There’s much we can do to please our knees and delicate soles
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We tend to ignore our knees and feet unless they hurt. A tactical error because, particularly from midlife on, they may give us trouble. About 180,000 workers are off sick long-term because of foot and leg-related problems, the ONS recently reported — a sharp rise over the past four years. Equally concerning is that austerity will lead to further cutbacks in NHS podiatry services.
Even minor ailments can be debilitating — and unexpected. “I’ve face-planted on the ground while walking along on a flat surface wearing sensible shoes,” says Emma McConnachie, a podiatrist and spokeswoman for the Royal College of Podiatry. (She tore ligaments and fractured her ankle, although the cake she was carrying was fine.) There’s no accounting for tripping over an invisible dog. This aside, there’s much we can do to please our knees and care for our delicate soles. Here the experts explain.
Strong thigh muscles, strong knees
Runner’s knee is a catch-all term for several causes of knee pain, says Professor Philip Conaghan, director of the Leeds Institute of Rheumatic and Musculoskeletal Medicine at the University of Leeds. Newly developed tendon problems, the stirring up of an existing issue such as a cartilage tear or osteoarthritis in your knee — take your pick.
If knee pain is linked to running or another activity, Conaghan asks his patients: what was different when this pain started? Do your favourite old trainers have zero shock absorption? Are you heavier? If so, “there’s that much more weight going through your knees when you run”.
Whatever the cause, the key to rebuilding is improving thigh muscle strength. “Most of the people I see, no matter what they come for, have weak thigh muscles,” he says. “Even some runners, or people who say they walk a few miles a day, still can’t do a good straight leg raise when you get them on a couch.”
A sign you’ve lost thigh muscle strength is if you’re using your arms to push yourself up out of a deep seat. It can happen fast. “Anyone who’s had a cold or flu and was in bed for days or more knows the feeling of getting up and having wobbly legs — and that’s muscle weakness.” It can make you feel as if your knee is giving way, he says. You start to get pain walking downstairs — and upstairs.
Thigh muscle strengthening reduces pain substantially for knee pain, almost irrespective of what damage exists inside the knee. “We’ve seen many people with ‘bad x-ray osteoarthritis’ who, if they’re strong, have very few symptoms.” Walking laps in a pool is great for strengthening quads, as are straight leg raises. You lie on the floor, one leg straight. (The other is bent with the knee raised and the foot on the floor.) Lift the straightened leg about 15cm off the ground, knee locked. Hold for ten seconds, lower, relax for three seconds, and repeat — until your thigh aches. Do this for each leg, twice daily. Conaghan is wary of prescribing lunges and squats until patients have gained strength — if their form isn’t correct, perhaps because of muscle weakness, lunges and squats may have triggered the initial problem. “First get strong, then get fit,” he says.
Whether you’re swimming, walking or running, take care of your joints with these tips. GETTY IMAGES
After an ankle sprain, take rehab seriously
We don’t appreciate our ankles. “The ankle joint is the only joint that can move in three planes of motion,” McConnachie says. It’s partly why one wrong twist or turn can cause injury. Poor footwear choices often cause ankle sprains, she says — the culprits are not just unstable higher-heeled shoes, but slip-on mules that come off easily. If you sprain your ankle, to reduce the risk of permanent weakness you can “do exercises over a few weeks to slowly rehabilitate the intricate network of muscles, ligaments and tendons in the area”.
Typically, she recommends using your big toe to draw a circle. “Stick your foot out in front of you, lift it slightly off the ground, imagine your big toe as a pointer, and use it to draw a circle of a few centimetres in diameter, clockwise ten times, then counter-clockwise.” This is great for improving ankle mobility. To improve dexterity (because often an ankle sprain damages ligaments at the top of your foot), “try to pick up a hankie with your toes. Take off your sock, put a tissue on the ground, and put your toes over it and try and use them to grab the tissue.” Some experts suggest a marble, but let’s not court disaster. “I prefer to do it with something I’m not then going to slip on,” McConnachie says.
Never wear wellies for walking (or golfing)
Tiger Woods recently withdrew from a golfing tournament after developing plantar fasciitis in his right foot, making it difficult to walk. Many midlifers feel his pain. “It’s quite common in the thirties, forties, fifties and beyond,” says Dr Ivan Bristow, a podiatrist and fellow of the Royal College of Podiatry. “It comes on quite suddenly, or seems to. What patients find is, they wake up and, particularly when they take their first steps in the morning, they get this dreadful pain on the underside of their heel.”
“It’s not uncommon in athletes,” he adds (and, sadly, in non-athletes). “A training shoe has a life expectancy of about 500 miles, then if you’re jogging on a shoe that is no longer as cushioned as it should be, or putting a lot of impact force through the heels and feet, certainly that can precipitate the pain.” Especially if you’re running on hard surfaces.
And wear those designer wellies for gardening, not walks. “Wellington boots are not really walking footwear,” Bristow says. “You put extra stress under the heel, and this ligament called the plantar fascia gets a bit tense and causes inflammation just where it inserts into the heel bone. You get this intense pain and swelling — particularly when you start walking or at the end of a long day when you take the weight off your feet.”
The good news? Most heel pain gets better on its own. The bad? It can take 12 months. In the meantime, footwear with cushioning and a bit of an arch contour will help — avoid loose-fitting or hard-soled shoes. “Mechanically, you’re trying to get the tension off that ligament which is across the sole of the foot.”
If it’s acute, elevate your feet when sitting. Icing the area can relieve some pain, as can gentle stretching exercises. “Roll a tennis ball under your feet while you’re sitting in a chair,” he says. “You gently massage the arch and heel area — that gives it a stretch if it’s not too uncomfortable.” In severe cases, one option is steroid injections. A treatment gaining popularity is ultrasonic shock waves applied to the heel. “Some studies have shown that can be helpful,” he says.
Reduce flat feet pain with cushioned soles
Flat feet are an issue only if they’re causing pain or a problem with walking, Bristow says. “You may get foot pain, ankle pain, leg pain, even hip or lower back pain.” But with flat feet, foot strain is common, particularly if you’re standing a lot. “Typically the symptoms are aching feet at the end of the day, you find your shoes are a bit tighter because your feet are slightly swollen,” he says. “A flat foot, in most cases, is fairly inflexible, so if you can imagine walking on a rigid foot, you’re going to get a lot of jarring and shocks.” What helps is to reduce impact and correct the foot position, so he advises footwear with some cushioning in the sole, and arch support to realign the arch. Very flat basic footwear isn’t helpful. “Flip-flops don’t give you much contouring on the sole of your foot or support.” (If this hasn’t improved it after two weeks, seek professional help.)
Get support for toe-related aches
The most common site for osteoarthritis in the foot is at the base of the big toe, Conaghan says. “Sometimes bunions are just base-of-big-toe osteoarthritis.” A stiff insole underneath it can help to reduce pain. He swears by shoes that are shock-absorbing, with a flexible sole and good arch support. “Arch support is important for taking load off both the heel and front of the foot.” (Decent trainers are better for knees and lower back too than, say, expensive but stiff-soled flat leathers.) Bunions can also be caused by compression of the bursa — a fluid-filled friction-reducing sac near a joint or tendon — at the side of the big toe. Pointy shoes and even modest heels have a lot to answer for, he says.
Don’t ignore an ingrown toenail
An ingrown toenail, tiny little thing, can cause big trouble. “A lot of people think, ‘It will be fine, it will grow out,’ ” McConnachie says. “Or they’ll keep cutting that toenail further and further back.” If your toenail has punctured your skin, causing pain, bleeding, infection, inflammation or — if you’re eating, stop now — “hypergranulation tissue, a thing that looks like a bleeding brain growing out the side of your toe”, seek professional advice, sharpish.
“My 12-year old nephew cut his ingrown toenail, ripped the rest of it off,” McConnachie says. “Within a week it was so bad I had to give him antibiotics. He had to have surgery three weeks later.” This is because if the inflammation process becomes embedded, the toenail may have to be removed, she says. Who, after this tale, would dare neglect their toenails again?