Dr. Berg's Foot Facts

Posts for: July, 2019

By Dr. Rion Berg
July 30, 2019
Tags: Untagged

When a new patient comes to my office, it's more likely to be a woman than a man. While it's true that women are more likely to see a doctor for a health issue sooner than a man, women are also at greater risk for many common foot problems. In this guide I'll be discussing the 1) types of foot problems women are likely to encounter, 2) the role of foot type and shoes in developing foot problems, 3) the role of exercise in women's foot and ankle problems, and 4) how to prevent and treat foot and ankle problems in women.

The Role of Foot Type in Women's Foot Problems
All of us have a particular foot type: either a flat arch, normal arch, or high arch. If you have a normal arch, you're fortunate. Although people with normal arches can still develop foot problems they are far fewer than those who have a flat arch or high arch.

It's important to know what kind of foot type you have so you can prevent some of the foot conditions that plague women. Your foot type is inherited, so if your parents had a specific foot type you're more likely to have it as well.

To determine your foot type, wet the sole of your foot. Step onto a blank piece of paper or a shopping bag. Step off the paper or shopping bag to examine the shape of your footprint and compare it to the photo to the right.

If you have flat feet you'll tend to role your feet inward or pronate. Pronation can increase your risk for many painful foot problems such as plantar fasciitis, bunions, neuroma, and hammertoes. High arches can put you more at risk for ball of foot pain.

Painful Foot Conditions More Common to Women
You might wonder why women are more likely to have painful foot conditions than men. While flat feet contribute to foot problems in both men and women, women get them more often for three reasons:
1) a greater amount of weight gain throughout life, 2) rapid weight gain during pregnancy, and
3) improper shoe choices.

Weight Gain Can Cause Foot Problems
Weight gain places more pressure on the feet causing the arch to flatten out. For women who already have a flat arch, weight gain can make them flatter. Women who gain weight are more likely to develop plantar fasciitis, bunions, and posterior tibial tendon dysfunction. Shoe size also increases with extra weight due to the flattening of the arch. It's important for women who have gained weight to get their feet measured when buying new shoes to avoid foot pain caused by wearing a shoe that's too small.

Pregnancy and Foot Problems
Weight gain
Rapid weight gain during pregnancy can bring on plantar fasciitis and Achilles tendonitis. Wearing a supportive shoe during this time is imperative.

Another common foot and ankle issue in pregnancy is swelling. In addition to retaining extra fluid, weight from the growing uterus compresses lower extremity veins, impeding their function of returning blood to the heart.  While this usually goes away when baby arrives, it can be incredibly uncomfortable.  Elevating the feet and wearing compression stockings help to control edema. Physical activity, including walking, reduces swelling by activating the leg muscles, which act as pumps on the deep veins. It's important to avoid tight shoes and instead wear shoes with a wide toe box to help prevent other foot problems during that time.

Loss of balance
Weight gain and changes in body shape shifts a women's center of gravity forward. Hormonal changes cause loosening of the foot ligaments. This combination can throw off a women's balance. For that reason women should never wear high heels when pregnant since this type of shoe is already less stable then a lower heeled option. Wearing more stable, low-heeled shoes are essential to prevent falls.

Shoe Choices That Can Cause Foot Problems
Women often make shoe choices that can cause painful foot problems.

Frequent high heel wear can increase your risk for ball of foot pain including bunions, neuromas, and hammertoes. When wearing high heels your weight is placed primarily on the ball of the foot which places a lot of stress on the metatarsals, the toes, and the nerves.

Tight shoes or shoes that are too short can increase your risk for ingrown toenails and fungal toenails. When the toenail is pushed against the front of the shoe, hiking boot, or ski boot an ingrown toenail can result. Shoes that are too tight or too short can cause damage to the nail plate, making it easier for fungus to set up shop.

Flat shoes can increase your risk for plantar fasciitis and Achilles tendonitis. Flat shoes with no arch support can be problematic for anyone but particularly women who have flat feet. When walking or engaging in other activities such as dancing or running the arch will flatten out causing the plantar fascia to stretch beyond its limits. This can result in pain and inflammation in the heel and at the Achilles tendon.

Shoes with no support can also cause foot pain. Women who have had problems with their feet in the past or have flat feet or high arches should not wear these types of shoes.

Pumps can be problematic for women who develop a bony enlargement called Haglund's deformity or so called "pump bump", due the location of the deformity and the rigidness of pumps. Any shoe with a rigid back can cause problems for anyone with this type of foot problem.

Flat flip flops with no arch support can lead to a myriad of foot problems for women. Flip flops were only created to be worn at the beach, swimming pool, gym locker rooms, and shower rooms. Unfortunately flip flops have become extremely popular and women wear them for long walks and for other activities that require a much more supportive shoe. The constant gripping at the toes to keep the shoe on, the flatness and lack of support, and absence of protection make flip flops problematic for women to wear off the beach. They can cause blisters, hammertoes, Achilles tendonitis, neuromas, heel pain, and worsen bunions. Their dearth of support can also lead to sprained ankles. A better choice is a Vionic sandal which is a flip flop with great support. Even better is a water sandal that has foot support and straps.

Preventing and Treating Women's Foot Conditions
Many women's painful foot problems can be prevented or reduced by wearing proper shoes. It's important to select shoes that work well for your foot type, the kind of athletic activity you prefer, while avoiding heels higher than one inch and shoes that are too tight. Shoes also need to provide proper support. To test any shoe before you buy it, watch this video.

While treatments vary widely by foot problem, some treatments can help resolve several types of painful foot issues. That's because several foot problems have a similar cause.

Flat feet and pronation
Earlier we talked about how foot type can play a role in women's foot problems. Flat feet and lower arched feet tend to pronate. Together these factors can cause a variety of foot problems such as plantar fasciitis, Achilles tendonitis, ball of foot pain, bunions, hammertoes, and neuromas.

Orthotics can correct the faulty biomechanics of a flatter foot providing relief from heel pain and Achilles tendonitis and preventing bunions and hammertoes from worsening. Initially I suggest patients with mild foot pain start with an over-the-counter insert such as Powerstep. If pain continues then a prescriptive custom orthotic will be required to control the abnormal foot motion.

Tight calf muscles
Heel pain, plantar fasciitis, and Achilles tendonitis will also require adequate stretching of the calf muscle since a tight calf muscle also plays a big role in development of these conditions. Learn more about how to reduce tight calf muscles by reviewing this information and these videos.

Inflammation plays a big role in many chronic foot problems including plantar fasciitis and Achilles tendonitis. Visit our website to learn how to reduce inflammation for these foot problems.

For acute injuries to the foot or ankle such as stubbing your toe or spraining your ankle, it's important to take immediate action to reduce the pain and swelling. The most effective treatment is a protocol called “RICE”. RICE is an acronym for rest, ice, compression, and elevation. 

  • Rest – Stop all activity. Keep weight bearing to a minimum, making sure ankle strength and stability have returned before attempting physical activities.

  • Ice - Apply an ice pack or a package of frozen peas to the affected area (use a layer of cloth between your skin and the ice) 20 mins on and 20 min off for up to 48 hours after the injury.

  • Compression - Hold it in place with an elastic bandage to provide compression.

  • Elevate - the ankle slightly higher than the heart to keep down swelling.

High arches

High arches come with their own set of foot problems. High arched feet primarily contact the ground in the heel and the ball of the foot. Pain can develop in three regions of the foot due to this foot structure.

Ball of Foot
Metatarsalgia or ball of the foot pain can occur with prolonged standing or exercise. Hammertoes can also form as a result of extra weight on that part of the foot.

Heel of the Foot
Pressure on the heel of the foot can lead to plantar fasciitis and Achilles tendonitis.

Middle of the Foot
Because most shoes don't support the middle of the foot, high arches can result in pronounced midfoot pain.

Supportive shoes with good arches are essential for preventing problems in the high arched foot.

Ball of foot pain
Many different conditions cause ball of foot pain including neuromas, metatarsalgia, hallux rigidus, sesamoiditis, and capsulitis. For a complete review of the causes, symptoms, and treatment for these conditions, visit our website.

Nail and Skin Problems

Nail and skin problems of the feet are most often caused by tight and poor fitting shoes, and physical activity, and diabetes.

Ingrown toenails result from shoes that are too tight and by cutting the toenails on an angle instead of straight across.

Toenail fungus is more common in women who wear tight shoes, participate in sports such as running, go barefoot in pool showers and gym locker rooms, or are exposed at nail salons. Sometimes trauma to the nail can look like toenail fungus. It's best to see a podiatrist who can test the nails to be sure it is fungus. Treatment methods include topicals, oral medications, laser therapy, and methods to keep nail fungus low. To avoid toenail fungus it's important to follow these recommendations. If you already think you have fungal toenails, visit our Seattle Fungal Toenail Center to learn more about how it's treated.

Diabetes is hereditary and also more common among women who are overweight, don't exercise, and have a diet high in fats and sugars. People with diabetes are at greater risk for developing wounds or ulcers of the feet which can be very dangerous. Dry skin on the feet is very common in people with diabetes and is treated with special moisturizers. An annual visit to the podiatrist to get a Comprehensive Diabetic Foot Exam is essential to prevent ulcers from forming.

Foot and Ankle Problems in Women Who Are Physically Active

Women who are physically active are more prone to foot and ankle problems due to the repetitive movements, high impact, constricting or unsupportive footwear, or increased risk of trauma due to the nature of the sport. It's important to understand the particular risks of a sport to help prevent pain and injury.

Women runners are at greater risk for plantar fasciitis, Achilles tendonitis, neuromas, and stress fractures. Purchasing supportive running shoes at a store that specializes in running, switching out the shoe insert for a better insert such as Powerstep, avoiding high heels, and doing dynamic warm-ups will help prevent many foot problems in women runners. Here's a more complete description of foot problems in women runners.

Women hikers need to assess the type of hiking they'll be doing before purchasing boots. The right socks are also extremely important in preventing blisters. Check out my "Definitive Guide to Prevent and Treat Heel Pain in Hikers".

Learn how to prevent foot and ankle injuries in other sports such as Zumba, martial arts, soccer, and tennis.

If you're experiencing foot or ankle pain, call us today at 206-368-7000 for an appointment. We'll often appoint you the same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

You can also download the following book for runners.

"The Complete Guide to Stopping Heel Pain in Runners".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

By Dr. Rion Berg
July 12, 2019
Category: sports injuries
Tags: Untagged

Seattle is one of the best places to cycle in the country. Along with the famed Burke Gilman Trail, the area boasts multiple urban and regional trails as well as a great biking network for commuting. Whether you bike to work on a daily basis or use cycling for recreation and a great workout, there are many things to keep in mind to ensure your feet remain pain-free.

Cycling is a repetitive sport. During one hour of cycling a rider can average up to 5,000 pedal revolutions. Add that to tight or narrow shoes and that can be a prescription for foot pain.

Ball of Foot Pain

One of the most common foot conditions found in cyclists is metatarsalgia or "hot foot". Symptoms can include hot, painful, burning sensations and swelling and numbness. These symptoms can be particularly problematic in the summer when your feet are more likely to swell. If you're in the middle of a ride you'll need to stop, get off your bike, and let the swelling and heat subside.

Sesamoiditis can occur when the sesamoids or small bones found underneath the first metatarsals get inflamed or rupture from too much pressure from sports such as cycling.

Morton's neuroma is caused by an enlarged bundle of nerves to the 3rd and 4th toes. Although cycling is likely not the cause of this condition it can put extra pressure on that area of the foot, worsening an existing neuroma.

Achilles tendonitis

The Achilles tendon can become inflamed and irritated due to improper pedaling and seat height, but can also occur due to ramping up your training too quickly if you're a competitive rider. Flat feet and a tight calf muscle can also be the culprits behind this common condition.

Luckily there's a lot you can do to prevent these conditions.

  • Purchase new shoes - your shoes are often one of the first things to consider changing when developing foot pain. If your feet have gotten larger (common in adults), your shoes are too tight and narrow, or if your shoes are worn out head to REI or another shoe store you trust.
  • Types of shoes
    • casual riders can purchase a cross-training shoe while more serious riders will benefit most from bicycle touring shoes (can still walk in these) or shoes with cleats.
    • a stiffer shoe can help redistribute pressure over the metatarsal heads.
    • a roomier toe box can help accommodate your feet when they swell to prevent ball of foot problems.
  • Purchase inserts or over-the-counter orthotics with a metatarsal pad or button - these devices can lift the metatarsals to maintain their natural arch and prevent nerve pain and numbness.
  • Custom orthotics made be necessary to alleviate and prevent sesamoiditis and Achilles tendonitis. Orthotics for cycling will need to be thinner to accommodate cycling shoes.
  • Move your cleats back. Cleats that are too far forward can cause ball of foot pain.
  • Wear thinner socks to make more room for your feet.
  • Wear socks made of man-made materials to help wick away moisture from your feet. This will help prevent blisters.

If your foot pain is keeping you from cycling, call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about foot and ankle problems, download our eBook, "No More Foot Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.




By Dr. Rion Berg
July 01, 2019
Category: sports injuries
Tags: Untagged

Lots of girls are watching in rapture as Team USA continues to dominate the Women's World Cup in France this year. Many of these girls will be ready to hit the soccer fields this summer but many more will compete against other Seattle school teams this fall. While the risk of concussions from heading the ball has been all over the news recently, less visible are concerns about the feet and ankles of teen girls.

Here are some of the most common soccer foot and ankle injuries in this population.

Ankle sprains
Ankle sprains are the most common injury in soccer due to the twisting and force put on the ankle during play. Combined these two factors can result in excessive stretching or tearing of one or more ligaments on the outside of the ankle.

Ankle fractures 
Ankle fractures can occur simultaneously with an ankle sprain. They result from the ankle rolling inward or outward. It's not usually apparent whether an ankle is sprained or broken, so a trip to your podiatrist is warranted to ensure proper treatment takes place.

Contusions and bone bruises
Contusions and bone bruises can result when players run into other players and when players get kicked during active play.

Plantar fasciitis (heel pain)
Soccer players most at risk for plantar fasciitis are those with flat feet. Teen girl soccer players at risk for plantar fasciitis can greatly benefit from wearing custom orthotics. For milder problems over-the-counter orthotics such as Powersteps or taping can be helpful.

Sever's Disease

Sever's disease is another common cause of heel pain in girl athletes. Up until the age 13 girls can have a heel plate that has not fully closed. An open heel plate can result in inflamed tissue in the heel as a result of playing soccer. Reducing activity, using over-the-counter or custom orthotics, or immobilization may be needed to stop the heel pain.

Ingrown Toenails

Ingrown toenails are common in young athletes as they return to school in the fall wearing their old shoes. Old shoes are usually short shoes with the potential to push against the big toe causing it to become ingrown. This problem is usually preventable by buying shoes with the correct fit.

Stress fractures
While stress fractures are most commonly caused by low bone density and this is uncommon in young girls, it can be a problem for those with low body weight. Low body weight and lack of a consistent or absent period are signals that an athlete is not taking in enough calories to support balanced hormones. Estrogen is needed to maintain strong bones. 

What You Can Do To Ensure Your Teen Girl Stays Safe During Soccer

  • Bring her for a pre-season physical examination with your doctor; make sure she asks whether your daughter has a regular period to rule out the potential for stress fractures.
  • Make sure her muscles are in condition for soccer; about a month before she begins to play take her out to a soccer field a few days a week to practice her soccer moves and build muscle strength and mobility.
  • Remind her to drink plenty of water even before she get thirsty.
  • Ensure she's eating a healthy snack every 3-4 hours so she gets enough calories.
  • Teach her to warm up prior to playing soccer; for example, a slow jog and then muscle stretches.
  • Choose athletic shoes made for soccer; if she buys cleats make sure they aren't too tight or short to prevent ingrown toenails and other foot problem.
  • Replace her athletic shoes every six months to ensure they're providing proper support.
  • If she has any specific foot issue such as flat feet or painful feet be sure to make an appointment with a podiatrist.
  • Teach her to pay attention to her body; she should tell you or her coach if she's have pain or discomfort.
  • Check out the soccer field ahead of time or find out if the coach does this. Ensuring there are no irregularities or divots in the field can help prevent unnecessary injuries.
  • Overuse injuries can also occur in young athletes; sometimes they may need to take a substantial break in their activity in order to allow the body to heal properly.

If your teen girl has painful feet or a foot problem that can put her at risk while playing soccer, call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

For more information about foot and ankle problems, download our eBook, "No More Foot Pain".

In addition, our newsletter "Foot Sense" comes out monthly.  You can also check out our past issues. Every issue contains a mouth-watering recipe and can be printed out for easier reading!

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

Follow Dr. Berg on Facebook, Twitter, and Pinterest.