Solutions for Tired, Achy Feet

Lynda Lampert, RN

Nurses deal with plenty of nagging pain problems. If it isn't your back or neck, it is likely your feet that are causing you pain. This is usually the result of standing from eight to twelve hours, moving constantly, and sometimes wearing less than supportive shoes. In honor of National Foot Care Awareness month for April, it would help to know a bit more about the mechanics of standing, what common foot problems nurses face, and strategies for overcoming the pain.

If you don't take care of your feet, then you will probably wind up limping through the hallways of your facility. In fact, there are many ways to take care of your feet other than buying the most expensive shoes you can find. Some of the expensive shoes are not supportive enough, and you should go with the ones that make your feet feel best. The main condition that arises in nurses' feet is plantar fasciitis. This is a stretching of a ligament in the foot that causes heel pain. It is often mistaken for bone spurs. Treating it can be difficult, but not impossible. The topic of foot health for nurses is a large one, but knowing a little preventative medicine can help you stay on your feet without pain.

The Problem with Standing

Your foot is affected in different ways depending on if you are standing or walking. Standing in one place is often worse for your feet than moving around. Standing takes on the forces of the heel to ground contact and the vertical weight of your body on the structures of your feet. It can also cause blood to pool in the feet and lower extremities, causing pain and stiffness. The veins can become inflamed, and these appear as varicose veins. Obviously, the constant pressure can lead to misalignment of the foot and degeneration of the joints. Usually, rubber standing mats help to decrease this problem.

Walking has a different set of mechanics associated with it. The part of the gait cycle that concerns foot researchers the most is the contact portion. This describes the time that the foot comes in contact with the ground and accounts for 27 percent of the cycle. The pressure of walking coupled with standing all day can lead to a very common foot problem called plantar fasciitis. The condition is a straining of the ligament that spans the length of the foot and helps to support the arch during the contact phase. As the fascia cushions the forces of standing and walking, it can lead to inflammation, tears, and pain.

Plantar Fasciitis

The plantar fascia is a long ligament that spans the length of the foot. It originates from the medial tubercle and the anterior portion of the calcaneus. The fascia actually arises from the Achilles' tendon where it inserts into the calcaneus. This tough, fibrous material leaves the heel bone, extends down the foot, across the arch, and inserts just below the phalanges. The mechanics of this ligament are important to understand. With contact and compression, the band stretches as the arch is depressed. When the pressure is off, the fascia contracts and restores the arch to the foot. This phenomenon is more common in people who have low arches, flat feet, are on their feet all day, are overweight, or those who overpronate their ankle laterally.

Symptoms of plantar fasciitis are rather simple but extremely painful. Most patients experience a stabbing pain in their heel or across the bottom of their foot. Usually, the pain occurs most acutely upon waking or after sitting for long periods of time. It tends to ease as you walk around, but it can still cause a nagging achiness. When plantar fasciitis isn't treated, it can lead to a rupture of the ligament, but this is very rare.

Diagnosis is usually determined by history and examination of the foot. One way to tell if you have plantar fasciitis is to dorsiflex your foot to see if the pain increases. The limited dorsiflexion often means that the calf and Achilles' tendon are tight, causing pressure on the flexion of the plantar fascia. Sometimes x-rays or MRIs are used to determine if there are structural problems with the foot. Bone spurs at the heel are often found in this imaging, but they are not the cause of plantar fasciitis. It is the tearing of the ligament that is causing the pain and the presence of the bone spur is incidental.

Foot Pain Strategies

It is easy for nurses to go to extremes to make their feet feel better. From high-tech shoes to wild inserts, the pain is often so bad that a nurse will try anything to make it go away. The first detail you need to attend to is the shoes themselves. If you have flat feet, you likely need an arch support to absorb the shock on the plantar fasciitis. For those who have high arches, an arch support can actually make the problem worse. These feet need soft, cushioned shoes. If you are unsure of your arch, find a podiatrist to help you. Knowing this, you need to find shoes that meet your needs.

Shoes come in a variety of types now, and it can be confusing to decide which is going to help your foot problem. Do you need a running shoe or a cross training shoe? Actually, the best shoe is probably a shoe designed for walking, since that is what you are going to be doing on the job. Research different shoes to determine which have arch support and which are cushioned or help with overpronation.

Once you have a pair of shoes that meet your needs, you may want to consider inserts or orthotics. Again, if you have flat feet, you absolutely need an arch support. Of course, soft and cushy inserts don't hurt, but that isn't as important as the support. Although department stores sell a wide variety of inserts, it is very easy to pick the wrong one. The best way to handle orthotics, especially if you have an existing problem with plantar fasciitis, is to get a custom insert from a podiatrist. They cost more, but they are likely to better support your feet.

Socks are another important consideration when attempting to protect your feet. As you age, the fat pads on your feet can wear away, and this can cause pain to the ball of your foot or your heel. You should wear cushioned socks that help protect these pads or make up for their absence. In addition, if you can, you should change your socks at least once per shift. If possible, have two pairs of shoes and alternate them every other day. This will cut down on smell, keep your skin intact, and protect your feet from the effects of sweat.

Another piece of equipment to consider is compression hose. This will not affect plantar fasciitis, but it will help you if you develop tired, achy, heavy legs by the end of the day. Standing in one place for long periods can mean the blood will collect in your lower body, and compression socks help to keep your legs from swelling. Although walking does tend to move the blood back toward the heart, compression stockings can assist this natural side effect of flexing the calf and thigh.

Finally, exercising and soaking can help prevent the effects of foot pain. You should stretch your foot via dorsiflexion, and stretch the calf to help to loosen up tight muscles. Massage is another great way to help your feet feel better. Take a tennis ball and roll it under your foot for a quick and easy massage. Soaking your feet in Epsom salts is another common recommendation, and it can help to make your feet feel better. Even if it doesn't, a nice foot soak is a great way to unwind from a stressful day.

References

Mayo Clinic; Plantar Fasciitis; Feb 27, 2014

Institute for Preventive Foot Health; How to Practice Good Foot Hygiene

Medscape; Plantar Fasciitis; Craig C. Young, MD; November 20, 2014