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If spending more time at home during the COVID-19 pandemic has led you to experience more foot pain than usual, you’re not alone.
“There’s absolutely been an uptick in patients with foot problems,” says Jackie Sutera, DPM, a podiatric surgeon with practices in New York City and Emerson, New Jersey. “It’s actually a little surprising, all of the problems that have trickled down, pun intended.”
One factor behind the increase in COVID-19-related foot problems is that many people have been going barefoot or wearing socks at home for extended periods of time. While even young, healthy people who’ve ditched their shoes have reported foot pain and injuries like stress fractures, padding around with no shoes can exacerbate the foot pain symptoms of people with arthritis, who often experience pain, stiffness, and swelling in their feet and ankles.
How Arthritis Affects the Feet
People with various kinds of arthritis are already prone to foot pain. For example:
For instance, about 90 percent of people with rheumatoid arthritis (RA) have some kind of foot pain, and in 20 percent of cases, it’s the first symptom of this autoimmune disease, according to the American Orthopaedic Foot & Ankle Society.
Psoriatic arthritis (PsA) also causes foot problems, including issues that are more unique to PsA than other types of arthritis. These including dactylitis (sausage toes) and enthesitis (inflammation at entheses, where tendons and ligaments connect to bones). In the feet, this commonly affects the Achilles tendon and the bottom of the foot, the plantar fascia.
“Wear-and-tear” osteoarthritis (OA), the most common type of arthritis, also commonly affects the feet — pain and stiffness in the big toe are often the first symptoms, though OA can also affect the midfoot and the ankle, says the American College of Foot and Ankle Surgeons.
Gout is a type of inflammatory arthritis that results from having too much uric acid, a normal waste product, in your blood. When there’s too much uric acid, it can collect and crystallize in the joints, causing pain and inflammation. Gout often first presents in the big toe, causing excruciating foot pain. Half of gout flares strike the big toe, according to the American College of Rheumatology.
How Going Barefoot Affects Foot Pain
Though there can be benefits to occasionally going barefoot (some health care providers recommend it for building foot strength), it’s considered a definite “don’t” for people with arthritis.
Going barefoot increases stress on joints
“Barefoot walking forces your feet to absorb all the shock from your body weight and gravity pushing down and the ground pushing up,” Dr. Sutera explains. This physical stress to your joints is aggravating, and for people with arthritis — who are already prone to irritated and inflamed joints — the effects can be devastating.
Going barefoot exacerbates the breakdown of shock-absorbing cushion in the feet
The natural thinning of your body’s natural shock-absorbing cushion can add insult to injury. “Our feet our designed to have a fatty layer to give appropriate support,” explains Adam Bitterman, DO, an orthopedic surgeon and foot and ankle specialist at Hofstra/Northwell in Hempstead, New York. While so-called fat-pad atrophy occurs as part of the normal aging process, “not wearing proper footwear can exacerbate the breakdown of this protective layer and put pressure on the joints in the feet that are not the norm,” he says.
The upshot: “People with arthritis can feel like they’re walking on skin and bone,” says Dr. Sutera.
Going barefoot exacerbates existing foot problems
Even worse, walking barefoot is also likely to exacerbate foot problems that people with arthritis are more likely to develop. Plantar fasciitis, heel spurs, and tendinitis are the main ones (they can happen suddenly, says Dr. Sutera), while bunions, bone spurs, and hammertones tend to progress slowly.
How Going Barefoot Causes Knee, Hip, Back, and Other Joint Pain
It’s very likely to feel the effects of going barefoot farther up your body as well.
“Feet are the foundation of your body and everything — including your ankles, knees, and hips, common hot spots for arthritis — is connected to them,” says Dr. Sutera.
This is known as the kinetic chain. Much like tire alignment affects a car, over time, walking around barefoot can change your gait — and lead to problems up the chain. For instance, our feet naturally pronate (roll inward) when we walk. This means the arch of the foot flattens to help with shock absorption, which can be one to three times our body weight.
“When the foot flattens, the knee torques, and even the hips move,” explains Amy Shevokas, DC, a chiropractor at Crosstown Chiropractic in Chicago. If the foot pronates too much, which can happen when it’s not supported by a shoe, knee pain, hip pain, and even low back pain can occur.
Walking on hard, manmade surfaces like tile and cement, as we often do in our daily lives, is especially hard on your joints.
The Solution: Wear ‘Indoor Shoes’ at Home
“I recommend that people with arthritis wear slippers or ‘indoor shoes’ most of the time, especially on hard surfaces,” says Dr. Sutera.
Avoid donning shoes you wear outside around your house because they track in dirt, germs, and allergens. Instead, Dr. Sutera suggests that you create a dedicated shoe wardrobe of at least three pairs of shoes that you wear only inside. “Alternating between a variety of shoes helps you avoid repetitive stress injuries,” she says.
When it comes to choosing a “house” shoe, Dr. Bitterman says to look for a good supportive sole with appropriate cushioning inside the shoe. “A running shoe is fantastic but even a slipper with a thick supportive layer on the bottom would be adequate,” he says. (Ugg-like slippers would fit the bill.)
Consider comfort shoe brands, which include the arch support, heel cups, thick soles, cushioning, and shock absorption that people with arthritis often need. These inclue:
Proper fit is important too, says Dr. Shevokas. “Frequently patients come in wearing a shoe that’s too narrow in the toe box and often a size too small.”
A good rule of thumb is to make sure the shoe shape matches your foot shape. That way it’s more likely to accommodate any foot issues, including the bunions and hammertoes that often accompany arthritic joints. Consider consulting a podiatrist or a specialty shoe store on proper sizing and to determine if you may benefit from an orthotic for additional arch support or to change the mechanics of your foot so you experience less discomfort.
Other Ways to Prevent and Treat Foot Pain
Proper footwear can go a long way to prevent and soothe pain in feet with arthritis, but there are also other things you can do to help minimize or prevent discomfort.
Use mats to provide cushioning
“Consider getting a gel mat for your kitchen, standing desk, or any other place where you tend to stand in one place a lot,” suggests Dr. Sutera. Standing on hard, bare floors can take a huge toll on your joints. These thick, multi-layered mats (sometimes called anti-fatigue mats) provide a cushion between your feet and the floor.
Stretch and strengthen your feet
Try picking up a towel with your toes or using them to “write” the alphabet. “These exercises can help you stay limber and increase range of motion, but too much can be overkill,” says Dr. Bitterman. “Listen to your body — if you start to experience pain, you want to back off.” Here are some good daily stretches and exercises for arthritis foot pain.
Avoid gaining weight
Working from home and spending more time at home — and being close to the fridge — has caused many people to pack on the “quarantine 15.”
“This excess weight puts added stress on joints, causing pain and worsening the damage from arthritis,” explains Vinicius Domigues, MD, a rheumatologist in Daytona Beach, Florida, and medical advisor to CreakyJoints.
It doesn’t take many excess pounds to feel an effect. Being just 10 pounds overweight increases the force on your knees by 30 to 40 pounds with every step you take. But on the flip side, even a modest weight loss (for instance, just 12 pounds for a 250-pound person) can dramatically diminish joint pain and improve the quality of life of overweight or obese people living with arthritis.
It can be hard to push yourself to exercise when you’re dealing with ongoing joint pain, but “motion is lotion,” as the saying goes. Too much rest means you’re likely to stiffen up and feel more pain. Regular physical activity also strengthens the muscles around affected joints, so they’re better able to support them. And of course, exercise can help burn calories, so you can shed weight.
To avoid stressing your joints, choose low-impact activities that allow you to stay in shape with less pain.
“Exercises that don’t involve constant pounding or excessive pressure on the foot are key,” says Dr. Bitterman. High-impact activities like running or jumping should be avoided unless you have adequate cushioning on your feet, say, from a natural surface like grass or a cushioned court or track.
Walking — even in short sessions, like a 10-minute walk around your neighborhood — is a simple way to sneak in activity, especially if you’re not going to the gym because of COVID-19. But if you find walking is hurting your feet, try an activity that put less pressure on your feet.
Using an elliptical machine or bicycle, swimming, and rowing tend to be gentle on joints. Dr. Sutera also recommends mat Pilates, core work, and seated weight training. “Remember, the body loves moderation and variety, so switch it up,” she advises. “Injury often comes from repetitive motion.”
Treat your feet
She also recommends massage, which increases blood flow to your joints and supplies them with synovial fluid, an oil-like material that helps keep them lubricated. When rubbing your feet, don’t be too gentle: According to one study, using moderate pressure to stimulate the nerves under the skin that convey pain-reducing signals to the brain is key to reducing symptoms.
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Bartlett S. Role of Exercise in Arthritis Management. Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/patient-corner/disease-management/role-of-exercise-in-arthritis-management.
Field T, et al. Moderate pressure is essential for massage therapy effects. The International Journal of Neuroscience. May 2010. doi: https://doi.org/10.3109/00207450903579475.
Gout. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Gout.
Interview with Amy Shevokas, DC, a chiropractor at Crosstown Chiropractic in Chicago
Interview with Jackie Sutera, DPM, a podiatric surgeon with practices in New York City and Emerson, New Jersey
Interview with Vinicius Domigues, MD, a rheumatologist in Daytona Beach, Florida
Osteoarthritis of the Foot and Ankle. Foot Health Facts. American College of Foot and Ankle Surgeons.https://www.foothealthfacts.org/conditions/osteoarthritis-of-the-foot-and-ankle.
Rheumatoid Arthritis of the Foot and Ankle. FootCareMD. American Orthopaedic Foot & Ankle Society. https://www.footcaremd.org/conditions-treatments/midfoot/rheumatoid-arthritis-of-the-foot-and-ankle.
Weight Loss for Adults with Arthritis. Arthritis. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/arthritis/communications/features/arthritis-weight-loss.html.