Stress and Foot and Ankle Pain: Techniques for Relaxation and Stress Management


Understanding Foot and Ankle Pain

There are many different parts of the foot and ankle that can be the source of pain. Often disease within a joint can cause discomfort. This may be due to loss in the cartilage surfacing the bones which results in bone rubbing on bone. This is often described as a deep ache within the joint and can cause morning stiffness and swelling in the foot and around the ankle. It can also be sharp and localized pain, usually on weight bearing activities. This may be due to subchondral cyst formation or osteophytes. An example of this type of pain would be at the base of the big toe which is often due to osteoarthritis of the 1st MTPJ. Abnormal joint function can also cause foot and ankle pain. This often occurs with ligament sprains or tears around a joint. The ligament may fail to heal and reattach properly or in some cases scar tissue will form and restrict movement. This can lead to chronic instability or pain at a joint. Often people compensate the way they walk after a lower limb injury and this change in biomechanics can cause overload of certain structures in the foot and ankle resulting in pain. An example of this would be Achilles tendinosis due to a change in gait pattern after an ankle sprain.

Pain experienced in the foot and ankle can be a debilitating symptom. It is commonly stated by patients that they cannot perform tasks they enjoy because their foot or ankle “just hurts too much”. Everyone from the sedentary individual to the high level athlete can be affected with foot or ankle pain. Pain can manifest in a variety of ways whether it be sharp and acute, develop slowly over time, or come and go. It can be localized to a specific spot such as on top of the foot or over time can spread and be more generalized throughout the whole foot. People experiencing orthopedic pain often have difficulty in describing what their pain feels like and what makes it worse. This is often due to the complex nature of the foot and ankle as well as the variety of structures that can be the pain generator.

Causes of Foot and Ankle Pain

There are a multitude of causes for foot and ankle pain. For this reason, in many cases it can be difficult to pinpoint the specific reason that is causing the discomfort. Although most of the weight of the body is placed on the lower limbs, and they take a considerable amount of impact in activities such as walking or running, foot and ankle pain is not limited to athletes. Pain or discomfort can be due to an acute injury such as a sprain or strain, which may result from something as simple as stepping awkwardly off a curb. No matter how insignificant it seems at the time, if it causes you to limp in an attempt to reduce pain and discomfort, it is likely to cause added stress to other areas of the lower limb and result in further problems. A limp can therefore cause an altered gait, which may put abnormal stress on other foot structures and higher leg joints, resulting in pain or discomfort. It is therefore possible for an injury to cause problems in other areas of the foot and ankle over time, such as a fracture to a bone which may not heal correctly and cause pain in later life. Other causes of foot and ankle pain include: arthritis, wear and tear to the joint surfaces or ligament damage, and these cause problems to develop slowly over time. With such a wide variety of causes, it is important to get an accurate diagnosis of foot and ankle pain, in order to have the most effective treatment and management.

Common Foot and Ankle Conditions

– Rheumatoid Arthritis: Although it is a systemic disease that affects many tissues in the body, including the lungs and heart, it can cause chronic inflammation in the joints. It also tends to affect the same joints on both the right and left feet symmetrically. Additionally, it can cause nodules to form on the affected area.

– Tarsal Tunnel Syndrome: This is very similar to carpal tunnel syndrome in the hands. When the tibial nerve becomes impinged inside the tarsal near the inner ankle, it can cause weakness and electric sensations in the bottom of the foot.

– Gout: A form of acute arthritis that causes severe pain and swelling in the joint. It usually occurs in the big toe joint and the symptoms are often mistaken for infection. However, it is caused by uric crystal deposits in the joint. Gout patients often mistakenly put pressure on their foot, worsening the condition.

If any of the conditions could affect the foot, ranging from paralysis (common peroneal nerve) which causes foot drop, to an inability to walk on the heels or toes.

The Relationship Between Stress and Foot and Ankle Pain

Additional studies have proven that those suffering from emotional disturbances, high stress, or depression have an increased perception of pain and discomfort, which is directly related to the detrimental effect of the corticosteroids that their bodies are releasing. This altered hormonal state can lower the pain threshold, reduce inflammation, and create a delayed healing response. A study by Leddy et al. stated that “Stress and depression lead to prolonged secretion of cortisol, which inhibits the healing of tissue” (2003). From this, we can conclude that stress at both an emotional and physiological level can be a cause of foot pain and can greatly hinder the recovery from existing painful conditions.

When studying the correlation between stress and foot pain, McGill et al. (1999) studied a sample population of 424 people, which included 202 women and 222 men. Participants were asked to indicate the current level of stress in their lives and answer questionnaires about their foot health. McGill concluded that “high levels of stress were significantly associated with reported foot pain.”

When discussing a topic such as “stress and foot and ankle pain,” it is important to consider the influence of stress as a cause of physical pain both in the feet and in the ankles, and as an exacerbating factor in existing painful conditions. Often, foot pain and foot problems can affect how a person feels and performs in everyday activities. It can lead to withdrawal from exercise and recreational activities, resulting in more stress and depression, which can result in further health problems.

How Stress Affects the Feet and Ankles

When a person is facing a stressor that does not go away, the stress response gets “stuck” in the body. The chain of events and maladaptive stress response in a person who is chronically stressed. The muscle tension is maintained and changes metabolic activity to sustain the contraction. The areas in the muscles where the energy and oxygen are being used are deprived of circulation. This creates mild ischemia, which is a lack of blood supply to the tissue. This ischemia is what causes the muscles to ache and feel stiff. Step by step, the tension and ischemia in the muscle cause trigger points to form. A trigger point is a small contraction knot in the muscle. This can cause referred pain throughout the foot and ankle. The sole of the foot can experience a wide range of symptoms. A person with mild ischemia in the flexor hallucis longus would feel pain when pushing off into walking.

The human foot is a biological masterpiece that amazingly handles hundreds of tons of force. They allow us to stand, walk, run, and dance. The foot is a part of the body that is most susceptible to the adverse effects of mental stress. Fear and anxiety are normal responses to modern threats to survival. They are triggered by emotions. Acute stress reactions, whether caused by an injury or by being in mortal danger, trigger the ancient fight or flight response. Muscles in the foot tense up in an effort to move the body more quickly. This stress response would be beneficial if the muscles were then allowed to relax again.

Stress Management Techniques

Progressive muscle relaxation is a method that involves tensing, then relaxing each of the body’s muscle groups. The effects of this relaxation technique are both physical and mental. First, the patient lies in a comfortable position and breathes deeply for 5 or 10 minutes. Then, starting at the feet and working up to the head, each muscle group is tensed for a few seconds, then relaxed for a longer period of time. Tension is released using this method because it is easier for most individuals to relax muscles than to create relaxation by other means. This technique has been found to be effective for pain reduction, especially lower limb pain, and the improvement of sleep patterns. Tensing and releasing muscle groups in the lower limbs may be done more than once and can be performed at any time, providing results in weeks to months.

Deep breathing, progressive muscle relaxation, and increasing body awareness are the most appropriate stress management techniques for patients with foot and ankle pain. Deep breathing involves slow, deep, regular breathing. To begin breathing deeply, a comfortable position is assumed. The patient then takes a slow, deep breath, filling the chest and lungs. This can be monitored by placing a hand on the stomach and feeling it rise as the patient inhales. The breath should be held for a few seconds, followed by a slow, controlled exhalation. The exhalation phase should take about twice as long as the inhalation. This breathing technique helps to decrease tension, anxiety, and stress and can be used at any time or in any place, providing almost immediate effects.

Tips for Relieving Foot and Ankle Pain

The best way to stretch the calf muscles is leaning against a wall with the heel flat on the floor and the knee extended. For those of you that need extra calf muscle flexibility, try doing the same thing with the knee slightly bent. This will also stretch the muscles in a longer position behind the knee. Static stretching of the plantar fascia can be achieved by sitting in a chair and crossing the ankle of the foot with pain over the knee of the other leg. Then, using the hand on the painful foot, pull the toes back towards the shin until a stretch is felt on the bottom of the foot. Hold this position for 20-30 seconds. Hamstring and hip muscle stretches can be done in the various positions mentioned above. Static stretching should be done no more than 5-6 days a week. Overstretching the muscles can cause more harm than good.

Stretching and strengthening are the most direct ways to alleviate stress and tension. When your muscles are tight and imbalanced, it is usually because they are in a shortened position and/or are too weak to sustain a proper posture. It’s been proven that the best time to stretch is after a workout, when the muscles are warm and are more receptive to change. Try static stretching exercises where the muscles are held in a lengthened position for 20-30 seconds.

As time goes on, stress can take a real physical toll on the body. The muscles can become tight and imbalanced, resulting in further and unnecessary pain and discomfort. When we are under stress, our feet take the grunt of the force. The feet are responsible for carrying the rest of the body and are therefore the foundation for the body. When stress is involved, it can lead to an orientation and ankle changes inward, leading to certain painful conditions. The best way to manage foot and ankle pain is to manage stress. By finding ways to relax and reduce tension, accumulated stress can be released so the muscles can return to their natural state and the feet will begin to feel better.

Stretching and Strengthening Exercises

Because flexibility in the calf muscles is essential to maintain the arch of the foot, this exercise is especially beneficial for those suffering from plantar fasciitis. This should be done in 2 positions because the gastrocnemius muscle crosses the knee joint, and the soleus muscle does not. To stretch the gastrocnemius muscle, push against the wall with both hands, one foot forward, one foot back, bending the front knee while keeping the back knee straight, and the back heel on the floor. Hold the position for 20-30 seconds, and repeat 2-4 times. To stretch the soleus muscle get into the same position, but this time bend the back knee, and hold the position for 20-30 seconds, and repeat 2-4 times. It is important to stretch both the Achilles tendon and the plantar fascia. This is achieved by keeping both feet flat on the floor and leaning forward while keeping the back knee straight. Hold this position for 20-30 seconds, and repeat 2-4 times. A slant board can also be used to stretch the Achilles tendon. Towel curls and marble/coin pick up exercises are very effective in strengthening the small muscles of the foot. This is important because these muscles are generally underused and weak. To do towel curls, sit in a chair with the foot at the end of a towel on a smooth surface. Using only the toes, scrunch the towel towards you and then push it back to the starting position. This can be made more difficult by placing a weight on the end of the towel. Do 3 sets of 10 repetitions. To do the marble/coin pick up exercise, place small objects on the floor and using only one foot, pick up the objects and place them in a cup. For the next time, you can do this exercise using the other foot. Do this exercise for 10 minutes.

Proper Footwear and Orthotics

Step into more comfortable shoes for perfect stress relief.

If the shoes provide insufficient support or do not alleviate existing foot pain, orthotics may be a good solution. Orthotics designed to restrict motion and support the joints on the inside of the foot are likely to help transfer weight more laterally and reduce load on the medial arch and big toe.

In a study of 247 women with an average age of 63.8 with knee pain, those who switched from their regular shoes to a new walking shoe designed to reduce knee pain were 57% less likely to have an increase in knee pain compared to the women who did not change shoes. This study demonstrates that shoe wear can be an effective, yet simple treatment for lower extremity joint pain.

If you already have foot pain, changing to a shoe with better shock absorption and more rigidity on the lateral side of the shoe may provide some relief. A simple test to determine shock absorption is to stand on one foot and tap the heel on the ground. A shoe that sounds loud is likely to have poor shock absorption. New athletic shoes tend to have the best shock absorption as it wears off with time. Replace your athletic shoes every 300-400 miles of walking/jogging. With athletes, 400 miles is usually reached within a year.

Over time, poor footwear may contribute to more serious orthopedic problems in the spine and upper extremities such as the shoulders. Studies have shown that walking barefoot may increase the load on the knees 12% more than when wearing supportive athletic shoes. The reduced impact with shoes on is due to the increased shock absorption at the foot.

Your feet are the foundation on which the weight of the rest of your body rests. Consequently, what you wear on your feet can have a great impact simply due to the effects of gravity. Shoes that are unsupportive or don’t have sufficient cushioning can cause increased stress to your joints and thus pain.

Rest and Relaxation Techniques

In turn, your body’s healing process will require maintaining a specific amount of weight and stress on the injured area. Should the area require immobilization in a cast or walking boot, your healthcare provider will have the best advice as to how to maintain your cardiovascular fitness. Old, non-weight-bearing techniques may be outdated. With the recent innovations in fitness equipment, such as deep water walking pools, you’ll be surprised to find how easy it is to maintain your fitness level. Step machines and stationary bikes are good options, as long as you are able to safely dismount the machine. If at any time your pain level exceeds two hours after an activity, or is severe enough to alter the way you walk, this is a sign that the activity is too strenuous and is delaying the healing process. A different, less stressful activity should be chosen.

A final, important strategy to consider when dealing with foot and ankle pain involves rest and relaxation. Overuse of the affected limb will result in increased pain and swelling. During periods of severe pain or swelling, use a compression bandage and ice to decrease swelling. To avoid further damage, consider using crutches, taking weight off the injured foot, or wearing a removable walking cast. Ignoring the body’s pain signals will only cause further damage and result in a longer recovery time. After the initial pain and swelling has subsided, if the injury is still not responding to weight-bearing activities and is stiff or weak after six weeks, there may be a more significant injury that requires the attention of a foot care specialist.