Walking more but hurting more? Why legs and feet complain
Leslie Budzynski DC | Doctor of Chiropractic | GCC No. 00043 | BCA No. 0072 | 39 years in practice | writes about leg and foot pain from walking and why it doesn’t seem to make sense that you are walking more but everything is hurting more and why legs and feet complain when the miles increase.
So you have upped your walking distance, it is a beautiful time of year and walking is free, surrounded by nature and fresh air with the sun on your skin and the sea breeze in your hair. Perfect. But since you have been walking more everything has been hurting more, that just doesn’t seem logical you may think.
Let me explain, every year at two distinct junctures, one at the beginning of spring and the other around the end of the summer, I see a regular occurrence. Somebody decides to get back into shape, get their steps up, get outside and relish all the aspects of where we all live by the sea in Bournemouth and they start walking the promenade. But instead of the leisurely stroll they usually do this is with more focused intention and the speed has picked up. Roughly three weeks later or so they are booking in to see me with sore heels, an aching shin or a knee that has started complaining. This is the seasonal appearance of specific leg and foot pain from walking.
My patients almost always open with the same line: “I did not do anything specific to cause the pain” and that is true. This conundrum is exactly the point of this article, leg and foot pain from walking is rarely caused by an injury. It is caused by asking a tissue to do more than it has recently been used to or is well prepared for.
I walk between 5 and 10km most days myself so I have an awareness of and an empathy for this problem and empathy too. This post covers what tends to hurt first when you increase your walking, why that happens, how much extra walking is sensible at a time and how to grade your walking regime up gradually to that goal and the very small number of symptoms that mean you should stop and get it looked at rather than push through.
It is almost never the walking. It is the change in the walking
Tissue adapts to load, but it does adapt slowly. Tendon, bone and fascia all remodel over weeks and months, whereas new human level enthusiasm for a new habit remodels almost instantaneously. The mismatch between what you have suddenly asked your legs to do and what they have been conditioned to do over the previous months is why it hurts and key to succeeding in your goal and subsequently remaining pain free is detailed below. Work on training load in sport suggests that rapid spikes in workload, rather than high workload itself are what tend to precede problems and the same principle applies to somebody who has swiftly gone from two thousand steps a day to nine thousand.[1]
This is why the walking itself is not the culprit and why the answer is usually not to stop walking. The answer is to adapt the rate of increase.
What tends to hurt first and what it usually means:
The heel
Pain under the heel that is at its worst for the first few steps out of bed in the morning, eases after five minutes of moving then returns later in the day is the classic plantar heel pain pattern. It is stubborn, it responds poorly to rest alone and there is some trial evidence of quicker improvement when progressive loading of the foot does better than stretching by itself.[2]
The Achilles
Stiff and sore at the back of the heel first thing, warms up as you get going, then grumbles a few hours after you stop. Tendons behave differently from joints. They respond to gradual, progressive load rather than to rest and the current understanding of tendon problems is that in long-standing cases of Achilles problems the tissue has changed structurally rather than simply become inflamed.[3]
The anatomy of the heel and ankle and the location of the Achilles tendon and where the pain is felt with Achilles Tendinopathy in the heel
The Shin
A diffuse ache along the inner border of the shin bone that builds through a walk is the usual presentation of medial tibial stress syndrome, better known as shin splints. It is common in walkers, not just runners particularly on hard surfaces.
The Knee
Pain at the front of the knee, worse going downhill and worse on stairs, is the pattern I see in people who have added distance. Hills and the cliff zig-zags are usually the cause somewhere in the training.
The Calf
Tightness, cramping and occasionally a sharp catch mid-calf. Beach walking is a frequent cause in our lovely location because soft sand and a sloping shoreline load the calf and ankle quite differently from a flat pavement or tarmac.
If you are experiencing any of these and it has not settled in a week or two, I would rather look at it early than late. You can call me on 01202 937568 or book a free 15-minute consultation to talk it through first.
What tends to hurt first and what it usually means
Leg and foot pain from walking. Find the pattern that matches yours, then read what it normally points to.
The knee
Pain at the front of the knee that is worse on stairs and worse going downhill. It is the pattern I see in people who have added distance, hills or the cliff zig-zags.
The shin
A spread-out ache along the inner border of the shin bone that builds through a walk. Usually medial tibial stress syndrome, better known as shin splints, and common in walkers on hard surfaces, not just in runners.
The calf
Tightness, cramping and occasionally a sharp catch mid-calf. Beach walking is a frequent cause here, because soft sand and a sloping shoreline load the calf and ankle quite differently from flat pavement.
The Achilles
Stiff and sore at the back of the heel first thing, warms up as you get going, then grumbles a few hours after you stop. Tendons behave differently from joints and respond to gradual, progressive load rather than to rest.
The heel
Pain under the heel at its worst for the first few steps out of bed, easing after five minutes of moving, then returning later in the day. That is the classic plantar heel pain pattern, and it responds poorly to rest alone.
Not settled after a week or two? I would rather look at it early than late. Call 01202 937568, or book a free 15-minute consultation and talk it through first.
How much extra walking is sensible
The ten thousand steps target has no real scientific origin and a large pooled analysis of fifteen international studies found that the benefit to mortality risk levels off well below it, at roughly 6-8,000 steps a day for adults over sixty and 8-10,000 steps for younger adults.[4] That is good news if you are currently doing four thousand and feeling guilty about it. Moving from very little to a moderate amount is where most of the benefit sits. Incorporating it into your day is an advisable way to grade that increase, it is also more likely to become a habit you keep.
As a practical rule, I suggest increasing weekly distance by roughly ten per cent and holding it there for a week or two before going up again. Increase either distance or gradient, not both in the same week. If you have had a fortnight off, come back at the level you were at before the break.
Shoes, surfaces and the Bournemouth problem
We have unusually varied walking terrain here in Dorset and it catches people out. The promenade from Bournemouth Pier to Sandbanks in Poole is flat, smooth and long which quietly encourages people to double their distance without noticing. The cliff zig-zags between Branksome Chine and the town centre add a sustained gradient that most people have not trained for. Walking on the beach puts you on a soft, cambered surface for an hour which is a completely different demand on the ankle and calf and knees.
On footwear, the honest answer is that comfort and familiarity matter more than any particular design or feature. If your shoes have done six hundred miles and the midsole has gone flat, replace them. If you have just replaced them and the pain started a week later, then that is worth mentioning to me because a sudden change in heel height or stiffness is a load change like any other.
When walking is good for you even though it aches
Patients with arthritic knees often assume that walking is wearing the joint out and that they should protect it. The evidence points the other way. In a large study of adults over fifty with knee osteoarthritis, those who walked for exercise were less likely to develop new frequent knee pain and there were signs of less structural progression in some groups.[5] Walking is one of the more sensible things you can do for an arthritic knee, provided the volume is sensible and you are not limping heavily when walking.
The same applies more broadly in pain that is mild, settles within twenty-four hours and does not make you limp is usually acceptable. Pain that builds session on session, wakes you at night or changes how you walk is not.
When to stop and get leg and foot pain from walking checked
Most of what I have described settles with sensible load management. A few things need medical attention.
Calf pain that comes on after a predictable walking distance and reliably eases when you stand still may not be a muscle problem and needs a medical opinion as it could indicate a circulation issue rather than a mechanical one. A calf that is swollen, warm and tender on one side only, particularly after surgery, illness or a long journey, needs same-day medical advice. A sudden sharp pain at the back of the ankle with a felt or heard snap and difficulty pushing off should be assessed urgently too. Focal, pinpoint pain on a bone that is worse at night rather than better suggests a bone stress problem rather than a soft tissue one and should be assessed before you walk on it further.
Any pain in the leg that comes with numbness, weakness or pins and needles may be coming from the lower back rather than the leg which is a different problem entirely and one I see often and I have written about in detail in my guide to sciatica.
Frequently asked questions about leg and foot pain from walking
How much should I increase my walking each week?
Around 5-10% of your weekly distance is a sensible guide. Increase distance or hills, but not both in the same week and hold each new level for a week or two before going up again. If you have had time off, restart again however lower than you finished on your previous session when you stopped.
Is walking bad for arthritic knees?
No. Research in adults over fifty, with knee osteoarthritis, found that those who walked for exercise developed new frequent knee pain less often than those who did not. Walking is generally good for an arthritic knee as long as the amount is sensible and you are not limping badly to manage it.
Should I walk through foot pain or rest it completely?
Complete rest can make stubborn foot pain worse rather than better because the soft tissue will decondition. Reducing the load rather than removing it and adding some progressive strength training, tends to work better. If the pain is sharp, worsening or changing how you walk, get it assessed first.
Do I need new walking shoes?
Only if the ones you have are worn out or uncomfortable. Comfort and familiarity matter more than any particular feature. Bear in mind that new shoes are themselves a change in load, so if symptoms started shortly after buying a pair, mention that at your appointment.
How long should heel pain take to settle?
Plantar heel pain can often be slow to settle. Many people take three to six months for it to settle properly and it responds better to a graded loading programme than to rest. That is frustrating, but knowing it in advance makes it easier to stick with the plan.
Can a chiropractor help with leg and foot pain from walking?
Chiropractic care may help with many mechanical leg and foot complaints, usually through hands-on treatment of the affected joints and soft tissues, alongside a specific loading programme and practical advice on walking volume and footwear. The first job is always working out where the pain is actually specifically coming from because leg pain does not always start in the leg.
Legs or feet complaining since you upped the mileage? Come and find out why
Most of the walkers I see have not injured anything. They have simply asked a heel, a shin or a knee to do more than it had been prepared for and the soft tissues have objected. Whether you walk the promenade from Sandbanks or take the Branksome Chine zig-zags, the first job is working out which structure is complaining and why because leg pain does not always start in the leg. Chiropractic care may help with many mechanical leg and foot complaints and I will tell you honestly if I think you need someone else.
Or call me directly on 01202 937568.
If you have walked yourself into a problem and it has not settled, I am happy to take a look. If you have not been to a chiropractor before, you can read about what happens at a first visit before you book.
Areas we cover
The promenade, the chines and the harbourside paths bring walkers to the clinic on Branksome Hill Road from right across the BCP area, including:
Written by Leslie Budzynski DC, GCC-registered chiropractor (GCC No. 00043) with 39 years of clinical experience. Principal chiropractor at Bournemouth Chiropractic.
This post is for information only and does not constitute medical advice. If you are experiencing severe or worsening symptoms, please consult your GP or call 111.
References on leg and foot pain from walking
- Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? British Journal of Sports Medicine, 2016;50(5):273-280. doi:10.1136/bjsports-2015-095788
- Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up. Scandinavian Journal of Medicine and Science in Sports, 2015;25(3):e292-e300. doi:10.1111/sms.12313
- Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? British Journal of Sports Medicine, 2016;50(19):1187-1191. doi:10.1136/bjsports-2015-095422
- Paluch AE, Bajpai S, Bassett DR, et al. Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. The Lancet Public Health, 2022;7(3):e219-e228. doi:10.1016/S2468-2667(21)00302-9
- Lo GH, Vinod S, Richard MJ, et al. Association between walking for exercise and symptomatic and structural progression in individuals with knee osteoarthritis. Arthritis and Rheumatology, 2022;74(10):1660-1667. doi:10.1002/art.42241
