Now, can we say that we are just adapted to our environment, or does the environment help define our state of pain? It has been found that there are some specific weather variables which are more strongly related to an increase in pain. In a double-blind study of patients with rotator cuff tendinitis, it was found that there was a significant relationship between shoulder pain and increases in barometric pressure. Other weather variables were not found to have a consistent effect on pain level, suggesting that at least for specific conditions, it may be possible to alter one’s pain level by avoiding exposure to specific weather stimuli.
Weather sensitivity is defined as exacerbation of specific symptoms and/or an increase in pain in response to changes in weather. Approximately two-thirds of patients with various forms of ailments acknowledge the influence of weather on their pain. This study suggests that weather sensitivity is neither a belief nor a delusional phenomenon, but is a credible experience which afflicts a large percentage of the population with different ailments. The types of painful conditions that are affected by the weather vary with the individual. However, weather has been found to have a consistent effect on pain levels of those suffering from conditions which affect the musculoskeletal system. This can be seen with one study which found that in patients with osteoarthritis, they have reported that they are able to predict changes in the weather based on their pain level. Musculoskeletal pain tends to be more localized compared to other types of pain and can vary in type. Because of this, it is easier for patients suffering from weather-related pain to link cause and effect.
Before we go on to the works, the main issue of getting pain in your feet with changing weather, it is good to know what weather sensitivity is. Or can weather affect your body? There may be anecdote after anecdote about how people know bad weather is on the way because of aches and pains. But is there any scientific evidence of the effect weather has on pain levels?
Understanding Weather Sensitivity and Foot and Ankle Pain
Biometeorology studies the weather’s impact on living organisms. It has been thought that changes in weather and/or climate can create changes in barometric pressure that can cause increases in tissue swelling. It can also create changes in tissue fluid dynamics. In normal tissue, the fluid levels in a particular area remain fairly constant. But changes in barometric pressure can change the fluid levels and cause increases in pain from expansion of tissue or pain from the stimulus of increased fluid on free nerve endings in an enclosed area. Water tends to move against the force of the atmosphere to an area of lower pressure, which typically occurs in the tissue where joint and tissue pain is often felt. These fluctuations in barometric pressure and fluid dynamics can cause a reasonably predictable increase in pain for those who are sensitive to these weather changes. This is similar to the arthritis sufferer who can predict rainfall coming from increased joint pain. In previous meteorology studies, it has been shown that the body’s reaction to weather can be an early indication of weather changes occurring.
There is an increasing interest in understanding the effects of weather on physical ailments. This has been noticed by the large number of individuals who can predict rainfall or a cold front coming into the area, by the increase in pain or stiffness in their ailment. Most people state that they can predict the weather better than their local weatherman. This area of study is known as biometeorology or how weather affects living organisms. There have been many studies conducted and articles written on how weather affects low back pain, but there has been very little done in the area of how weather affects musculoskeletal pain in the lower extremity.
Factors contributing to weather sensitivity
Weather sensitivity and foot and ankle pain: Coping with changes in climate explains factors contributing to weather sensitivity with a very broad scope. The authors mention that the controversial topic regarding the patient’s weather. During the past 24 years, it has been noted countless times that extremity pain increased before the onset of a storm and decreased when the storm subsided. Another study found that increased hours of sunshine resulted in lower, occasional, or constant pain in 75% of the subjects. Although their primary focus is on foot and ankle pain, it is important to recognize that broader aspects of weather sensitivity could have physiological and psychological effects. The study where patients with rheumatoid arthritis were asked to numerically rate their joint pain relative to weather changes for 5 weeks concluded that there was a correlation between increasing joint pain and decreasing temperature with an r-value of 0.938, which is statistically highly significant (p <0.001). Data collected allowed the authors to effectively predict changes in joint pain from the local weather forecast.
Common foot and ankle conditions affected by climate changes
Different types of weather affect gout differently. This was what a client suffering from gout impersonated, but in fact, weather sensitivity for gout is a lot worse. A small-scale study had 47 gout sufferers keep a daily diary of the weather conditions and note any changes in gout pain for a year. 42 out of the 47 patients reported that changes in the weather brought on extra pain in the joints, with 67% of these being sure that they were affected by the rain. This is a very high percentage that indicates much could be done to advise gout sufferers on methods of coping with weather changes. High humidity and low temperature were also reported as risk factors. In the same survey, around 13% of sufferers mentioned that they thought the weather brought on the onset of a gout attack. Although the influence of weather on gout is undeniable, the mechanism is unclear as the attack often begins at night and does not coincide with falling temperatures.
Rheumatoid arthritis affects the joints as it is an inflammatory, autoimmune disease. Cold and damp weather increases the level of pain for most clients, whereas a larger majority state that they feel less pain in the joints during hot and dry weather. Analysis between weather and foot pain for people with rheumatoid arthritis has shown that over 60% report having seasonal symptoms. A recent study investigated possible predictors of variation in pain and disability in rheumatoid arthritis. It showed that disease activity and foot symptoms are affected by meteorological conditions. Another analysis conducted in Japan looked at 2078 patients with osteoarthritis. The results showed that higher air pressure was associated with higher pain in osteoarthritis. Although results for this study suggest that further investigations involving larger samples are necessary in order to determine whether it is the change in meteorological conditions that influenced pain. No one can deny the effect of severe chilblains in the winter caused by exposure to cold, damp conditions in the UK.
Symptoms and impact of weather sensitivity on foot and ankle pain
Given the complexity of it, weather sensitivity is at present a poorly understood phenomenon, with several theories concerning the how and why it affects an individual’s pain. It is still, however, important to consider the impact of your symptoms and whether you believe that weather can influence the severity and frequency of your pain. Identification of a weather-sensitive painful area is usually determined through self-reported findings and diaries, as most clinical research would not take into account weather conditions in the results. Typically, a patient will notice an increase in pain in correlation with worsening weather. This is frequently described as a dull and aching discomfort, with alterations in the level and type of pain experienced. Some will notice increased joint stiffness, making getting out of bed in the morning or after long periods of sitting more difficult. All will agree on a preference for warmer and drier weather conditions! In terms of specific symptoms and their impact on foot and ankle pain, weather sensitivity has been shown to worsen the pain experienced in the chronic stage of an acute injury. This is relevant to several foot and ankle conditions.
Coping Strategies for Weather-Related Foot and Ankle Pain
Non-weight bearing exercises, such as cycling and swimming, protect the joints and are good choices during times of especially painful flare or following a surgical procedure. Regular participation in hydrotherapy has also been shown to prolong the time before a total joint replacement is needed in patients with rheumatoid arthritis.
Static strengthening exercises, such as towel scrunches and marble pickups, can prevent muscle atrophy in the foot. Range of motion and flexibility exercises sustain motion in the joints and help to prevent stiffness. Aerobic conditioning can improve cardiovascular and overall health.
Physical therapy and exercises can keep the foot and ankle strong and flexible. It provides pain relief and improves overall function. Specific exercises can be prescribed by a podiatrist or physical therapist, or may be found in self-management and self-help books.
Wearing the same shoe with no variation is also beneficial. Studies suggest that changes in footwear, such as wearing sandals or walking barefoot indoors, can lead to increased foot pain and a higher frequency of swollen and stiff joints in arthritic patients.
Proper footwear will also act as protection from the elements. A well-insulated, waterproof shoe can keep the foot warm and dry during colder, damper periods. This will reduce stiffness and pain caused by arthritis. When the weather is warm and dry, the foot is supported and protected.
Maintaining proper footwear is essential for minimizing stress on the joints. The right shoe offers support and motion control. It should also have a good shock absorbency system. A bad shoe choice can affect the way force is distributed throughout the foot and can lead to misalignment in the joints, as well as increased stress on certain areas.
Maintaining proper footwear
Proper footwear should provide stability and prevent changes in the shape of the foot. This can be achieved with supportive lace-up shoes or boots. The use of an over-the-counter insert of good quality can help improve the fit of the footwear and reduce abnormal motion of the foot. New shoes should be well padded and provide good arch support. A molded to the shape of the foot is best. Lacing techniques can improve the fit of the shoes and prevent abnormal foot motion. Women should be mindful that tight or high-heeled shoes can result in abnormal foot mechanics and should be avoided where possible. This can be addressed more specifically with the use of orthoses. When purchasing footwear, patients should take into account a number of factors to ensure the shoes have the desired effect on foot mechanics. This includes the quality, fit, and the likely effect of the footwear on the shape and movement of the feet. Time should be taken to try on several different shoes from different brands before making a final decision. A more detailed description of choosing specific types of footwear which may benefit certain foot conditions can be found in the online paper associated with this article.
Physical therapy and exercises
The RICE principle is alive and well for managing rehab effects in musculoskeletal injuries. However, weather can sometimes affect the effectiveness of the RICE activities. “I tell patients to put their injured foot in a bucket of ice. Now if it’s already cold outside, they might not find it does much for reducing pain or inflammation,” says physical therapist Anne Vogel from Auburn, Massachusetts. The effects of the second principle, which is to restrict activity or weight bearing, are difficult for sufferers of weather-related pain. This usually involves indoor rest, which can lead to lower activity levels and increased pain trigger from sedentary behavior. Substituting with an upper body or non-weight bearing activity such as swimming can be effective. Joint protection is an important concept that can be effectively exhibited in the field of rheumatoid arthritis. This refers to the practice of using muscles to decrease joint stress and protect from further damage while performing daily activities. An example of this is lifting with the forearms and keeping the wrists in a neutral position while lifting and carrying objects. Although the demonstration of such activity is difficult to monitor, it can be taught as a means to reduce pain triggers from certain activities and change the behavior of patients.
Physical therapist focused on treating foot and ankle problems usually has two goals when treating weather-related pain. The first is to address any issues in the lower extremity that may be contributing to the pain. The second is to work with the patient to identify pain triggers and determine a way to reduce the impact of the weather on the pain.
Managing inflammation and pain
When weather changes are noticed, it is very important to be vigilant about your general health with dietary considerations, adequate hydration, and antioxidants. As mentioned earlier, changes in diet can be for the betterment of health year-round. Try to maintain a healthy diet and health-conscious decisions in times of weather changes as it is easier to let go and “cheat” with bad foods and nutritional decisions when feeling the blues from weather-induced pain. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) e.g. Ibuprofen, Aleve or Motrin, are an easy quick-fix for decreasing pain symptoms. Be cautious not to break the recommended dosage and do not rely on these medications as a sole remedy for your pain. There is no harm in dietary supplementation to naturally accommodate your reduced ability to cope with inflammation from weather changes. Glucosamine, chondroitin, fish oil, and/or flaxseed oil all have claimed to reduce inflammation and increase comfort from arthritis pains, but are not immediately acting so it is best to be taking these items routinely. Throughout the entire course of physical therapy treatment for arthritis or other foot/ankle pains, utilizing ice on painful areas at the end of the day can help to decrease punishment to your lower extremities that day. It has been said that 15-20 minutes is the safest duration of icing and ice should not be put in direct contact with skin to avoid cold burns or irritation. Ice gels and freezer packs available at drug stores could be an alternative to ice cubes with less mess. Custom or over-the-counter orthotics can balance weight distribution and reduce stress to susceptible areas in the feet.
Lifestyle modifications for weather sensitivity
Footing is important when in outdoor situations. Individuals with foot and ankle pain will notice a difference in symptoms when walking on grass, dirt, or gravel versus walking on a hard, level surface. It is best to avoid surfaces that cause an increase in pain or swelling. This may mean that those who enjoy outdoor activities such as gardening, or playing golf or tennis may need to find new hobbies or limit these activities to keep symptoms at a minimum.
Change of geographic location to rehabilitate foot and ankle pain caused by weather-sensitive individuals can prevent reactivation of symptoms. Those living in the Midwest, the South, and the Northeast of the United States will notice a large amount of precipitation, particularly rain, which can increase both pain and swelling. A move to a drier climate such as Arizona or Colorado can be effective for symptomatic relief. Another easy approach is to stay indoors as much as possible during times of inclement weather or temperature change.
Seeking Professional Help for Weather-Related Foot and Ankle Pain
In cases where arthritis or other chronic conditions are suspected to be the cause of pain, patients may be referred to a rheumatologist. While podiatrists and orthopedic specialists are able to provide diagnoses and treatments for foot and ankle pain, many patients find it useful to receive treatment for their systemic condition. If it is determined that foot and ankle pain is related to a systemic condition, the patient’s primary care physician will aid in coordinating care with the rheumatologist or other medical specialist. Treatment by a medical specialist is often essential for changing the progression of pain and preventing further damage to the foot and ankle.
Many individuals experiencing weather-related foot and ankle pain seek the help of medical professionals in order to understand and overcome their discomfort. A common practice is to consult a podiatrist or orthopedic specialist. The expertise of podiatrists and orthopedic specialists lies in understanding the mechanics of the foot and ankle, which is essential in identifying the source of pain. With this knowledge, they are able to perform diagnostic tests and evaluations designed to effectively pinpoint the cause of pain.
Consulting a podiatrist or orthopedic specialist
Individuals experiencing chronic foot and ankle pain due to changes in weather should strongly consider consulting a podiatrist or orthopedic specialist. Both of these specialized clinicians are trained to diagnose and treat musculoskeletal disorders of the lower extremity and understand the structure and function of the foot and ankle in static and dynamic positions. Podiatrists and orthopedists often work together in an integrated practice as well. Orthopedists are medical doctors who have completed training in the appropriate field of medicine and then gone on to specialize in orthopedics, while podiatrists specialize in the foot and ankle after attending podiatric medical school. A person may seek both professionals with the same background of knowledge on the disorders, but an orthopedist may have a better understanding of how the foot and ankle disorders may affect other areas of the body due to training in overall musculoskeletal health. With specialist care, individuals may receive a diagnosis and custom-made treatments aimed at their specific foot and ankle disorder that may be affected by changes in weather.
Diagnostic tests and evaluations
Diagnostic injections may be used in some cases to help confirm a specific diagnosis. For example, an injection of local anesthetic into a specific joint could be used to see if it provides pain relief for the patient. If there is 100% pain relief, then it is likely that the joint that has been injected is the source of the pain. Another example would be injection of a corticosteroid medication around a tendon that is suspected to have tendonitis. If it provides significant relief of pain and inflammation, then it increases the likelihood that the problem is coming from the tendon in question.
In most cases, the results from a physical examination and patient history will be sufficient to diagnose the cause of the foot or ankle pain. Often the patient is sent for x-rays or other types of imaging studies. Depending on the cause of the pain, additional tests or diagnostic studies may be suggested. Diagnostic ultrasound may be used to help the doctor confirm the presence of inflammation. CT or MRI scans could be ordered to get a better look at a specific area where the patient is experiencing pain. In some cases, blood work may be ordered. This is usually done if the doctor suspects a systemic type of arthritic condition or a certain type of infectious process. The purpose of the blood work would be to rule out certain conditions and help confirm the diagnosis.
Treatment options and interventions
By determining the causative factors involved, the physician may have to alter the treatment plan to include methods to prevent symptom exacerbation when the patient is faced with the aggravating weather. This can be done by getting the patient to use orthoses and a supportive shoe that is less flexible and has a more shock absorbent sole in the case of a person with posterior tibial tendon dysfunction who experiences increased pain on rainy days.
In this case, if the symptoms are triggered by adverse weather, then the physician would have to examine what type of weather is worsening those symptoms. If the pain is caused by increased activity due to participation in outdoor summer sports, then the pain is not weather related. If the pain is caused by an increase in inflammatory response during colder months, then it is indeed weather related.
A treatment plan for a specific type of foot pain can depend on the clinical diagnosis. For example, anterior tibial tendonitis can be treated in a variety of ways, including orthoses, support shoes, medication to reduce inflammation, physical therapy, and in some cases, surgery.
Many treatments that are used for weather-related foot and ankle pain are the same as those used in non-weather related pain. However, the treating physician must take into account the patient’s sensitivities to weather when coming up with a treatment plan.