Most people say their feet are supposed to hurt. At least some pain should be originating from that far-flung appendage, especially after a hard day of work.

It is appropriate, normal, expected. Certainly, we all deal with some pain during our lives, aging being part of the human condition. The implication is with the passing years comes some discomfort from somewhere. There’s so much that can go wrong with the complex biological machinery that is the human body.

Although generally neglected, our feet are important, being essential to the process of ambulation. Think about what mobility means to an individual, the ability to go places (if only to the bathroom).

The feet of homo sapiens are structures unique to the biome, meaning all of life. But then, there are no other truly bipedal species. The ability to walk and run allowed early man to escape predators.

Necessary changes had to occur to allow the human frame to walk on two, after being on all four. Many health conditions of a musculoskeletal nature, dare I say most, are due to poor biomechanics. This term refers to the complex motions and activities involved in the functioning musculoskeletal system.

Nearly every structure in the lower extremity is involved in some way with the act of ambulation, aka walking, running, strolling, skipping……ambulating.

How can this relatively small structure, the human foot, allow us to do all those (at least some of them)? It is a marvel of bio-engineering, and when functioning well, does wonderful things for humans.

But what happens when things don’t work right? Maybe they don’t line up right? Or we damage them?

One of the body parts most abused are the feet. They carry us around, while being stuffed into all manner of protective vessels, also known as shoes.

For hundreds of years, shoes were primitive constructions, leather and tacks, stitched together, ill-fitting.

Why would an ankle joint hurt? How about a big toe? What happens if a ligament gets stretched too much….. repeatedly, over time? This happens every day, to many people.

Perhaps it is one of those medical clichés that have arisen over the years. “Your feet are supposed to hurt” (which is right up there with  “an apple a day keeps the doctor away” or “an ounce of prevention is worth a pound of cure”). Is foot pain a requirement or consistent finding? How is it then some people can perform difficult, physically demanding occupations for many years without problem?

The primary factor is genetic in nature, that being your foot type. Many variations exist.

The toes are a common source of pain, stuffed into some beaten, poorly-fitting shoe all day. Like the fingers, the toes are endowed with a higher distribution of sensory nerves. More opportunity for pain signals to be initiated.

And those toe bones tend to be rather “bumpy” with knobs and prominences. This results in excess pressure to the skin and nerves, with almost no padding in the region. Or, those uncooperative toes start curling down, causing the toe joint to be prominent and rub on shoes.

Should you wonder what causes many foot problems, think of an arch that rolls down too much. This is an incredibly common situation and is termed pronation. It often causes some of the structures on the bottom of the arch to get stretched, excessively and repeatedly.

These structures are likely to become inflamed, again the result of being physically stressed.

Improving foot/leg mechanics can have that benefit and others. But, once again, father time is at work, gradually pulling some ligament, or pinching a vital tendon. If the alignment issue is ascertained early enough, many of the resultant maladies can be prevented.

Commonly, some subtle deformity, often genetic or congenital, is the source of abnormal biomechanics. For example, it could be a foot with an arch too high which will alter how the foot works. This foot type has its own set of problems and pain (including a tendency to heel pain…but wait, so did the pronating foot type!).

Any body part or tissue, stressed sufficiently, will go through certain chemical changes leading to pain due to inflammation. But inflammation gets a bad rap. It is actually a natural and important part of the healing process. When it proceeds in an orderly and timely fashion, the result of acute inflammation is healing. The take-home message is acute inflammation is a necessary step on the pathway to healing.

It’s when the acute inflammatory process develops into a chronic process……this is another animal. Chronic inflammation is distinct from acute, both chemically and biologically. It can be enduring, with the condition, and the pain, continuing for years.

Chronically inflamed tendons and ligaments are weakened tissues as a result of (inflammatory) chemical changes, and so more likely to fray or tear. Living with chronically inflamed tendons, joints, or any body part, is a potentially dangerous thing.

How the foot and leg work to move us is a subject of intense study. We continue to research how problems develop and what to do for them. Many of the causes of painful foot conditions are subtle, and not blatantly obvious. These are abnormalities rarely recognized by the non-specialist. Yet, despite their subtlety, the cumulative effect of years of motion just slightly off can lead to problems and therefore pain. There are many treatments for these conditions. Once again, the key is identification. Once accurately diagnosed, relief is possible. You read it here first: don’t live with foot pain!


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