Activity Modification
Most foot problems are either caused or aggravated by the repetitive loading that goes through the foot throughout the day. Tendons can get overloaded from the repetitive stress of standing and walking leading to painful tendonitis. Arthritic or injured joints tend to become more painful and swollen the more they are used. In fact, many problems in the foot or ankle are either caused or aggravated by the cumulative force that the foot absorbs when walking and standing. This force is proportional to:
1. the number of steps taken (or time standing) and
2. the force that goes through each step (which is determined by a person's weight and effected by their footwear, and walking surface).
Activity modification looks to decrease one or both of the above factors. Activity modification does NOT necessarily involve decreasing activity level. In fact, weight loss is often a large component of managing foot and ankle conditions and therefore activities to burn of calories and lose weight may be critical for managing chronic problems. However, the type of activity (ex. cycling instead of running) may need to be modified to decrease the amount of force going through the foot with each step. Activity modification is really three-fold process which includes:
1. Challenging the patient to look at their lifestyle and find out how they can take less steps and spend less time standing each day
2. Exploring strategies for how they can have less force go through their feet with each step (ex. footwear modifications, walking surfaces, etc.)
3. Identifying and avoiding activities that aggravate their symptoms.
1. Minimizing the daily load on the feet (i.e. taking fewer steps each day)
Modifying activity in order to minimize the daily load on the feet may involves figuring out ways to sit down more or to be on their feet less. Some creativity (and perhaps some understanding on the part of their employer) can enable patients to remain seated or decrease unnecessary walking. There are also several medical devices aimed at off loading the feet.
2. Miniming the Force absorbed by the feet with each step
Minimizing the amount of force going through the foot with each step involves looking for ways to absorb the shock of each step by selecting appropriate footwear. Patients should look for comfort shoes which distribute the force evenly through the foot and provide the right amount of support for their particular activity. It also involves minimizing the amount of impact. Switching from running and walking to activities like swimming or cycling enable patients to put substantially less force through the foot without detracting from the cardiorespiratory benefits of their exercise regimes. Restricting the amount of impact activity, for example, running two or three days a week instead of five, is another method by which to minimize the amount of shock on the feet.
3. Identify and avoid Precipitating Activities
The third element is the idea that sometimes activities that you would not normally think of as being problematic will in fact precipitate symptoms. Precipitating activities may vary from individual to individual depending upon the particular condition and the pateints particular characteristics (foot type, weight, alignment, etc.) Common activities that precipitate symptoms may include walking on certain types of terrain or working out on certain surfaces. Having a better understanding of what aggravates symptoms can help patients better prevent them. To determine activities that precipitate symptoms a patient often needs to be a bit of a detective. If symptoms are increased think back to what was done one or two days before to try and identify any precipitating events or activities. Identifying activities that aggravate symptoms is often the first step to managing achronic foot problem non-operatively.
Edited July 26th, 2009