Walking for 4-5 hours on a golf course is one of life's great pleasures. It's not all that surprising, really, given the average golfer walks 8-10km during a round, up and down hills, through rough and sand, that this can lead to pain and discomfort.
The extended period of time on your feet is often the main cause of load-based, overuse injuries, although it's not the only cause. Swing pattern is another possible factor. How do you distribute your weight through the swing, and how does that vary between your left and right foot? For example, the big toe on your trail foot may not love the pivoting and pointing required to achieve that classic photo finish.
We chatted to Mark Millerd, our Co Founder and in-house Podiatrist at Jack Oliver Golf to discuss some of the common foot issues that golfers experience as well as some real-world remedies that may help those suffering on the links.
THE BASICS - Skin and Nail Care
- Regular use of a foot moisturiser massaged into the heels and around the toes will help maintain skin integrity and reduce any callous build-up. A 10-25% urea based moisturiser works a treat.
- Thicker corns and callouses that are felt when walking can be treated by your local podiatrist. These can feel like walking on pebbles with each step. This involves debriding these areas back to healthy skin. Your podiatrist can also provide advice on how to reduce the friction that causes these callous and corns in the first place. You may find regular treatment every 2-3 months helps maintain your foot comfort, rather than leaving it until they begin to hurt.
- Long nails, ingrowing nails, thick nails - I get it, they can be pretty uncomfortable. Regular filing and cutting is the key. When cutting, follow the natural curve of the nail edge, try not to cut too deep into the corners and give them a little file to remove any rough edges. To be honest, it can be hard to cut your own nails properly, particularly if they are thickened or ingrowing. Once again, your local podiatrist can help with this. They can help get your nails back to a healthy shape and advise on any treatments you may benefit from to improve the health of the nail.
- Footwear also plays a role. Proper fitting footwear, that has a more natural shape, and matches the actual shape of your foot goes a long way to reducing these corns and callouses building up in the first place. Nails can deform and become ingrown if your shoes are overly narrow and tight, so please, find a size that gives your toes some room. Let them wiggle - they’ll thank you for it.
Are your shoes designed to match the natural shape of your feet?
BUNIONS
Put plainly, a bunion is a deviation (subluxation) of the big toe towards the lesser toes. The visible bump is the head of the 1st metatarsal which becomes more prominent and unstable as the big toe drifts inwards. The level of pain and arthritic change varies between people.
Mechanically, this effects your ability to propel through your foot, but also how load is distributed through the foot. People who maintain some range of motion through the big toe joint often tolerate the change better than those who develop joint stiffness, bony spurring and arthritis within the joint.
Footwear, family history (who your parents and parents' parents are), joint injury and foot posture all play a role in how quickly the joint changes and the severity of symptoms experienced. So, what can you do?
- Wider, natural-shaped shoes to accommodate the increased width of your forefoot.
- A lower heel drop shoe to reduce the weight placed through the forefoot.
- If you develop blisters, corns or callouses from the shape of your bunion, gel sleeves, toe spacers and simple taping techniques can be a big help.
- Foot orthotics to distribute the load away from the irritated joint and support the other structures in your foot
- Joint mobility exercises to both maintain and hopefully improve range of motion. Using the “Wild Toes” training aid can help improve strength and mobility around the big toe and lesser toes.
- Routine podiatry care to maintain skin and nails. Corns, callouses and ingrowing toenails can develop due to the change in joint position and the increased irritation from shoes that are too narrow.
- Bunions often increase the width of your foot. So it's important to take this into consideration when buying shoes. Your podiatrist or shoe repairer can stretch your leather shoes directly over the bunion and adjacent hammer toes to give them a bit more room. We can also provide this service if you need a bit more room in your TRUEs.
Wild Toes Training Aid
HEEL PAIN
People who experience plantar heel pain typically experience first step pain after rest and pain which increases during periods of sustained weight bearing. It's easy to see how this could develop regularly walking the 4-5 hours required during a round of golf if you are not in suitable shoes. It is also a condition not specific to a certain foot posture. People with low and high arches can experience plantar heel pain, which is often associated with long periods of standing/walking, hard surfaces, joint stiffness or a rapid increase in activity.
A number of structures in the heel can be affected. More commonly, the plantar fascia, plantar intrinsic muscles, neural structures, the fat pad in the heel and the heel bone itself can be irritated. Whilst is it important to determine the actual cause of the symptoms, it is worth noting, that in most cases, plantar heel pain is not a permanent condition and will often resolve once the tissues and neural structures in the heel adapt to the load they are under.
So, what's the first line of treatment? We often recommend our patients a phased treatment plan which starts with the basics.
- Plantar fascia and calf stretching, low dye (arch) taping and education on the causes, including helpful ways to manage pain and load on the irritated heel.
- It is also worth considering your individual issues relating to the development of heel pain. Foot posture, joint mobility, footwear, weight, BMI and activity level all impact the overall management plan.
- There is great evidence to suggest that extra-corporeal shockwave therapy can help manage pain associated with plantar heel pain if symptoms continue longer than 4 weeks. Your local podiatrist can help provide this treatment.
- The addition of foot orthotics to offload the structures in the heel, whether that be a custom foot orthotic, over-the-counter arch support or heel cushion depends on the level of pain you are experiencing. Your foot posture, dtrength and mobility will factor into which form of arch support is required.
- Wearing appropriate footwear which is stable and cushioned is important. It may be as simple as changing your worn out shoes which provides the biggest relief.
- Also, understanding how to manage the pain associated with plantar heel pain. That could be as simple as heat or ice, analgesics, dry needling or shock wave therapy. In some instances (generally as a last resort) a corticosteroid injection can settle down the issue. Speak with your local podiatrist or GP about these treatment options.
Plantar fascia and calf stretching provides good first-line management for plantar heel pain.
NERVE PAIN (NEUROMA)
This develops when the nerve which services the affected toes becomes swollen and thickened. Often associated with bursitis in the same area. And the most common cause - narrow fitting, pointy-toed, higher-heeled shoes, compressing the joints, nerves and bursa in the forefoot. Not very pleasant and something that can linger for quite some time. If you experience these symptoms through your 3rd or 4th toe, you’ll most likely have a Mortons Neuroma with or without bursitis, although it can affect any of your lesser toes.
A great place to start is to look at the footwear you wear when you experience pain. Is the toe box overly tapered, narrow or pointy? Does it look like the shape of your actual foot?
Once you’ve found a pair of shoes that don’t squash your toes, the next step is to look at ways to offload the forefoot. Plantar padding using a metatarsal dome is often helpful, and this can be used in conjunction with a full foot orthotic if extra arch support is required for your specific foot posture. Lower heel drop shoes will reduce the load placed through the forefoot. Imagine wearing a 2-3cm heel (or even higher in some cases) and how that may force your weight forward onto a sore, irritated neuroma. Many golf and athletic shoes have upwards of 20mm heel lift - not ideal for these forefoot conditions.
If the neuroma has been confirmed with imaging, and persists once footwear and orthomechanical treatments have been implemented, you may find a corticosteriod injection helpful. Once again, it's worth speaking to your local podiatrist or GP about these treatment options.
Look for footwear that's shaped like a natural foot.
Whilst this list of issues is not exhaustive, it does demonstrate that your foot health plays an important role in how you perform on the course.
Putting up with foot pain may not be necessary. And you guessed it, proper fitting footwear that is fit for purpose is so important. There are some conditions that require some time and effort to get right. Most conditions can be treated in a manner that “fixes” the issue or at the very least “manages” the issue to the point you can still play golf in relative comfort.
Your local podiatrist is a great resource should your foot issue be lingering or not improving as expected. If you have specific foot issues, our in-house podiatrist can provide general advice and help point you in the right direction in relation to footwear and treatment. Don't hesitate to reach out via email or phone.
WRITTEN BY MARK MILLERD
Co Founder & In-House Podiatrist - Jack Oliver Golf