Understanding Foot Pain Through The Lifespan: Beyond Orthopedics
This week on the Unreal Results podcast, I go deep into the various causes of foot pain through the different stages of life. I have some personal experience with foot pain that you’ll hear me talk about but I also talk about my 5-year-old niece’s foot pain experience that was not related to a musculoskeletal or neurological origin; you’re definitely going to want to hear why! You’ll also hear me talk about how foot pain can be related to the viscera, hormonal changes, and fluid imbalance. This is an excellent episode to gain a deeper understanding of foot pain through a whole-organism perspective.
Resources Mentioned In This Episode
Episode 3: Swelling Reduction Protocol That Works Like Magic
Episode 14: The Stories We Tell: A Lesson From My Compartment Syndrome
Episode 37: Swelling Protocol Update
Episode 47: Always Check The Distal Pulses
Episode 52: Foot Pain Shocker: It Might Not Be Plantar Fasciitis
Episode 53: Shin Splints: Beyond Overtraining & Rest - Complete Guide
Episode 89: The Pink Eye Chronicles
Blog Post: Rock Mats to Revitalize Your Sole
Bonnie's Instagram: Milestone_Mama
Learn the LTAP™ In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello. Welcome to another episode of the Unreal Results podcast. Um, today, and maybe even for this week and maybe even for the next week or two, maybe more. We'll see how long it stays on my brain. Um, I'm going to be talking about the foot, the foot and ankle I've been working on. On my plate. I don't want, saying I'm working on it is probably, And Not accurate, but on my plate for a while now has been to get out a new self paced course on the foot and ankle.
I actually promised it during the 2023 birthday flash sale. I want to, like, I want to be embarrassed by that, but I'm not, because that's just I'm a procrastinator. This is also why I don't do things like that normally. I probably shouldn't have sold it then. Well, I didn't sell it. I offered it as a bonus.
I probably shouldn't have done it then. But part of the reason I did it was to put me on the hook to finish it, but Life happened and that it didn't happen. So, um, I owe it to those 10 people. Then for my 2024 birthday flash sale, I was like, Oh, this is the chance. Get it done by then. So then I offered it as a bonus
to actually not, did I offer it as a bonus during that flash sale? Maybe not. I reached out to them and was like, it's don't worry. I haven't forgotten about you. But then maybe during the LTAP, I offered it as a bonus during that. So, I owe, oh my gosh, sorry for the yawns, I owe another group of people this course.
So, my apologies for you if you've been waiting for it for a while. I had it scheduled, all scheduled in my calendar to, to do and finish and have out in November. But, if you're, if you've been here, you know, November 2024 was lost to severe pink eye. And, um, I wasn't able literally to do any work on the computer and so it got pushed again.
And then I was like, Oh, get it out by December. But between the eyes still being sensitive to all the work on the computer and then Christmas and the new year, still not done. But it is back on the docket as the primary first thing to get out in 2025. So with that said, I've been mentally thinking through all of the things I want to cover in The course.
Of course, all of my courses, like a big part of it is like, Yes, foot and ankle from a movement and a musculoskeletal standpoint, but also looking at visceral and nervous system issues and how they relate. And also, how do we even look at the movement and biomechanics through this whole organism lens of view that considers the viscera and the nervous system as a deeper driver for, or like the whole organism as a deeper driver for what's going on.
So, um, what I wanted to share about that in this episode, um, because like I said, I'm probably going to do multiple episodes on foot and ankle as I'm going here to sort of like filter out my ideas, but one thing that's been on my mind has been foot pain through the lifespan or foot complaints through the lifespan maybe.
So a few months ago you might remember me talking about foot pain that I've been having sort of on and off for a while now but like pretty intense foot pain especially in the morning and um with no like specific mechanisms and I was thinking about the other day and I was like no I haven't had foot pain For a while now.
Um, I am walking a little bit less, so that could be part of it. But I think really what it is, and, and sort of what it's come down to, is very visceral of a driver, and like, more related to hormonal, visceral, visceral, visceral, visceral. It's a fluid driver for me than anything else. And um, I've, in just being more curious about it, I have noticed that like on the days that maybe I do have a little bit of foot pain when I wake up, it's definitely on days that I know I am more bloated or like have more fluid congestion in my whole system.
Um, And, or have like a bigger load on my kidneys and liver from a toxin standpoint. Um, so, that's interesting. And the other bit of just noticing my feet is,
Um, My niece, my youngest niece, she's four, turning five soon, she's been complaining of foot pain for the last, not pain, foot discomfort, specifically foot weakness and feet being tired for the, for a while now, like a few, few months, if not more, it's kind of one of those things when, especially when they're little kids, that's like.
Are they just complaining to complain or is this like a legitimate thing? So this has been on my mind of just like They're good examples of how Foot pain is not musculoskeletal foot pain also, and it's not just As we age because I think that well and this is kind of like in regards to my foot pain and like how even i'm framing this is Being the age I'm at, which is 44, I turn 45 this year.
And then also like, the people I follow on social media, sometimes it's just the algorithm, right? Seeing a lot about perimenopause
and menopause. And then also like, my sister's a little bit older than me, so she's kind of in that stage too. And then also I feel like it's kind of like, A buzzword in online business marketing right now, like trend, you know, like the trends go. So like we've been in that trend of like vagus nerve and nervous system regulation and all the things, right?
Like the next trend is being like perimenopause and everything's like perimenopause, which I don't think is a bad thing because boy, I As I'm learning all the symptoms that can come with perimenopause, the transition into menopause, the time around this transition, um, I think back to my grandma. And some of the symptoms that she was having in her body that The doctors kind of like poo pooed and didn't have answers for and she literally thought she was a crazy person She had ringing in her ears for years and nobody could really figure it out.
And Now I'm like, it's probably a perimenopause symptom that if we had like addressed it from that lens of view, she probably could have gotten some relief. Um, but instead the doctors are just like, oh, it's from using Advil too much. I'm like, what? I mean, I wish, I guess can be a thing, but I'm like, or it's menopause.
Anyways, um, so I, I'm not like mad about this trend. It's just like, obviously, like, I see a lot of information for it. And I even, I think I even mentioned this during the Pink Eyes Chronicle episode, was like, I was kind of daily in this game of like, I was having a low grade fever and like, body aches, and I'm like, is this hormones?
Like, is this perimenopause? Or is this pink eye? Or am I sick? Like, do I have, is something else going on? Do I have like, some sort of Serious thing happening. So this is like a day, like we were at the age now that it's a daily question. Like, is this thing that's happening to me in my body? Is this a legit illness, a legit orthopedic thing, or is it perimenopause or something else?
So that's why it's been on my mind, but okay. Going back to my niece, who's not going through perimenopause, who is going through the first stages of life as she turns five. So, um, Like I said, she's been complaining of her feet being tired. And when they get really tired, she's like, I can't walk. And finally it, the complaint had gotten like common enough that my sister finally took her to the pediatrician and was like, Do you know what's going on with her?
And the pediatrician, when asking my niece, like, what does she feel? Like, is it painful? My niece, who's very smart, is like, it's not, like, very adamant. Like, it's not pain. My feet don't hurt. They feel tired. They feel weak. Like, when we ask her to describe it more, she's like, they feel weak. Which I'm like, first of all, what four year old, five year old, like, knows what that even means?
But yet, that's the best way that she can describe it. And so they did some blood work on her and the blood work came back. I would assume like, fairly unremarkable because it didn't trigger a follow up from the doctor. Which is a whole other conversation of annoyance. But when I looked at the Or like when my sister sent me, like the, the only thing my sister noticed was this like one thing that was out of range, but it turns out that the range they were referencing was in the adult limit and she was totally normal within the kids limit.
And then the other thing that was low, she had like, her potassium was a little low and um, that's all my sister really noted. I didn't look at the results personally. So I go home. We don't live in the same town. So I go home at, um, like Thanksgiving and I evaluated her just real quick. Like, when it's little kids like that, it's not like you sit down for a 90 minute session.
It's like, hey, can you sit still long enough for me to check a couple things out? And I'm like, oh, yeah, yeah. you know, so your feet have been not feeling great. Can you describe it? And again with me, she was like, they're tired, they're weak. And I'm like, okay, well let me like test it. And I tested the mobility and I did a little listening and I'm not feeling like a lot of like tightness, like not limited mobility.
Um, not really feeling any nerve tension or anything like that. And, um, So, I'm like, hmm, I wonder, like, you're complaining of weakness, so, like, I wonder if I strength tested you, like, how would it be? And then I'm like, I don't even know how accurate a strength test is in a, almost five year old. And so I was like, just did a couple simple things.
I was like, Hey, like, let me see you point your feet. Let me see you dorsiflex, which did no problem. And then I was like, can you spread your toes? And she's like, ah, she couldn't spread her toes. So I was like, that's. Not ideal, but it's also like well, it's not like the weakest thing in the world But i'm also like as someone like she doesn't spend that much time in shoes She's like barefoot quite a bit like she should have better toe splay So i'm like, hmm.
I was like, well, will you stand up and do calf raises for me? and so You know and balance on one leg and so she balances on one leg. No problem um calf raises though I was like, you know first it was like You getting her to understand what I'm asking her, right? Demonstrating it, showing her, like, helping her out.
And she, double leg calf raise, could only do like three to five before she significantly decreased her range of motion. And I'm like, well, that's, that's, concerning that's weak. And so then I, you know, and I looked at single leg and same thing, like barely could do three without losing significant range of motion.
And I'm like, you know, I'm not sure. Like, is it just task oriented focus or what? Because at the same time, she's like super athletic kid, loves playing sports, loves running around, jumping around. Like she's always on the go, always moving. So I'm also like looking at this. Potential weakness and thinking like I don't even understand how she could be this weak, but be that active So it was a little weird, but I was like, okay Well, maybe do these exercises and then like I don't know We'll see how you feel and then I was like, you know what this I need to reach out to my friend Bonnie Marlowe I will have Joe link her in the show notes.
She is an amazing pediatric physical therapist Um I think her Instagram handle is like be well baby. Um, but like I said, I'll, I'll link it in the show notes. So I reached out to Bonnie and I was like, Hey, is it okay if I ask you a professional question? And of course she's like, yeah. So I'd send her this whole scenario and she's like, wow, that's a really weird thing for that age to complain about.
And also she's like, Yeah, her, she should be stronger than that. Like the things that you strength tested are pretty simple and she should be able to demonstrate them better. And she's like, she's okay. Single leg balance. And I was like, yeah. And you know, and both me and her like wondering about neuro stuff, but I'm like, I'm, the doctor checked her reflexes according to my sister.
And like, I'm like, it's just not really feeling neuro to me, but it's not feeling orthopedic. I was like, but it's confusing me. And so. Bonnie keeps thinking about it and she asked me a question. She's like, so she did blood work and I was like, yeah, and I don't think that it came back anything significant.
She's like, did they test her iron? And I was like, huh. I don't, I was like, actually, I don't know. My sister didn't tell me that. So I said, but I'll ask her about it because in general, my family tends to have low iron and I was like, Hey, you know, ask my sister, what's her iron. And sure enough, her iron was low.
And so I was like, Oh yeah, it can be low. So then I Googled low iron, weak feet. And that is, Shockingly enough, and this is why I'm like Bonnie is amazing because that is a symptom of low iron in children is to have weak feet. And then what I read when I Googled it, I was like, Oh my gosh, this is totally what's going on is low iron can be caused by excessive milk consumption.
And my niece is 100 percent so significantly addicted to drinking milk. Still a bottle, that's a whole other story. But, um, she drinks a lot of milk. And I'd say 24 ounces at minimum a day. Like some days, more. And I was like, oh my gosh, that's what it is. So I told my sister, and she tried to decrease, which is a challenge when a kid is that addicted to the cow's milk and um, but anyways over Christmas I was like helping with this and like sure enough like when she has less milk she doesn't complain about her feet and then I strength tested her and she strength tests better and so I explained to her I explained to Ella, like, hey, this was, again, like, thinking she's smart, and then I gave her this, like, visual, I clapped, I was like, you know what milk does to iron?
Because I explained to her how the iron was helping our muscles be strong by bringing air, oxygen, to them. And I said, you know what the milk does to the iron? And she's like, what? And I was like, and I clapped really hard and I was like, it destroys it. It smashes it, smashes the iron and then the iron can't bring the oxygen to the muscles and that's why you feel weak.
And she was like, whoa. And then for the few days after that, she would like refuse milk and then she would explain to anybody who was listening that the milk smashes the iron and that's why your feet are weak. And so I was like, wow, fascinating. I was like, this is fascinating when I don't even know if people knew that it was a thing.
Um, so spoiler alert, excessive milk. That is why doctors have limits on how much milk kids should be consuming. Um, and at certain ages and When they consume too much, it can affect their iron levels, and when their iron levels are low, one of the things that could be a symptom is foot weakness and the other symptoms are like irritability, mood swings, like all the things that she happen, happens to also have, but I'm also like, and that's a kid.
It's hard to know if it's mood swings and irritability, um, from a hematocrit type thing versus like just a terrible terrorist two year old, three year old, whatever, four year old. So anyways, um, it's nice to have a little bit more. Understanding of what's going on with her. And it was so interesting and I'm so thankful for Bonnie for like, helping us figure it out.
And um, now we're just challenged to still get her off the milk. She's doing better but has her moments. So, but it just was a really good example to me of like, huh. foot pain across the lifespan often is driven from other things that we're not really necessarily always thinking about and, um, goes back to like, again, this whole organism view that when you can appreciate all of the systems
of the body having to run optimally and being more important for the full function of the body, you start to see the feet, the orthopedics in a different way. And so, um, I just was like, I want to share this story on the podcast because I think it's, it's Highlights things so much and then like, yeah, so one of a really common thing in perimenopause men and then in menopause also into menopause after menopause is Foot pain and Women's arches collapsing arched foot to a flat foot Um As they transition through these stages because of the effect of the hormones on the tissue.
So, as estrogen decreases, our collagen types shift. We become stiffer. Our collagen becomes less elastic. And it just also decreases the amount of, like, our fat pads and our fatty tissues. It affects every part Soft tissue in the body, the, um, decrease of estrogen. And, um, so it's something to consider, especially in your patients who are in the perimenopause or postmenopausal that are having foot pain that doesn't, um, isn't resolving like traditional foot pain, right?
It's something to consider. There's also like as we age both male and female this decrease of fat pad stiffness and because we are bipedal upright people, right? This change in our fat pad changes our the pressures of our foot and can create a lot of foot pain. This is also why Achilles tears and Achilles tendonitis is so much more common as you age versus younger, right?
So this, um, role that the fat pad has in the relationship between plantar fasciitis or the plantar fascia and the Achilles tendon meat. Probably plays a significant role in our heel pain and our general foot pain or Achilles tendonitis issues as we age. Um, The other big part of it, I think of everyone's foot pain throughout the spectrum of the timeline of, of, of their aging is the role that the fluid system plays.
On foot pain and I know it is like sometimes feels like a broken record from me But I cannot stress enough how powerful the swelling reduction protocol is in whole body health and wellness and especially see this in the low leg right and I I discuss this a lot in the podcast about my exertional compartment syndrome in the podcast about shin splints in the podcast about restoring distal pulses post surgical Our lower leg and therefore our foot and ankle function, mobility, strength, stability, performance of the movement of plantar flexion and dorsiflexion, inversion, like all the movements that our foot and ankle have to make, are significantly affected when we have stagnant fluid in our lower leg that is having a hard time returning to the trunk.
Right? And the easiest way to know if this is happening or not is when you take off your sock or if you take off your pants, is there a line around your ankle? If you have any bit of a line around your ankle, you have a fluid balance problem. And this could mean that you have entrapments in some of these key spots that our fluid systems get entrapped.
That's the whole, like, premise behind the swelling reduction protocol, or it could be from hormonal issues or dietary issues around the function of our liver, our spleen, and our kidneys. And for me, especially, what I've shared about is, um, So, I'm going to talk a little bit about how important it has been to increase potassium because potassium is what helps us, like, let go of the fluid from our cells to, like, drain things.
And so, I really see this change throughout my cycle in the month of, like, at times when my hormones have a greater, right, because progesterone, um, is a hormone that sort of makes us, like, hold on to the fluid. And so during these times of the month where my progesterone is higher, it's so important for me to like stay on top of my potassium supplementation and, and getting foods in that have high potassium because it really has a huge effect on the general amount of lymphatic congestion.
Fluid congestion or bloating throughout my whole body and when I have more volume of fluid I'm going to have a tendency toward pooling in my lower extremity and then what I get is foot pain. I get significant foot pain on both feet and it's actually more lateral than it is medial. And why I say actually with that, because when I look at the visceral referrals, typically a visceral referral for the urogenital organs, like the kidneys, which we associate mostly with fluid balance, is the medial foot.
Lateral foot viscerally tends to be more associated with the digestive organs, with the intestines. But The intestines have a lot of lymph in them, right? Like 80 percent or something like that. Or I don't even know, not 80 percent of the immune system, but the immune system and the lymphatic system are very much the same thing.
And so we don't think of it often, but our intestines are a big driver of our fluid balance system. And so it's like, no wonder I have lateral foot pain and foot pain in general. But I've even noticed that I'm like, Oh yeah, if I have like been on top, the, the, the months that I am on top of my potassium and my hydration and my, Movement to facilitate general lymphatic and fluid movement in my body.
I don't have foot pain. I can walk for, you know, I can do a day of walking at Disneyland and like have not a whole lot of foot pain. Um, so. I think foot pain especially is one of those things that we need to always, like, think about the bigger picture. I think foot, I mean, foot pain, so many people have foot pain.
It is, like, a very common thing to have, foot pain. And it often comes down to, like, okay, is there a visceral thing? Is there a hormonal thing? Is there a nutritional thing? Is there a fluid balancing? And then what's the sensory situation like, right? Like I'll have a whole episode on like the revitalize your soul, like the use of the rock mats and why that's important.
Our feet at the end of the day are sensory organs, but we stuff them in shoes and socks and we don't feel with them at all. So oftentimes foot pain can just be general, like decrease of sensory information too. So there's so many things that we can address with foot pain. Before we actually blame a joint or blame the tissue or blame the foot itself.
So, especially if you're doing all the soft tissue treatment and the exercises and you're not really seeing a huge change, it's probably not be it's probably because it's not orthopedic or musculoskeletal. That was the scenario with my foot, like, I'm like, I have this pretty intense foot pain that some mornings feels like I have a fracture.
But I do all the things. I check my mobility. I work on mobility. I work on strength. And it doesn't shift things. Then it ain't an orthopedic musculoskeletal thing in the first place. So now I gotta look bigger and see what else is going on. And like I shared with you, it's like just another Um, expression of my fluid congestion challenges that I have, which some are driven hormonally and some are driven inflammatory from a nutritional standpoint.
And then like, it's a little bit of it, especially too, I tend towards hypermobility, a little bit of it is because I don't have the stiffness to maintain the pressure in the veins and in the lymphatics to keep elevating it towards the heart. Alright, so when we can look at these things from a more whole organism approach, all the way from pediatrics to geriatrics, right, the whole lifespan, we start to be able to troubleshoot things a little bit better.
And like, like I said, like, this is, the whole thing was like. Dealing with these two spectrums, dealing with these like perimenopausal type feelings of foot pain and changes in the collagen and like changes in my body, like feeling the stiffness of me losing, like changing collagen types, but then also like having my niece who is at the beginning of life, like having these issues.
So, very great. Like I said, very grateful to Bonnie. Shout out, Bonnie. Um, Bonnie Soto. I might have called her her maiden name at the beginning of the show. But, um, for also seeing full picture. And actually, now that I'm talking about it in my course, like sometimes when I'm talking to other practitioners and my courses are on the Instagram, two of the practitioners that always sort of like this whole organism lens of view makes sense to pelvic floor physical therapists.
I've shared that a lot. Like it makes sense to them that the viscera is a driver of musculoskeletal pain because they see it every day and then pediatric PTs. Pediatric PTs are forced to see the The, through the lens of the whole organism and consider everything because so often with the kids, it's not a musculoskeletal, truly biomechanical thing.
There is, yes it is, but it's being driven by something deeper. It's being driven by, you know, like torticollis being driven by reflux, torticollis being driven by some cranial tension. and then this affecting their whole body and the way they move, right? Like a baby who has a reflux, like they move their head and neck and trunk very differently, right?
So they already see things through this whole organism lens of view, so sometimes it makes more sense to them to consider things like iron levels, hormone levels. as a first idea instead of a last idea. So anyways, that's it for now. We'll see you next time. Hope you enjoy this different dive into foot and ankle pain.