One of the most common human maladies is foot pain. It is so prevalent in our society that it has given rise to enormous technological growth in shoe and sneaker manufacturing. There are shoes for different activities, for different foot types and for different objectives. All fine and good. More specialized shoe gear has certainly been a partial answer to some of the pain syndromes we treat. However, it is woefully inadequate to assume that all foot pain is caused solely by the wrong fit or the wrong type of shoe.
It’s extremely important to understand that the foot is not an appendage that is autonomous. It is intimately connected to the body, not just in terms of its locomotion, but in all of the physiologic aspects of human homeostasis. Feet are complex structures. They house 25% of all of the bones in the human body. As small as they are, feet are called upon to support and propel the body, at times carrying 2 to 4 times body weight in pounds per square inch for literally thousands of steps daily. The level of metabolic activity needed to successfully carry out its duties is huge. As such, circulation (the delivery of oxygenated blood and nutrients) must be adequate to supply what is demanded. Neurologic feedback to the brain is critical so that the foot can navigate terrain, fire intrinsic muscles and relay messages to the brain. The foot contains sensory fibers for stability, pain fibers for protecting injured cells, temperature fibers to protect bare feet from freezing and burning and motor fibers for locomotion and all aspects of foot function. The musculoskeletal configuration of the human foot is an architectural wonder. These small appendages are designed to support and propel a comparatively large body with very little surface area and very compact anatomy. And they do it for many decades.
Many people who suffer from foot pain will naturally think only of their foot and its relationship to their shoes or sneakers. Blaming shoes may be the default thinking, but there is a much larger pink elephant in the room. Since the foot requires adequate delivery of blood, it is intimately connected to the circulatory system. Its neurologic duties connect it to the nervous system. It’s structure and function connect it to the musculo-skeletal system. It’s metabolic demands connect it to the respiratory and endocrine systems. Clearly, the foot is part of the whole and is affected by the whole as much as the whole is affected by the foot.
So dealing with foot pain, especially chronic foot pain, requires a much deeper understanding of human physiology than meets the eye. Our current health care system looks at pain as the problem and addresses it with the use of anti-inflammatory drugs or pain relieving medications. In fact, pain is not the problem. Pain is a symptom of the underlying problem. Suppressing pain and inflammation with medications does nothing to address the cause of the pain. In fact, the very nature of medications adds toxic load to the body, thereby feeding mechanisms that may be the actual cause of the pain.
So what exactly is pain? Other then the “ouch” part of it which we don’t like, it is actually a symptom pathway generated by the immune system. When you understand why the immune system needs to recruit a pain pathway, you will understand a lot about the underlying causes of the pain. So let me break it down for you. The human body is always seeking homeostasis (that being the efficient engineering of all body systems). Every night the human body requires sleep so that it can detoxify all of the cells and repair or replace injured and senescent cells . This detoxification and repair pathway is known as primary inflammation. Primary inflammation is essential to the maintenance of good health. However, there are many reasons why the primary inflammatory pathway may not be efficient enough to effectively detoxify and repair in a timely manner. When this occurs, the immune system recruits a different pathway since, what it cannot properly repair, it must protect. The pathway that protects injured cells that are not being repaired efficiently is called chronic inflammation. This pathway is critically important because its objective is to prevent these injured cells from dying. The most important part of this pathway is pain. Pain is the signal to your brain that there is a problem. Pain minimizes your ability to use the injured part, giving it an all important decrease in function and metabolism to minimize further damage. So, while we all abhor pain, its purpose is actually quite important and very necessary.
With this in mind, it is easier to understand why anti-inflammatory drugs, although capable of relieving symptoms, actually interfere with both pathways of inflammation and make it harder for the body to heal. In other words, the drugs are used to ease the pain by suppressing the pathway of chronic inflammation. Unfortunately, these drugs also suppress primary inflammation, so we have essentially interfered with detoxification, repair and protection. As many of you know, patients on anti-inflammatory drugs must be monitored regularly for liver damage, since the detoxification pathways are suppressed and the liver will build up toxins that cannot readily be removed.
So what does this mean? The evaluation of foot pain must have a multi-tiered approach. Since the foot is involved in high metabolic activity of locomotion, the biomechanics of the patient’s foot function must be well understood and managed. Once this is accomplished (perhaps with orthotics, stretching exercises, strengthening exercises, etc.), we then must look for anything that may burden the immune system leading to an inefficient primary pathway of inflammation. It is often as simple as a diet that lacks essential nutrients. But it can be far more complex. Patients can have food sensitivities which elevate inflammation in the body. There may be inefficient detoxification pathways, adrenal stress, neurotransmitter imbalance, heavy metal toxicity, hormone imbalances, digestive disorders, sleep disorders, occult infection of parasites, etc., all of which elevate oxidative stress in the body and burden the immune system.
Specific lab tests are performed to see where these burdens may be emanating from and then they are managed. Clearly, once the burdens are lifted, we now have a patient whose health will improve. From this point, we can use natural medicines to stimulate the primary pathway of inflammation to heal the pain syndrome. The birds eye view here is simple. Assist the patient on the road to salutogenesis (the road to improved health) and then use non-toxic nutritional, herbal or homeopathic medicines to heal the symptoms. Obviously, this is not a magic bullet approach. It takes time to get the information from the lab work and then takes time to manage the burdens. At that point, the actual chief complaint can be addressed and the patient can heal.
Understanding cause and effect is critical in managing any chronic pain syndrome, the foot and ankle included. Our role as physicians is to help our patients become healthier and stay that way. Anti-inflammatory drugs and pain relievers do not make patients healthier. They are temporary managements for pain at best. After practicing a more holistic, mechanistic, functional medicine approach for 30 of my 36 years in practice, I can unequivocally say that the end results are profound and much appreciated by the patients.