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Foot & Ankle Pain, Treatment & Prevention

December 11, 2014 1:00 PM with Dr. Lan Chen

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This chat was originally scheduled for Thursday, December 4th. We apologize for the inconvenience. It’s likely you’re on your feet for at least part of every day, so pain, especially in feet and ankles, can have a huge impact on your day-to-day life. Don’t live with pain or risk further injury by waiting to see if it goes away on its own. Lan Chen, MD, Orthopaedic Surgeon, will answer questions on foot and ankle pain, from when pain shouldn’t be ignored and how to prevent injury to surgical and non-surgical treatments for chronic pain or sudden foot and ankle injury. Submit your questions early.

Brenna (Moderator) - 12:41 PM:
Our chat with Dr. Chen--Watch Your Step: Foot & Ankle Pain, Treatment and Prevention--will begin at 1 PM. You can submit questions now or at any point during the chat.

Dr. Lan Chen (NorthShore) - 12:43 PM:
Hi everyone. My name is Lan Chen. I am a board certified orthopedic surgeon specializing in foot/ankle reconstruction. Thanks for taking the time to join me this afternoon. I hope you will find some helpful information during this hour.

  Vanji (Mt Prospect, IL) - 12:59 PM:
My foot(toe mounds, arch and heel) hurts me a lot. It all started 2 years back on its own. It gets so painful when I walk on hard floor or even after brief stay on my bare foot. I can wear only certain shoes and sandals. I tried various physical therapy and arch shoes. Nothing helped. What is the best treatment for this pain?
Dr. Lan Chen (NorthShore)
Hi Vanji - there are a number of reasons why are have pain on the bottom of your foot. if you have heel pain, and it is particularly worse in the morning, you could have plantar fasciitis. this is one of the most common causes of pain over the bottom of heel. treatment includes stretching (most importan) and cushioned supports like arch supports or orthotics. another reason for pain in the bottom of the foot is what we call metatarsalgia. this is usually pain in the front, ball of the foot. this is usually caused by tight calf muscle and achilles and again stretching is the most important, as well as some inserts. also as we all get older, the fat pad on the bottom of our feet wears out and this causes more pressure and pain. lastly, when you do have these conditions, try to avoid walking barefoot - as walking without supportive shoes will exacerbate the pain!

  Katrina (Chgo) - 1:06 PM:
I have bone marrow edema in my left foot. Its very painful and the doctor recommended orthotics. I just got them and I wonder is it anything I can do to make it go away. I have RA for about 30 years.
Dr. Lan Chen (NorthShore)
Hi Katrina. Bone marrow edema are essentially bruises to the bone. this can result from overuse or just osteoporotic bone (ie softening of the bones). orthotics can be helpful, but the more important solution is to try a period of limited or non weight bearing to allow the bone to heal. depending on which bones are bruised, you may need to be off the foot for 2-3wks. sometimes a walking boot can be helpful as well. you can get this from your doctor. lastly, since you have RA, you may be on some medications such as steriods - which often times can lead to premature bone softening. if you have been on these meds for long periods of time, they can have a cummulative effect on your bone and this makes you at a little higher risk of getting bone bruises.

  leonard (morton grove il) - 1:12 PM:
Is there a cure for plantar fasciitis or is there such thing as minor surgery to take care of the pain/problem.
Dr. Lan Chen (NorthShore)
Hi Leonard - excellent question. Plantar fasciitis is one of the most common causes of pain over the bottom of the heel. I usually say that everyone at some point in their lives will get this. Believe it or not, this condition is self limiting - which means that at some point, it will actually go away on its own. However, it can be debiliating when you have the pain. Stretching of the plantar fascia, also stretching the achilles tendon are the mainstay of treatment. There are surgical options - such as release of the plantar fascia, however success rates are variable and sometimes unpredictable. As a rule of thumb, I would recommend doing simple things like the the stretching for at least 9months before trying something surgical. Often times, when it comes to plantar fasciitis, patience is the key!

  Jill (Evanston, IL) - 1:20 PM:
I have a history of plantar facsiitis and sciatica, both of them are just mild currently. But I have had sharp pain from the arch of my left foot that travels along inner foot to dorsal aspect. It is most noticeable when walking a lot or on the treadmill. After walking on treadmill, I will often limp the rest of the day because of this pain. I can't complete a full step on the left foot due to the sharp pain and cut the step short, therefore limping. Is there treatment for this?
Dr. Lan Chen (NorthShore)
Hi Jill - the real questions is why do you have all this pain after walking. is the pain in the heel? if so, your plantar fasciitis could be contributing to part of this pain. If the pain is over the arch of the foot, there are a number of other things it could be. These include some arthritis over the joints in the middle portion of foot or it could be tendonitis. Alternatively, you could have a stress fracture or bone bruise in your foot. If these symptoms that you are describing have been progressive and persistent, or maybe even worsening, then it's definitely a good time to see your doctor. A thorough physical exam and some simple xrays will help to get to the bottom of this. Hope you feel better!

  Linus (Oak Park) - 1:26 PM:
I'm 35 yr old male. I notice that I sometimes have numbness in my feet after I've been sitting for awhile and sometimes when I wear certain shoes. is this a nerve thing? What causes it?
Dr. Lan Chen (NorthShore)
Hi Linus - excellent question. I see a lot of patients with similar symptoms as yourself. Numbness of any kind in your foot or ankle is usually due to nerve impingment. This means that there is sometime pressing on the nerve to cause numbness in the distribution of the nerve. his can mean that if you are setting indian style or crossing your legs (or wearing tight shoes as you mentioned), there is more pressure on certain areas of your foot and ankle where nerves are located, and this will give you some temporary numbness. the most important thing is to know that this numbness is temporary. This mean when there is no pressure over the areas, then your numbness should go away. If you have constant numbness, then we need to think about things like neuropathy - which means that there is something more significant that is causing the numbness.

  Becca (Chicago) - 1:32 PM:
Can wearing heels actually permanently damage your feet? What could happen or is it more just don't wear them because they cause immediate discomfort?
Dr. Lan Chen (NorthShore)
Hi Becca. Again, a great question. With so many options out there for women's fashionable shoes, it is hard to resist a cute pair of shoes (myself included). Speaking from an orthopedic perspective, high heel shoes are particularly bad for your feet for a variety of reasons. They can lead to bunions (which is a bump over the great toe area), they also shift all of the weight onto the front/ball of your feet (normally your would carry your weight even throughout your feet in flat shoes). This can cause pain over the ball of the feet. Lastly they shorten the achilles tendon in the back of the ankle and over time, this can again set you up for more pain in the foot. Lastly, I've seen several patient who ended up ankle fracture after wearing very high heels! With all of this said, it doesn't mean that you have to get rid of your high heels - just remember, moderation is the key!

  Vytas (Chicago) - 1:41 PM:
What can you do to prevent running injuries to feet and ankles? I'm a regular runner. How often should you be changing your shoes? Even if you are not having pain, should you be using inserts? I want to keep running but I don't want to deal with injuries down the road.
Dr. Lan Chen (NorthShore)
Hi Vytas. I'm glad you asked this question. A good number of my patients are young and healthy and they often come to see me in the office just for preventative visits. One of the most important things is to make sure you have good running shoes. I like shoes suchs a New Balance because they make a variety of shoes for all foot types (flatter feet, higher arched foot, wide/narrow fee). In general, depending on how much you run per week, I recommend getting new running shoes every 6months. Inserts and orthotics can be helpful, but they are really for comfort. this means that if you are feelig fine without them, there is no need to start using them. Also, you should try to incorporate some stretching exercises into your routine before you start running. This helps to loosen the joints and prevent injuries. Lastly, do you know what your vit D level is? You want to make sure you are not vit D deficient. Hope this helps!

  FS (Skokie, IL) - 1:49 PM:
Refering to Linus qs, what if the numbness is temporary but over the period/years has increased in time and intensity? Thanks for your time and advise in advance.
Dr. Lan Chen (NorthShore)
Hi FS. If you have had longstanding numbness in your foot and ankle, you may have some neuropathy. Neuropathy just means that the nerves are irritated. A medical history that includes diabetes or increased alcohol intake at some point, can increase the likelihood of developing neuropathy. Also vit B deficicency can cause persistent numbness and tingling. This is something that your primary doctor can check out. Lastly, you could also have irritation of the nerve at the ankle area or sometimes in your lower back. If you have a history of low back pain or arthritis in your spine, then you could have referred pain to your feet. This means that the location of the pinched nerve is actually in the lower back, but your feel the numbness in the foot. I know this is a lot of different possibilities, but again, a good physical exam and visit to the doctor can help to focus on the cause of the problem.

Brenna (Moderator) - 1:51 PM:
There are 10 minutes left in this chat. please submit your final questions. This has been a very popular topic. Unfortunately, we will not be able to answer every question. We apologize in advance.

  Bonnie (Wheaton il) - 1:56 PM:
I have two jobs, one standing in the same location for 12 hours a week, the other teaching pool aerobics classes for four classes a week. My feet are constantly in pain. The pain is mostly in the balls of my feet but generates up towards the top of my foot above my toes. What can be done? What is causing it?
Dr. Lan Chen (NorthShore)
Hi Bonnie - sounds like you have a pretty busy and full schedule! It's "normal" to have some aches and pain in our feet since we put a significant amount of stress on them. There are several reasons why you could have foot pain in the balls of your feet. There may be more pressure over this area and perhaps less padding, thus causing your pain. stretching and using pads to off load the ball of the foot will help with this. Another reason could be a neuroma, which means there is a small enlarged nerve that can cause pain - usually this is more a tingling and numbness over the top of your toes. Lastly, maybe it could be a stress fracture? The treatment for this is taking a break from the high impact activities. Trying some cross training can be helpful for this.

Brenna (Moderator) - 2:02 PM:
Unfortunately, this will be the last question of our chat. You can view a transcript of the chat later today on this same page. Thank you to all our participants for your great questions and to Dr. Chen for your time. For more information on foot and ankle pain and orthopaedics at NorthShore, visit our NorthShore Orthopaedics Institute page here

Dr. Lan Chen (NorthShore) - 2:03 PM:
Thanks everyone for sending in your questions! I have been typing nonstop trying to answer all of the questions! I see patients at skokie, glenview, and highland park - so if I haven't answered one of your questions, come in for an appointment if you have time!
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