Foot Pain: When Walking becomes a Challenge

Dr. CHAN Wai Chung

Specialist in Orthopaedics

Have you recently experienced significant heel pain when you take your first steps in the morning, or sensations of numbness and extreme discomfort in the soles of your feet after extending periods of sitting? Do your children complain about fatigue and discomfort after walking short distances? 

Plantar fasciitis is a common cause of foot pain and walking difficulties, amongst various other factors. The plantar fascia is a strong, fibrous band connecting the heel to the base of the toes, essential for supporting the foot's arch and dispersing pressure from activities like walking and jumping. Additionally, it absorbs impact, provides cushioning, and aids in maintaining balance.

Excessive Weight and Overexertion can Lead to Plantar Fasciitis

When body weight increases, intense exercise, excessive walking, or wearing new shoes can all lead to plantar fasciitis. The heel pain caused by plantar fasciitis is often felt when getting up in the morning or standing up, as the heel touches the ground for the first time. This is because after a period of rest, standing up or walking suddenly puts a strain on the plantar fascia, causing sharp pain. If the pain is endured and activity and walking continue, the plantar fascia will relax slightly and the pain will decrease. However, when walking for a longer period of time, the pain will reappear, making it difficult to walk and seriously affecting daily life.

Plantar fasciitis generally does not require surgical treatment. First and foremost, it is important to rest as much as possible, reduce walking and avoid walking barefoot. Applying ice in the early stages of the condition can help reduce swelling and pain. If necessary, the doctor may prescribe anti-inflammatory medication, and the patient should choose appropriate insoles and engage in proper stretching exercises and physical therapy. However, if the symptoms persist for more than six months, it may be necessary to consider shockwave therapy, which generally requires six to nine months of continuous treatment for the condition to improve.

Plantar fasciitis has a tendency to reoccur. Therefore, it is imperative to reduce body weight after recovery to alleviate pressure on the feet's arches, and modify exercise routines to reduce prolonged standing and overly vigorous physical activity. After physical activity, ice therapy to the feet and massaging the arches is recommended. Additionally, sufferers of plantar fasciitis should choose suitable footwear; women should avoid high heels to protect their feet, and running shoes with compromised shock absorption should be discarded, regardless of their apparent good condition.

Is Foot Pain Always Caused by Plantar Fasciitis?

Flat feet, in addition to plantar fasciitis, are commonly associated with foot pain. This condition refers to a decreased arch height in the foot, causing it to collapse and bring the inner side of the foot close to the ground, resulting in reduced cushioning pressure. While mild cases may be asymptomatic and may not require treatment, severe cases combined with prolonged activity can lead to foot pain.

Flat feet are broadly classified as flexible and rigid. Flexible flat feet display an arch when not weight-bearing, but it collapses when standing or walking. Rigid flat feet, on the other hand, lack an arch under any circumstances.

Infants and young children under the age of two, almost all have flat feet, as their foot ligaments are not fully developed yet. In most cases, the condition will disappear as they grow older. Children may also have rigid flat feet, but this is much less common and may require surgery for corrections. If a child experiences discomfort or pain on their feet while walking, it is necessary to seek medical advice.

Adult Flat Feet Due to Posterior Tibial Tendon Dysfunction

Adult flat feet that emerge in their forties or fifties without any symptoms do not need treatment. However, cases of rigid flat feet that necessitate treatment are typically the result of severe flat feet caused by aging and damage to the calf muscles. The calf muscles, responsible for lifting the foot arch, are located on the inside of the lower leg, extending down along the shin bone to the sole of the foot. As individuals age, there is a risk of developing posterior tibial tenon dysfunction (PTTD) which can lead to the collapse of the foot arch.

The flat feet caused by posterior tibial tenon dysfunction can cause severe pain on the inside of the foot, making it difficult for patients to stand on one foot or tiptoe, and causing the ankle to turn outward when walking. If the condition worsens, the doctor will assess the level of inflammation and degeneration to choose the most appropriate treatment method, including: tendon debridement surgery to remove inflamed tissue, tendon transfer to rebuild function, or joint fusion surgery. Generally, surgery can correct flat feet and alleviate pain issues, but maintaining a healthy weight and engaging in regular tendon exercises is necessary for ongoing care.

There are other potential causes of foot pain including foot deformity such as hallux valgus, forefoot pain due to Morton neuroma, inflammatory disease such as gouty arthritis, rheumatoid arthritis, and more severe conditions such as lumbar nerve compression, all of which must be excluded through clinical examination before determining the appropriate treatment plan. There is also a probability of pain being “transferred” from the original painful foot to the uninvolved foot, or from having a “painful foot” to having a “painful knee”, due to overuse of the uninvolved body parts. If the pain in the foot continues for more than two to three weeks despite resting and stopping strenuous activity, it is essential to promptly seek medical attention.

It is important to note that some patients who suffer from foot pain may actually be experiencing symptoms related to issues outside of their feet. Along with foot pain, they may also exhibit symptoms such as limb numbness, sensory deficit, weakness in the lower limb muscles, and stiff joints. If these symptoms persist or if specific other symptoms are present, it is recommended to seek assistance from an orthopaedic specialist for a more comprehensive examination.

• Persistent back pain, especially severe at night, sometimes lasts for more than two or three weeks without improvement
• Back pain and other symptoms do not improve with bed rest, rest, or even anti-inflammatory medication
• Gradual weakening of the lower limbs
• Urinary or fecal incontinence
• Spinal lordosis (spinal kyphosis or hunchback) or scoliosis (spinal scoliosis)
• Persistent fever or sudden weight loss.

To prevent foot pain related to plantar fasciitis, it is recommended to adhere to the following guidelines, under the assumption that no serious illness is present:

• Avoid excessive strenuous physical activity.
• Remember to do regular stretching exercise.
• Avoid prolonged activity on uneven surfaces.
• Select appropriate footwear with adequate support.
• Individuals who are overweight should consider weight loss to alleviate the strain on their feet.