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Dr. Darren Herzog and Dr. Xan Courville. Photo by Ellen Jaskol.
As we age, four common changes happen to our feet: they get wider, they get longer, our toes begin to curl, and the fat pads under the balls of feet get thinner.
“These changes happen to everyone, but to various degrees,” said Dr. Xan Courville, an orthopedic surgeon and foot and ankle specialist with Panorama Summit Orthopedics. “Some of the changes are genetic and are influenced by having flat feet or high arches.”
Physically active residents and visitors in Summit County should pay special attention to any overuse injuries such as plantar fasciitis, ankle sprains and achilles tendinitis. With the right diagnosis and treatment, the pain and duration of these injuries can be greatly reduced.
Wear the right shoes
It’s essential to wear the right shoes for the specific activity you’re doing, Dr. Courville said. There are a lot of great retail stores in Summit County that can help you find the right shoe and the right fit.
“Don’t wear biking shoes when you’re out running,” she said.
Dr. Courville said it’s common for feet to grow about a ½ size every 10 years. If you’ve been buying the same size shoe for a couple of decades, it might be time to go in for a proper shoe fitting.
As for wear-and-tear, shoes experience a fair amount of it — especially among those who are active. You want to wear a shoe that offers enough cushion and support.
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“Start by looking at the sole and the inserts in the shoes and see if they are in good condition,” Dr. Courville said. “When you lose the fat pad on your feet, you have to have enough cushion in your shoes to compensate for the loss. If your shoes are worn out, you can develop heel pain or achy feet after standing too long.”
While there’s no specific shelf-life for a pair of shoes, Dr. Courville said some shoe companies recommend replacing hiking and running shoes every 300 to 500 miles.
When is it time to see a specialist?
Rather than hiking or working through foot and ankle pain, Dr. Courville said you should see a specialist anytime pain is continuing beyond about two weeks.
“A specialist would begin with a comprehensive history and examination to figure out where the pain is coming from,” Dr. Courville said. “Often times there are simple treatments if the problems are detected early. However, if the problem is left untreated for months, it can be much harder to reverse bad or compensatory habits that have formed.”
Foot and ankle problems sometimes don’t originate with the foot or ankle, either.
“If a person has hip or core weakness, they may have asymmetry in their gait or stance, which then can lead to compensatory foot and ankle overuse injuries,” she said. “Our bodies have a kinetic chain from our backs, hips, knees to our feet and ankles that are all connected.”
If you don’t address conditions like plantar fasciitis, which is an inflammation of the fibrous tissue on the bottom of the foot that connects the heel bone to the toes, early, Dr. Courville said people can experience heel pain for 6 to 18 months or longer.
“Patients come in and say they’ve had something going on for years. If you have pain or swelling or a recent injury, I recommend you come in and see an orthopedic surgeon within two weeks of the symptoms so the problems don’t linger,” she said.
Surgery as a last resort
Dr. Courville said it can be a common misperception that most foot and ankle injuries need surgery. A fear of surgery is often one of the reasons people delay seeing a specialist.
“We can treat most foot and ankle injuries conservatively and most people may never need surgery,” she said. “It’s much easier to seek care and treatments early on so we can help make subtle changes. Physical therapy often can prevent people from suffering.”
Physical therapists might try to help patients unlearn certain bad habits, may identify areas of weakness to improve upon, and use soft tissue modalities to decrease pain, scar tissue and inflammation.
“If you’re ankle hurts, for example, and you’re turning your foot sideways when you walk to compensate, that could be causing hip and knee problems,” Dr. Courville said. “But, if instead we found a treatment for your ankle pain and you continued walking normally, there would be less progression to pain elsewhere in the body.”
Some easy, every day exercises that Dr. Courville recommends to most of her patients include calf stretching, with the runners’ stretch, and toe raises. Everything gets tighter as we age, which is why Dr. Courville recommends stretching as a great preventative tool. And, toe raises can help strengthen feet and ankles and improve balance.