The Pandemic Has Been Hard on Our Feet

Jennifer E. Engen

In March of 2020, Krista Fahs began working from home. As she sidled up to her desk, the 53-year-old sales associate for a computer distributor put aside her usual sneakers. She found herself doing laundry, playing with her cat and even visiting neighbors without putting on shoes. “I was barefoot all the time,” she said.

A few months into working from home, she began to feel a twinge of heel pain, but disregarded it until last month, when it got too intense to ignore. Even as she lay in bed, the throbbing wouldn’t stop. “‘This is ridiculous,’” she remembered thinking, “I didn’t even know how I was going to fall asleep.”

The beginning of the pandemic coincided with a steep decline in foot trauma, said Dr. Robert K. Lee, chief of podiatric foot and ankle surgery at UCLA Santa Monica Medical Center, but his practice quickly repopulated with patients like Ms. Fahs who complained about foot pain. “I was like, ‘Aha, so this is the effect of the pandemic on feet across the country,’” he said.

There is no hard data on the increase in foot pain, but Dr. James Christina, the executive director of the American Podiatric Medical Association, said it’s been a clear trend for many of his 12,000 members.

Members like Dr. Rock Positano, the co-director of the Non-surgical Foot and Ankle Service at the Hospital for Special Surgery in New York, who has seen foot pain increase so much — 20 to 30 percent — that he called the phenomenon “pandemic foot.”

Now that spring is here, mandates are relaxing and people are eager to get their prepandemic bodies and hobbies back, they are hitting the pavement, said Dr. James Hanna, a podiatrist and president of the New York State Podiatric Medical Association. Many are exacerbating existing foot injuries or creating new ones.

“People thought they could just return to where they left off or try something they hadn’t tried in a couple years,” he said, “but their feet aren’t prepared for what their bodies want to do.”

By instituting a few simple measures, Dr. Hanna assures owners of achy feet everywhere that foot pain can be alleviated as well as prevented.

Some of the most common foot ailments occur simply because the foot is under increased strain during the pandemic. Perhaps you opted to walk long distances instead of use public transportation or went barefoot at home. “People don’t realize how much mileage they put on walking and standing in their houses,” Dr. Positano said.

Ms. Fahs was diagnosed with one such overuse injury, plantar fasciitis, where the ligament under the foot that supports the arch becomes inflamed, often felt as pain in the heel. “I knew what it was because my brother, sister and one of my best friends all got it recently, too,” she said.

Metatarsalgia is another overuse injury, similarly caused by inflammation, but in the toe joints, which causes pain in the ball of the foot.

For those starting ambitious running routines right out of the pandemic gates, Achilles’ tendinitis has been a common diagnosis. The tendon connects the calf muscle to the heel bone and with a sudden increase in use, it can become irritated and swell.

These injuries can impact more than foot health. If they are not addressed, they can “go up the chain,” and cause knee, hip and back pain. “People think they are falling apart, but they are not,” Dr. Positano said. “They are overusing their feet.”

Overuse injuries aren’t the only reasons people have been feeling foot pain lately. Dr. Priya Parthasarathy, a Maryland-based podiatric surgeon, has also seen an uptick in toe and foot fractures. Some are caused, she said, by accidentally kicking furniture — a result of being home and barefoot more often — and tripping and falling awkwardly over pets. “You see one, then you see two, then three and then four,” she said of such pet-related fractures, “and you’re like, ‘Wait, there’s definitely a connection here.’”

Meanwhile, Dr. Judith F. Baumhauer, an orthopedic surgeon at University of Rochester Medical Center, has been removing more bunions, which are bony protrusions at the base of the big toe. Without supportive shoes, the foot can splay — actually widen — and the anatomical structures can change. Among other issues, this can aggravate bunions.

“They let their feet do whatever they wanted,” Dr. Baumhauer said, “and now that they have to go back to work, their feet are rebelling.”

Dr. Baumhauer said that pandemic weight gain may also be to blame for the rise in foot discomfort. She explained that even an extra couple of pounds makes an impact. “It’s literally just physics,” she said, explaining that the foot takes on four times the force of our body weight when walking. Losing or gaining five pounds would be a change of “20 pounds to their ankle and foot,” she said.

Jacquelyn M. Dylla, an associate professor of clinical physical therapy at the University of Southern California, said one of the biggest triggers is people doing too much too fast. Many of us have undergone atrophy and bone density loss from inactivity without noticing it, making it harder to stabilize ourselves on uneven surfaces. “Smaller injuries are causing more catastrophic problems,” she said. “I have patients who look like they were in a car accident,” she added, “but they just rolled their ankle during a hike.”

Even young children, after a year or two doing virtual school, are experiencing issues as they jump headlong into sports. “You have a kid sitting at home every day for a year going straight into cross-country practice,” Dr. Parthasarathy said.

Podiatrists say one of the fixes for foot pain can be quite simple: Wear supportive footwear. That means a semirigid sole, a spacious toe box and a small heel lift. Get properly fitted at a shoe store and, if you don’t want street shoes in your home, get a pair specifically for use indoors. If using older shoes, be sure that the tread is not too worn, as those may have degraded too much to offer substantial support. Insoles can also be added for additional arch support.

Dr. Dylla said it’s also essential to prepare our bodies for renewed activity by strengthening them first. This means exercising the feet with toe curls and foot doming. “There’s a crunch for the stomach,” Dr. Dylla said, “doming is the crunch for the foot.”

Dr. Hanna said the best advice may be to start slow. “If you’re going to start walking, do moderate pace at short distance,” he said. “If you tolerate that well, maybe go at a faster pace for longer distance.”

Podiatrists also say stretching is crucial to prevent and treat unhappy feet. “A proper warmup,” Dr. Hanna said, “I cannot emphasize this enough.”

In the morning, even before going to the bathroom, Dr. Hanna recommends flexing your feet by pulling your toes up toward your body. Then pretend your toes are a pencil and write out the alphabet. “If you do that,” he said, “you’ll activate all the joints and be much less likely to injure yourself.”

Even though the calf seems distant from the bottom of the foot, stretching it plays an essential role in pain-free walking. “When your calf and Achilles are tight,” Dr. Lee said, it “creates a lot more stress to all your foot joints.”

He suggests getting into a lunge position with one foot in front of the other, your hands up against a wall and your feet flat on the ground. You should feel the stretch in the calf of the back leg. He suggests doing this several times throughout the day.

Massaging the arch area can also prevent injury by keeping the bottom of our feet limber. Dr. Lee advises grabbing a tennis ball or golf ball while sitting at a desk or while watching TV. “Roll your foot over the ball and massage into that area to loosen up those fibers,” he said.

However, if you are having heel pain, get your foot checked by a doctor before stretching. In some cases, Dr. Positano said, there can be undiagnosed tears in the plantar fascia that stretching can worsen.

If you are experiencing any persistent foot pain, book an appointment with a podiatrist. There are many simple ways doctors can relieve pain and prevent chronic issues from developing. If you’re in discomfort, “seek care,” Dr. Baumhauer said, “because there are a lot of tricks up our sleeves.”


Mara Altman is a journalist and the author of “Gross Anatomy: Dispatches From the Front (and Back)”

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