Why Do My Feet Hurt?

Last Editorial Review: 10/23/2003

By Alan Mauser
WebMD Live Events Transcript

Event Date: 09/12/2000.

Bunions, blisters, ingrown toenails, plantar fasciitis, corns and calluses, stress fractures, heel spurs, athlete's foot, fungal toes, plantar warts, bursitis, Achilles tendonitis - what's making your feet hurt?

This event is being brought to you by Humana. Humana may have determined the selection of the speaker or topic of this event. The views expressed by the speaker during this event are those of the speaker and do not necessarily represent the opinions of the sponsor.

Moderator: Welcome to Humana Live Events. Our guest today is podiatrist Dr. Alan K. Mauser. We will be discussing foot health.

Welcome Dr. Mauser. How are you today?

Dr. Mauser: Fine, and how is everyone out there?

Moderator: Before we begin taking questions can you please tell everyone a little bit about your background and area of expertise?

Dr. Mauser: I have been in private practice for the last 15 years, and am certified by the American Board of Podiatric Surgery, and a fellow of the American College of Foot and Ankle Surgeons (ACFAS).

Moderator: What is a podiatrist?

Dr. Mauser: A podiatrist is a physician who specializes in the treatment of the foot, and its disorders. A podiatrist is trained by attending a podiatry college, then doing a residency program from one to four years. Podiatrists deal with all sorts of problems with the feet, from orthopedic problems to skin problems, from children to adults in all aspects of health care.

Moderator: svlarde asks: "My feet hurt first thing in the morning, or after sitting. I work on my feet most days, with some relief but not much. I wear work boots that fit good and until the last few months have had no problem. Any suggestion as to what the problem could be?"

Dr. Mauser: Generally, foot pain in the morning is a result of biomechanical problems that occur when a person walks and is very active on their feet. The pain you feel in the morning, after a night's rest, the feet are generally tight and contracted, they need to be stretched. The most common problem first thing in the morning is heel pain, and this is when the plantar fascia is tight and needs to be stretched out first thing in the morning. These types of problems can be helped with anti-inflammatory medication, modification of shoes, orthotic devices, and other treatments specific to your doctor.

Moderator: gboogiegirl asks: "My feet ache and burn and hurt so bad that at the end of a day I can't walk, and in the morning I have to hobble out of bed. It is mostly in my heels. I have never felt anything like this before. I have good shoes and I have inserts. What could be causing this?"

Dr. Mauser: This scenario is similar to the first one, that as your feet stretch out during the day, and as you walk, the fascia on the bottom of the foot can become stretched, where when you go to bed at night, you have to stretch it out all over again in the morning. Treatment consists of medication, orthotic devices, stretching exercises, possible surgery, and again, that's up to the discretion of your physician.

Moderator: What are some of the stretching exercises you would recommend?

Dr. Mauser: Stretching exercises are targeted towards stretching the calf muscles. A simple wall push up type of stretch, can help stretch the calf muscles. It's difficult to stretch the plantar fascia. It's important to note that when performing any activity or exercise that stretching is important, and you should stretch your whole body.

Moderator: cookie612 says: "I have spurs on my feet; how did I get them and how do I get rid of them?"

Dr. Mauser: Generally, if indeed this is what you have, heel spurs don't necessarily hurt. Again, this relates to the previous question; if you have pain in the bottom of your foot in the morning, this is related to the fascia and not necessarily the spur. The spur is a reactive zone that occurs due to the chronic stretching of the fascia. That is heel spurs. If indeed you have spurs on other places, it is usually reactive due to some repetitive force. Spurs can occur in other parts of the foot such as toes, in between toes, and on top of the foot.

rosie2000_webmd: I have problems with ingrown toenails on my big toe. I've been told to cut them straight across, but when I do, they go into my toe. If I cut the edges down, it relieves the pain in my toes. What do you suggest I do?

Dr. Mauser: Ingrown toenails are a common problem. Certainly, you should cut them straight across. But when the toe is curled such that it continues to dig into skin, something more definitive needs to be done. There is a relatively simple surgical procedure that can be done in a podiatrist's office, which is that the side of the toenail is removed, the growth center is treated with a chemical, and this should eliminate the recurrent ingrown toenail. This can be done on any of the toes, or any of the sides of the toes, or entire nails can be removed, utilizing this procedure. It is a simple, easy, relatively painless procedure.

Moderator: imilton asks: "I need to walk to get weight off. But my feet hurt. It's not my shoes. I wear only soft leather with thick soles (or air) and thick socks. I take no medicine of any kind, sugar, blood pressure and cholesterol is normal. I have great circulation. First the doctors said I was too young, now I am told it is because I am old. Can one's bones hurt just for the heck of it?"

Dr. Mauser: Certainly, walking is the best exercise for anyone, and I encourage people to walk. It's a Catch-22 if you need to walk to lose weight, yet the weight is contributing to pain in your feet. I would advise you to find a good running store, and check out the different brands of running shoes. The people in the stores are knowledgeable about the shoes. A custom made pair of orthotic devices may alleviate discomfort. Additionally, one with this problem should seek medical advice, as there may be a specific cause for the pain rather than just a general type of pain.

Moderator: Can you please tell us more about orthotic devices? What are they, and what are they designed to do?

Dr. Mauser: Orthotic devices are usually a custom made device inserted into the shoe that is made from a mold of a patient's foot, that will control abnormal motion, provide support, and accommodate specific problems. There are various different devices that could be made, and there are devices for different activities. The specific device would be at the discretion of your physician. In my office I use a computer, and a force plate which a patient walks over and it records the force of the foot, and them I'm able to generate a fabricated device from the computer generated image.

Moderator: David_Cheri asks: "What is the best way to keep feet from getting the hard, dry skin on them - especially the heels?"

Dr. Mauser: I'd like to talk about calluses in general. A callous is the build up of superficial layers of skin. This occurs in areas with increased pressure, or frictional forces. Commonly these form on the front of the foot, underneath a metatarsal head that has dropped down or is too large. This results in increased pressure, increasing callous formation. Calluses that occur around the back of the heels are generally due to the lack of elasticity of the skin, and moisture content in the skin, and when one puts pressure on the heel, the fat pad of the heel displaces outward causing increased pressure around the periphery of the heel, resulting in increased calluses and perhaps cracking of the skin. For those heel calluses, one needs to moisturize their skin really well. There are some very good prescription moisturizers out there. Additionally, shoes that have a good sturdy heel counter, that can hold the heel in place will help. Calluses on the front part of the foot are often treated by trimming them down and reducing the thickness of the skin, but the continued pressure will result in the recurrence of the callous. Sometimes it's necessary to look at the cause of the callous, and if a specific metatarsal bone is the problem, perhaps surgery is performed to alleviate the pressure in that area.

Moderator: bmaxwell asks: "What causes feet to feel like they are burning?"

Dr. Mauser: There are many different causes for burning feet. Usually they are of a neuropathic ideology. This means that there is a problem with the nerves, and the signal sense of the brains. This can be a symptom of long-standing diabetes, vascular problems, MS (multiple sclerosis), and other diseases. There is also what we call idiopathic neuropathy, in where there is no obvious cause of the burning. There is a good book on the subject called Aching Souls and Painful Toes, and the author is a layperson who has peripheral neuropathy, and does a great job of talking about the different causes and treatment options available for this condition. Some of the treatment options for this consist of oral medications, such as Tricyclic antidepressants and Neurontin (gabapentin). There are also topical medications that can be applied to the soles of the feet. Keep in mind that each and every case of burning feet, or neuropathy, is different, and responds to different treatment in different ways. One should consult their podiatrist, family physician, or a neurologist for a complete treatment plan. 

I would like to talk about some common foot problems. We have already talked about ingrown toenails, I'd like to talk about fungal toenails. Fungal toenails are thick, dystrophic, discolored nails that can be an isolated nail, or all ten toenails. Usually they are painful, and cause problems with shoes. The toenail has become infected with a fungus. The fungus is in our environment, is opportunistic, and when given the opportunity to get up into the nail, does so quite readily. Usually there is a trauma associated with the fungus getting under the toenail. The trauma doesn't have to be anything more than your shoes rubbing your nail. Once fungus is under the toenail, it's in a nice dark, warm, moist environment, and continues to grow. It can spread to the other nails easily. The fungus is essentially a disease of the nail, and should be treated as a disease. There are medications that can be taken orally that will be incorporated into the nail and kill the fungus as the nail grows out. Topical medication can be useful by helping this process and reducing the amount of fungus around the nail plate. Occasionally it is necessary, when the nails are nonresponsive to medication or severely deformed, to remove them permanently. This is a fairly simple process done in an office under local anesthesia. The important thing to remember is that this is a disease process; it can be cured by oral medication. But it is not effective in every instance. medications need to be taken for a period of about three months. The effectiveness of medication will need to be evaluated over the next six to 12 months. Medicare, in our elderly population, will pay for these nails to be reduced in size and trimmed, if they are painful. 

Another common foot problem is plantar warts. Plantar warts are a virus that specifically infects the superficial layer of skin. When the virus is given the opportunity through some type of mechanical breakdown of the skin, it will infect the skin and grow there. When one gets a wart on their hand, that virus will grow above the level of skin, but when it occurs on the bottom of the foot, because you walk on it, the virus will grow within the layer of skin. It won't grow deep into the deep layers. Because this is a virus, there's no medication that can be given orally to eradicate the virus. The virus would have to be treated locally at the site of infection. This is done with topical acid preparations, freezing, injectable medications, and removal. Removal of the wart can be done in several different ways, utilizing cautery agents, and/or laser techniques. Keep in mind whichever way your wart is removed, they can reoccur, they can spread, they can reinfect. Warts are usually found in the younger population, and not in the elderly. Important things to do to prevent this problem is generally good foot hygiene, and disinfecting areas of the home, such as the bathroom and shower. It is not possible to totally eradicate the virus, and usually most people who are susceptible to the virus will contract it.


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Moderator: mgonzales asks: "The arch on my right foot has been hurting for the past week. It has become so bad, that I can't walk. It feels like the arch in my foot is falling. What should I do to get rid of the pain?"

Dr. Mauser: It is difficult to determine whether the problem is truly in the arch, or the heel. A lot of times, pain from arches are deferred from the heel, but there are things you need to be aware of in the arch that could be a problem. If you are active, one would have to consider the possibility of a stress fracture. There is also the possibility that a tendon can rupture in the arch, causing pain and problems. There are also accessory bones that can occur that may become symptomatic over time, specifically, the best option would be to be evaluated, take some X-rays, and other diagnostic testing to determine the exact cause of the arch pain.

Moderator: Let's talk about shoes. What should we be looking for besides style?

Dr. Mauser: I will give my view on shoes, and this is what I tell my patients. Shoes are a shell that go around your foot. The shoe is only as good as the foot that goes into it. Shoes can make your feet feel better, but won't correct problems. There are things you should look for. I don't recommend a particular brand of shoe, because no sooner than I recommend it, the patient can't wear it. People need to be consumers of shoes, meaning they need to try many types and brands on, and walk around the shoe store walking around, and should go at the end of the day when their feet are tired and swollen. They should look for shoes geared towards specific activities. If the shoe doesn't feel good in the store, it won't feel good at home. A good sensible walking shoe is usually best, and there are many different brands. Women's dress shoes are not necessarily the best thing for your feet, and I certainly do not recommend four-inch heels. Again, when purchasing dress shoes, you need to be a careful consumer. In terms of the specific attributes of the shoe, they should have a good sturdy soul, wide base, the toe box should be deep enough to accommodate any deformities, the heel counter should be fairly stiff, lace up or slip-ons are your preference. A lot of shoes come with a removal insole. That is what they consider the arch support, when in reality it is nothing more than a little pad in the shoe. Often times the insole can be removed and replaced with something more supportive that you can buy over the counter in a running store, or this is an excellent place for the custom orthotic devices. Again, shoes are activity specific. You should not run ten miles in your basketball shoes, nor should you play a day of basketball in your running shoes.

fcrockow_lycos: My toes and the balls of my feet have hurt, increasingly so, for years. My primary care doc seems to have ruled out all ideas he is aware of. When I stand or jump they are particularly painful, and when I lay down they are excruciating. Walking around actually seems to help. Please help.

Dr. Mauser: It is certainly difficult to get the complete idea of your situation over the Internet. I encourage you to obtain a copy of the book I mentioned earlier. Entrapment of nerves are possible in the front of the foot, and we call those neuromas. It sounds like you've been evaluated fairly extensively, and in some cases, as mentioned before, there is no known ideology as to why people have some conditions. It does sound like you have a generalized neuropathy in which there is no specific cause. Perhaps the book can give you some good information.

Moderator: Jeanhoney says: "Dr. Mauser, my daughter has been diagnosed with plantar fibromatosis. Her doctors told her there is nothing they can do for her. She has too many nodes to be operated on. Do you have any experience treating this condition? I am in a discouraging and bewildering situation. Thank You."

Dr. Mauser: In this situation, if plantar fibromatosis is a single isolated nodule, or several small nodules, they could be removed. If the problem is related to a more systemic problem, such as neurofibromatosis, there is probably not much that can be done in terms of removing the lesion. I would encourage you to seek out a podiatrist or an orthopedist as someone who can make an accommodative orthotic or an accommodative custom made shoe.

Moderator: Colleen asks: "My mother is 70-years  old, and insulin dependent. No heart problems. She suffers from arthritis. Her feet have started swelling and her ankles hurt when she walks. The doctor has given her water pills and she takes Naprosyn (naproxen sodium). We are not sure what line of treatment she should pursue. Can you help?"

Dr. Mauser: Regarding this question, I will comment on the feet with diabetes in general. This case should be evaluated more completely by this woman's physician. Diabetes in general will affect feet in several ways, in circulation either on a large or small vessel. This is called macro- and microangiopathy. This results in decreased blood flow to the extremities resulting in pain, ulceration, gangrene, and if not corrected can result in loss of toes, foot, or limb. This type of condition is evaluated by a podiatrist, and if necessary, surgery for revascularization can be performed by surgeon to restore blood flow to the limb. A second way diabetes affects the foot or extremity is neuropathy, which can affect the nerves, resulting in a wide range of symptoms such as numbness, tingling, complete loss of sensation, burning, crawling sensation, restless sensation. An offshoot of neuropathy is loss of sensation of movement of the joint, resulting in destruction of the joint and bony structure of the foot. This is called Charcot foot, or condition. In general, it's important that diabetics take care of their feet. Diabetic patients should inspect their feet daily, cleanse their feet regularly, wear good shoes and socks, take care of problems immediately, and should be inspected by their podiatrist on at least a yearly basis. Whether treatment of diabetic feet is a covered Medicare service is left to each individual situation, and evaluations by their podiatrist.

Moderator: Can you give us some tips to maintain good foot health?

Dr. Mauser: 1. Take care of them. They need to last a lifetime. 2. Wear sensible shoes. 3. Don't neglect problems that arise. If they hurt, see somebody about it. 4. Take care of problems such as hammer toe, bunions, heel pain. They will not get better as time goes on. 5. See your podiatrist.

Moderator: We are almost out of time. Dr. Mauser, do you have any final comments?

Dr. Mauser: I think we covered them in the last question. I've enjoyed taking your questions, and giving you the WebMD public the opportunity to ask questions, and to answer them. I've tried to talk in general terms. Nothing I've said is necessarily advice, and if you have a medical problem you seek out care. It's been fun. I know there's lots of questions, and perhaps we can do this again sometime.

Moderator: We are out of time. Our thanks to our guest Dr. Alan K. Mauser.

Moderator: For more information, please visit the Humana website at www.humana.com and the American Podiatric Medical Association website at www.apma.org. Also visit our WebMD message boards and articles for more information.

Moderator: Thanks for joining us for Humana Live Events. Be well and goodbye.

This event is being brought to you by Humana. Humana may have determined the selection of the speaker or topic of this event. The views expressed by the speaker during this event are those of the speaker and do not necessarily represent the opinions of the sponsor.


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