Stephan J. LaPointe, DPM, PhD, FACFAS
When it comes to maintaining foot health, wearing properly-fitting shoes is important. While wearing the appropriate pair of shoes may seem like a trivial concern, the reality is that improperly fitted shoes cause an astounding amount of injuries to the feet. The overall structure and the biomechanics of our bodies are directly affected by our posture, gait, and feet. Because of this, pain and discomfort felt throughout the body are often related to a problem in the feet. And, most foot problems usually stem from improper footwear.
Shoes should not be purchased with the expectation that they will easily stretch and contort to the size and shape of your feet. When shopping for footwear, look for shoes that fit correctly and comfortably as soon as you put them on. Do not purchase shoes that are too large or that slip in the heel area when you walk. Do not choose shoes that are loose with the intention of wearing thicker socks to compensate for the space. The widest portion of the shoe, the ball of the foot, must be made sure to fit comfortably in the shoe.
Keeping all of these suggestions in mind may be difficult when shopping and when trying to select from a wide array of different shoes. Nonetheless, your time and money will be wasted if you purchase a pair of shoes that are too uncomfortable for you to actually wear them. After finally selecting and purchasing a pair of shoes, try them on at home. To truly ensure whether or not your shoes fit comfortably with normal activity, walk around on a carpeted surface to determine how they feel on your feet.
The possibility of damaging your feet’s 33 joints, 26 bones, and 100+ ligaments is much higher than many people suspect. Finding an appropriate and properly-fitted pair of shoes is perhaps the single most important action you can take to maintain excellent foot health and help prevent injury. The fact that our feet continue to change with age is one that many people often forget. Even if our feet no longer change in size when we mature, our feet will still change in shape.
If you already have pre-existing foot problems, there is a greater possibility that wearing improperly-fitted shoes will worsen those problems. The good news, however, is that appropriate footwear is not difficult to find. While shopping for shoes, remember that improper footwear can detrimentally affect the feet, the entire body and its biomechanical structure as well. The shoes you wear can greatly impact your legs, back, and entire body, as your posture and gait are related to your feet. Finding and selecting the best properly-fitted shoes is necessary in achieving optimal health.
While proper foot care is important for everybody, senior citizens have the tendency to be more susceptible to certain foot conditions. The elderly should therefore be well informed about any problems that may arise and about what they can do to properly avoid or treat them.
Some of the most common foot problems seniors are susceptible to include foot ulcers, ingrown toenails, fallen arches, and fungal nails. A foot ulcer is an open sore on the foot and can be a result of diabetes and decreased sensation in the feet. An ingrown toenail is defined as when the nail grows into the side of the toe. Fallen arches are indicated by the instep of the foot collapsing. A fungal nails is a condition that results in deformed and discolored toenails.
In order to avoid these conditions it is recommended that the feet be inspected by the patient on a regular basis. If these inspections are carried out routinely, there is a good likelihood that problems can be identified before they become severe, or can even be avoided altogether. If any abnormality is discovered, it is important that the individual consult a podiatrist for diagnosis and information on treatment options.
Proper foot hygiene is also important. Making sure that you always have clean, dry socks on can be a major deterrent to many different problems including bacterial infections, foot odor, and certain types of fungus. Wet feet are a major cause of many of these problems. If your socks get wet, it is important to change them. Walking around in wet socks may not only lead to various infections, but can irritate the skin and result in a number of various complications. Clean, dry feet are less likely to be affected by fungal and other infections.
As people age, the fat present on your feet begins to deteriorate. The protective nature of this fat keeps the feet healthy by providing a barrier between your bones and the ground. This also aids in giving the skin on the feet a certain amount of elasticity. This is one factor that causes elderly people to develop some serious foot issues. Foot moisturizers can be helpful to avoid certain problems associated with this. However, water-based moisturizers do not work as well for elderly people as they do for the young. Instead, it is more effective to use an emollient instead. An emollient is effective because it binds the water in the foot, keeping it from becoming absorbed too readily which will result in dry skin. Emollients also have a special property called occlusion, which provides a layer of oil on the skin. This layer prevents the foot from drying up and can be very effective in treating dry skin disorders. If you can keep the skin on your feet healthy, this will substantially reduce the number of foot problems you will encounter in old age.
Proper footwear is another way to keep feet healthy. Shoes that fit well and provide proper support help prevent ingrown toenails and fallen arches.
Certain medical conditions such as diabetes or poor blood circulation increase the risk for foot issues. For individuals with any of these conditions it is extremely important to conduct regular foot inspections to make sure that there are no sores or infections present.
The forefoot is composed of five metatarsal bones and fourteen phalanges. Each toe has three phalanges except for the big toe which only has two. Our toes play an essential role to the walking process, which is why a broken toe could seriously disrupt one’s ability to move around. Toe fractures are common and can be very painful. Fortunately, these injuries rarely require surgery and usually heal with rest and a change in activity.
Broken toes typically result from a traumatic event such as falling, stubbing the toe, or dropping something on the toe. Traumatic toe fractures may be categorized as either minor or severe fractures. At times, one may hear a “pop” or “crack” sound when the bone breaks. Common symptoms of a traumatic toe fracture include pain, throbbing, bruising, swelling, and redness.
Another type of toe fractures is a stress fracture. These injuries usually appear in the form of small hairline breaks on the bone. Stress fractures develop after repetitive activity instead of a single injury. Stress fractures occur when the muscles in the bone become too weak to absorb impact. Consequently, the toe bone becomes vulnerable to any pressure and impact it endures. Symptoms for a stress fracture in the toe include swelling without bruising, tenderness to the touch, pain that goes away with rest, and pain after walking or running.
If you suspect that you have a broken toe, you should make an appointment with your podiatrist. He or she will likely diagnose you by performing a physical exam and an X-ray. Treatment for a broken toe may include the R.I.C.E. method, buddy taping, surgery, or antibiotics. The R.I.C.E. method (Rest, Ice, Compression, and Elevation) is a common treatment method for many injuries because it decreases pain. Buddy tapping involves wrapping the injured toe next to an adjacent toe to keep it supported and protected. These two methods have proven to be effective in the healing process for toe fractures. The estimated healing time for a broken toe is approximately four to six weeks. If the injury becomes infected or requires surgery, the estimated healing time may take eight weeks or more.
Fungal infection of the toenail, or onychomycosis, typically appears as a gradual change in a toenail’s texture and color that involves brittleness and darkening. The fungal infection itself occurs beneath the surface of the nail. Aside from discoloration, other symptoms include the collection of debris beneath the nail plate, white marks on the nail plate, and a foul odor emanating from the nail. If ignored, the infection can spread into other nails and the skin; in severe cases, it can hinder one’s ability to work or walk.
The toenails are particularly vulnerable to contracting infection in moist environments where people are likely to be walking barefoot, such as around swimming pools, public showers, and locker rooms. Fungal infection may also be more likely to occur in nail beds that have been injured, and sufferers of chronic diseases such as diabetes, circulatory problems, or immunodeficiency conditions are particularly prone to developing fungal nails.
Fungal nails can be primarily prevented by practicing proper hygiene and regularly examining the feet and toes. Carefully washing the feet with soap and water and thoroughly drying the feet afterwards are essential. Other tips include wearing shower shoes in public areas, changing shoes and socks daily, keeping toenails clipped at a short length, wearing breathable shoes that fit properly, wearing moisture-wicking socks, and disinfecting home pedicure tools and instruments used to cut nails.
Fungal nail treatment may vary between patients and the severity of the condition. Your podiatrist may suggest a daily routine of cleansing that spans over a period of time to ease mild infections. Over-the-counter or prescription antifungal agents may also be prescribed, including topical and/or oral medications. Debridement, or the removal of diseased nail matter and debris, may also be performed. In more severe cases, surgical treatment may be needed. In some instances, the temporary removal of the fungal nail allows for the direct application of a topical antifungal to the nail bed. In other cases, a chronically painful fungal nail that has not responded to other treatments may be permanently removed; this allows the infection to be cured and avoids the growth of a deformed nail.
Sever's disease, also known as calcaneal apophysitis, is a medical condition that causes heel pain in children’s feet while they’re growing. Sever's disease occurs most commonly in boys and girls between the ages of 8 and 14.
Sever's disease occurs when the child’s growth plate, or the calcaneal epiphysis, an area attached to the Achilles tendon, is injured or when the muscles and tendons of the growing foot do not keep pace with bone growth. The result is constant pain experienced at the back of the heel and the inability to put any weight on the heel. This forces the child to bear weight on their toes while walking. When a toe gait develops, the child must change the way they walk to avoid placing weight on the painful heel. If this is not properly addressed, this can lead to further developmental problems.
The most common symptom of Sever's disease is acute pain felt in the heel when a child engages in physical activity such as walking, jumping or running. Children who are active athletes are among the group most susceptible to experiencing Sever's disease. This is due to the extreme stress and tension placed on their growing feet. The rolling movement of the foot during walking or running and obesity are both additional conditions linked to causing Sever's disease.
The first step in treating Sever's disease is to rest the foot and leg and avoid physical activity. Over the counter pain-relieving and anti-inflammatory medications can be helpful for reducing the amount of heel pain. A child with Sever's disease should also wear shoes that properly support the heel and the arch of the foot. Consider purchasing orthotic shoe inserts which can help support the heel and foot while it is healing. Most patients with Sever's disease symptoms report an eventual elimination of heel pain after wearing orthotic insoles that support the affected heel.
Sever's disease may affect either one heel or both. It is important for a child experiencing heel pain to be examined by a foot doctor who can apply the squeeze test. The squeeze test compresses both sides of the heel in order to determine if there is intense pain. Discourage any child diagnosed with Sever's disease from going barefoot as this can intensify the problem. Apply ice packs to the affected painful heel two or three times a day for pain relief.
Exercises that help stretch the calf muscles and hamstrings are effective at treating Sever's disease. An exercise known as foot curling has also proven to be very effective at treating Sever's disease. When foot curling, the foot is pointed away from the body, then curled toward the body to help stretch the muscles. The curling exercise should be done in sets of 10 or 20 repetitions and repeated several times throughout the day.
Treatment methods can continue for at least 2 weeks and as long as 2 months before the heel pain completely disappears. A child can continue doing daily stretching exercises for the legs and feet to prevent Sever’s disease from returning.
Although ankle sprains may not be as serious as a broken ankle, they should be given immediate attention and care. An ankle sprain can lead to a significant amount of pain, as well as limited mobility. They are often characterized by the swelling and discoloration of the skin. This occurs when the ligaments are stretched beyond their limits.
The simple act of walking can sometimes cause a sprain, which makes ankle sprains a very common injury that can happen to anyone. They occur when the ankle twists in an awkward way or rolls over itself, causing a pop or snap in the tendons around the ankle. Some people are more at risk than others. These include athletes who continually push their bodies to the limits and also people who have previously suffered accidents to the feet, ankles, or lower legs.
Most of the time, an ankle sprain is not severe enough for hospital attention. There are many at-home treatment options available, including propping the leg up above your head to reduce blood flow and inflammation, applying ice packs to the affected area as needed, taking over-the-counter pain relievers and anti-inflammatory medication, using an ACE bandage to wrap and support the injured ankle, and most importantly, remaining off your feet until the ankle has fully healed.
Despite this, an ankle sprain can turn into a severe injury that might require hospitalization. If the ankle ligaments or muscles are damaged from a tear or rip, that is one sign that the sprain is severe enough for hospital attention and possibly for surgery. Even after the surgery, the recovery process can be long. You may need to have rehabilitation sessions administered by your podiatrist to get your ankle back to full health.
The severity of your sprain might become apparent if you are unable to stand or walk, consistent pain occurs over a prolonged period of time, swelling is much more severe than initially present, or if you start to experience tingling or numbness. These signs may indicate that your ankle sprain might actually be a broken ankle, an injury that requires immediate medical attention.
Although they are not completely avoidable, ankle sprains can be curbed with some preventative treatment measures. These include wearing appropriate-fitting shoes that not only provide a comfortable fit, but also ankle support. It is also recommended to stretch before doing any kind of physical activity, as this will help lower your body’s chance for an injury.
Foot and ankle injuries are common among people who participate in sports. Several factors contribute to this. They include failing to stretch or warm up properly, not wearing the proper type of shoe and not taping or providing other types of support for the ankle or foot. The most common foot and ankle injuries suffered by people involved in sports are plantar fasciitis, ankle sprains and Achilles tendon damage or ruptures. If not treated properly, they can lead to permanent disability.
Treating these injuries is relatively simple if they are identified and addressed early. Many athletes dismiss the initial aches and pains associated with injury as just soreness or tired muscles. Their first response is usually to try to work through it. This can lead to serious problems. Many minor injuries are made far more serious when athletes continue to put strain and pressure on them. That attitude can change a mild strain into a serious strain and a minor tear into a rupture. Athletes should have unusual aches and pains evaluated by a skilled medical professional.
Plantar fasciitis is a painful injury. It is inflammation of the plantar fascia, the thick band of tissue running from the heel to the base of the toes. If left untreated, it can lead to a degenerative disease called plantar fasciosis. There are several effective treatments for this ailment. Doctors often prescribe rest, massages, stretching, night splints, physical therapy, anti-inflammatory medication, corticosteroids or surgery, usually in that order. The most effective treatment for plantar fasciitis is orthotics, which offers foot support. Surgery is occasionally used as a last resort, but it comes with the risk of nerve damage and infection and often does not stop the pain.
The Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel bone. Running, jumping and walking all impact this tendon. Two common injuries to the Achilles tendon are tendonitis and a rupture of the tendon. Tendonitis is inflammation in the tendon often caused by an increase in the amount of stress placed on it. Non-surgical treatments include rest, ice or anti-inflammatory medication. A rupture (tear) of the Achilles tendon can be treated by placing the lower leg in a cast for several weeks or with surgery. Many physicians feel surgery is the better option because it lowers the risk of re-ruptures. Both methods require 4 to 6 months of rehabilitation.
Ankle sprains are the most common sports related foot and ankle injury. A sprain occurs when the ligament holding the ankle bones and joint stretches beyond its normal range. It can be treated non-surgically with a combination of rest, ice wrapped around the joint for 30 minutes immediately after injury, compression by a bandage and elevating the ankle above the heart for 48 hours. This combination is referred to as RICE. Severe ankle sprains in which the ligaments are torn may require reconstructive surgery followed by rehabilitation.
Bunions are large bony bumps at the base of the big toe. Medically known as hallux valgus, a bunion is a misalignment of the metatarsophalangeal joint, or big toe joint. The misalignment will generally worsen with time if left untreated.
The exact cause of bunions is unknown, with genetics seen as a potential cause. High heels and poorly-fitted footwear, rheumatoid arthritis, and heredity all seem to be potential factors behind the exacerbation of bunions. Women have been found to be more likely to develop bunions in comparison to men.
Bunions do not always produce symptoms. The best way to tell is if the big toe is pushing up against the next toe and there is a large protrusion at the base of the big toe. You may or may not feel pain. Redness, swelling, and restricted movement of the big toe may be present as well.
Podiatrists use a variety of methods to diagnose bunions. If there are symptoms present, podiatrists will first consider that it is a bunion. If not, a physical examination will be conducted to check function of the big toe. Finally, an X-ray may be taken to view the extent of the bunion and confirm it is a bunion.
Typically, nonsurgical methods are used to treat bunions, unless the bunion has become too misaligned. Orthotics, icing and resting the foot, roomier and better fitted shoes, taping the foot, and pain medication are usually utilized first. If the bunion doesn’t go away or causes extreme pain, surgery may be required. Surgeons will either remove part of the swollen tissue or bone to straighten the toe out.
If you have a bunion, it is recommended to see a podiatrist. The longer it is left untreated, the worse it may get. Podiatrists can properly diagnose and treat a bunion before it gets worse.
Gout, typically found in diabetic patients, is an unusually painful form of arthritis caused by elevated levels of uric acid in the bloodstream. The condition typically strikes the big joint on the big toe. It has also been known to strike the knees, elbows, fingers, ankles and wrists—generally anywhere that has a functioning, moving joint.
The high level of uric acid in a person’s bloodstream creates the condition known as hyperuricema—the main cause of gout. Genetic predisposition occurs in nine out of ten sufferers. The children of parents who suffer gout will have a two in ten chance of developing the condition as well.
This form of arthritis, being particularly painful, is the leftover uric acid crystallizing in the blood stream. The crystallized uric acid then travels to the space between joints where they rub, causing friction when the patient moves. Symptoms include: pain, redness, swelling, and inflammation. Additional side effects may include fatigue and fever, although reports of these effects are very rare. Some patients have reported that pain may intensify when the temperature drops, such as when you sleep.
Most cases of gout are easily diagnosed by a podiatrist’s assessment of the various symptoms. Defined tests can also be performed. A blood test to detect elevated levels of uric acid is often used as well as an x-ray to diagnose visible and chronic gout.
Treatment for gout simply means eliminating symptoms. Non-steroid anti-inflammatory drugs or NSAIDs (Colchicine and other corticosteroid drugs, etc.) will quell the redness, the swelling, and the inflammation. However, managing your diet, lifestyle changes, and using preventative drugs are all helpful toward fully combating the most severe cases.
Those that lead an inactive lifestyle are at a higher risk for gout. Any amount of exercise decreases the probability of repeat encounters with the condition. Reducing your consumption of red meat, sea food, and fructose-sweetened drinks also reduces the likelihood of chronic gout as well.
Ingesting Vitamin C, coffee, and particular dairy products can help with maintaining a healthy lifestyle. There are new drugs out on the market that inhibit the body’s production of uric acid-producing enzymes. However, reducing or eliminating your overall levels of uric acid is the best remedy to ensuring you lead a gout-free life.
Diabetics must be wary of all wounds, regardless of depth or size. Diabetes, a chronic disease in which the body cannot properly use glucose the way it normally would, causes various complications that make wounds difficult to heal. Nerve damage or neuropathy will cause diabetics to have trouble feeling the pain of a blister or cut until the condition has significantly worsened or become infected. A diabetic’s weakened immune system can make even the most minor of wounds easily susceptible to infection. Diabetics are also more prone to developing narrow, clogged arteries, and are therefore more likely to develop wounds.
Wounds should be taken care of immediately after discovery, as even the smallest of wounds can become infected if enough bacteria build up within the wound. To remove dirt, wounds should be first rinsed under running water only. Soap, hydrogen peroxide, or iodine can irritate the injury and should be avoided. To prevent infection, apply antibiotic ointment to the wound and cover it with a bandage. The bandage should be changed daily. The skin around the wound may be cleaned with soap.
To prevent further exacerbation, see a doctor—especially if you have diabetes. Minor skin conditions can become larger problems if not properly inspected. As the wound heals, make sure to avoid applying pressure to the affected area.
