Watch Video: Activity Modification
Most foot problems are either caused by or aggravated by the repetitive loading that goes through the foot throughout the day. Tendons can get overloaded from the repetitive stress of standing and walking, leading to painful tendonitis. Arthritic or injured joints tend to become more painful and swollen the more they are used. In fact, many problems in the foot or ankle are either caused by or aggravated by the cumulative force that the foot absorbs when walking and standing. The forces that each foot experiences is proportional to:
- The number of steps taken (or time standing) and
- The force that goes through each step (which is determined by a person’s weight and affected by their footwear, and walking surface).
- An individual’s foot posture (very high arch or very flat foot)
Activity modification looks to decrease one or more of the above factors. Activity modification does NOT necessarily involve decreasing activity level. In fact, weight loss is often a large component of managing foot and ankle conditions, and therefore activities to burn calories and lose weight may be critical for managing chronic foot problems. However, the type of activity (ex. cycling instead of running) may need to be modified to decrease the amount of force going through the foot with each step. Activity modification is really a four-fold process which includes:
- Challenging the patient to look at their lifestyle and find out how they can take less steps and spend less time standing each day
- Exploring strategies for how they can have less force go through their feet with each step (ex. footwear modifications, walking surfaces, etc.) while still maintaining an active lifestyle
- Identifying and avoiding activities that aggravate their symptoms
- Maintaining proper leg and core strength and balance to diminish the shock to the feet.
Minimizing the daily load on the feet (i.e. taking fewer steps each day)
Modifying activity in order to minimize the daily load on the feet may involve figuring out ways to sit down more or to be less on their feet. Some creativity (and perhaps some understanding on the part of their employer) can enable patients to remain seated or decrease unnecessary walking. There are also several medical devices aimed at offloading the feet.
Minimizing the force absorbed by the feet with each step
Minimizing the amount of force going through the foot with each step involves looking for ways to absorb the shock of each step by selecting appropriate footwear. Patients should look for comfort shoes which distribute the force evenly through the foot, and provide the right amount of support for their particular activity. Shoes with cushioned insoles provide important shock absorptions. These are often combined with a stiff sole to allow force to be spread more evenly over the foot and up the leg. For individuals with a significant foot deformity, an orthotic may help minimize the force to overloaded bones, joints and tendons. It also involves minimizing the amount of impact. Switching from running and walking to activities like swimming or cycling enables patients to put substantially less force through the foot, without detracting from the cardiorespiratory benefits of their exercise regimes. Restricting the amount of impact activity, such as running on softer surfaces two or three days a week instead of five, is another method by which to minimize the amount of shock on the feet. In addition, optimizing running styles can also help diminish foot stresses.
Identify and avoid precipitating activities
The third element is the idea that sometimes activities that you would not normally think of as being problematic will in fact precipitate symptoms. Precipitating activities may vary from individual to individual, depending upon the particular condition and the patient’s particular characteristics (foot type, weight, alignment, etc.). Common activities that precipitate symptoms may include walking on uneven terrain or working out on hard surfaces. Having a better understanding of what aggravates symptoms can help patients better prevent them. To determine activities that precipitate symptoms, a patient often needs to be a bit of a detective. If symptoms are increased, think back to what was done one or two days before to try and identify any precipitating events or activities. Identifying activities that aggravate symptoms is often the first step to managing a chronic foot problem non-operatively.
Previously edited by: Robert Leland MD
Edited October 12th, 2023