By John Kline, PT, DPT, CSCS, FAFS, Clinic Director of Spooner Fountain Hills
We may not think about our feet much day to day, but they take on the impact of thousands of steps. If you average even 5,000 steps a day, that adds up to more than 1.8 million steps every year. Over a lifetime, that is a tremendous amount of work.
Your feet also do much more than get you from one place to another. How they move, absorb force, and interact with the ground can influence movement throughout your ankles, knees, hips, and even your back. That is one reason foot pain should not simply be ignored.
We asked John Kline, PT, DPT, CSCS, FAFS, Clinic Director at Spooner Fountain Hills and an expert in foot and ankle biomechanics and orthotic prescription, about the warning signs to watch for, how footwear can affect foot pain, when orthotics may help, and why seeing a physical therapist for foot pain means looking beyond just the painful area.
Why Should You See a Physical Therapist for Foot Pain?
When you see a physical therapist for foot pain, the evaluation does not stop at your foot.
A physical therapist can assess how your foot and ankle move as well as how your knees, hips, back, strength, mobility, and overall movement mechanics may be contributing to your symptoms. Your treatment can then address both the area that hurts and other factors that may be contributing to the problem.
Treatment may include exercises to improve strength and mobility, hands-on treatment, gait or movement assessment, footwear recommendations, and, when appropriate, orthotics.
Why Are the Feet So Important to How the Rest of the Body Moves?
For anyone walking around throughout the day, the foot is the part of the body repeatedly interacting with the ground. Because of that, the way the foot moves can affect how forces are absorbed and transmitted through the rest of the body.
For example, a very rigid foot may not absorb shock efficiently. Those forces still have to go somewhere and can influence movement and loading at the knee, hip, or back.
On the other hand, a very flat or flexible foot that experiences excessive pronation, or the inward rolling movement of the foot, when walking, running, or jumping may also change how forces travel through the rest of the body.
This is why we often describe the foot as one of the “drivers” of the body.
Can Foot Mechanics Contribute to Knee, Hip, or Back Pain?
They can.
Someone with a flat or excessively pronating foot, for example, may also experience changes in movement at the knee or hip. As activity increases, those movement patterns may contribute to symptoms elsewhere in the body.
This can create a frustrating cycle: The more active I am, the more my knees or hips hurt, so I should become less active.
Instead of simply avoiding activity, a physical therapist can assess how your entire body moves and determine whether your foot and ankle mechanics, strength, mobility, or another part of the kinetic chain may be contributing to the problem.
The goal is to help you continue doing the things you enjoy.
Want to learn more about the kinetic chain?
Read “What are Kinetic Chain Reactions” on the Spooner blog.
How Do I Know What Shoes Are Best for My Feet?
Start by understanding your foot type and how your feet move.
A very flat foot that excessively pronates may benefit from a different type of shoe than a high-arched, rigid foot. However, there is not one shoe that is right for everyone. Your activity, symptoms, movement mechanics, and personal comfort all matter.
Here are some general considerations.
Shoes for a Neutral Foot
Someone with a relatively neutral foot and good mechanics may be comfortable in a wider variety of footwear, including different types of athletic shoes, sandals, and, depending on the activity, going barefoot.
Shoes for Flat Feet or Collapsed Arches
Someone with a very flat foot or collapsed arch may benefit from greater support, particularly if excessive foot motion is contributing to symptoms.
Depending on the individual, supportive footwear or sandals may be more comfortable than spending long periods barefoot. An orthotic may also be considered to provide additional support.
Shoes for High-Arched or Rigid Feet
Someone with a high-arched or rigid foot may benefit from a shoe that provides more cushioning.
A rigid foot may not absorb force as effectively as a more mobile foot, making footwear selection particularly important for activities involving repetitive impact, such as running.
What Shoe Brands Do Physical Therapists Recommend?
One of the most common questions I hear in the clinic is, “Should I get Hokas?” or “What kind of shoe should I buy?”
My answer is usually: It depends.
Rather than choosing a shoe simply because it is popular or heavily cushioned, consider your foot mechanics, activity, symptoms, and what feels comfortable to you.
At Spooner, we can evaluate how your foot and the rest of your body move and make recommendations based on what we find.
We also work with Sole Sports in Arizona, where their team uses tools including 3D foot scanning and video gait analysis to help people find footwear that works for their individual needs.
Spooner patients can ask their clinic about available Sole Sports discount coupons.
What Happens If You Ignore Foot Pain or Poor Foot Mechanics?
Foot problems can sometimes become more difficult to manage when they are allowed to progress.
For example, specifically with a flat foot, you can develop an acquired flatfoot deformity where the tendons and ligaments supporting the foot become progressively overloaded. Over time, those structures can become damaged and may no longer adequately support the arch.
As the condition progresses, the arch can collapse further and walking can become painful.
That does not mean everyone with flat feet will develop a serious problem. Many people have flat feet without significant symptoms. However, not addressing a foot deformity or changing symptoms early can allow problems to progress over years of walking and activity.
The important thing is to pay attention to changes. Increasing pain, decreasing mobility, changes in your arch, difficulty walking, or symptoms that interfere with your normal activities are good reasons to have your feet evaluated rather than simply trying to work around the problem.
What Does Calf Tightness Have to Do With Foot Pain?
A lot of people don’t realize that calf tightness can also play a role in foot health.
People who sit for long periods can develop tightness in their calves. One of the calf muscles, the gastrocnemius, crosses the knee, and tightness can limit ankle dorsiflexion—the ability to bring your shin forward over your foot. When ankle mobility is limited, it can place additional stress through the midfoot and affect how the foot moves.
In fact, a large study of thousands of people found that the number one indicator of future injury was a tight calf or lack of dorsiflexion.
Something as simple as regularly stretching your calves and maintaining good ankle range of motion, or dorsiflexion, can be an important part of keeping your feet and the rest of your body moving well.
Can a Physical Therapist Help With Orthotics?
Yes. A lot of patients don’t realize that physical therapists can assess whether an orthotic may be helpful and, depending on the clinic and therapist, may provide or fit orthotics.
Podiatrists are also a great resource for orthotics and frequently offer custom, rigid orthotics as well as more affordable semi-custom options.
At Spooner Fountain Hills, we offer semi-custom orthotics for $60. One advantage of fitting an orthotic in the physical therapy clinic is that we can evaluate how it affects not just your foot, but your entire kinetic chain.
We can test different adjustments and assess how you walk and move with the orthotic in place. That allows us to tailor the support to your individual movement needs, and you can leave the clinic with the orthotics the same day.
I’ve even had patients take their orthotics back to their podiatrist and say, “Here’s the combination that works best for me,” if they ultimately want to invest in a more expensive, rigid custom orthotic.
It is also important to remember that a rigid custom orthotic is not necessarily the best option for every foot. For some people, a more forgiving semi-custom option may work better.
The goal is not simply to put an insert in your shoe. It is to determine what type of support, if any, works best for you.
Physical Therapist vs. Podiatrist for Foot Pain: What’s the Difference?
Physical therapists and podiatrists can both play important roles in treating foot and ankle conditions, but they approach the problem from different perspectives.
A podiatrist specializes in diagnosing and treating conditions of the foot and ankle and can provide medical and surgical care when needed.
A physical therapist focuses heavily on movement and function.
When evaluating foot pain, a physical therapist may look at your foot and ankle as well as your knee, hip, back, strength, mobility, walking or running mechanics, and other factors that could influence the way your foot is being loaded.
For example, if we see excessive pronation, the answer may not simply be additional support under the foot. We might also find that hip strength, knee control, or ankle mobility is influencing what happens at the foot.
Treatment can then address those contributing factors through strengthening, mobility work, hands-on treatment, movement retraining, footwear recommendations, or orthotics when appropriate.
Here’s a question I pose to students to illustrate just how connected the body can be: Why would treating a runner’s neck help them get over their plantar fasciitis?
It may not seem connected at first. But a physical therapist looks at the whole body and how different areas influence movement. What appears to be an isolated painful foot may involve movement dysfunction elsewhere in the kinetic chain.
That whole-body perspective is one of the biggest reasons to consider physical therapy for foot pain. Instead of looking only at where it hurts, we want to understand why it hurts and what may be contributing to it.
When Should You See a Physical Therapist for Foot Pain?
You do not have to wait until foot pain becomes severe.
Consider seeing a physical therapist if foot or ankle pain is interfering with walking, running, exercise, work, or daily activities; if symptoms keep returning; if you notice changes in the way you walk; or if you simply are not sure why your foot continues to hurt.
You may also benefit from an assessment if you have questions about your foot mechanics, footwear, calf or ankle mobility, or whether orthotics could help.
A physical therapist can help determine what may be contributing to your symptoms and create a plan based on how your body moves.
