For acute foot pain relief, use all relevant tools at your disposal. Chiropractic manipulative therapy, soft tissue massage, instrument-assisted soft tissue mobilization, therapeutic taping techniques and physical therapy modalities such as cold laser, microcurrent and ultrasound may all be helpful in treating acute foot pain. The following points discuss strategies to help restore foot health and anatomy, provide long-term relief for foot problems and prevent future foot, ankle and lower extremity ailments:

• Encourage your patients to choose shoes that are flat from heel to toe, have wide toe boxes (toe boxes that are widest at the ends of the toes), possess little or no toe spring and have flexible soles that can easily be bent or twisted (note: these features can be hard to find in shoes, including athletic shoes; Leming and Altra shoes as well as certain Crocs models are examples of brands that encourage or support natural foot health). Accordingly, encourage your patients to avoid shoes that possess heel elevation, tapering toe boxes, toe ramps, rigid soles and arch support or other motion control features. True arch support involves positioning both ends of your foot arch — your calcaneus and forefoot — level with each other and flat on the ground, not propped in the middle. An arch becomes stronger when large forces are placed upon it, as the increased weight causes the arch's components to mesh more effectively.
• Encourage your patients to use a toe spacing device that realigns their toes to the normal anatomical position; that is, with toes properly splayed, the individual phalanges aligned with their metatarsals and the toes resting flat on the ground. Realigning the big toe to its normal anatomical position — in line with its corresponding metatarsal bone and the inside or medial edge of the foot — can help prevent overpronation, as the big toe has a supinatory effect on the foot when it is placed in this position. Suggest starting with 30 minutes of use the first day and increasing wear duration in increments of 30 minutes to 1 hour per day. Encourage your patients to select a toe spacing appliance, such as Correct Toes™, that can be comfortably used in footwear during weight-bearing activity (many of these appliances are designed such that they can only be used while at rest). Correct Toes additionally is durable, flexible, and spaces the toes appropriately, not arbitrarily.
• Place metatarsal pads inside your patients' shoes. Metatarsal pads, which should be placed just behind the ball of the foot, help spread the transverse foot arch, prevent tightness in the toe extensor muscles and tendons and encourage the return of the forefoot fat pad to a location that supports the metatarsal heads. Your patients should allow a few days for their foot to adjust to the pad.
• Counsel your patients to use toe socks instead of conventional socks. Toe socks allow your patients' toes to move freely, and they help keep your patients' feet cooler. Many conventional socks pinch the toes together, further contributing to the toe deformation caused by tapering toe boxes. Toe socks can, in many cases, be used in combination with toe spacing devices and appropriate footwear.
• Prescribe relevant foot stretches or exercises, including the toe extensor stretch. To stretch your toe extensor muscles and tendons, curl your toes under, place the tops of your toes on the floor and gently press your ankle forward. Many patients will have an imbalance between the toe extensor and flexor muscles and tendons that can be normalized with this stretch.
• Counsel your patients to apply deep heat (e.g., Sombra gel, Icy Hot, Tiger Balm, heating pad, etc.) to their painful area at the beginning of the day or before activity and cold (e.g., ice pack, ice water soak, bag of frozen peas, etc.) for 6 to 10 minutes at the end of their day or after activity.
• Arm your patients with all the information they need to make healthy shoe choices and develop healthy foot care habits.

Many patients with foot pain or problems will enjoy at least some degree of immediate relief using this protocol. Most people will experience full or significant relief after several weeks or months of adopting this approach. Patient compliance with this protocol is absolutely necessary to achieve the desired treatment goals, and this should be emphasized when you're explaining the treatment plan to your patient.

The Shoe Liner Test

To help your patients shop for healthy footwear, encourage them to perform the shoe liner test. Instruct your patient to remove the liner from their shoe of interest and stand on it, placing all their weight on that foot. Your patient should buy the shoe only if their entire foot (with toes in their correct anatomical position) fits within the margins of the liner. If any part of their toes, the sides of their feet, or their heel hangs over the liner, the shoe is too small or narrow to support natural foot form, function, and health.

Chiropractors are musculoskeletal health experts who understand the importance of structural alignment for long-term health and well-being. The natural foot care approach described in this article is complementary to the conservative treatment methods used by chiropractors to treat all kinds of musculoskeletal problems, as it respects and encourages the body's own natural healing mechanisms. Natural foot health techniques — shoe therapy, toe re-approximation, simple stretching exercises — can have a profound effect on your patients' structural health and quality of life, and this approach can be used for many different types of foot problems and in patients of all ages. Natural solutions for your patients' foot and ankle ailments are safe, cost-effective and a helpful first line of approach to many foot and ankle problems.

References

1. American Academy of Orthopedic Surgeons
2. Rossi WA. Footwear: the primary cause of foot disorders. Podiatry Management. February 2001.
3. Hoffman P. Conclusions drawn from a comparative study of the feet of barefooted and shoe-wearing peoples. The American Journal of Orthopedic Surgery. 1905 Oct; 3(2): 105-136.
4. Sim-Fook L, Hodgson AR. A comparison of foot forms among the non-shoe and shoe-wearing Chinese population. The Journal of Bone & Joint Surgery. 1958 Oct; 40: 1058-1062.
5. Kalcev B. The hallux position in natives of Madagascar. East African Medical Journal. 1963 Feb; 40: 47-54.
6. Shulman SB. Survey in China and India of feet that have never worn shoes. The Journal of the National Association of Chiropodists. 1949; 49: 26-30.
7. Shakoor N, Block JA. Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis. Arthritis & Rheumatism. 2006 Sep; 54(9): 2923-2927.
8. McClanahan, Ray. Personal interview. 26 May 2012.

Dr. Robyn Hughes is a naturopathic physician and the Director of Medical Education for Correct Toes. She practices natural foot care at Asheville Natural Health in Asheville, NC, and is a co-founder of NaturalFootgear.com.