How to relieve pain at the bottom of your foot: A Chiropractor’s guide

Foot pain is a common complaint among Singaporeans and it can significantly impact your daily life. As a chiropractor, I often see patients struggling with discomfort at their soles or the bottom of their feet.

What is the most common type of foot pain?

The most common cause of foot pain is plantar fasciitis. This condition occurs when the plantar fascia, a thick band of tissue running from the heel to the toes, becomes inflamed. It often causes sharp pain in the heel or arch of the foot, particularly noticeable in the morning or getting up after prolonged periods of sitting.

Untreated plantar fasciitis can become chronic and may lead to Achilles tendinopathy (e.g., tendinitis, tendinosis). This is the result of “overuse” or repetitive stress to the tendon that connects your calf muscles to your heel bone (i.e., calcaneus).

What causes foot pain

In the absence of traumatic injury, most foot pain are not singular in cause. In other words, there are probably many factors at play that lead you to your eventual foot pain.

What is flat feet?

Flat feet, on its own, is not a problem. In other words, you can have flat feet and have a perfectly normal life. Flat feet can be differentiated into two types: functional or structural.

If you have functional flat feet, your feet appears flat only when you are standing or weight bearing. When you are seated or lying down, an arch is observable. In most cases, functional flat feet occurs when the muscles in your sole (i.e., intrinsic foot muscles) are weak and cannot support your arch when weight is added to it.

Functional flat feet can also be caused by ligament laxity where the ligaments that support your arch are looser than normal. This can lead to instability of the foot, which cause the arch to collapse when you are on your feet.

Structural flat foot is a condition where the arch of the foot is permanently flat. Unlike functional flat foot, where the arch may collapse under load but is present when not bearing weight, the arch is always absent in structural flat foot regardless of the position of the foot.

What is improper footwear?

I think the term improper footwear is misleading. By labelling some footwear as improper, it suggests that some are “proper”. However, this is not the case. No shoes are inherent good or bad!

When professionals talk about improper footwear, it does not mean a shoe is not good. It means the shoe is not fitting for you. Proper footwear is about wearing shoes that are suited for your needs. Like how you would not want to be wearing slippers climbing Mount Kinabalu, you also do not want to wear GORE-TEX shoes into the shower.

Personally, I almost exclusively wear slippers. As long as there is no dress code for the occasion, I would wear flip flops. I only wear shoes once every few months. While many podiatrist would frown on this, it has not given me problem for the past decades.

Do we really need arch support?

I think marketers have pushed the arch support narrative so hard that, when buying shoes, most Singaporeans would inevitable ask which shoes have the best arch support. The truth is arch support shouldn’t matter for most people. Runners inclusive.

In an analysis of over 150 studies, researchers found that arch support made very little difference to injury risk. When it comes to orthosis, they were ineffective at preventing running injuries. However, they are not totally useless. Arch support can change how mechanical stress is distributed in your feet. In doing so, they can help with running economy and reduce pain for certain conditions.

So, you do not need arch support per se. But arch support can be an useful interim solution.

Over-reliance on arch support

Believe or not, you can be excessively dependent on your arch support shoes, insoles, or orthotics!

If you have muscle weakness in your foot and it’s causing your natural arch to collapse and pain, artificial arch support can reduce your pain intensity. Why? Effectively your shoes or insoles are acting as muscles to support your arch.

There is, however, an unintended long-term consequence. Prolonged use of arch support can disrupt with the normal function of the intrinsic muscles of the foot. Overtime, reduce use of these muscles can lead to muscle atrophy, decreased foot stability, and an increased need for more support.

Can you fix fallen arches with exercise?

Yes, you absolutely can! A study in 2016 showed that doing exercises for the tiny muscles in your feet can be more effective than wearing arch support insoles. These exercises are often refer to as short foot exercises because contracting the intrinsic muscles in your foot will pull your forefoot back. In doing so, your foot appears to be shorter.

For best results, it is best to spend at least 30 minutes working on these foot exercises daily. While that may seem like a long time, a lot of them can be done while watching TV or scrolling TikTok!

Can overuse cause foot pain?

Foot overuse injuries are common among athletes and even those with sedentary lifestyles! These overuse injuries occur as a result of repeated stress to your foot structures. They can be considered repetitive stress injuries (RSI). Common contributors to “overuse” including standing, walking, and sports participation.

The best way to avoid overuse of your body is to have a good understanding of load management. Load management looks at all the stressor your body is exposed to and from there decide if it’s too much for your body. If it is, then a deload is necessary.

How can a sedentary individual get overuse injuries?

When looking at overuse injuries, we compare the activity levels to the condition of the person’s body. As such, it is not only about how much exercises you are doing, but also how fit or strong your feet are.

If you are sedentary and your feet is deconditioned (e.g., poor strength, reduced muscle mass), then simple daily walking alone can be “too much” for your foot. This results in repetitive stress or overuse injuries.

How to push my body’s limits to be stronger?

If you are already utilising your body to its capacity and would like to do more, this is also possible in the mid to longer term. There are two approaches you can take. One, you take a graded or progressive approach. In this instance, you will very slowly incrementally increase your activity level. In doing so, you allow your body to adapt to the new load. Do note that in order for this to happen, you must allocate sufficient time and nutrition for recovery.

The other approach is to train your body for the new load. For example, you are already squatting 200kg and you have maxed out at it for a long time. You want to be able to squat 220kg. Instead of pushing hard at 200kg and try to get over it, you can deload on your squat and work on accessory exercises that can help you squat better. This can include working on leg extensions to just train the quad alone. It could also be doing good mornings or back extensions to strengthen your back more.

Small changes can cumulatively add up to a big change

While these exercises are fairly isolated, they allow you to work in the individual components of the squat and push harder in those areas. Once you have made sufficient progress, you can come back to the squat again and try again for 220kg.

How much you can do today is not how much you can do next week or next year. Through progressive training, you can get stronger! Similarly, with physical inactivity, you will also get weaker.

What is the best relief for foot pain?

With a variety of foot pain treatment options in Singapore, it can be overwhelming to determine the best course of action. From home remedies like ice therapy and stretching exercises to professional interventions such as podiatry or chiropractic, understanding what works best for your specific situation is key.

Rest and recovery

The simplest thing you can do for yourself is to rest. By rest, I don’t mean complete rest. Rest in most foot pain cases will involve a reduction in aggravating rather than complete rest (e.g., staying in bed, using a wheelchair). If you often wear high heels, “resting” from them can also be a good idea.

By reducing aggravating stimuli and/or activities, you can reduce the irritation to the structures in your foot. In doing so, you are providing your body with a window of opportunity for recovery. .

Ice therapy

There is a lot of contention to whether ice therapy is actually helpful. However, it is still worth considering because of the low risk of adverse outcomes. The chances of making your injury or condition worse is very low with icing.

Because icing is accessible for most people, you can give it a try to see it helps you feel better. If so, you can give it a shot for 24-48 hours. If not, you can skip it entirely!

Stretching and strengthening exercises

I personally prefer strengthening exercises over stretching ones. You may be surprise to learn that strengthening exercises can also improve range of motion! As such, I don’t find stretching exercises to be very compelling.

If stretching exercises resonate better with you, that’s definitely a good place to start. Similar to icing, the risk of making your condition worse is very low with stretching. To be safe, always stay within your range of motion and pain-free range. It is tempting to keep pushing the end range but that alone could irritate the tissues in your foot and make your pain worse.

Proper Footwear and orthotics

Because of the high cost associated with buying new shoes and orthotics, I highly recommend patients to start with other interventions first. There are downsides to using footwear and orthotics for pain-free (e.g., dependency, muscle weakening) so they definitely should not be your first choice treatment.

Having said that, if you have already tried other treatments and are not getting satisfactory results, changing footwear and orthotics could be good options to consider.

Who is the best person to treat foot pain?

Like how chiropractors are considered by many to be conservative spinal care experts, podiatrists are known to be the go-to professionals for foot and lower limb health. The best person to treat foot pain can vary depending on the underlying cause and severity of the issue.

Podiatrist

Podiatrists are healthcare professionals trained to diagnose and treat conditions of the lower limb such as the foot and ankle. They can address issues like plantar fasciitis, bunions, heel pain, ingrown toenail, and other injuries.

Other treatments commonly provided by podiatrist include custom foot orthotics, Extracorporeal Shockwave Therapy (ESWT), Extracorporeal Magnetotransduction Therapy (EMTT), physiotherapy exercises, sports taping, etc.

Physiotherapist

Physiotherapists are healthcare professionals trained to diagnose and treat musculoskeletal, neurological, and cardiorespiratory conditions. Because of the vast nature of their training, they are generally not considered experts in foot care. However, foot pain is still within their scope as they are often caused by musculoskeletal conditions.

A physiotherapy can help you with your foot pain through manual therapy such as massage and joint mobilisation. They can also give you targeted exercises to strengthen the foot and surrounding muscles can improve stability and function. Stretching exercises are also commonly prescribed for the calves and feet in attempts to alleviate pain and improve flexibility.

Like podiatrist, electrotherapy such as shockwave, ultrasound, laser may also be used.

Orthopedic Surgeon

For more serious cases, referrals to specialists such as an orthopaedic surgeon may be necessary. Orthopaedic surgeons may be consulted for severe injuries, deformities, or conditions that require surgical intervention.

Common procedures by orthopedic surgeon for the foot include  bunionectomy to remove a bunion and realign the big toe, plantar fascia release surgery, Achilles tendon repair, or foot fracture surgery to align and stabilise broken bones in the foot.

Chiropractor

Believe it or not, you can choose to seek treatment with a chiropractor for your foot pain! Similar to physiotherapists, chiropractors are not considered experts in foot care. However, it still falls under our scope because it is part of musculoskeletal care.

Unlike physiotherapists, chiropractors only trained in diagnosing and treating musculoskeletal condition. Our specialised training for musculoskeletal conditions puts us in a good position to work with the muscles and joints of your foot.

Treatments provided by chiropractors often include manipulation or adjustments. It is common for patients to experience an immediate relief post-treatment. However, results tend to be short-lived.

At Square One Active Recovery, we do not provide treatments that only offer temporary relief. As such, no adjustments or manipulation will be offered at treatment.

Instead, we use exercises and lifestyle change strategies to help you help yourself find freedom from pain.

Finding freedom from foot pain

Foot pain doesn’t have to be a barrier to enjoying your life in Singapore. By choosing the right professional, you can achieve good recovery outcomes for your foot pain. If you’re unsure of how to proceed, drop us a message with your concerns and we’ll get back to you with our suggestions.