Nutrition and Foot and Ankle Pain: Dietary Strategies for Managing Inflammation

by Dora

Another common overuse condition is plantar fasciitis which is a painful inflammatory condition of the plantar fascia on the bottom of the foot. Both of these conditions have a tendency to linger and may become very difficult to treat.

One of the more debilitating and misunderstood foot/ankle ailments is posterior tibialis tendon dysfunction (PTTD). This is an overuse condition in which there is a gradual onset of pain and a change in the shape of the foot, which results in a gradual collapse of the arch – this leads to a condition known as adult acquired flatfoot. Although there may be some traumatic incidents related to this condition, it is primarily an overuse condition that affects active individuals between the ages of 30-55.

Pain and injuries to the lower extremity are common problems among active individuals. Whether the ‘weekend warrior’, the competitive athlete or the recreational exerciser, all are susceptible to lower body injuries. Of all the injuries incurred by athletes, those to the lower extremities especially the foot/ankle complex have been reported to be the most prevalent. These conditions are often attributed to biomechanical abnormalities and traumatic incidents, but in many cases, overuse or excessive training has been diagnosed as the primary cause.

Understanding Foot and Ankle Pain

Arthritis is often considered to be the cause of foot and ankle pain. The most common form of arthritis in the foot is degenerative arthritis or arthrosis. Often the cause of this is either previous trauma or abnormal stress on a certain part of the foot. An example of this is arthritis localized to the joints in the ball of the foot, often as a result of altered gait pattern or long periods of increased activity. This can be quite painful and even cause swelling in the joints. Diseases like rheumatoid arthritis can also affect the foot and ankle. It is important to diagnose the cause of arthritis type symptoms as the treatment can vary from simple pain relief and orthotics to reduce stress on certain joints, to medication to slow the progression of the disease. High arches in the foot may increase stress on the joints and cause inflammation of the connective tissue between bones, often as a result of abnormal traction and stress on a certain area. In the case of arthritis in any form, pain is often the limiting factor and may cause reluctance to exercise the affected lower limb. Osteoarthritis and rheumatoid arthritis are also a part of the second category of causes of foot and ankle pain, systemic disease. This type of arthritis changes the mechanics of the foot and often results in increased stress on certain points.

Foot and ankle pain can be quite debilitating, making it difficult to be active. It often prevents people from maintaining a healthy weight and exercising, which is unfortunate as both are very important in relieving foot and ankle pain. The severity of the pain can vary from mild and annoying to severe and debilitating. It can prevent people from walking comfortably for long periods of time. It may be present in the morning and ease during the day or worsen with activity. The location of the pain often helps to determine the cause and especially in the case of systemic inflammatory types of arthritis, the general health of the patient. Patients with rheumatoid arthritis often have symptoms in the small joints of the hands and feet and general systemic symptoms. An accurate diagnosis and understanding of causative factors is important to determine the most effective treatment.

Causes of Foot and Ankle Pain

The main causes of foot and ankle pain are poor gait mechanics and overuse, problems in foot structure, and systemic diseases. Poor gait mechanics – Foot pain is a common problem with those with flat feet and results from a change in the natural alignment of the foot and leg. It is those who have a functional or structural leg length discrepancy that are prone to developing chronic overuse injuries in the foot, ankle, shin, and knee on the longer leg side. Overuse – Overtraining and overuse are also significant causes of foot and ankle pain. They can lead to chronic muscle fatigue and overuse injuries, and stress fractures. Problems in foot structure – Some members will recall learning about the problems common with the older generation such as bunions, hammer toes, and other degenerative joint changes. Such problems often result in foot pain due to the change in foot and ankle mechanics and the subsequent altered force distribution through soft tissues and bone. Systemic diseases – There are a number of systemic diseases that affect the foot and present as foot or ankle pain. These include, but are not limited to, osteoarthritis, rheumatoid arthritis, and gout. Osteoarthritis and rheumatoid arthritis often affect older individuals and can result in joint pain, stiffness, and swelling. Gout is a condition where an abnormal metabolism of uric acid results in arthritis, especially in the smaller bones of the feet.

Impact of Inflammation on Foot and Ankle Pain

Non-steroidal anti-inflammatory drugs (NSAIDs) are helpful in the management of this type of inflammation and are often prescribed to reduce the overall inflammatory load and thus pain.

A study has shown that inflammation localized to the entheses could contribute to new bone formation in diseases like ankylosing spondylitis. Inflammation is often accompanied by pain, swelling, heat, and redness of the joint. Pain and stiffness often worsen following rest. With inflammatory types of arthritis, such as rheumatoid arthritis and ankylosing spondylitis, the immune system creates inflammation that can cause damage to the surrounding tissues.

Inflammation is the body’s reaction to an injury or irritant. It causes increased blood flow, which brings nutrients and other helpful materials to the area. White blood cells, present in increased numbers, battle any possible infection. But in some conditions, the inflammatory process could go on for too long or get out of control. In these cases, the chronic inflammation can cause damage to the surrounding tissues, contributing to an increased level of inflammation and pain and a further worsening of the condition.

Dietary Strategies for Managing Inflammation

High consumption of refined carbohydrates has been associated with increased levels of CRP and IL-6. Weight loss studies have also shown a positive association between refined carbohydrate intake and increased production of these cytokines, and their levels can be reduced in general by the use of a low carbohydrate diet. Both n-6 and n-3 fatty acids are precursors for the production of the eicosanoids, which play a key role in inflammation. The three major groups of eicosanoids – prostaglandins, thromboxanes, and leukotrienes – are all derived from either dietary arachidonic acid or the n-3 equivalents EPA and DHA and have variously pro-inflammatory or anti-inflammatory effects.

The relationship between diet and inflammation is of great interest. The overconsumption of energy-rich, high glycemic load foods and the large increase in consumption of n-6 fatty acids relative to n-3 fatty acids over the course of the 20th century has generated a pro-inflammatory state in Western societies. This dietary pattern can potently affect inflammatory gene expression and the production of inflammatory adipokines and cytokines. In contrast to this pro-inflammatory diet, a Mediterranean-style diet rich in vegetables, fruits, and whole grains, which includes consumption of monounsaturated fats and fish, has been shown to reduce the biochemical markers and the risk of several inflammatory conditions.

At the cellular and molecular level, much has been learned about the events surrounding inflammatory cell recruitment and the mediators responsible for activation of the above-mentioned inflammatory changes. Knowledge of the pathways that lead to the activation of specific pro-inflammatory genes is increasing, and all of these potentially represent therapeutic targets for the future. However, complex gene activation is not easily amenable to pharmacological intervention, and therefore, it may be more realistic to consider manipulation of the endogenous hormones and cytokines which play a pivotal role in the skewing of inflammatory responses seen in certain diseases.

The acute inflammatory response plays a critical role in the body’s defense against infection and injury. This beneficial process repairs and regenerates, which is the desirable end-point of inflammation. However, a strictly pro-inflammatory response is not always elicited, and in certain circumstances, the inflammation culminates in extensive tissue destruction and delayed repair. In these situations, control of the inflammatory response with drugs can be beneficial. A more fundamental way of blocking resolution would be to modulate elements of the resolution phase, and while this may be the aspiration for the future, at present, it is not a practical therapeutic strategy. In considering ways to modulate inflammatory responses, it is, of course, important to underscore that the host defense and inflammatory response are closely interwoven, and any intervention that might compromise the former is not a viable option.

Anti-Inflammatory Foods

Next on the list is foods that are high in omega-3 fatty acids. This includes fish, flaxseed, and chia seeds. Omega-3’s have been shown to have a strong anti-inflammatory effect compared to omega-6 fatty acids, which tend to promote inflammation. As such, it is also important to lower consumption of omega-6 heavy oils such as sunflower oil or soybean oil. Other categories of food that have been shown to reduce inflammation include nuts, dark chocolate, and small amounts of red wine. This is not an exhaustive list, but it provides an idea of what to look out for when trying to build a diet that reduces inflammation.

Anti-inflammatory foods are foods that, as the name implies, help reduce inflammation in the body. The biggest and most well-known category of these foods are fruits and vegetables. This is mainly due to the antioxidants that they provide. Antioxidants are molecules that can slow or prevent damage to cells caused by free radicals. Free radicals are a byproduct of the body’s natural processes, such as the conversion of food to energy or the body’s immune response to an infection, but can also be caused by external factors such as pollution or radiation. Free radicals play a dual role in the body as they can be beneficial at low levels but have been shown to be the cause of disease and aging when they occur in excess.

The foods we eat can have a big impact on the inflammation in our body. When put simply, some foods can contribute to inflammation while others can help reduce it. The goal here is to have a diet that is balanced on the side of reducing inflammation. For some people, it may be a complete diet change, while others may only need to make minor adjustments. It’s all about finding what’s right for you.

Foods to Avoid

A high sodium intake has been shown to increase inflammation in otherwise healthy individuals, as well as increasing the symptoms of autoimmune diseases. Various studies have shown a direct correlation between increased sodium intake and biomarkers of inflammation. A very recent study found that an increased dietary intake of saturated fats and omega-6 fatty acids increases the likelihood of developing an inflammatory musculoskeletal condition.

High intake of omega-6 fatty acids may also promote inflammation. Although omega-6 fatty acids are essential and must be obtained through the diet, an imbalance of omega-6 and omega-3 fatty acids has been linked to increased inflammation. Because omega-6 fatty acids are prevalent in many foods, a variety of nuts, seeds, and vegetable oils, it is easy to exceed the upper limits for omega-6 intake.

High fat intake may also spur systemic inflammation. Some experimental studies have shown that short-term consumption of certain types of fat leads to increased inflammation. Saturated fats, such as those found in meat and dairy products, can cause an increase in the production of proinflammatory messengers. Trans fats, which are found in many commercially prepared products and fast foods, are known to cause inflammation and are considered to be harmful to one’s health. They are also high in calories and low in vital nutrients.

Diets high in certain foods have been linked to higher levels of inflammatory markers. When such foods are ingested over long periods of time, they may increase systemic levels of inflammation and the pain associated with it. Consumption of too many calories has been linked to higher levels of inflammatory markers. High-calorie foods also can lead to obesity, which is a risk factor for inflammatory conditions. Foods high in refined sugar have been shown to increase the production of inflammatory messengers, as well as being linked to obesity and chronic diseases. These foods cause low energy, mood swings, and hunger/craving cycles. They are also high in calories and low in the micronutrients your body needs.

Importance of Hydration

This warrants the reminder that beer consumption should be moderate and is not a recommendation for individuals at risk for or with a history of alcohol abuse, nor is it a recommendation for those with other health problems that alcohol would exacerbate.

Last, moderate consumption of beer has been associated with a lower risk of gout, especially in men. This was first noticed when it was observed that there is lower prevalence of gout in countries with higher beer consumption, but for those with pre-existing gout, beer consumption has been shown to increase the likelihood of recurrent attacks. Although this appears contradictory, as alcohol consumption can be dehydrating and dehydration can increase the risk of gout, xanthine oxidase, an enzyme involved in purine metabolism and the formation of uric acid, is inhibited by the ethanol in beer and its consumption has been shown to lower uric acid levels.

Tea is the second most consumed beverage in the world. It is a source of both fluid and antioxidants, and consistent with the theme of this article on inflammation and foot pain, regular consumption of tea has been shown to result in lower risk of rheumatoid arthritis.

Numerous types of mineral water are also widely available. Mineral water can be a substantial source of minerals and is a good alternative for individuals with higher sodium needs, as some types can be higher in sodium content.

Hydration is a low-cost, low-risk intervention that has been shown to reduce inflammation and the perception of pain. For most individuals, water is the most effective way to stay hydrated. Water is vital for normal cellular functioning, and inadequate hydration can lead to a number of health problems, such as poor organ function, impaired healing, and a weakened immune system. Dehydration can also increase the frequency and severity of gout and the risk of developing exercise-related transient abdominal pain.

Incorporating a Balanced Diet for Foot and Ankle Pain Relief

– Lean protein. Fish and soy are good choices, followed by poultry. Red meats and pork can be eaten but should be limited to several times per month. Protein can also come from vegetable sources, such as legumes. High purine proteins, such as anchovies, sardines, mussels, scallops, trout, haddock, mackerel, and organ meats, can increase gout risk and should be avoided.

– Adequate essential fats, which are fats that the body cannot make and therefore must come from the diet. Excellent sources are cold-water fish, walnuts, and flaxseeds. Fish oil supplements are also beneficial. Fats have many calories, so keep the amount in balance with the activity level.

– At least 5 servings per day of fruits and vegetables. The more colors, the better. Choose more vegetables than fruits. Vegetables are best eaten in their natural state, as heating destroys some valuable nutrients. Organic produce is preferable, as toxicity from pesticides can promote inflammation. The dirty dozen will guide you to the produce highest in pesticides and it is wise to buy organic.

For many health conditions, a diet change is the first step in getting symptoms under control. The same is true for foot and ankle pain. A common cause of pain in the lower extremities is inflammation in the soft tissues (muscles, tendons, and ligaments), and when it comes to inflammation, the choice of foods and timing of meals can work in your favor or against you. A diet aimed at reducing inflammation is a very balanced one and quite similar to what is recommended for most people. Here’s what it encompasses:

Meal Planning Tips

Carbohydrates are a hot topic for diets when health is concerned. With the recent insurgence of fad diets like the Atkins Diet, the South Beach Diet, and even other diets like the Zone or Weight Watchers, carbohydrates have been the first macronutrient to get the axe. While these diets, the Zone and Weight Watchers specifically, have good concepts because they stress balanced eating habits, the Atkins and South Beach diets stress low-carbohydrate, high-protein diets. This forces the body to go into ketoacidosis (unsustainable due to the fact that glycogen is not turned into energy) and tries to utilize fat as a primary energy source. The biggest problem is that people are only selecting certain carbohydrates that are currently processed. It is processed foods that are the main cause of the spike in inflammation worldwide. People are unaware that there are many foods that are low on the glycemic index. A good example is white rice and brown rice. White rice has a glycemic index of 70, which is considered high. Any index 55 or above is considered high. Brown rice has a glycemic index of 55. This difference may not seem too substantial, but if one were to adopt a diet of lower average index, it would be possible to see significant decreases in inflammation within a few weeks. Any low glycemic index carbohydrate would be a good choice for foot and ankle pain sufferers.

The idea is simple: for a day, try and plan four to six smaller meals. This will seem contrary when compared to the traditional three-meal-a-day plan. Nonetheless, eat smaller amounts and include a variety of high-quality, nutrient-dense foods. Try to avoid the high saturated and trans fat content. Substitute with good fats from nuts, flax seed, olive oil, and fish. An overall balanced diet should consist of roughly 50% carbohydrates, 30% protein, and no more than 30% fat. Fat intake can be decreased a lot by simply not frying the food and choosing to bake.

Supplements for Reducing Inflammation

Vitamin E is a fat-soluble antioxidant that has been hailed for its anti-inflammatory benefits. It is a major player in protecting the body from pro-inflammatory molecules and it has been shown to have a profound effect on the immune system. It is an often overlooked nutrient and a simple, relatively low dosage (200-400IU) of a natural mixed tocopherol supplement can provide benefits with very minimal risk. Vitamin E is well absorbed with meals and also when taken together with vitamin C.

Certain fatty acids have been heavily researched and are now widely used as anti-inflammatory agents. Two of these are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are types of omega-3 fatty acids that are typically found in fish oil. Scientific data and extensive research on EPA and DHA has been done in both animals and humans with results showing that these fatty acids have potent anti-inflammatory properties and can benefit a wide range of inflammatory conditions. High quality fish oil supplements can vary in EPA and DHA content and a reasonable dosage ranges from 600-800mg, two to four times a day. Omega-3 fatty acids are naturally incorporated into our cell membranes and it is important to maintain an adequate intake of these in relation to the intake of omega-6 fatty acids, the latter found in many vegetable oils and processed foods and known to promote inflammation. Omega-3 fatty acid supplementation can shift the omega-3 to omega-6 ratio favorably towards a decrease in inflammation.

Supplements are a popular way to add dietary nutrients beyond what food provides. For people with foot and ankle pain, a variety of supplements might help to reduce inflammation as a natural and less risky alternative to anti-inflammatory drugs. Before starting a new supplement regimen, it would be wise to discuss with your physician to make sure there are no potential interactions with existing medications. In general, the formulation of a supplement and the body’s absorbance of it both play a role in its efficacy. Encapsulated or “esterified” forms of nutrients can be more readily absorbed in the digestive system than powdered or crystalline forms. Additionally, it is sometimes better to take a smaller dosage of a particular nutrient more frequently throughout the day to maintain a tissue saturation level. This can be a more effective inflammatory strategy than taking large doses less frequently.

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