Chances are we all either know someone who has foot ankle ankle pain or we have it ourselves. There are a number of different things you can do for foot and ankle pain, but there are so many conflicting things you hear on the internet about what to do. Listed below are the top 5 frequently asked questions we, as physical therapists, get asked the most.

Why does the bottom of my foot hurt?
- There could be a number of reasons that you are having pain on the bottom part of your foot but the most common is pain below the heel which is known as plantar fasciopathy. This is typically caused by tightening and/or weakness of the muscles in the foot and along the back of the lower leg. Over time this causes tissue degeneration and possibly inflammation that makes it painful to put weight through the foot. It usually improves after moving around a little as more blood flow is sent to the area but then will stiffen back up if you sit or are inactive for a period of time. Around 90% of cases will resolve with conservative care if properly treated.

Why does it feel like there’s a pebble in my shoe when I walk?
- The most common cause for this feeling is something called a morton’s neuroma which is a thickened area of tissue between the toes that commonly surrounds a nerve. This can be caused by improper foot mechanics or improperly sized footwear. Shoes that are too tight will compress the front of the foot together and over time irritate the nerve and cause this thickening. Make sure your toes fit inside the lining of your shoe when you are standing – if they hang over the edge of the liner the shoes are too narrow and are squeezing the front of your foot.

Do I need surgery for my bunions?
- It depends on the duration and severity of your symptoms and how much it has progressed. This could be determined during a free screen or an initial evaluation at Robbins Rehabilitation West. Depending on the severity of your symptoms and how long you have been dealing with the issue it may be possible to treat with conservative care including manual therapy, stretching, exercise, use of toe spacing devices, and footwear modifications. Surgery should only be considered with your doctor if conservative measures do not alleviate symptoms.

It’s been 2 months since I rolled my ankle, why does it still hurt?
- Sprained ankles will not appropriately heal on their own without a proper course of physical therapy. Ankle sprains involve damage to the ligaments most commonly on the outside of the ankle which can cause persistent instability if not addressed. There are receptors in the muscles, tendons, and ligaments in your ankle that help maintain your balance and these get disrupted as well when you roll your ankle and require training to properly stabilize again.

Do I need to wear orthotics to make the pain go away?
- Orthotics may be recommended by your doctor due to your foot pain but ideally they are only used for a short period of time as you address the underlying issues. It is very rare to have a true structural issue with your feet that would require a long term orthotic. Your feet should be capable of supporting themselves provided you have adequate strength and flexibility through the foot and ankle musculature, which can be improved through the exercises in this guide. By wearing an orthotic long-term your feet do not have the strength to support themselves and will rely more and more on the external support provided by the orthotic.

Why do my feet ache after walking on the beach? Shouldn’t the soft sand help my pain?
- It would make sense that walking on soft surfaces should help foot pain doesn’t it? Depending on the person that may be the case, but, for the majority of people who spend their days in very supportive shoes and possibly orthotics it may have the opposite effect. Tendons have a degree of elasticity that allows them to collect energy as they are stretched, then use that stored energy to aid in motion. Think of a bowstring as an example, it stretches as you pull it back collecting energy, then as you release it, it uses that magnified energy to propel the arrow forward rapidly without much effort. When you are walking on soft surfaces, like sand, you cannot collect and transfer this energy passively and it forces your muscles to do more of the work. The ache you feel in your feet is akin to muscle fatigue after a hard workout and over time would help strengthen the small muscles around the feet and ankles. This would have to be gradually introduced though, otherwise you may develop overuse type injuries of those muscles.