Elective foot surgery is expensive, debilitating, time consuming, frequently unnecessary, and patients are often worse pain following surgery. Matter of fact, if you find anyone happy with an elective foot surgery you might also want to go ahead and buy yourself a lottery ticket…the odds are about the same. I always say, “there is NOTHING surgery can’t make worse”.   That is especially true in elective foot procedures.

Has your surgeon told you that you need surgery for the following?

•  Neuroma
•  Bunion
•  Hammertoe
• Plantar fasciitis
• or maybe because you had advanced degenerative Osteoarthritis?

Trust me, the surgery will not address the cause of any of the above pathology.  If you fuse, remove, dissect, or realign something in the foot without addressing the cause, you are just kicking the can down the road until you need surgery #2, #3, etc.

A brief bio on me to provide credibility on this subject:  I became the Army’s expert in lower extremity biomechanics and foot/ankle treatment specialist in 2000 and was honored to hold that position until my retirement in 2013.  I’ve attended 120 hours of continuing education in biomechanics and have taught courses all over the country.  I have also successfully treated thousands of patients in my career, relieving their pain and in countless circumstances, avoided the above mentioned surgeries.

The BARE NECESSITIES Do’s and Don’ts of foot pain…

The Don’ts

1. Don’t see a podiatrist. Podiatrists are foot surgeons and they have little knowledge or inclination toward conservative treatment options.
2. Don’t let anyone inject your foot. Cortisone injections are somewhat effective in treating foot pain, BUT they do NOTHING to address the cause of foot pain. As a result, when the steroid wears off the foot pain often returns worse than before.
3. Don’t let anyone sell you a hard plastic arch support. Your foot was designed to bend and flex during the stance phase of gait, and it can’t perform correctly with a hard piece of plastic wedged under the arch. These “custom” arch supports are also expensive and rarely covered by health insurance.
4. Don’t let anyone convince you that you just need to “stretch” more. Typically the most common cause of foot pain is an underlying instability… instabilities get WORSE with stretching even though it can feel a bit better short term.

The Do’s

1. Do try a change of shoe. Many times replacing a worn out, or poorly fit shoe will be enough to start the healing process. If possible get advice on footware from a reputable shoe dealership (none of the chains) or medical professional with significant foot/shoe experience or training. If you are on your feet a lot (work, home, sports), don’t skimp on your shoes. You don’t need to spend a fortune, but the shoe market is competitive and you do get what you pay for.
2. Do try a full length off-the-shelf shoe insert that you can usually get in a running shoe store for $40-$70. This is a semi-rigid arch support and will still allow your foot to flex and bend as it’s intended to, but will still provide some support.
3. Do find a good manual therapist (Massage or Physical Therapist) to break up the adhesions that are likely contributing to the pain in your foot. If your therapist tries pushing “exercise” as the cornerstone of treatment and does no or very little manual therapy, go find a different provider. This condition cannot be fixed with exercise, though exercise can be a component of recovery…the main emphasis should be on manual therapy (not dry needling) to both lower extremities.
4. If all else fails…Do find a biomechanical specialist to construct a custom biomechanical corrective orthotic (shoe insert) to address the underlying cause of your foot pain. These professionals are few and far between. I noted above how I became a specialist in this field, and here is a link to my website. You will find information on the difference between arch supports and biomechanical orthotics as well as examples of what I would need to conduct an assessment on you (video and other) if you happen to not live close to Colorado Springs.

Lastly, if you happen to find this blog AFTER you already had a surgery (or 4)…there is still hope. Follow these same do’s and don’ts and you will be amazed at your recovery!!

By LTC Tony Bare (ret), DPT, OCS, ATC