regular breaks to avoid pain and injury. Takeaway two, check in with your feet on a regular basis. Changes in color, growths, discoloration could tell you something about your health, from circulation issues to skin cancers. Takeaway three, consider a foot strengthening regimen. Adding simple exercises like calf raises and foot filming to your daily routine can help you avoid pain and injury.

24:09Takeaway four, there's mixed messaging out there about how much support the foot really needs from your shoes and orthotics. Ultimately, what type of footwear is best for you is up to you and what you think is best for the health and longevity of your feet. Choose wisely and make any transition from one shoe type to the other slowly to avoid injury. Every foot is different and everyone is walking their own path.

24:41That was LifeKit reporter Andy Tegel. For more LifeKit, check out our other episodes. We've got one on preventing eye strain and another on protecting your hearing. You can find those at npr.org slash life kit. And if you love Life Kit and want even more, subscribe to our newsletter at npr.org slash life kit newsletter. Also, we love hearing from you. So if you have episode ideas or feedback you want to share, email us at life kit at npr.org. This episode of Life Kit was produced by Margaret Serino. Our visuals editor is Beck Harlan and our digital editor is Malika Green. Megan Cain is our supervising editor and Beth Donovan is our executive producer.

25:17Our production team also includes Claire Marie Schneider, Sam Yellowhorse Kessler, and Sylvie Douglas. Engineering support comes from Zoe Vangenhoven. Special thanks to Greta Pittenger and Barkley Walsh. I'm Mariel Segarra. Thanks for listening.