You need this article prior to googling your symptoms.
Here’s the problem.
A myriad of problems can happen in the foot and ankle. The foot is very complex, so you tend to go down a deep rabbit hole when you start learning more about it. There are 26 bones. 70+ muscles. One thing causes another, so things get complex in a hurry.
Many of these injuries and issues feel the same. They have overlapping and similar symptoms, so saying, “It hurts here!” doesn’t help much for diagnosis or treatment, despite what TikTok would have you believe. Links in google searches suggesting, “If it hurts here…you have (Plantar fasciitis, bursitis, heel spurs, tendonitis) based on the location of the pain aren’t going to get you anywhere.
Even the doctors and therapists aren’t 100% in agreement on what to call your case, as each of us has our unique specialty, experience, and perspective.
Nearly every time, there is more than one of these issues happening at the same time. Everyone has an opinion on how to treat them. The pain often has very little to do with what it is called and what is happening. In fact, the Plantar fascia reacts to nearly every other foot issue, so you’re not technically wrong saying to me, “It’s not plantar facia,” as well as “I think it definitely is the plantar fascia!” (btw this is an everyday occurrence…both sides.)
It’s daunting- because these issues are COMPLEX.
Foot issues hurt and bring in a ton of business to our clinics. Yet, despite “trying everything” over months of self rehab, Clients are nearly always disappointed when I don’t give them a silly, stupid fixes such as:
“Wear this brace.”
“Roll on this ball”
“Do this stretch”
or “Take this Med.”
They are mad. Because I won’t give them a simple fix despite an incredibly complex problem. And this is after they’ve tried and failed at the same simple fixes, often for months!
You want a simple answer? Fine.
Shoes aren’t very good for you, especially for your feet.
There you go. Problem solved. A simple fix that actually works. Just go barefoot for the next decade, and these issue will resolve.
That’s just not reality. Despite 100% knowing that shoes aren’t great for the human animal, I still wear shoes. If I didn’t, I’d be out of business, and that’s just a fact. New patients would think I was a new-age witch doctor. Plus, it’s over 100 degrees a lot down here; the concrete gets hot. I like to run outside, and it’s just not practical in modern human life to not wear shoes. I don’t live in a rainforest, and the outliers that have gone total barefoot are unique and have their own websites because of that.
There is some Good news! Despite the many different issues, most of your problems respond well to similar treatments. If you can take a little time to understand the process, I think you can get on the right path. So just hold off on the proper medication, simple fix, and accurate diagnosis for a second and take a moment to get some understanding.
Most likely, if you seek help, you have a few things going on.
2) Movement problems– specifically through the toes, foot joints, ankle, and muscles.
3) Elasticity problems – the muscles, tendons, ligaments, and fascia aren’t as stretchy and springy as they should be. They are, in a sense, glued together and not sliding and gliding as they should.
4) Neuro-connectivity problems – the brain doesn’t know what is happening down there. Think of it as the “map” being blurred or a poor connection. You haven’t moved, played with, or touched your feet for decades and things are offline because of this.
5) the Pain is actually coming from the brain as a protection mechanism hoping to limit use and motion.
6) you are doing something wrong to keep irritating it and the cycle continues.
7) you have a bad Technique that is forcing the area to move incorrectly.
8) activation/balance/control/strength is poor.
9) you have the wrong shoes – maybe even shoes you thought were helping (too much cushion, pronation limiting shoes, and arch support keeping the foot function incorrect) that are actually accentuating the problem.
10) you have or have had an injury, surgery, or issue that makes normal motion impossible.
These can continue on, but a list of ten is plenty.
Let’s be honest here – you definitely have more than 1 or 2 of these issues. Maybe all ten. This is why just rolling on the ball or sleeping with a brace never seems to get you anywhere. Even if the pain goes away or “mysteriously changes to another location,” it’s not resolved.
You may not even care! “Just make the pain go away!” Well. I won’t. You need to do something; you need to give a damn. There is no fix that any therapist, trainer, chiro, or shoe can do without YOU. It’s primary health care.
“Don’t be upset with the results you didn’t get from the effort you didn’t put forth.”
Here’s some good news.
If you look at the above list and rationalize the issues, you can go about a plan that helps combat and attack these problems. There is a system and ideas that work for a HUGE number of these problems, and despite the name, there is a commonality that allows a broad approach for many of these common foot/ankle/Achilles issues.
Here’s my note!
There is a better system. Just trying to do everything at once won’t work.
See my article on the road to recovery (essential link) for why rehab and training should be done properly rather than all at once to maximize results and speed healing and performance.
Without an organized plan and a proper step-by-step approach, I haven’t seen good results.
So without knowing you, Here’s a plan I’ll offer that is most likely better than what you currently do.
- Inflammation better be dealt with first.
Nothing seems to improve or change when the foot is irritated and inflamed. Healing is slowed for a variety of reasons. It’s my first line of attack but also my most significant reason for noncompliance and failure. Runners, triathletes, and cross-fitters are type 1A people; they want more, faster, better, live for a challenge, and can push through. So often, they will move on to steps 2-6 without ever dealing with inflammation. I’m one of these people. I’m telling you, it just doesn’t work.
- Movement happens next.
When was the last time you played with your toes? 2 years old, I’d bet. I talk about the Big 3, “Toe movement, Foot Fist, and Spread ’em.” These include the basic ankle motion of “spell the alphabet out with your ankle.” In my experience, I felt next to nothing the first 5 days I did this. In fact, I quit even doing these MOVEMENTS multiple times because I saw no noticeable improvement in anything. Or I did the typical spell of the alphabet A-G and then stopped because it was silly. Until I grew up and I decided to stay consistent and gave myself the 3 minutes to honestly do it. I had to #7 “check my ego” and decide that better movement for all purposes was more essential than the run that day and counted for something. Going for another crappy painful run wasn’t as important as helping my feet move correctly. Day 6 was eye-opening; I noticed tons more movement with a significant decrease in pain. It was a missing step for me and probably is for you.
- Activation – the foot is built to be a sensor to the world around us more than any other function. Now that inflammation is controlled, and movement is returning, start to make the brain pay attention. Spiky balls, walking on different surfaces, being barefoot, temperature, scratching, E-stim, vibration. Try turning on the sensor and then activating the muscles. Can you control your arch without moving your feet (short foot)? Can you pick up a marble? Can you walk on tile, gravel, or grass? Eye-opening hint: Cushioned shoes help with pain initially. But your foot needs sensation to trigger the rest of the body with how to react to ground forces.
A modern idea is that the more cushion you have, the more you may have to subconsciously push down or slam your foot to get that sensation. Hmm?! -That’s one of the primary concepts behind the whole “barefoot thing.” also, HINT! This doesn’t happen overnight. There is a colossal failure and problem with going from hugely cushioned and supported shoes to minimalist style footwear overnight. This is a process and takes time.
- Strength – get strong feet!
- Endurance – tends to work better after you have all the above factors working for you. In seminars, I’ll have people sit in a chair and try to get up using a 1 leg squat technique. If you can’t do ten reps at body weight from a chair, what makes you sure you can handle 2-4x body weight at 1000 strides per mile? I like jump rope as a great fitness tool for strength, endurance, and strength-endurance, and jump rope tends to get your feet into the proper landing position. Build up to multiple 1-minute sessions of jump rope.
- other fitness factors such as balance, technique, form, and gait patterns – there are books devoted to just gait alone. It’s a critical step. This article is about where I think it fits into the recovery from injury. Note. It’s not step one!
- Ego Check. This was my failure for years and an idea I need to constantly come back to – I have to be honest with myself when my form goes to hell while running after 3 minutes. Or when my hip pops out because my glute med. is weak. I have willpower. I can power through any issue and get a solid 6 miler in. Heck, we’re HUMAN. We’re amazingly adaptable, and compensation is wired into us. It’s simply that adaptation, balance, and willpower are not ideal. A better plan is fixing the problem, so you get benefit rather than detriment with your workouts, be it running, cardio, strength, or whatever. It’s the entire concept of the “Road to Recovery” infographic.
The moment this really changed for me was while I was up on stage during a lecture on fitness. I was talking about how much I work out, my proper nutrition, and lifestyle. “I am in better shape than I was 20 years ago, and I was a college football player, basically paid to workout!” But I paused. I froze on stage. The reality hit me like a ton of brick as I continued out loud. “You know something? I’m lying to you and myself right now…Screw that. I work out way too hard and dedicate a tremendous amount of time toward fitness.” (be it running/strength/body comp/cardio -take your pick) “I should be way better. I can tough it out, but what’s the return? In 20 years, I help starve off father-time? That’s not good enough! If I’m going to commit and spend 20 years running – why not fix the issues I have- so that over 20 years, I improve? I’m not focusing on willpower at this point. I’ve GOT that! Why just “willpower my way” into slower decline– compensating, adapting, limping my way to countless finisher medals and workout checklists? If I fixed these faults, ran better, and gained efficiency, I should be, in theory, WAY healthier and better at running in 20 years. 20 years of practice should make us ALL better!”
It’s the coaching adage of “Practice makes perfect.”
We know that’s garbage.
- Practicing something incorrectly is devastating to athletics, performance, and improvement. It’s actually harder to improve and break poor habits. “Perfect Practice makes Perfect.” is what good programs teach. Fix this. It’s an ego thing of pushing through vs. a saner approach of doing it correctly consistently that reaps the rewards.