Foot Health and Aging

Medicine and health awareness have progressed so rapidly since 1900 that life expectancy of the average American has increased by about 30 years. Older persons have become an increasingly significant proportion of our total population -- and their numbers are growing rapidly. In 1900, for example, there were three million Americans aged 65 or older. In the year 2000, older people outnumber children for the first time in history.

If older people are to live useful, satisfying lives, they must be able to move about. Mobility is a vital ingredient of the independence that is cherished by our aging population, and foot ailments make it difficult or impossible for them to work or to participate in social activities.

According to the US National Center for Health Statistics, impairment of the lower extremities is a leading cause of activity limitation in older people. As if foot problems weren't enough of a nuisance, they can also lead to knee, hip, and lower back pain that undermine mobility just as effectively. The NCHS says one-fourth of all nursing home patients cannot walk at all and another one-sixth can walk only with assistance.

Mirror of Health

The human foot has been called the "mirror of health." Foot doctors, or doctors of podiatric medicine (DPMs), are often the first doctors to see signs of such systemic conditions as diabetes, arthritis, and circulatory disease in the foot. Among these signs are dry skin, brittle nails, burning and tingling sensations, feelings of cold, numbness, and discoloration. Always seek professional care when these signs appear.

Foot Problems Can Be Prevented

For reasons that are difficult to fathom, many people, including a lot of older people, believe that it is normal for the feet to hurt, and simply resign themselves to enduring foot problems that could be treated.

There are more than 300 different foot ailments. Some can be traced to heredity, but for an aging population, most of these ailments stem from the cumulative effect of years of neglect or abuse. However, even among people in their retirement years, many foot problems can be treated successfully, and the pain of foot ailments relieved.

Whether due to neglect or abuse, the normal wear and tear of the years causes changes in feet. As persons age, their feet tend to spread, and lose the fatty pads that cushion the bottom of the feet. Additional weight can affect the bone and ligament structure. Older people, consequently, should have their feet measured for shoe sizes more frequently, rather than presuming that their shoe sizes remain constant. Dry skin and brittle nails are other conditions older people commonly face. Finally, it's a fact that women, young and old, have four times as many foot problems as men, and high heels are often the culprits.

Observing preventive foot health care has many benefits. Chief among them are that it can increase comfort, limit the possibility of additional medical problems, reduce the chances of hospitalization because of infection, and lessen requirements for other institutional care.

Keep Them Walking

Studies show that care for a bedridden patient costs much more than care for an ambulatory patient. In their private practices and in foot clinics, podiatric physicians are providing services designed to keep older people on their feet, and they serve in hospitals and nursing homes across the country.

Records indicate that amputations and other forms of surgery due to infections of the feet, many brought about by diabetes, have been significantly reduced in recent years because of early diagnosis and treatment. Further reduction in this area is a goal of Healthy People 2010, a US Department of Health and Human Services campaign endorsed by podiatric physicians, to encourage understanding and application of preventive medical practices.

Foot Health Tips
  • Properly fitted shoes are essential; an astonishing number of people wear shoes that don't fit right, and cause serious foot problems.
  • A shoe with a firm sole and soft upper is best for daily activities.
  • Shop for shoes in the afternoon; feet tend to swell during the day.
  • Walking is the best exercise for your feet.
  • Pantyhose or stockings should be of the correct size and preferably free of seams.
  • Do not wear constricting garters or tie your stockings in knots.
  • Never cut corns and calluses with a razor, pocket knife, or other such instrument; use over-the-counter foot products only with the advice of a podiatrist.
  • Bathe your feet daily in lukewarm (not hot) water, using a mild soap, preferably one containing moisturizers, or use a moisturizer separately. Test the water temperature with your hand.
  • Trim or file your toenails straight across.
  • Inspect your feet every day or have someone do this for you. If you notice any redness, swelling, cracks in the skin, or sores, consult your podiatrist.
  • Have your feet examined by a DPM at least twice a year.

Ankle Sprains

What is it?

An ankle sprain is an injury (a stressing, pulling or tearing) of the ligaments supporting the ankle. Most ankle sprains affect the outside of the ankle, where three small ligaments act together to support the joint. The foot will turn inward at the ankle, in what is called an inversion sprain. Afterward, the joint may feel sore, unstable or both.

A patient who has sustained an ankle sprain will feel pain, but the degree to which they feel this pain can vary widely. A minor sprain may cause a few twinges at the time of impact and possibly some minor swelling, while others may feel a crippling pain and see pronounced swelling, and may also find the foot unable to bear weight altogether. It all depends upon the damage done to the ligament (and of course, upon the individual's threshold of pain). In no case, however, should a sprain be ignored. Left untreated, a sprain can cause weakness in the joint that can - and often will - lead to re-injury of that joint, or worse yet - to a particularly harmful fall.

Sprained ankles are a common injury in both athletes and sedentary persons. For every tennis player, runner or aerobics dancer that feels the unexpected and painful roll when they are out exercising, there's a less active individual whose ankle unexpectedly twists under them while they are going down the steps to retrieve mail from the mailbox, or while walking out to their car.

What to look for:

First, think about the moment you injured your ankle. Try to identify a time when joint became unsteady or unstable, and the ankle seemed to twist sideways, possibly causing your leg to buckle. If you can remember an incident like that, chances are you have joined the legions of sprain patients.

Next, check the joint itself. Are you seeing swelling? If you're not sure, check the joint by comparing it to the one on the opposite leg. Does one look larger, or redder? If you rotate the foot, do you feel any degree of pain in the ankle? If you do, and/or if walking is suddenly difficult, with the ankle feeling as though it might twist again any second, suspect a sprain.

Note that we say SUSPECT a sprain. A podiatric physician should examine the injury and render a diagnosis. Remember that other injuries, such as fractures and stress fractures may cause pain and weakness in a bone or in a joint. And to the layperson, the injuries may look and/or feel identical. A doctor can confirm your injury and rule out other possibilities. In some cases, an x-ray may be used to ascertain that there are no broken bones since some sprains can hurt as much as, or worse, than broken bones, depending upon the severity and location of the break. (The technical term for injuries that do not involve bone breaks is "soft tissue damage." It sounds mild but don't be fooled - it can be painful, serious, and have long-reaching consequences if not tended properly).

What NOT to believe:

Common misconceptions concerning sprains are that in the case of a sprain, the patient has not suffered a "real" injury, since there are no broken bones. Nothing could be further from the truth. A sprain can be not only terribly painful, but seriously disabling. What's worse, the insistence that a sprain is not a serious injury can lead to the patient simply waiting for it to "go away on its own." It won't. Repeated use of a sprained ankle will only weaken the joint, making it ever more unstable. The patient runs the risk of long-term damage to the joint by allowing the ligaments to become even more weakened, stretched or torn - and worse, he or she runs the risk of tripping and falling, which can result in actual broken bones.

The other common misconception is "no pain, no gain," suggesting that continuing to use an injured ankle will cause it to "toughen up." No such luck. The only thing that re-use can result in is re-injury.

How can I know it's a sprained ankle?

Unfortunately, you can't know, at least not without professional assistance. A podiatric physician will need to examine you and make a determination after having an x-ray, or even an M.R.I. or C.A.T. scan performed. Any number of problems, such as fractures (although there are many, many others) can cause localized pain and/or swelling that worsens over time and makes walking painful or even impossible. A doctor will be glad to examine your ankle and rule out other problems.

What it means to you:

While a sprained ankle is not a life-threatening condition, it certainly is a problem that deserves medical attention. A podiatric physician can evaluate the symptoms and recommend a course of treatment. As with just about every other medical problem, the best way to rid yourself of a sprain once and for all is to get treatment for it as soon as possible.

What causes it?

Hyperextension, or hyperflexion of the joint, which stretches those all-important ligaments, sometimes tearing them. This takes place when the ankle rolls, stretching the ligaments beyond the limits they were designed to accommodate. It can happen during any level of activity, although many report that it takes place when they are on uneven ground, such as grass with soft spots or holes, rocky areas, on sandy surfaces or where the ground is slippery for any reason. Often, the unexpected movement of the foot as it slips or slides on these surfaces will twist the ankle. A person might also fall, and twist their ankle under them as they land.

What cures it?

The course of action chosen by your doctor will depend upon the severity of the sprain. If the sprain is minor, the doctor may prescribe rest, and will ask the patient to refrain from weight-bearing activities. Crutches are often the best option to insure that the joint is rested so it can heal.

Some sprains will require immobilizing and stabilizing the area. Ankle braces, air casts and compression bandages are often employed, depending upon the severity of the injury, and upon the patient's lifestyle and preferences.

A formula to remember for treatment and care of sprains is RICE:

R = REST: Stop walking, running, dancing - whatever - on that injured leg. Crutches will work best to hold it off the ground and to keep all weight off it.

I = ICE: Apply an ice bag or an ice wrap to the affected area to keep the swelling down. Each doctor has a different theory on how often to apply ice. Some recommend 20 minutes of ice followed by 20 minutes without. Others might say for 30 minutes every two hours. Still others might have different ideas. Find out what your podiatric physician recommends. Your local pharmacy or medical supply store may have strap-on ice wraps that will relieve you of having to hold a bag in place constantly. (Note: Other physicians prefer to alternate ice and heat; ask your doctor what she/he recommends)

C = COMPRESSION: Compression bandages, such as an Ace bandage, will provide support and stability to the joint and keep swelling down. Air casts and ankle braces might be used in addition to, or instead of, a compression bandage, depending upon your podiatric physician's recommendation.

E = ELEVATION: Keep the affected leg propped up, so that it does not hang lower than the level of your heart. If you are working at a desk, bring a chair and a few pillows over, and prop the foot up on those. This will discourage swelling and increase circulation to the area. This in turn will make the injury less painful.

Your doctor will be best able to recommend a treatment method based on your specific condition; listen to his/her recommendations, and do not be afraid to ask for a second opinion if you are concerned. Remember that pain and instability in the ankle can be caused by many things, and that it's best to receive a definitive diagnosis from your podiatric physician before proceeding with any course of treatment. The longer you wait, the longer it will take the injury to heal, and the more likely you are to re-injure yourself, or to worsen an existing injury.

Never try to self-diagnose or self-treat a suspected sprain; always have it diagnosed by a professional.

One note of caution: It's natural to want to get back to your normal activities as soon as possible. Sprains will become less painful relatively quickly, as long as the patient is resting the injured area. Many people, upon discovering that their pain isn't as severe when they stand or walk, will immediately want to do just that. Remember that as long as you can feel pain - any pain at all - the ligaments are still fragile in that area, and are susceptible to re-injury. Keep on using the RICE, the crutches, the soft cast, or any other measure prescribed by your doctor, as long as he or she directs. You won't heal a sprain by adding to the stress on the joint.

How can sprains be prevented?

If your foot has a tendency toward instability (some athletes, for example, over-pronate, or have excessive foot movement in their normal stride), ask your doctor about preventive treatments for sprain. There are several helpful products on the market, including ankle braces, which can be worn to stabilize the joint during periods of activity (this can mean when you exercise, or it can mean times when you are standing, walking, shopping or doing other activities where you are on your feet for a while.) The brace may be hard plastic, with a hinge so that you can move comfortably and remain active despite its presence, or it may be a compression bandage that provides light support. Some patients find that orthoses or motion-control shoes are all they need in order to stay injury-free. Your doctor and you can work together to arrive at a solution that works best for you.

You may decide that walking or running on specific surfaces, such as uneven trails, or wet or slippery areas, make you more prone to ankle injuries. Your doctor may be able to recommend specific footgear, or he/she might even advise you to cut back on the time spent on such surfaces, in order to reduce the possibility of injury.

Do these symptoms always mean a sprain?

No - as mentioned before, multiple problems, including, but not limited to, injuries caused by improper footwear, stress or traditional fractures, and many other conditions (some very serious) can cause pain in varying degrees of severity. Therefore, it's essential to get a professional's diagnosis of the problem. A delay in getting the correct treatment - not to mention the additional trauma you have inflicted on the damaged area in the meantime - can mean the difference between a simple sprain that heals properly and one that results in a long-term disability.

Ankle Fractures

An ankle fracture is a break of one or more of the bones that make up the ankle.

The ankle is a hinge type joint that connects the leg to the foot. It consists of one large bone (tibia), one small bone (fibula), and one square shaped bone (talus). These bones fit together snugly and are supported by strong ligaments.

Ankle fractures result when the ankle is forced inward or outward past its normal range of motion. Fractures result from the same causes as sprains. This can occur when a jumping or running athlete lands on an uneven surface. It may also occur when the foot is firmly planted and the body gets twisted. Equipment and surface conditions may also play a role. Sports most commonly associated with ankle fractures include: Basketball, Football, Baseball and Soccer.

The diagnosis of an ankle fracture is considered when a patient gives a history of "turning" or "rolling" his or her ankle accompanied by sudden pain and swelling. The physical exam will reveal tenderness over the involved bones. Deformity and at times severe swelling of the ankle may be present. X-rays are needed to confirm the fracture and plan for treatment. Occasionally, a CT or MRI is ordered to evaluate the cartilage or tendons around the ankle.

Nonoperative: Less severe ankle fractures can be treated by nonoperative means. Typically, a cast or splint is used to stabilize the ankle for several weeks. After the period of immobilization a course of physical therapy to strengthen the muscles around the ankle is needed to complete the recovery process.

Operative: Surgery is often needed to stabilize ankle fractures. Usually, the surgery involves the placement of screws and plates. The patient then is placed in a cast or splint after surgery for a variable period of time depending on the severity of the fracture. Weight bearing may be delayed until there is evidence of early fracture healing. This may take 4-8 weeks depending on the severity of the fracture.

Arthritis

What is Arthritis?

Arthritis, in general terms, is inflammation and swelling of the cartilage and lining of the joints, generally accompanied by an increase in the fluid in the joints. Arthritis has multiple causes; just as a sore throat may have its origin in a variety of diseases, so joint inflammation and arthritis are associated with many different illnesses.

Arthritis and the Feet

Arthritis is a frequent component of complex diseases that may involve more than 100 identifiable disorders. If the feet seem more susceptible to arthritis than other parts of the body, it is because each foot has 33 joints that can be afflicted, and there is no way to avoid the pain of the tremendous weight-bearing load on the feet.

Arthritis is a disabling and occasionally crippling disease; it afflicts almost 40 million Americans. In some forms, it appears to have hereditary tendencies. While the prevalence of arthritis increases with age, all people from infancy to middle age are potential victims. People over 50 are the primary targets.

Arthritic feet can result in loss of mobility and independence, but that may be avoided with early diagnosis and proper medical care.

Some Causes

Besides heredity, arthritic symptoms may arise in a number of ways:

  • Through injuries, notably in athletes and industrial workers, especially if the injuries have been ignored (which injuries of the feet tend to be).
  • Through bacterial and viral infections that strike the joints. The same organisms that are present in pneumonia, gonorrhea, staph infections, and Lyme disease cause the inflammations.
  • In conjunction with bowel disorders such as colitis and ileitis, frequently resulting in arthritic conditions in the joints of the ankles and toes. Such inflammatory bowel diseases seem distant from arthritis, but treating them can relieve arthritic pain.
  • Using drugs, both prescription drugs and illegal street drugs, can induce arthritis.
  • As part of a congenital autoimmune disease syndrome of undetermined origin. Recent research has suggested, for instance, that a defective gene may play a role in osteoarthritis.
Symptoms

Because arthritis can affect the structure and function of the feet it is important to see a doctor of podiatric medicine if any of the following symptoms occur in the feet:

  • Swelling in one or more joints
  • Recurring pain or tenderness in any joint
  • Redness or heat in a joint
  • Limitation in motion of joint
  • Early morning stiffness
  • Skin changes, including rashes and growths
Some Forms of Arthritis

Osteoarthritis is the most common form of arthritis. It is frequently called degenerative joint disease or "wear and tear" arthritis. Although it can be brought on suddenly by an injury, its onset is generally gradual; aging brings on a breakdown in cartilage, and pain gets progressively more severe, although it can be relieved with rest. Dull, throbbing nighttime pain is characteristic, and it may be accompanied by muscle weakness or deterioration. Walking may become erratic.

It is a particular problem for the feet when people are overweight, simply because there are so many joints in each foot. The additional weight contributes to the deterioration of cartilage and the development of bone spurs.

Rheumatoid arthritis (RA) is a major crippling disorder and perhaps the most serious form of arthritis. It is a complex, chronic inflammatory system of diseases, often affecting more than a dozen smaller joints during the course of the disease, frequently in a symmetrical pattern - both ankles, or the index fingers of both hands, for example. It is often accompanied by signs and symptoms - lengthy morning stiffness, fatigue, and weight loss - and it may affect various systems of the body, such as the eyes, lungs, heart, and nervous system. Women are three or four times more likely than men to suffer RA.

RA has a much more acute onset than osteoarthritis. It is characterized by alternating periods of remission, during which symptoms disappear, and exacerbation, marked by the return of inflammation, stiffness, and pain. Serious joint deformity and loss of motion frequently result from acute rheumatoid arthritis. However, the disease system has been known to be active for months, or years, then abate, sometimes permanently.

Gout (gouty arthritis) is a condition caused by a buildup of the salts of uric acid - a normal byproduct of the diet - in the joints. A single big toe joint is commonly the affected area, possibly because it is subject to so much pressure in walking; attacks of gouty arthritis are extremely painful, perhaps more so than any other form of arthritis. Men are much more likely to be afflicted than women, an indication that heredity may play a role in the disease. While a rich diet that contains lots of red meat, rich sauces, shellfish, and brandy is popularly associated with gout, there are other protein compounds in foods such as lentils and beans that may play a role.

Diagnosis

Different forms of arthritis affect the body in different ways; many have distinct systemic affects that are not common to other forms. Early diagnosis is important to effective treatment of any form. Destruction of cartilage is not reversible, and if the inflammation of arthritic disease isn't treated, both cartilage and bone can be damaged, which makes the joints increasingly difficult to move. Most forms of arthritis cannot be cured but can be controlled or brought into remission; perhaps only five percent of the most serious cases, usually of rheumatoid arthritis, result in such severe crippling that walking aids or wheelchairs are required.

Treatment

The objectives in the treatment of arthritis are controlling inflammation, preserving joint function (or restoring it if it has been lost), and curing the disease if that is possible.

Because the foot is such a frequent target, the doctor of podiatric medicine is often the first physician to encounter some of the complaints - inflammation, pain, stiffness, excessive warmth, injuries. Even bunions can be manifestations of arthritis.

Arthritis may be treated in many ways. Patient education is important. Physical therapy and exercise may be indicated, accompanied by medication. In such a complex disease system, it is no wonder that a wide variety of drugs have been used effectively to treat it; likewise, a given treatment may be very effective in one patient and almost no help at all to another. Aspirin is still the first-line drug of choice for most forms of arthritis and the benchmark against which other therapies are measured.

The control of foot functions with shoe inserts called orthoses, or with braces or specially prescribed shoes, may be recommended. Surgical intervention is a last resort in arthritis, as it is with most disease conditions; the replacement of damaged joints with artificial joints is a possible surgical procedure.

Athletes Foot

What is Athlete's foot?

Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes.

The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth.

The warmth and dampness of areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi. Because the infection was common among athletes who used these facilities frequently, the term "athlete's foot" became popular.

Not all fungus conditions are athlete's foot. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete's foot.

Symptoms

The signs of athlete's foot, singly or combined, are dry skin, itching, scaling, inflammation, and blisters. Blisters often lead to cracking of the skin. When blisters break, small raw areas of tissue are exposed, causing pain and swelling. Itching and burning may increase as the infection spreads.

Athlete's foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere. The organisms causing athlete's foot may persist for long periods. Consequently, the infection may be spread by contaminated bed sheets or clothing to other parts of the body.

Prevention

It is not easy to prevent athlete's foot because it is usually contracted in dressing rooms, showers, and swimming pool locker rooms where bare feet come in contact with the fungus. However, you can do much to prevent infection by practicing good foot hygiene. Daily washing of the feet with soap and water; drying carefully, especially between the toes; and changing shoes and hose regularly to decrease moisture, help prevent the fungus from infecting the feet. Also helpful is daily use of a quality foot powder.

Tips
  • Avoid walking barefoot; use shower shoes.
  • Reduce perspiration by using talcum powder.
  • Wear light and airy shoes.
  • Wear socks that keep your feet dry, and change them frequently if you perspire heavily.
Treatment

Fungicidal and fungistatic chemicals, used for athlete's foot treatment, frequently fail to contact the fungi in the horny layers of the skin. Topical or oral antifungal drugs are prescribed with growing frequency.

In mild cases of the infection it is important to keep the feet dry by dusting foot powder in shoes and hose. The feet should be bathed frequently and all areas around the toes dried thoroughly.

Consult Your Podiatrist

If an apparent fungus condition does not respond to proper foot hygiene and self care, and there is no improvement within two weeks, consult your podiatrist. The podiatrist will determine if a fungus is the cause of the problem. If it is, a specific treatment plan, including the prescription of antifungal medication, applied topically or taken by mouth, will usually be suggested. Such a treatment appears to provide better resolution of the problem, when the patient observes the course of treatment prescribed by the podiatrist; if it's shortened, failure of the treatment is common.

If the infection is caused by bacteria, antibiotics, such as penicillin, that are effective against a broad spectrum of bacteria may be prescribed.

Bunions

What Is a Bunion?

A bunion is an enlargement of the joint at the base of the big toe - the metatarsophalangeal (MTP) joint - that forms when the bone or tissue at the big toe joint moves out of place. This forces the toe to bend toward the others, causing an often painful lump of bone on the foot. Since this joint carries a lot of the body's weight while walking, bunions can cause extreme pain if left untreated. The MTP joint itself may become stiff and sore, making even the wearing of shoes difficult or impossible. A bunion - from the Latin "bunio," meaning enlargement - can also occur on the outside of the foot along the little toe, where it is called a "bunionette" or "tailor's bunion."

Symptoms
  • Development of a firm bump on the outside edge of the foot, at the base of the big toe.
  • Redness, swelling, or pain at or near the MTP joint.
  • Corns or other irritations caused by the overlap of the first and second toes.
  • Restricted or painful motion of the big toe.
How Do You Get a Bunion?

Bunions form when the normal balance of forces that is exerted on the joints and tendons of the foot becomes disrupted. This can lead to instability in the joint and cause the deformity. They are brought about by years of abnormal motion and pressure over the MTP joint. They are, therefore, a symptom of faulty foot development and are usually caused by the way we walk, and our inherited foot type, our shoes, or other sources.

Although bunions tend to run in families, it is the foot type that is passed down - not the bunion. Parents who suffer from poor foot mechanics can pass their problematic foot type on to their children, who in turn are prone to developing bunions. The abnormal functioning caused by this faulty foot development can lead to pressure being exerted on and within the foot, often resulting in bone and joint deformities such as bunions and hammertoes.

Other causes of bunions are foot injuries, neuromuscular disorders, or congenital deformities. People who suffer from flat feet or low arches are also prone to developing these problems, as are arthritic patients and those with inflammatory joint disease. Occupations that place undue stress on the feet are also a factor; ballet dancers, for instance, often develop the condition.

Wearing shoes that are too tight or cause the toes to be squeezed together is also a common factor, one that explains the high prevalence of the disorder among women.

What Can You Do For Relief?
  • Apply a commercial, nonmedicated bunion pad around the bony prominence.
  • Wear shoes with a wide and deep toe box.
  • If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
  • Avoid high-heeled shoes over two inches tall.
  • See your podiatric physician if pain persists.
Conservative Treatment For Bunion Pain

Treatment options vary with the type and severity of each bunion, although identifying the deformity early in its development is important in avoiding surgery. Podiatric medical attention should be sought at the first indication of pain or discomfort because, left untreated, bunions tend to get larger and more painful, making nonsurgical treatment less of an option.

The primary goal of most early treatment options is to relieve pressure on the bunion and halt the progression of the joint deformity. A podiatric physician may recommend these treatments:

Padding & Taping

Often the first step in a treatment plan, padding the bunion minimizes pain and allows the patient to continue a normal, active life. Taping helps keep the foot in a normal position, thus reducing stress and pain.

Medication

Anti-inflammatory drugs and cortisone injections are often prescribed to ease the acute pain and inflammations caused by joint deformities.

Physical Therapy

Often used to provide relief of the inflammation and from bunion pain. Ultrasound therapy is a popular technique for treating bunions and their associated soft tissue involvement.

Orthotics

Shoe inserts may be useful in controlling foot function and may reduce symptoms and prevent worsening of the deformity.

Surgical Options

When early treatments fail or the bunion progresses past the threshold for such options, podiatric surgery may become necessary to relieve pressure and repair the toe joint. Several surgical procedures are available to the podiatric physician. The surgery will remove the bony enlargement, restore the normal alignment of the toe joint, and relieve pain.

A simple bunionectomy, in which only the bony prominence is removed, may be used for the less severe deformity. Severe bunions may require a more involved procedure, which includes cutting the bone and realigning the joint.

Recuperation takes time, and swelling and some discomfort are common for several weeks following surgery. Pain, however, is easily managed with medications prescribed by your podiatric physician.

Bunion Tips
  • Wear comfortable shoes that conform to the shape of your foot.
  • Wear shoes with a wide and deep toe box.
  • Always fit the larger foot and have your feet sized each time you purchase shoes.
  • Apply a commercial, nonmedicated bunion pad around the bony prominence.
  • If your bunion becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
  • Avoid high-heeled shoes over two inches tall.
  • Seek professional podiatric evaluation and assistance with uncomfortable or noticeable bunions.

Diabetes

Diabetes: Startling Statistics

Diabetes mellitus is a chronic disease that affects the lives of nearly 24 million people in the United States, nearly 6 million of whom are unaware that they even have the disease. In 2007 alone, 1.6 million new cases of diabetes were diagnosed in people aged 20 years or older. The disease is marked by the inability to manufacture or properly use insulin and impairs the body's ability to convert sugars, starches and other foods into energy.The long-term effects of elevated blood sugar (hyperglycemia) are damage to the eyes, heart, feet, kidneys, nerves and blood vessels.

Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow-to-heal wounds and susceptibility to certain infections. People who have any of these symptoms and have not been tested for diabetes are putting themselves at considerable risk and should see a physician without delay.

Part of keeping your diabetes in control is testing your blood sugar often. Ask your doctor how often you should test and what your blood sugar levels should be. Testing your blood and then treating high blood sugar early will help you to prevent complications.

The socioeconomic costs of diabetes are enormous. In 2007, the total annual economic cost of diabetes was estimated at $174 billion - about $116 billion of which are direct costs from the disease with $58 billion indirectly related. Diabetes is the sixth leading cause of death by disease in the United States, and individuals with diabetes are two to four times as likely to experience heart disease and stroke.

The growth of the disease worldwide is especially alarming. The World Health Organization (WHO) expects the number of new diabetes cases to double in the next 25 years from 135 million to nearly 300 million. Much of this growth will occur in developing countries where aging, unhealthy diets, obesity, and sedentary lifestyles will contribute to the onset of the disease.

According to a recent survey, about 86,000 lower limbs are amputated annually due to complications from diabetes. Diabetes is the leading cause of end-stage kidney disease, accounting for about 44 percent of new cases. Diabetes is also the leading cause of new cases of blindness among adults aged 20 to 74.

While there is no cure for diabetes, there is hope. With a proper diet, exercise, medical care and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.

How Do You Get Diabetes?

No one knows why people develop diabetes, but once diagnosed, the disease is present for life. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing diabetes. Type 1, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, afflicts five to ten percent of diagnosed cases of diabetes. This type occurs most frequently in children and adolescents, and is caused by the inability of the pancreas to produce the insulin needed for survival. Type 2, previously called noninsulin-dependent diabetes mellitus or adult-onset diabetes, affects the other 90-95 percent of all diagnosed cases of diabetes, many of whom use oral medication or injectable insulin to control the disease. The vast majority of those people (80 percent or more) are overweight; many of them obese, as obesity itself can cause insulin resistance.

Certain characteristics put people at a higher risk for developing Type 2 diabetes. These include:

  • A family history of the disease
  • Obesity
  • Prior history of developing diabetes while pregnant
  • Being over the age of 40
  • Being a member of one of the following ethnic groups: African American, Native American, Latino American, Asian American, Pacific Islander

African Americans are 1.7 times more likely to have diabetes than the general population, with 25 percent of African Americans between the ages of 65 and 74 diagnosed with the disease. Hispanic Americans are almost twice as likely to develop type 2 diabetes, which affects 10.6 percent of that population group. Native Americans are at a significantly increased risk for developing diabetes, and 12.2 percent of the population suffers from the disease. In some tribes, as many as 50 percent of its members have diabetes.

Of all the risk factors, weight is the most important, with more than 80 percent of diabetes sufferers classified as overweight.

The Role of Your Podiatric Physician

Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The podiatric physician, as an integral part of the treatment team, has documented success in the prevention of amputations. The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, at least annually, from a podiatric physician.

In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician or podiatrist. They include:

  • Skin color changes
  • Elevation in skin temperature
  • Swelling of the foot or ankle
  • Pain in the legs
  • Open sores on the feet that are slow to heal
  • Ingrown and fungal toenails
  • Bleeding corns and calluses
  • Dry cracks in the skin, especially around the heel
Wound Healing

Ulceration is a common occurrence with the diabetic foot and should be carefully treated and monitored by a podiatrist to avoid amputations. Poorly fitted shoes, or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose skin sensation is diminished. Left unattended, such ulcers can quickly become infected and lead to more serious consequences. Your podiatric physician knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable products that have the appearance and handling characteristics of human skin. These living, skin-like products are applied to wounds that are properly prepared by the podiatric physician. Clinical trials have shown impressive success rates.

If You Have Diabetes Already . . . Do:

Wash feet daily.

Using mild soap and lukewarm water, wash your feet in the mornings or before bed each evening. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder to wick away moisture. If the skin is dry, use a good moisturizing cream daily but avoid getting it between the toes.

Inspect feet and toes daily.

Check your feet every day for cuts, bruises, sores or changes to the toenails, such as thickening or discoloration. If age or other factors hamper self-inspection, ask someone to help you, or use a mirror.

Lose weight.

People with diabetes are commonly overweight, which nearly doubles the risk of complications.

Wear thick, soft socks.

Socks made of an acrylic blend are well suited but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.

Stop smoking.

Tobacco can contribute to circulatory problems, which can be especially troublesome in patients with diabetes.

Cut toenails straight across.

Never cut into the corners, or taper, which could trigger an ingrown toenail. Use an emery board to gently file away sharp corners or snags. If your nails are hard to trim, ask your podiatric physician for assistance.

Exercise.

As a means to keep weight down and improve circulation, walking is one of the best all-around exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear appropriate athletic shoes when exercising. Ask your podiatric physician what’s best for you.

See your podiatric physician.

Regular checkups by your podiatric physician—at least annually—are the best way to ensure that your feet remain healthy.

Be properly measured and fitted every time you buy new shoes.

Shoes are of supreme importance to diabetes sufferers because poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.

New shoes should be comfortable at the time they’re purchased and should not require a "break-in" period, though it’s a good idea to wear them for short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leave room for toes to wiggle freely, and be cushioned and sturdy.

Don’t go barefoot.

Not even in your own home. Barefoot walking outside is particularly dangerous because of the possibility of cuts, falls, and infection. When at home, wear slippers. Never go barefoot.

Don’t wear high heels, sandals, and shoes with pointed toes.

These types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open-toed shoes and sandals with straps between the first two toes should also be avoided.

Don’t drink in excess.

Alcohol can contribute to neuropathy (nerve damage) which is one of the consequences of diabetes. Drinking can speed up the damage associated with the disease, deaden more nerves, and increase the possibility of overlooking a seemingly minor cut or injury.

Don’t wear anything that is too tight around the legs.

Pantyhose, panty girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet, as can men’s dress socks if the elastic is too tight.

Never try to remove calluses, corns, or warts by yourself.

Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your podiatric physician for assistance in these cases.

Diabetes

Diabetes: Startling Statistics

Diabetes mellitus is a chronic disease that affects the lives of nearly 24 million people in the United States, nearly 6 million of whom are unaware that they even have the disease. In 2007 alone, 1.6 million new cases of diabetes were diagnosed in people aged 20 years or older. The disease is marked by the inability to manufacture or properly use insulin and impairs the body's ability to convert sugars, starches and other foods into energy.The long-term effects of elevated blood sugar (hyperglycemia) are damage to the eyes, heart, feet, kidneys, nerves and blood vessels.

Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow-to-heal wounds and susceptibility to certain infections. People who have any of these symptoms and have not been tested for diabetes are putting themselves at considerable risk and should see a physician without delay.

Part of keeping your diabetes in control is testing your blood sugar often. Ask your doctor how often you should test and what your blood sugar levels should be. Testing your blood and then treating high blood sugar early will help you to prevent complications.

The socioeconomic costs of diabetes are enormous. In 2007, the total annual economic cost of diabetes was estimated at $174 billion - about $116 billion of which are direct costs from the disease with $58 billion indirectly related. Diabetes is the sixth leading cause of death by disease in the United States, and individuals with diabetes are two to four times as likely to experience heart disease and stroke.

The growth of the disease worldwide is especially alarming. The World Health Organization (WHO) expects the number of new diabetes cases to double in the next 25 years from 135 million to nearly 300 million. Much of this growth will occur in developing countries where aging, unhealthy diets, obesity, and sedentary lifestyles will contribute to the onset of the disease.

According to a recent survey, about 86,000 lower limbs are amputated annually due to complications from diabetes. Diabetes is the leading cause of end-stage kidney disease, accounting for about 44 percent of new cases. Diabetes is also the leading cause of new cases of blindness among adults aged 20 to 74.

While there is no cure for diabetes, there is hope. With a proper diet, exercise, medical care and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.

How Do You Get Diabetes?

No one knows why people develop diabetes, but once diagnosed, the disease is present for life. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing diabetes. Type 1, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, afflicts five to ten percent of diagnosed cases of diabetes. This type occurs most frequently in children and adolescents, and is caused by the inability of the pancreas to produce the insulin needed for survival. Type 2, previously called noninsulin-dependent diabetes mellitus or adult-onset diabetes, affects the other 90-95 percent of all diagnosed cases of diabetes, many of whom use oral medication or injectable insulin to control the disease. The vast majority of those people (80 percent or more) are overweight; many of them obese, as obesity itself can cause insulin resistance.

Certain characteristics put people at a higher risk for developing Type 2 diabetes. These include:

  • A family history of the disease
  • Obesity
  • Prior history of developing diabetes while pregnant
  • Being over the age of 40
  • Being a member of one of the following ethnic groups: African American, Native American, Latino American, Asian American, Pacific Islander

African Americans are 1.7 times more likely to have diabetes than the general population, with 25 percent of African Americans between the ages of 65 and 74 diagnosed with the disease. Hispanic Americans are almost twice as likely to develop type 2 diabetes, which affects 10.6 percent of that population group. Native Americans are at a significantly increased risk for developing diabetes, and 12.2 percent of the population suffers from the disease. In some tribes, as many as 50 percent of its members have diabetes.

Of all the risk factors, weight is the most important, with more than 80 percent of diabetes sufferers classified as overweight.

The Role of Your Podiatric Physician

Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The podiatric physician, as an integral part of the treatment team, has documented success in the prevention of amputations. The key to amputation prevention in diabetic patients is early recognition and regular foot screenings, at least annually, from a podiatric physician.

In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician or podiatrist. They include:

  • Skin color changes
  • Elevation in skin temperature
  • Swelling of the foot or ankle
  • Pain in the legs
  • Open sores on the feet that are slow to heal
  • Ingrown and fungal toenails
  • Bleeding corns and calluses
  • Dry cracks in the skin, especially around the heel
Wound Healing

Ulceration is a common occurrence with the diabetic foot and should be carefully treated and monitored by a podiatrist to avoid amputations. Poorly fitted shoes, or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose skin sensation is diminished. Left unattended, such ulcers can quickly become infected and lead to more serious consequences. Your podiatric physician knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable products that have the appearance and handling characteristics of human skin. These living, skin-like products are applied to wounds that are properly prepared by the podiatric physician. Clinical trials have shown impressive success rates.

If You Have Diabetes Already . . . Do:

Wash feet daily.

Using mild soap and lukewarm water, wash your feet in the mornings or before bed each evening. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder to wick away moisture. If the skin is dry, use a good moisturizing cream daily but avoid getting it between the toes.

Inspect feet and toes daily.

Check your feet every day for cuts, bruises, sores or changes to the toenails, such as thickening or discoloration. If age or other factors hamper self-inspection, ask someone to help you, or use a mirror.

Lose weight.

People with diabetes are commonly overweight, which nearly doubles the risk of complications.

Wear thick, soft socks.

Socks made of an acrylic blend are well suited but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.

Stop smoking.

Tobacco can contribute to circulatory problems, which can be especially troublesome in patients with diabetes.

Cut toenails straight across.

Never cut into the corners, or taper, which could trigger an ingrown toenail. Use an emery board to gently file away sharp corners or snags. If your nails are hard to trim, ask your podiatric physician for assistance.

Exercise.

As a means to keep weight down and improve circulation, walking is one of the best all - around exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear appropriate athletic shoes when exercising. Ask your podiatric physician what's best for you.

See your podiatric physician.

Regular checkups by your podiatric physician- at least annually- are the best way to ensure that your feet remain healthy.

Be properly measured and fitted every time you buy new shoes.

Shoes are of supreme importance to diabetes sufferers because poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.

New shoes should be comfortable at the time they're purchased and should not require a "break-in" period, though it's a good idea to wear them for short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leave room for toes to wiggle freely, and be cushioned and sturdy.

Don't go barefoot.

Not even in your own home. Barefoot walking outside is particularly dangerous because of the possibility of cuts, falls, and infection. When at home, wear slippers. Never go barefoot.

Don't wear high heels, sandals, and shoes with pointed toes.

These types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open-toed shoes and sandals with straps between the first two toes should also be avoided.

Don't drink in excess.

Alcohol can contribute to neuropathy (nerve damage) which is one of the consequences of diabetes. Drinking can speed up the damage associated with the disease, deaden more nerves, and increase the possibility of overlooking a seemingly minor cut or injury.

Don't wear anything that is too tight around the legs.

Pantyhose, panty girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet, as can men's dress socks if the elastic is too tight.

Never try to remove calluses, corns, or warts by yourself.

Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your podiatric physician for assistance in these cases.

Diabetic Complications and Amputation Prevention

People with diabetes are prone to many foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor blood circulation. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection.

When you have diabetes, you need to be aware of how foot problems can arise from disturbances in the skin, nails, nerves, bones, muscles, and blood vessels. Furthermore, in diabetes, small foot problems can turn into serious complications. You can do much to prevent amputation by taking two important steps: Follow the proactive measures discussed below-and see your foot and ankle surgeon regularly.

Diabetes-Related Foot and Leg Problems

Having diabetes puts you at risk for developing a wide range of foot problems:

  • Infections and ulcers (sores) that don't heal. Because of poor circulation in the feet, cuts or blisters can easily turn into ulcers that become infected and won't heal. This is a common and serious complication of diabetes and can lead to a loss of your foot, your leg, or your life. An ulcer is a sore in the skin that may go all the way to the bone.
  • Corns and calluses. When neuropathy is present, you can't tell if your shoes are causing pressure and producing corns or calluses. Corns and calluses must be properly treated or they can develop into ulcers.
  • Dry, cracked skin. Poor circulation can make your skin dry. This may seem harmless, but dry skin can result in cracks that may become sores.
  • Nail disorders. Ingrown toenails (which curve into the skin on the sides of the nail) and fungal infections can go unnoticed because of loss of feeling. If they're not professionally treated, they can lead to ulcers.
  • Hammertoes and bunions. Motor neuropathy (nerve damage affecting muscles) can cause muscle weakness and loss of tone in the feet, resulting in hammertoes and bunions. If left untreated, these deformities can cause ulcers.
  • Brittle bones. Neuropathy and circulation changes may lead to brittle bones (osteoporosis). This makes you susceptible to breaking a bone, even without a major blow or injury occurring.
  • Charcot foot. This is a complex foot deformity. It develops as a result of loss of sensation and an undetected broken bone that leads to destruction of the soft tissue of the foot. Because of neuropathy, the pain of the fracture goes unnoticed and the patient continues to walk on the broken bone, making it worse. This disabling complication is so severe that amputation may become necessary.
  • Blocked artery in the calf. In diabetes, the blood vessels below the knee often become narrow and restrict blood flow. A severely blocked artery is a serious condition that may require intervention from a vascular surgeon. If vascular surgery fails and the wound does not heal, amputation may be necessary.
What Your Foot and Ankle Surgeon Can Do

A major goal of the foot and ankle surgeon is to prevent amputation. There are many new surgical techniques available to save feet and legs, including joint reconstruction and wound healing technologies. Getting regular foot checkups and seeking immediate help when you notice something can keep small problems from worsening. Your foot and ankle surgeon works together with other health care providers to prevent and treat complications from diabetes.

When is Amputation Necessary?

The goals of treatment of diabetic foot problems are not only to save the life and limb, but also to get the patient healed and moving about as soon as possible. If vascular surgery cannot improve blood flow and podiatric surgery cannot restore function, amputation may be the only solution that gets the patient walking again. Amputation may involve one or two toes, part of the foot, or part of the leg. It is selected on the basis of the patient's condition and level of predicted healing. A return to normal life is especially possible today because of advances in prosthetics.

Your Proactive Measures

You play a vital role in reducing complications. Follow these guidelines and contact your foot and ankle surgeon if you notice any problems:

  • Inspect your feet daily. Skin or nail problems-Look for cuts, scrapes, redness, drainage, swelling, bad odor, rash, discoloration, loss of hair on toes, injuries, or nail changes (deformed, striped, yellowed or discolored, thickened, or not growing). Signs of fracture-If your foot is swollen, red, hot, or has changed in size, shape, or direction, see your foot and ankle surgeon immediately. (If your eyesight is poor, have someone else do it for you.)
  • Observe for changes in circulation. Pay attention to the color of your toes. If they turn red, pink, or purplish when your legs hang down while sitting, poor circulation may be a problem.
  • Don't ignore leg pain. Pain in the leg that occurs at night or with a little activity could mean you have a blocked artery. Seek care immediately.
  • Nail cutting. If you have any nail problems, hard nails, or reduced feeling in your feet, your toenails should be trimmed professionally.
  • No bathroom surgery. Never trim calluses or corns yourself, and don't use over-the-counter medicated pads.
  • Keep floors free of sharp objects. Make sure there are no needles, insulin syringes, or other sharp objects on the floor.
  • Don't go barefoot. Wear shoes, indoors and outdoors.
  • Check shoes and socks. Shake out your shoes before putting them on. Make sure your socks aren't bunched up.
  • Have your sense of feeling tested. Your foot and ankle surgeon will perform various tests to see if you've lost any feeling.

Diabetic Wound Care

What is a Diabetic Foot Ulcer?

A diabetic foot ulcer is an open sore or wound that most commonly occurs on the bottom of the foot in approximately 15 percent of patients with diabetes. Of those who develop a foot ulcer, six percent will be hospitalized due to infection or other ulcer-related complication.

Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer have an amputation. Research, however, has shown that the development of a foot ulcer is preventable.

Who Can Get a Diabetic Foot Ulcer?

Anyone who has diabetes can develop a foot ulcer. Native Americans, African Americans, Hispanics and older men are more likely to develop ulcers. People who use insulin are at a higher risk of developing a foot ulcer, as are patients with diabetes-related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.

How do Diabetic Foot Ulcers Form?

Ulcers form due to a combination of factors, such as lack of feeling in the foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of feeling in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain and one may not even be aware of the problem. Your podiatric physician can test feet for neuropathy with a simple and painless tool called a monofilament.

Vascular disease can complicate a foot ulcer, reducing the body's ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body's ability to fight off a potential infection and also retard healing.

What is the Value of Treating a Diabetic Foot Ulcer?

Once an ulcer is noticed, seek podiatric medical care immediately. Foot ulcers in patients with diabetes should be treated for several reasons such as, reducing the risk of infection and amputation, improving function and quality of life, and reducing health care costs.

How Should a Diabetic Foot Ulcer be Treated?

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

  • Prevention of infection.
  • Taking the pressure off the area, called "off-loading."
  • Removing dead skin and tissue, called "debridement."
  • Applying medication or dressings to the ulcer.
  • Managing blood glucose and other health problems.

Not all ulcers are infected; however if your podiatric physician diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

There are several important factors to keep an ulcer from becoming infected:

  • Keep blood glucose levels under tight control.
  • Keep the ulcer clean and bandaged.
  • Cleanse the wound daily, using a wound dressing or bandage.
  • Do not walk barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be "off-loaded." Patients may be asked to wear special footgear, or a brace, specialized castings, or use a wheelchair or crutches. These devices will reduce the pressure and irritation to the ulcer area and help to speed the healing process.

The science of wound care has advanced significantly over the past ten years. The old thought of "let the air get at it" is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full strength betadine, peroxide, whirlpools and soaking are not recommended, as this could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. These range from normal saline to advanced products, such as growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers.

For a wound to heal there must be adequate circulation to the ulcerated area. Your podiatrist can determine circulation levels with noninvasive tests.

Controlling Blood Glucose

Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or endocrinologist to accomplish this will enhance healing and reduce the risk of complications.

Surgical Options

A majority of noninfected foot ulcers are treated without surgery; however, when this fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony "bumps."

Healing Factors

Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.

How Can a Foot Ulcer be Prevented?

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing a podiatrist on a regular basis. He or she can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you:

  • have neuropathy,
  • have poor circulation,
  • have a foot deformity (i.e. bunion, hammer toe),
  • wear inappropriate shoes,
  • have uncontrolled blood sugar.

Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose are important in the prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks. Your podiatric physician can provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial in noticing a potential problem as early as possible. Inspect your feet every day-especially between the toes and the sole-for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to your podiatrist as soon as possible, no matter how "simple" it may seem to you.

The key to successful wound healing is regular podiatric medical care to ensure the following "gold standard" of care:

  • lowering blood sugar
  • appropriate debridement of wounds
  • treating any infection
  • reducing friction and pressure
  • restoring adequate blood flow

The old saying, "an ounce of prevention is worth a pound of cure" was never as true as it is when preventing a diabetic foot ulcer.

Foot and Ankle Injuries

Immediate Treatment

Foot and ankle emergencies happen every day. Broken bones, dislocations, sprains, contusions, infections, and other serious injuries can occur at any time. Early attention is vitally important. Whenever you sustain a foot or ankle injury, you should seek immediate treatment from a podiatric physician.

This advice is universal, even though there are lots of myths about foot and ankle injuries. Some of them follow:

Myths
  • "It can't be broken, because I can move it." False; this widespread idea has kept many fractures from receiving proper treatment. The truth is that often you can walk with certain kinds of fractures. Some common examples: Breaks in the smaller, outer bone of the lower leg, small chip fractures of either the foot or ankle bones, and the often neglected fracture of the toe.
  • "If you break a toe, immediate care isn't necessary." False; a toe fracture needs prompt attention. If X-rays reveal it to be a simple, displaced fracture, care by your podiatric physician usually can produce rapid relief. However, X-rays might identify a displaced or angulated break. In such cases, prompt realignment of the fracture by your podiatric physician will help prevent improper or incomplete healing. Often, fractures do not show up in the initial X-ray. It may be necessary to X-ray the foot a second time, seven to ten days later. Many patients develop post-fracture deformity of a toe, which in turn results in a deformed toe with a painful corn. A good general rule is: Seek prompt treatment for injury to foot bones.
  • "If you have a foot or ankle injury, soak it in hot water immediately." False; don't use heat or hot water on an area suspect for fracture, sprain, or dislocation. Heat promotes blood flow, causing greater swelling. More swelling means greater pressure on the nerves, which causes more pain. An ice bag wrapped in a towel has a contracting effect on blood vessels, produces a numbing sensation, and prevents swelling and pain. Your podiatric physician may make additional recommendations upon examination.
  • "Applying an elastic bandage to a severely sprained ankle is adequate treatment." False; ankle sprains often mean torn or severely overstretched ligaments, and they should receive immediate care. X-ray examination, immobilization by casting or splinting, and physiotherapy to ensure a normal recovery all may be indicated. Surgery may even be necessary.
  • "The terms 'fracture,' 'break,' and 'crack' are all different." False; all of those words are proper in describing a broken bone.
Before Seeing the Podiatrist

    If an injury or accident does occur, the steps you can take to help yourself until you can reach your podiatric physician are easy to remember if you can recall the word "rice."

  • Rest. Restrict your activity and get off your foot/ankle.
  • Ice. Gently place a plastic bag of ice wrapped in a towel on the injured area in a 20-minute-on, 40-minute-off cycle.
  • Compression. Lightly wrap an Ace bandage around the area, taking care not to pull it too tight.
  • Elevation. To reduce swelling and pain, sit in a position that allows you to elevate the foot/ankle higher than your waist.
  • For bleeding cuts, cleanse well, apply pressure with gauze or a towel, and cover with a clean dressing. See your podiatrist as soon as possible. It's best not to use any medication on the cut before you see the doctor.
  • Leave blisters unopened if they are not painful or in a weight-bearing area of the foot. A compression bandage placed over a blister can provide relief.
  • Foreign materials in the skin-such as slivers, splinters, and sand-can be removed carefully, but a deep foreign object, such as broken glass or a needle, must be removed professionally.
  • Treatment for an abrasion is similar to that of a burn, since raw skin is exposed to the air and can easily become infected. It is important to remove all foreign particles with thorough cleaning. Sterile bandages should be applied, along with an antibiotic cream or ointment.
Prevention
  • Wear the correct shoes for your particular activity.
  • Wear hiking shoes or boots in rough terrain.
  • Don't continue to wear any sports shoe if it is worn unevenly.
  • The toe box in "steel-toe" shoes should be deep enough to accommodate your toes comfortably.
  • Always wear hard-top shoes when operating a lawn mower or other grass-cutting equipment.
  • Don't walk barefoot on paved streets or sidewalks.
  • Watch out for slippery floors at home and at work. Clean up obviously dangerous spills immediately.
  • If you get up during the night, turn on a light. Many fractured toes and other foot injuries occur while attempting to find one's way in the dark.

Forefoot Surgery

When is Foot Surgery Necessary?

Many foot problems do not respond to "conservative" management. Your podiatric physician can determine when surgical intervention may be helpful. Often when pain or deformity persists, surgery may be appropriate to alleviate discomfort or to restore the function of your foot.

Bunions

A common deformity of the foot, a bunion is an enlargement of the bone and tissue around the joint of the big toe. Heredity frequently plays a role in the occurrence of bunions, as it does in other foot conditions. When symptomatic, the area may become red, swollen, and inflamed, making shoe gear and walking uncomfortable and difficult. If conservative care fails to reduce these symptoms, surgical intervention may be warranted. Your podiatric physician will determine the type of surgical procedure best suited for your deformity, based on a variety of information which may include X-rays and gait examination.

Tailor's Bunion

Tailor's Bunion is shown above -- red area on the left. The red area to the right is an example of a bunion.

Hammertoes

A hammertoe deformity is a contracture of the toe(s), frequently caused by an imbalance in the tendon or joints of the toes. Due to the "buckling" effect of the toe(s), hammertoes may become painful secondary to footwear irritation and pressure. Corn and callus formation may occur as a hammertoe becomes more rigid over time, making it difficult to wear shoes. Your podiatric physician may suggest correction of this deformity through a surgical procedure to realign the toe(s).

Hammertoe

Hammertoe

Neuroma

An irritation of a nerve may produce a neuroma, which is a benign enlargement of a nerve segment, commonly found between the third and fourth toes. Several factors may contribute to the formation of a neuroma.

Trauma, arthritis, high-heeled shoes, or an abnormal bone structure are just some of the conditions that may cause a neuroma. Symptoms such as burning or tingling in the ball of the foot or in the adjacent toes and even numbness are commonly seen with this condition. Other symptoms include swelling between the toes and pain in the ball of the foot when weight is placed on it.

Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe.

Your podiatric physician will suggest a treatment plan. If conservative treatment does not relieve the symptoms, then your podiatric physician will decide, on the basis of your symptoms, whether surgical treatment is appropriate.

Neuroma

A neuroma is shown above -- inflamed yellow area in the middle left region.

Bunionette (Tailor's Bunion)

A protuberance of bone at the outside of the foot behind the fifth (small) toe, the bunionette or "small bunion" is caused by a variety of conditions including heredity, faulty biomechanics (the way one walks) or trauma, to name a few. Pain is often associated with this deformity, making shoes very uncomfortable and at times even walking becomes difficult. If severe and conservative treatments fail to improve the symptoms of this condition, surgical repair may be suggested. Your podiatric physician will develop a surgical plan specific to the condition present.

Bone spurs

A bone spur is an overgrowth of bone as a result of pressure, trauma, or reactive stress of a ligament or tendon. This growth can cause pain and even restrict motion of a joint, depending on its location and size. Spurs may also be located under the toenail plate, causing nail deformity and pain. Surgical treatment and procedure is based on the size, location, and symptoms of the bone spur. Your podiatric physician will determine the surgical method best suited for your condition.

Preoperative Testing and Care

As with anyone facing any surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to improve a successful surgical outcome. Prior to surgery, the podiatric physician will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status may be ordered by the podiatric physician, such as blood studies, urinalysis, EKG, X-rays, a blood flow study (to better evaluate the circulatory status of the foot/legs), and a biomechanical examination. A consultation with another medical specialist may be advised by a podiatric physician, depending on your test results or a specific medical condition.

Postoperative Care

The type of foot surgery performed determines the length and kind of aftercare required to assure that your recovery from surgery is rapid and uneventful. The basics of all postoperative care involve to some degree each of the following: rest, ice, compression, and elevation. Bandages, splints, surgical shoes, casts, crutches, or canes may be necessary to improve and ensure a safe recovery after foot surgery. A satisfactory recovery can be hastened by carefully following instructions from your podiatric physician.

Your Feet Aren't Supposed to Hurt

Remember that foot pain is not normal. Healthy, pain-free feet are a key to your independence. At the first sign of pain, or any noticeable changes in your feet, seek professional podiatric medical care. Your feet must last a lifetime, and most Americans log an amazing 75,000 miles on their feet by the time they reach age 50. Regular foot care can make sure your feet are up to the task. With proper detection, intervention, and care, most foot and ankle problems can be lessened or prevented. Remember that the advice provided in this pamphlet should not be used as a substitute for a consultation or evaluation by a podiatric physician.

Footwear

Proper footwear can reduce foot problems

From ancient Egyptian times down through the centuries, footwear has been designed to meet mankind's real and perceived needs-protection, support, comfort, sturdiness, and stylishness.

Feet endure tremendous pressures of daily living. An average day of walking brings a force equal to several hundred tons on them. They are subject to more injury than any other part of the body, underscoring the need to protect them with proper footwear.

Doctors of podiatric medicine are health care professionals trained for both palliative and surgical care of the foot and ankle. They also are fully qualified to recommend selection of the right pair of shoes, or address other aspects of foot health, for all members of the family.

Children's Shoes

When a child begins to walk, shoes generally are not necessary. Allowing an infant to go barefooted indoors, or to wear only a pair of socks, helps the foot grow normally and develop its muscles and strength, as well as the grasping ability of toes.

As children grow more active, and their feet develop, the need for shoes becomes apparent. It becomes necessary to change shoe sizes at a pace that frequently surprises and even dismays parents, to allow room for growth.

When purchasing shoes for children, remember these tips:

  • Examine the shoe itself. It should have a firm heel counter (stiff material on either side of the heel), adequate cushioning of the insole, and a built-in arch. It should be flexible enough to bend where the foot bends- at the ball of the foot, not in the middle of the shoe.
  • The child's foot should be sized while he or she is standing up and fully weight-bearing.
  • There should be about one-half inch of space (or a thumb's width) between the tip of the toes and the end of the shoe. The child should be able to comfortably wiggle his or her toes in the shoe.
  • Have the child walk around the store for more than just a few minutes wearing the shoe with a normal sock. Ask the child if he or she feels any pressure spots in the shoe. Feel the inside of the shoe for any staples or irregularities in the glue that could cause irritation. Examine where the inside stitching hits the foot. Look for signs of irritation on the foot after the shoe is worn.
  • Shoes should not slip off at the heels. Children who tend to sprain their ankles will do better with high-top shoes or boots.
  • Both feet should be measured, and if they are two different sizes, shoes should be chosen that fit the larger foot best.
Women's Shoes

Women inflict more punishment on their feet in part from improper footwear that can bring about unnecessary foot problems. Some of the problems result from high-heeled shoes (generally defined as pumps with heels of more than two inches). Doctors of podiatric medicine believe such heels are medically unsound and attribute postural and even safety problems to their use.

To relieve the abusive effects of high heels, women can limit the time they wear them, alternating with good quality sneakers or flats for part of the day.

They can also vary heel height. There are comfortable and attractive "walking" pumps (also called "comfort" or "performance" pumps) for work and social activities, that blend fashion considerations and comfort. These pumps offer athletic shoe-derived construction, reinforced heels, and wider toe room.

Activity has a bearing on the considerations; wearing the right shoe for a particular activity is probably as important a factor in the choice of shoes as any.

Perhaps the best shoe for women is a walking shoe with laces (not a slip-on), a polymerized composition sole, and a relatively wider heel with a rigid and padded heel counter, no more than three-quarters of an inch in height.

Men's Shoes

The best shoes for men are good quality oxford styles, shoes ordinarily associated with wing-tip or cap toe designs. Also suitable are slip-ons, dressy loafers, and low dress boots.

Men as well as women should buy shoes for work, leisure, and special activities, matching the shoe to the activity.

Male (and female) office workers should earmark three to five pairs of shoes for business hours-general oxfords and loafers for men; pumps and oxfords for women. Cushioned-sole shoes that give good support are essential for those who spend most of their working days on their feet.

There is no question about the need for foot protection for those who work in heavy industry. Safety shoes and boots-those that are waterproof or water-resistant, with insulated steel toe caps and soles of non-conducting materials-help prevent injuries to the feet and reduce the severity of injuries that do occur.

Shoes for Athletics

Different sports activities call for specific footwear to protect feet and ankles. Sports-specific athletic shoes are a wise investment for serious athletes, though perhaps a less critical consideration for the weekend or occasional athlete; nevertheless, it's a good idea to use the correct shoe for each sport. Probably a more important consideration is the condition of the shoe-don't wear any sport or other shoes beyond their useful life.

Athletic footwear should be fitted to hold the foot in the position that's most natural to the movement involved.

For example, a running shoe is built to accommodate impact, while a tennis shoe is made to give relatively more support and permit sudden stops and turns. For sports, "cross trainers" are fine for a general athletic shoe, such as for physical education classes. But if a child is involved more heavily in any single sport, he or she should have a shoe specifically designed for that sport.

Shoe Care

For longer service, keep shoes clean and in good repair. Avoid excessive wear on heels and soles. Give your shoes a chance to breathe-don't wear the same pair two days in a row (you prolong the life of shoes by rotating their use). Never wear hand-me-down shoes (this is especially important for children).

Seal of Acceptance

The American Podiatric Medical Association awards its Seal of Acceptance to a wide variety of shoes (and shoe-related products), which have been deemed to enhance a consistently applied program of daily foot care and regular professional treatment.

The intent of such endorsements is to make a significant contribution to the foot health and foot health education of the public.

For a list of shoe companies holding the APMA Seal of Acceptance, visit the APMA's online seal information.

Buying Tips
  • Have your feet measured while you're standing.
  • always try on both shoes, and walk around the store.
  • Always buy for the larger foot; feet are seldom precisely the same size.
  • Don't buy shoes that need a "break-in" period; shoes should be comfortable immediately.
  • Don't rely on the size of your last pair of shoes. Your feet do get larger, and lasts (shoemakers' sizing molds) also vary.
  • Shop for shoes later in the day; feet tend to swell during the day, and it's best to be fitted while they are in that state.
  • Be sure that shoes fit well-front, back, and sides-to distribute weight. It sounds elementary, but be sure the widest part of your foot corresponds to the widest part of the shoe.
  • Select a shoe with a leather upper, stiff heel counter, appropriate cushioning, and flexibility at the ball of the foot.
  • Buy shoes that don't pinch your toes, either at the tips, or across the toe box.
  • Try on shoes while you're wearing the same type of socks or stockings you expect to wear with the shoes.
  • If you wear prescription orthotics-biomechanical inserts prescribed by a podiatric physician-you should take them along to shoe fittings.

General Foot Health

A Biological Masterpiece, But Subject to Many Ills

The human foot is a biological masterpiece. Its strong, flexible, and functional design enables it to do its job well and without complaint-if you take care of it and don't take it for granted.

The foot can be compared to a finely tuned race car, or a space shuttle, vehicles whose function dictates their design and structure. And like them, the human foot is complex, containing within its relatively small size 26 bones (the two feet contain a quarter of all the bones in the body), 33 joints, and a network of more than 100 tendons, muscles, and ligaments, to say nothing of blood vessels and nerves.

Tons of Pressure

The components of your feet work together, sharing the tremendous pressures of daily living. An average day of walking, for example, brings a force equal to several hundred tons to bear on the feet. This helps explain why your feet are more subject to injury than any other part of your body.

Foot ailments are among the most common of our health problems. Although some can be traced to heredity, many stem from the cumulative impact of a lifetime of abuse and neglect. Studies show that most Americans experience foot problems of a greater or lesser degree of seriousness at some time in their lives; nowhere near that many seek medical treatment, apparently because they mistakenly believe that discomfort and pain are normal and expectable.

There are a number of systemic diseases that are sometimes first detected in the feet, such as diabetes, circulatory disorders, anemia, and kidney problems. Arthritis, including gout, often attacks foot joints first.

Specialized Care

Your feet, like other specialized structures, require specialized care. A doctor of podiatric medicine can make an important contribution to your total health, whether it is regular preventive care or surgery to correct a deformity.

In order to keep your feet healthy, you should be familiar with the most common ills that affect them. Remember, though, that self-treatment can often turn a minor problem into a major one and is generally not advisable. You should see a podiatric physician when any of the following conditions occur or persist.

Athlete's foot is a skin disease, usually starting between the toes or on the bottom of the feet, which can spread to other parts of the body. It is caused by a fungus that commonly attacks the feet, because the wearing of shoes and hosiery fosters fungus growth. The signs of athlete's foot are dry scaly skin, itching, inflammation, and blisters. You can help prevent infection by washing your feet daily with soap and warm water; drying carefully, especially between the toes; and changing shoes and hose regularly to decrease moisture. Athlete's foot is not the only infection, fungal or otherwise, which afflicts the foot, and other dry skin/dermatitis conditions can be good reasons to see a doctor of podiatric medicine if a suspicious condition persists.

Blisters are caused by skin friction. Don't pop them. Apply moleskin or an adhesive bandage over a blister, and leave it on until it falls off naturally in the bath or shower. Keep your feet dry and always wear socks as a cushion between your feet and shoes. If a blister breaks on its own, wash the area, apply an antiseptic, and cover with a sterile bandage.

Bunions are misaligned big toe joints which can become swollen and tender. The deformity causes the first joint of the big toe to slant outward, and the big toe to angle toward the other toes. Bunions tend to run in families, but the tendency can be aggravated by shoes that are too narrow in the forefoot and toe. There are conservative and preventive steps that can minimize the discomfort of a bunion, but surgery is frequently recommended to correct the problem.

Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction and pressure from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas. Never cut corns or calluses with any instrument, and never apply home remedies, except under a podiatrist's instructions.

Foot odor results from excessive perspiration from the more than 250,000 sweat glands in the foot. Daily hygiene is essential. Change your shoes daily to let each pair air out, and change your socks, perhaps even more frequently than daily. Foot powders and antiperspirants, and soaking your feet in vinegar and water, can help lessen odor.

Hammertoe is a condition in which any of the toes are bent in a claw-like position. It occurs most frequently with the second toe, often when a bunion slants the big toe toward and under it, but any of the other three smaller toes can be affected. Although the condition usually stems from muscle imbalance, it is often aggravated by ill-fitting shoes or socks that cramp the toes. Avoid pressure on the toes as much as possible. Surgery may be necessary to realign the toes to their proper position.

Heel pain can generally be traced to faulty biomechanics which place too much stress on the heel bone, ligaments, or nerves in the area. Stress could result while walking or jumping on hard surfaces, or from poorly made footwear. Overweight is also a major contributing factor. Some general health conditions-arthritis, gout, and circulatory problems, for example-also cause heel pain.

Heel spurs are growths of bone on the underside of the heel bone. They can occur without pain; pain may result when inflammation develops at the point where the spur forms. Both heel pain and heel spurs are often associated with plantar fasciitis, an inflammation of the long band of connective tissue running from the heel to the ball of the foot. Treatments may range from exercise and custom-made orthotics to anti-inflammatory medication or cortisone injections.

Ingrown nails are nails whose corners or sides dig painfully into the skin, often causing infection. They are frequently caused by improper nail trimming but also by shoe pressure, injury, fungus infection, heredity, and poor foot structure. Toenails should be trimmed straight across, slightly longer than the end of the toe, with toenail clippers. If the ingrown portion of the nail is painful or infected, your podiatric physician may remove the affected portion; if the condition reoccurs frequently, your podiatrist may permanently remove the nail.

Neuromas are enlarged, benign growths of nerves, most commonly between the third and fourth toes. They are caused by bones and other tissue rubbing against and irritating the nerves. Abnormal bone structure or pressure from ill-fitting shoes also can create the condition, which can result in pain, burning, tingling, or numbness between the toes and in the ball of the foot. Conservative treatment can include padding, taping, orthotic devices, and cortisone injections, but surgical removal of the growth is sometimes necessary.

Warts are caused by a virus, which enters the skin through small cuts and infects the skin. Children, especially teenagers, tend to be more susceptible to warts than adults. Most warts are harmless and benign, even though painful and unsightly. Warts often come from walking barefooted on dirty surfaces or littered ground. There are several simple procedures which your podiatric physician might use to remove warts.

Top Ten Foot Health Tips

Diseases, disorders and disabilities of the foot or ankle affect the quality of life and mobility of millions of Americans. However, the general public and even many physicians are unaware of the important relationship between foot health and overall health and well-being. With this in mind, the American Podiatric Medical Association (APMA) would like to share a few tips to help keep feet healthy.

1.Don't ignore foot pain-it's not normal. If the pain persists, see a podiatric physician.

2. Inspect your feet regularly. Pay attention to changes in color and temperature of your feet. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet could indicate athlete's foot. Any growth on the foot is not considered normal.

3. Wash your feet regularly, especially between the toes, and be sure to dry them completely.

4. Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; it can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet because they are more prone to infection.

5. Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest and replace worn out shoes as soon as possible.

6. Select and wear the right shoe for the activity that you are engaged in (i.e., running shoes for running).

7. Alternate shoes-don't wear the same pair of shoes every day.

8. Avoid walking barefooted-your feet will be more prone to injury and infection. At the beach or when wearing sandals, always use sunblock on your feet just as on the rest of your body.

9. Be cautious when using home remedies for foot ailments; self-treatment can often turn a minor problem into a major one.

10. If you are a person with diabetes, it is vital that you see a podiatric physician at least once a year for a check-up.

Hammertoes

What is a Hammertoe?

A hammertoe is a contracture-or bending-of the toe at the first joint of the digit, called the proximal interphalangeal joint. This bending causes the toe to appear like an upside-down V when looked at from the side. Any toe can be involved, but the condition usually affects the second through fifth toes, known as the lesser digits. Hammertoes are more common to females than males.

There are two different types:

Flexible Hammertoes:

These are less serious because they can be diagnosed and treated while still in the developmental stage. They are called flexible hammertoes because they are still moveable at the joint.

Rigid Hammertoes:

This variety is more developed and more serious than the flexible condition. Rigid hammertoes can be seen in patients with severe arthritis, for example, or in patients who wait too long to seek professional treatment. The tendons in a rigid hammertoe have become tight, and the joint misaligned and immobile, making surgery the usual course of treatment.

Symptoms
  • Pain upon pressure at the top of the bent toe from footwear.
  • The formation of corns on the top of the joint.
  • Redness and swelling at the joint contracture.
  • Restricted or painful motion of the toe joint.
  • Pain in the ball of the foot at the base of the affected toe.
How Do You Get a Hammertoe?

A hammertoe is formed due an abnormal balance of the muscles in the toes. This abnormal balance causes increased pressures on the tendons and joints of the toe, leading to its contracture. Heredity and trauma can also lead to the formation of a hammertoe. Arthritis is another factor, because the balance around the toe in people with arthritis is so disrupted that a hammertoe may develop. Wearing shoes that are too tight and cause the toes to squeeze can also be a cause for a hammertoe to form.

What Can You Do for Relief?
  • Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area.
  • Wear a shoe with a deep toe box.
  • If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
  • Avoid heels more than two inches tall.
  • A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician's office will be necessary to repair the toe to allow for normal foot function.
  • Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.
  • See your podiatric physician if pain persists.
What Will Your Podiatrist Do to Treat a Hammertoe?

The treatment options vary with the type and severity of each hammertoe, although identifying the deformity early in its development is important to avoid surgery. Podiatric medical attention should be sought at the first indication of pain and discomfort because, if left untreated, hammertoes tend to become rigid, making a nonsurgical treatment less of an option.

Your podiatric physician will examine and X-ray the affected area and recommend a treatment plan specific to your condition.

Padding and Taping:

Often this is the first step in a treatment plan. Padding the hammertoe prominence minimizes pain and allows the patient to continue a normal, active life. Taping may change the imbalance around the toes and thus relieve the stress and pain.

Medication:

Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the joint deformity.

Orthotic Devices:

Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the hammertoe deformity.

Surgical Options:

Several surgical procedures are available to the podiatric physician. For less severe deformities, the surgery will remove the bony prominence and restore normal alignment of the toe joint, thus relieving pain.

Severe hammertoes, which are not fully reducible, may require more complex surgical procedures.

Recuperation takes time, and some swelling and discomfort are common for several weeks following surgery. Any pain, however, is easily managed with medications prescribed by your podiatric physician.

Your Feet Aren't Supposed to Hurt

Remember that foot pain is not normal. Healthy, pain-free feet are a key to your independence. At the first sign of pain, or any noticeable changes in your feet, seek professional podiatric medical care. Your feet must last a lifetime, and most Americans log an amazing 75,000 miles on their feet by the time they reach age 50. Regular foot care can make sure your feet are up to the task. With proper detection, intervention, and care, most foot and ankle problems can be lessened or prevented. Remember that the advice provided in this pamphlet should not be used as a substitute for a consultation or evaluation by a podiatric physician.

Hammertoe Tips
  • Apply a commercial, nonmedicated hammertoe pad around the bony prominence of the hammertoe. This will decrease pressure on the area.
  • Wear a shoe with a deep toe box.
  • If the hammertoe becomes inflamed and painful, apply ice packs several times a day to reduce swelling.
  • Avoid heels more than two inches tall.
  • A loose-fitting pair of shoes can also help protect the foot while reducing pressure on the affected toe, making walking a little easier until a visit to your podiatrist can be arranged. It is important to remember that, while this treatment will make the hammertoe feel better, it does not cure the condition. A trip to the podiatric physician's office will be necessary to repair the toe to allow for normal foot function.
  • Avoid wearing shoes that are too tight or narrow. Children should have their shoes properly fitted on a regular basis, as their feet can often outgrow their shoes rapidly.
  • See your podiatric physician if pain persists.

Heel Pain

Heel Pain Has Many Causes

In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we've suffered.

When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury.

Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.

Heel Pain

Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight.

The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.

Heel Spurs

A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome."

Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.

Plantar Fasciitis

Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and it can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.

The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.

Excessive Pronation

Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern.

As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation-excessive inward motion-can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.

Disease and Heel Pain

Some general health conditions can also bring about heel pain.

  • Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.
  • Heel pain may also be the result of an inflamed bursa (bursitis), a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur.
  • Haglund's deformity ("pump bump") is a bone enlargement at the back of the heel bone, in the area where the achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe.
  • Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called achilles tendinitis. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
  • Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.

Stress fractures of the heel bone also can occur, although infrequently.

Children's Heel Pain

Heel pain can also occur in children, most commonly between ages 8 and 13, as they become increasingly active in sports activity in and out of school. This physical activity, particularly jumping, inflames the growth centers of the heels; the more active the child, the more likely the condition will occur. When the bones mature, the problems disappear and are not likely to recur. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain relief. Other good news is that heel spurs do not often develop in children.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions:

  • Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters.
  • Wear the proper shoes for each activity.
  • Do not wear shoes with excessive wear on heels or soles.
  • Prepare properly before exercising. Warm up and do stretching exercises before and after running.
  • Pace yourself when you participate in athletic activities.
  • Don't underestimate your body's need for rest and good nutrition.
  • If obese, lose weight.
Podiatric Medical Care

If pain and other symptoms of inflammation-redness, swelling, heat-persist, you should limit normal daily activities and contact a doctor of podiatric medicine.

The podiatric physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone.

Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments.

A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting of the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.

Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

Heel Pain Tips
  • If you have experienced painful heels try wearing your shoes around your house in the evening. Don't wear slippers or socks or go barefoot. You may also try gentle calf stretches for 20 to 30 seconds on each leg. This is best done barefoot, leaning forward towards a wall with one foot forward and one foot back.
  • If the pain persists longer than one month, you should visit a podiatrist for evaluation and treatment. Your feet should not hurt, and professional podiatric care may be required to help relieve your discomfort.
  • If you have not exercised in a long time, consult your podiatric physician before starting a new exercise program.
  • Begin an exercise program slowly. Don't go too far or too fast.
  • Purchase and maintain good shoes and replace them regularly.
  • Stretch each foot and achilles tendon before and after exercise.
  • Avoid uneven walking surfaces or stepping on rocks as much as possible.
  • Avoid going barefoot on hard surfaces.
  • Vary the incline on a treadmill during exercise. Nobody walks uphill all the time.
  • If it hurts, stop. Don't try to "work through the pain."

High Blood Pressure

The Podiatric Physician and Cardiovascular Ailments

As a member of the health care team, your doctor of podiatric medicine (DPM) is vitally concerned about hypertension (high blood pressure) and vascular disease (heart and circulatory problems). There are several reasons for this concern. First, because you are a patient, your podiatric physician and surgeon is interested in all aspects of your health and your treatment program. Second, he or she supports the goals of high blood pressure detection, treatment, and control.

Your podiatric physician should know if you have any of the following cardiovascular or related conditions:

Hypertension and/or cardiovascular disease: Hypertension sometimes causes decreased circulation. A careful examination is required to determine if there is lower than normal temperature in any of the extremities, absence of normal skin color, or diminished pulse in the feet. The concern is that these are signs of arterial insufficiency (reduced blood flow). Increased or periodic swelling in the lower extremities is important because it may mean that hypertension has contributed to heart disease.

Rheumatic heart disease: Persons who have had rheumatic heart disease must be protected with prophylactic antibiotics prior to any surgical intervention. If you take medication for this condition, tell your podiatric physician. Any medication you may be taking for high blood pressure, a heart condition, or any other reason should be reported to the DPM to ensure that it does not conflict with medications that may be prescribed in the treatment of your feet.

Diabetes: This condition frequently affects the smaller arteries, resulting in diminished circulation and decreased sensation in the extremities. Let your podiatric physician know if you have ever been told that you have diabetes, particularly if you are talking medication or insulin for this condition.

Ulceration: Open sores that do not heal, or heal very slowly, may be symptoms of certain anemias, including sickle cell disease. Or they may be due to hypertension or certain inflammatory conditions of the blood vessels. Your DPM is on the alert for such conditions, but be sure to mention if you have ever had this problem.

Swollen feet: Persistent swelling of one or both feet may be due to kidney, heart, or circulatory problems.

Burning feet: Although it can have a number of causes, a burning sensation of the feet is frequently caused by diminished circulation.

Control of High Blood Pressure

High blood pressure is a major risk factor for cardiovascular disease. Uncontrolled high blood pressure can cause fatal strokes and heart disease. As a health care provider, your podiatric physician assists in controlling this public health problem. There are three major areas in which he or she provides this important public service:

Detection: Many podiatric physicians routinely take every patient's blood pressure and determine if it is elevated.

Treatment: After confirming that blood pressure is elevated and making this information part of the patient's record, the DPM refers all patients with elevated blood pressure to their primary care physicians for evaluation, diagnosis, and treatment.

Long-Term Control: By encouraging patients at every visit to adhere to treatment, and by monitoring reductions in blood pressure, side effects of treatment, and referring for reevaluation as needed, the podiatric physician facilitates long-term control.

Foot Health Tips

Diseases, disorders and disabilities of the foot or ankle affect the quality of life and mobility of millions of Americans. However, the general public and even many physicians are unaware of the important relationship between foot health and overall health and well-being. With this in mind, the American Podiatric Medical Association (APMA) would like to share a few tips to help keep feet healthy.

1. Don't ignore foot pain-it's not normal. If the pain persists, see a podiatric physician.

2. Inspect your feet regularly. Pay attention to changes in color and temperature of your feet. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet could indicate athlete's foot. Any growth on the foot is not considered normal.

3. Wash your feet regularly, especially between the toes, and be sure to dry them completely.

4. Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; it can lead to ingrown toenails. Persons with diabetes, poor circulation, or heart problems should not treat their own feet because they are more prone to infection.

5. Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest and replace worn out shoes as soon as possible.

6. Select and wear the right shoe for the activity that you are engaged in (i.e., running shoes for running).

7. Alternate shoes-don't wear the same pair of shoes every day.

8.Avoid walking barefooted-your feet will be more prone to injury and infection. At the beach or when wearing sandals, always use sunblock on your feet just as on the rest of your body.

9. Be cautious when using home remedies for foot ailments; self-treatment can often turn a minor problem into a major one.

10. If you are a person with diabetes, it is vital that you see a podiatric physician at least once a year for a check-up.

Nail Problems

Barometers of Health

Toenails often serve as barometers of our health; they are diagnostic tools providing the initial signal of the presence or onset of systemic diseases. For example, the pitting of nails and increased nail thickness can be manifestations of psoriasis. Concavity-nails that are rounded inward instead of outward-can foretell iron deficiency anemia. Some nail problems can be conservatively treated with topical or oral medications while others require partial or total removal of the nail. Any discoloration or infection on or about the nail should be evaluated by a podiatric physician.

Nail Ailments

Ingrown Toenails

Ingrown nails, the most common nail impairment, are nails whose corners or sides dig painfully into the soft tissue of nail grooves, often leading to irritation, redness, and swelling. Usually, toenails grow straight out. Sometimes, however, one or both corners or sides curve and grow into the flesh. The big toe is usually the victim of this condition but other toes can also become affected.

Ingrown toenails may be caused by:

  • Improperly trimmed nails (Trim them straight across, not longer than the tip of the toes. Do not round off corners. Use toenail clippers.)
  • Heredity
  • Shoe pressure; crowding of toes
  • Repeated trauma to the feet from normal activities

If you suspect an infection due to an ingrown toenail, immerse the foot in a warm salt water soak, or a basin of soapy water, then apply an antiseptic and bandage the area.

People with diabetes, peripheral vascular disease, or other circulatory disorders must avoid any form of self treatment and seek podiatric medical care as soon as possible.

Other "do-it-yourself" treatments, including any attempt to remove any part of an infected nail or the use of over-the-counter medications, should be avoided. Nail problems should be evaluated and treated by your podiatrist, who can diagnose the ailment, and then prescribe medication or another appropriate treatment.

A podiatrist will resect the ingrown portion of the nail and may prescribe a topical or oral medication to treat the infection. If ingrown nails are a chronic problem, your podiatrist can perform a procedure to permanently prevent ingrown nails. The corner of the nail that ingrows, along with the matrix or root of that piece of nail, are removed by use of a chemical, a laser, or by other methods.

Fungal Nails

Fungal infection of the nail, or onychomycosis, is often ignored because the infection can be present for years without causing any pain. The disease is characterized by a progressive change in a toenail's quality and color, which is often ugly and embarrassing.

In reality, the condition is an infection underneath the surface of the nail caused by fungi. When the tiny organisms take hold, the nail often becomes darker in color and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails. If ignored, the infection can spread and possibly impair one's ability to work or even walk. This happens because the resulting thicker nails are difficult to trim and make walking painful when wearing shoes. Onychomycosis can also be accompanied by a secondary bacterial or yeast infection in or about the nail plate.

Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot, such as swimming pools, locker rooms, and showers, for example. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. Those who suffer from chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributing factors may be a history of athlete's foot and excessive perspiration.

Prevention
  • Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails.
  • Clean and dry feet resist disease.
  • Washing the feet with soap and water, remembering to dry thoroughly, is the best way to prevent an infection.
  • Shower shoes should be worn when possible in public areas.
  • Shoes, socks, or hosiery should be changed more than once daily.
  • Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
  • Wear shoes that fit well and are made of materials that breathe.
  • Avoid wearing excessively tight hosiery, which promote moisture.
  • Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks.
  • Disinfect instruments used to cut nails.
  • Disinfect home pedicure tools.
  • Don't apply polish to nails suspected of infection-those that are red, discolored, or swollen, for example.
Treatment of Fungal Nails

Treatments may vary, depending on the nature and severity of the infection. A daily routine of cleansing over a period of many months may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid antifungal agent. However, even the best over-the-counter treatments may not prevent a fungal infection from coming back.

A podiatric physician can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral medication, and debridement (removal of diseased nail matter and debris) of an infected nail.

Newer oral antifungals, approved by the Food and Drug Administration, may be the most effective treatment. They offer a shorter treatment regimen of approximately three months and improved effectiveness. Podiatrists may also prescribe a topical treatment for onychomycosis, which can be an effective treatment modality for fungal nails.

In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical antifungal. Permanent removal of a chronically painful nail that has not responded to any other treatment permits the fungal infection to be cured and prevents the return of a deformed nail.

Trying to solve the infection without the qualified help of a podiatric physician can lead to more problems. With new technical advances in combination with simple preventive measures, the treatment of this lightly regarded health problem can often be successful.

Nail Care Tips
  • Proper hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails.
  • Clean and dry feet resist disease.
  • Washing the feet with soap and water, remembering to dry thoroughly, is the best way to prevent an infection.
  • Shower shoes should be worn when possible in public areas.
  • Shoes, socks, or hosiery should be changed more than once daily.
  • Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
  • Wear shoes that fit well and are made of materials that breathe.
  • Avoid wearing excessively tight hosiery, which promote moisture.
  • Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks.
  • Disinfect instruments used to cut nails.
  • Disinfect home pedicure tools.
  • Don't apply polish to nails suspected of infection-those that are red, discolored, or swollen, for example.

Neuromas

What is a Neuroma?

A neuroma is a painful condition, also referred to as a "pinched nerve" or a nerve tumor. It is a benign growth of nerve tissue frequently found between the third and fourth toes that brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot.

The principal symptom associated with a neuroma is pain between the toes while walking. Those suffering from the condition often find relief by stopping their walk, taking off their shoe, and rubbing the affected area. At times, the patient will describe the pain as similar to having a stone in his or her shoe. The vast majority of people who develop neuromas are women.

Symptoms
  • Pain in the forefoot and between the toes.
  • Tingling and numbness in the ball of the foot.
  • Swelling between the toes.
  • Pain in the ball of the foot when weight is placed on it.
How Do You Get a Neuroma?

Although the exact cause for this condition is unclear, a number of factors can contribute to the formation of a neuroma.

Biomechanical deformities, such as a high-arched foot or a flat foot, can lead to the formation of a neuroma. These foot types bring on instability around the toe joints, leading to the development of the condition.

Trauma can cause damage to the nerve, resulting in inflammation or swelling of the nerve.

Improper footwear that causes the toes to be squeezed together is problematic. Avoid high-heeled shoes higher than two inches. Shoes at this height can increase pressure on the forefoot area.

Repeated stress, common to many occupations, can create or aggravate a neuroma.

What Can You Do for Relief?

Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment.

Wear shoes with thick, shock-absorbent soles and proper insoles that are designed to keep excessive pressure off of the foot.

High heels should be avoided whenever possible because they place undue strain on the forefoot and can contribute to a number of foot problems.

Resting the foot and massaging the affected area can temporarily alleviate neuroma pain. Use an ice pack to help to dull the pain and improve comfort.

For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, podiatric medical treatment or surgery may be necessary to remove the tumor.

Use over-the-counter shoe pads. These pads can relieve pressure around the affected area.

Treatment by Your Podiatric Physician

Treatment options vary with the severity of each neuroma, and identifying the neuroma early in its development is important to avoid surgical correction. Podiatric medical care should be sought at the first sign of pain or discomfort; if left untreated, neuromas tend to get worse.

The primary goal of most early treatment regimens is to relieve pressure on areas where a neuroma develops. Your podiatric physician will examine and likely X-ray the affected area and suggest a treatment plan that best suits your individual case.

Padding and Taping: Special padding at the ball of the foot may change the abnormal foot function and relieve the symptoms caused by the neuroma.

Medication: Anti-inflammatory drugs and cortisone injections can be prescribed to ease acute pain and inflammation caused by the neuroma.

Orthotic Devices: Custom shoe inserts made by your podiatrist may be useful in controlling foot function. An orthotic device may reduce symptoms and prevent the worsening of the condition.

Surgical Options: When early treatments fail and the neuroma progresses past the threshold for such options, podiatric surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks. Your podiatric physician will thoroughly describe the surgical procedures to be used and the results you can expect. Any pain following surgery is easily managed with medications prescribed by your podiatrist.

Your Feet Aren't Supposed to Hurt

Remember that foot pain is not normal, and any disruption in foot function limits your freedom and mobility. It is important to schedule an appointment with your podiatrist at the first sign of pain or discomfort in your feet, and follow proper maintenance guidelines to ensure their proper health for the rest of your life. The advice in this pamphlet should not be used as a substitute for a consultation or evaluation by a podiatric physician.

Neuroma Tips
  • Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment.
  • Wear shoes with thick, shock-absorbent soles and proper insoles that are designed to keep excessive pressure off of the foot.
  • High heels should be avoided whenever possible because they place undue strain on the forefoot and can contribute to a number of foot problems.
  • Resting the foot and massaging the affected area can temporarily alleviate neuroma pain. Use an ice pack to help to dull the pain and improve comfort.
  • For simple, undeveloped neuromas, a pair of thick-soled shoes with a wide toe box is often adequate treatment to relieve symptoms, allowing the condition to diminish on its own. For more severe conditions, however, podiatric medical treatment or surgery may be necessary to remove the tumor.
  • Use over-the-counter shoe pads. These pads can relieve pressure around the affected area.

Orthotics

What are Orthotics?

Orthotics are shoe inserts that are intended to correct an abnormal, or irregular, walking pattern. Orthotics are not truly or solely "arch supports," although some people use those words to describe them, and they perhaps can best be understood with those words in mind. They perform functions that make standing, walking, and running more comfortable and efficient by altering slightly the angles at which the foot strikes a walking or running surface.

Doctors of podiatric medicine prescribe orthotics as a conservative approach to many foot problems or as a method of control after certain types of foot surgery; their use is a highly successful, practical treatment form.

Orthotics take various forms and are constructed of various materials. All are concerned with improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain.

Foot orthotics fall into three broad categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

Rigid Orthotics

The so-called rigid orthotic device, designed to control function, may be made of a firm material such as plastic or carbon fiber and is used primarily for walking or dress shoes. It is generally fabricated from a plaster of paris mold of the individual foot. The finished device normally extends along the sole of the heel to the ball or toes of the foot. It is worn mostly in closed shoes with a heel height under two inches. Because of the nature of the materials involved, very little alteration in shoe size is necessary.

Rigid orthotics are chiefly designed to control motion in two major foot joints, which lie directly below the ankle joint. These devices are long lasting, do not change shape, and are usually difficult to break. Strains, aches, and pains in the legs, thighs, and lower back may be due to abnormal function of the foot, or a slight difference in the length of the legs. In such cases, orthotics may improve or eliminate these symptoms, which may seem only remotely connected to foot function.

Soft Orthotics

The second, or soft, orthotic device helps to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. It is usually constructed of soft, compressible materials, and may be molded by the action of the foot in walking or fashioned over a plaster impression of the foot. Also worn against the sole of the foot, it usually extends from the heel past the ball of the foot to include the toes.

The advantage of any soft orthotic device is that it may be easily adjusted to changing weight-bearing forces. The disadvantage is that it must be periodically replaced or refurbished. It is particularly effective for arthritic and grossly deformed feet where there is a loss of protective fatty tissue on the side of the foot. It is also widely used in the care of the diabetic foot. Because it is compressible, the soft orthotic is usually bulkier and may well require extra room in shoes or prescription footwear.

Semirigid Orthotics

The third type of orthotic device (semirigid) provides for dynamic balance of the foot while walking or participating in sports. This orthotic is not a crutch, but an aid to the athlete. Each sport has its own demands and each sport orthotic needs to be constructed appropriately with the sport and the athlete taken into consideration. This functional dynamic orthotic helps guide the foot through proper functions, allowing the muscles and tendons to perform more efficiently. The classic, semirigid orthotic is constructed of layers of soft material, reinforced with more rigid materials.

Orthotics for Children

Orthotic devices are effective in the treatment of children with foot deformities. Most podiatric physicians recommend that children with such deformities be placed in orthotics soon after they start walking, to stabilize the foot. The devices can be placed directly into a standard shoe or an athletic shoe.

Usually, the orthotics need to be replaced when the child's foot has grown two sizes. Different types of orthotics may be needed as the child's foot develops and changes shape.

The length of time a child needs orthotics varies considerably, depending on the seriousness of the deformity and how soon correction is addressed.

Other Types of Orthotics

Various other orthotics may be used for multidirectional sports or edge-control sports by casting the foot within the ski boot, ice skate boot, or inline skate boot. Combinations of semiflexible material and soft material to accommodate painful areas are utilized for specific problems.

Research has shown that back problems frequently can be traced to a foot imbalance. It's important for your podiatric physician to evaluate the lower extremity as a whole to provide for appropriate orthotic control for foot problems.

Orthotic Tips
  • Wear shoes that work well with your orthotics.
  • Bring your orthotics with you whenever you purchase a new pair of shoes.
  • Wear socks or stockings similar to those that you plan on wearing when you shop for new shoes.
  • Return as directed for follow-up evaluation of the functioning of your orthotics. This is important for making certain that your feet and orthotics are functioning properly together.

Peroneal Tendon Injuries

Peroneal Tendons
What are the Peroneal Tendons?

A tendon is a band of tissue that connects a muscle to a bone. In the foot, there are two peroneal tendons. They run side-by-side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sprains.

Types of Peroneal Tendon Injuries

Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. The following are the three basic types of peroneal tendon injuries:

Tendonitis is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon or trauma (such as an ankle sprain). Symptoms of tendonitis include:

  • Pain
  • Swelling
  • Warmth to the touch

Acute tears are caused by repetitive activity or trauma. Immediate symptoms of acute tears include:

  • Pain
  • Swelling
  • Weakness or instability of the foot and ankle
Posterior tibial tendon

As time goes on, these tears may lead to a change in the shape of the foot, in which the arch may become higher.

Degenerative tears (tendonosis) are usually due to overuse and occur over long periods of time-often years. In degenerative tears, the tendon is like taffy that has been overstretched until it becomes thin and eventually frays. Having high arches also puts you at risk for developing a degenerative tear. The signs and symptoms of degenerative tears may include:

  • Sporadic pain (occurring from time to time) on the outside of the ankle
  • Weakness or instability in the ankle
  • An increase in the height of the arch

Subluxation occurs when one or both tendons have slipped out of their normal position. In some cases, subluxation is due to a condition in which a person is born with a variation in the shape of the bone or muscle. In other cases, subluxation occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation may include:

  • A snapping feeling of the tendon around the ankle bone.
  • Sporadic pain behind the outside ankle bone.
  • Ankle instability or weakness.

Early treatment of a subluxation is critical, since a tendon that continues to sublux (move out of position) is more likely to tear or rupture. Therefore, if you feel the characteristic snapping, see a foot and ankle surgeon immediately.

Diagnosis

Because peroneal tendon injuries are sometimes misdiagnosed and may worsen without proper treatment, prompt evaluation by a foot and ankle surgeon is advised. To diagnose a peroneal tendon injury, the surgeon will examine the foot and look for pain, instability, swelling, warmth and weakness on the outer side of the ankle. In addition, imaging studies such as an MRI or ultrasound may be needed to fully evaluate the injury.

An ankle sprain may sometimes accompany a peroneal tendon injury. The surgeon is trained to look for signs of this and other related injuries. Proper diagnosis is important because prolonged discomfort after a simple sprain may be a sign of additional problems.

Treatment

Treatment depends on the type of peroneal tendon injury.

Posterior Tibial Tendon Dysfunction PTTD (Ankle pain)

What is PTTD?

Posterior tibial tendon dysfunction (PTTD) is an inflammation and/or overstretching of the posterior tibial tendon in the foot. An important function of the posterior tibial tendon is to help support the arch. But in PTTD, the tendon's ability to perform that job is impaired, often resulting in a flattening of the foot.

The posterior tibial tendon is a fibrous cord that extends from a muscle in the leg. It descends the leg and runs along the inside of the ankle, down the side of the foot, and into the arch. This tendon serves as one of the major supporting structures of the foot and helps the foot to function while walking.

PTTD is often called "adult-acquired flatfoot" because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse-especially if it isn't treated early.

PTTD PTTD2

Symptoms of PTTD

The symptoms of PTTD may include pain, swelling, a flattening of the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change.

For example:

  • When PTTD initially develops, typically there is pain on the inside of the foot and ankle (along the course of the tendon). In addition, the area may be red, warm, and swollen.
  • Later, as the arch begins to flatten, there may still be pain on the inside of the foot and ankle. But at this point, the foot and toes begin to turn outward and the ankle rolls inward.
  • As PTTD becomes more advanced, the arch flattens even more and the pain often shifts to the outside of the foot, below the ankle. The tendon has deteriorated considerably and arthritis often develops in the foot. In more severe cases, arthritis may also develop in the ankle.
What Causes PTTD?

Overuse of the posterior tibial tendon is frequently the cause of PTTD. In fact, the symptoms usually occur after activities that involve the tendon, such as running, walking, hiking, or climbing stairs.

Treatment:

Non-surgical Approaches

Because of the progressive nature of PTTD, it's best to see your foot and ankle surgeon as soon as possible. If treated early enough, your symptoms may resolve without the need for surgery and progression of your condition can be arrested. In contrast, untreated PTTD could leave you with an extremely flat foot, painful arthritis in the foot and ankle, and increasing limitations on walking, running, or other activities.

When is Surgery Needed?

In cases of PTTD that have progressed substantially or have failed to improve with non-surgical treatment, surgery may be required. For some advanced cases, surgery may be the only option. Surgical treatment may include repairing the tendon, realigning the bones of the foot, or both. Your foot and ankle surgeon will determine the best approach for your specific case.

Rearfoot Surgery

Many Conditions Affect the Rearfoot

Many conditions can affect the back portion of the foot and ankle. Fortunately, many of these problems can be resolved through conservative treatments. However when pain persists or deformity occurs, surgical intervention can often help alleviate pain, reduce deformity, and/or restore the function of your foot or ankle.

Heel Surgery

Two common conditions that can cause pain to the bottom of the heel are plantar fasciitis and heel spur(s). Although there are many causes of heel pain in both children and adults, most can be effectively treated without surgery. When chronic heel pain fails to respond to conservative treatment, surgical care may be warranted.

Plantar Fasciitis is an inflammation of a fibrous band of tissue in the bottom of the foot that extends from the heel bone to the toes. This tissue can become inflamed for many reasons, most commonly from irritation by placing too much stress (such as excess running and jumping) on the bottom of the foot.

Heel Spur(s) or heel spur syndrome are most often the result of stress on the muscles and fascia of the foot. This stress may form a spur on the bottom of the heel. While many spurs are painless, others may produce chronic pain.

Based on the condition and the chronic nature of the disease, heel surgery can provide relief of pain and restore mobility in many cases. The type of procedure is based on examination and usually consists of plantar fascia release, with or without heel spur excision. There have been various modifications and surgical enhancements regarding surgery of the heel. Your podiatric physician will determine which method is best suited for you.

There are many other causes of heel pain, which has become one of the most common foot problems reported by patients of podiatric physicians. Many of them have a basis in heredity, as do a lot of other foot conditions. Among the causes are stress fractures and stress-fracture syndrome, entrapped nerves, bruises, bursitis, arthritis (including gout), deterioration of the fat pad on the heel, improper shoes, and obesity, just to name some. Most of these conditions will be treated nonsurgically, though surgery may be recommended in some instances.

Haglund's Deformity (pump bump)

This deformity is characterized by a bony enlargement on the back of the heel. Although not always painful, it may become so if bursitis develops near the Achilles tendon secondary to footwear irritation. If attempts at shoe modification and other medical treatments fail to improve this condition, surgical correction may be beneficial. Based on X-ray evaluation and other tests or examinations, your podiatric surgeon will select an operative treatment to alleviate the condition.

Insertional Achilles Clarification/Spur

This deformity differs from Haglund's deformity, in that spur formation or calcification at the insertion of the achilles tendon is the cause of pain. Often associated with achilles tendinitis, this deformity can often be difficult to treat medically and therefore surgical treatment may be necessary in chronic cases. There are many causes of this condition, including arthritis, but the most common appears to be overuse syndrome, where trauma occurs where the achilles tendon attaches to the heel bone. Surgical treatment includes removal of the bone spur and/or calcification, along with repair of the achilles tendon.

Reconstructive Surgery

Reconstructive surgery of the foot and ankle consists of complex surgical repair(s) that may be necessary to regain function or stability, reduce pain, and/or prevent further deformity or disease. Unfortunately, there are many conditions or diseases that range from trauma to congenital defects that necessitate surgery of the foot and/or ankle. Reconstructive surgery in many of these cases may require any of the following: tendon repair/transfer, fusion of bone, joint implantation, bone grafting, skin or soft tissue repair, tumor excision, amputation and/or the osteotomy of bone (cutting of bones in a precise fashion). Bone screws, pins, wires, staples, and other fixation devices (both internal and external), and casts may be utilized to stabilize and repair bone in reconstructive procedures.

Preoperative Testing and Care

As with anyone facing any surgical procedure, those undergoing foot and ankle surgery require specific tests or examinations before surgery to obtain a successful surgical outcome. Prior to surgery, the podiatric surgeon will review your medical history and medical conditions. Specific diseases, illnesses, allergies, and current medications need to be evaluated. Other tests that help evaluate your health status that may be ordered by the podiatric physician include blood studies, urinalysis, EKG, X-rays, blood flow studies (to better evaluate the circulatory status of the foot/legs), and biomechanical examination.

A consultation with another medical specialist is sometimes advised by a podiatric physician, depending on your test results or a specific medical condition.

Postoperative Care

Surgery of the rearfoot requires close care following surgery. To assure a rapid and uneventful recovery, it is important to follow your podiatric surgeon's advice and postoperative instructions carefully. Rest, ice, compression and elevation of your foot/ankle postoperatively is often advised. The usage of bandages, splints, casts, surgical shoes, crutches, or canes may be necessary after surgery. Your podiatric surgeon will also determine if and when you can bear weight on an operated foot.

Tailor's Bunion - Bunionette

A painful enlargement on the outside of the foot near the base of the small toe is known as a Tailor's bunion. Some medical practitioners refer to it as a bunionette, or a smaller version of the true bunion that occurs at the base of the large toe. This bony prominence or enlargement results in pain, local redness, and swelling, and is aggravated by various forms of shoe gear. A Tailor's bunion can be quite painful, not only because the bone is enlarged and prominent, but also because the joint capsule can become inflamed, which can increase the pain level. In the most severe cases, a bursa (fluid filled sack) can develop between the skin and the bony enlargement, and increase the pain level.

Tailor's Bunion
Causes:

This deformity received its name from medieval times when tailor's sat all day cross-legged with the outside portion of their feet resting on the ground. This repetitive position resulted in the irritation of the 5th metatarsal head causing local redness, swelling, and pain. A Tailor's bunion is the result of abnormal structural position of the front end of the 5th metatarsal, which is a hereditary condition. In other cases, the 5th metatarsal head is abnormally enlarged, which is also a hereditary condition. These hereditary structural deformities or bony enlargements can result in partial dislocation of the 5th toe. There are some patients who will also have pain, redness, and swelling at this joint because of abnormal bio-mechanical function of their foot, or as a complication of their systemic arthritis.

Narrow, pointed, ill fitting shoes are certainly the most common aggravating factors in irritating any abnormal structure or bony enlargement of this joint in our modern society.

Treatment:

The appropriate treatment for Tailor's bunion cannot be determined without a proper history and physical evaluation by your Podiatric physician/surgeon. The determination of the type of deformity that a particular patient may have will require x-rays.

Conservatively, anti-inflammatory medication, padding, shoe modifications, and orthoses can all be attempted to eliminate an individual's symptoms of Tailor's bunion.

When conservative treatment has been unsuccessful, then surgical treatment may be available to the patient. Depending on the type of deformity that an individual may have, various surgical procedures are recommended in an attempt to remove the bony prominence, or realign the abnormal structure to allow for the normal function of the joint. These various treatment options should be discussed in detail with your Podiatric physician/surgeon.

Toe and Metatarsal Fractures

The structure of your foot is complex, consisting of bones, muscles, tendons, and other soft tissues. Of the 26 bones in your foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot). Fractures of the toe and metatarsal bones are common and require evaluation by a specialist. A foot and ankle surgeon should be seen for proper diagnosis and treatment, even if initial treatment has been received in an emergency room.

Toe Fracture
What is a Fracture?

A fracture is a break in the bone. Fractures can be divided into two categories: traumatic fractures and stress fractures.

Traumatic Fractures

Traumatic fractures (also called acute fractures) are caused by a direct blow or impact-like seriously stubbing your toe. Traumatic fractures can be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required.

Traumatic Fractures

Traumatic fractures (also called acute fractures) are caused by a direct blow or impact-like seriously stubbing your toe. Traumatic fractures can be displaced or nondisplaced. If the fracture is displaced, the bone is broken in such a way that it has changed in position (dislocated). Treatment of a traumatic fracture depends on the location and extent of the break and whether it is displaced. Surgery is sometimes required.

Signs and symptoms of a traumatic fracture include:

  • You may hear a sound at the time of the break.
  • "Pinpoint pain" (pain at the place of impact) at the time the fracture occurs and perhaps for a few hours later, but often the pain goes away after several hours.
  • Deviation (misshapen or abnormal appearance) of the toe.
  • Bruising and swelling the next day.
  • It is not true that "if you can walk on it, it's not broken." Evaluation by the foot and ankle surgeon is always recommended.
Stress Fractures

Stress fractures are tiny, hairline breaks that are usually caused by repetitive stress. Stress fractures often afflict athletes who, for example, too rapidly increase their running mileage. Or they may be caused by an abnormal foot structure, deformities, or osteoporosis. Improper footwear may also lead to stress fractures. Stress fractures should not be ignored, because they will come back unless properly treated. Symptoms of stress fractures include:

  • Pain with or after normal activity
  • Pain that goes away when resting and then returns when standing or during activity
  • "Pinpoint pain" (pain at the site of the fracture) when touched
  • Swelling, but no bruising
Is it a Fracture, or a Sprain?

Sprains and fractures have similar symptoms, although sometimes with a sprain, the whole area hurts rather than just one point. Your foot and ankle surgeon will be able to diagnose which you have and provide appropriate treatment. Certain sprains or dislocations can be severely disabling. Without proper treatment they can lead to crippling arthritis.

Consequences of Improper Treatment

Some people say that "the doctor can't do anything for a broken bone in the foot." This is usually not true. In fact, if a fractured toe or metatarsal bone is not treated correctly, serious complications may develop. For example:

  • A deformity in the bony architecture which may limit the ability to move the foot or cause difficulty in fitting shoes.
  • Arthritis, which may be caused by a fracture in a joint (the juncture where two bones meet), or may be a result of angular deformities that develop when a displaced fracture is severe or hasn't been properly corrected.
  • Chronic pain and long-term dysfunction.
  • Non-union, or failure to heal, can lead to subsequent surgery or chronic pain.
Treatment of Toe Fractures

Fractures of the toe bones are almost always traumatic fractures. Treatment for traumatic fractures depends on the break itself.

Treatment of Metatarsal Fractures

Breaks in the metatarsal bones may be either stress or traumatic fractures. Certain kinds of fractures of the metatarsal bones present unique challenges.

Walking

Walking: Rx for Health, Happiness

For a healthier, happier lifestyle, try walking--the most popular form of exercise.

It's easy, safe, and inexpensive. It's also relaxing and at the same time invigorating, requires little athletic skill, and does not call for club membership or special equipment other than sturdy, comfortable shoes. And it is fun and natural--good for your mind and self-esteem.

The results of walking are physically rewarding--a trim, fit body better able to enhance general health and add enjoyable years to your life.

Fundamental walking--also called healthwalking--can be done almost anywhere and at any time, year around--to the store, in the mall, or in your neighborhood; alone, with your dog, or with others; and at your own pace. It is simple, uncomplicated--physical fitness at your leisure.

Walking benefits most everybody, regardless of age. About 67 million men and women are walking regularly. Convinced that it is good exercise, they're making it a part of their daily routine. And their numbers are increasing every year, according to the President's Council on Physical Fitness and Sports.

A Sure Way To Fitness

For those with a long history of inactivity, problems with obesity, or who just don't like strenuous activity, walking is an excellent way to begin an exercise program. You can start slowly, then increase your speed and maintain a steady pace. A good conditioning program begins with moderation and dedication.

Podiatric and family physicians recommend walking to ease or ward off a number of physically related ills. Walking can help you:

  • Strengthen your heart and lungs, and improve circulation.
  • Prevent heart attacks and strokes.
  • Reduce obesity and high blood pressure.
  • Boost your metabolic rate.
  • Favorably alter your cholesterol.
  • Improve muscle tone in your legs and abdomen.
  • Reduce stress and tension.
  • Reduce arthritis pain; stop bone tissue decay.
Walking: There's An Art To It

Before you start walking, some simple warmup exercises--but not strenuous, advanced stretching--can give your muscles added flexibility. Body twists at the waist, in a slow hula-hoop motion, and a few toe-touching or knee-bend exercises are appropriate. When you're ready to begin, the best way to start is walking 20 uninterrupted minutes at least three times a week. Walk at a comfortable pace, slowing down if you find yourself breathing heavily. Don't tire yourself. If 20 minutes is too much, cut back to l0 or l5 minutes. You can gradually increase your time and pace as your body adapts to the exercise.

There are several ways to measure your pace. One is to walk on routes which you have pre-measured with your car's odometer. Perhaps the simplest is to use a wristwatch. Count the number of steps you take in a 15-second period; if you're taking 15 in that time, you're walking about two miles an hour. At about 23, you're probably going three miles an hour, and at 30, the pace is close to four miles an hour.

You may want to keep an activity log, in which you jot down the dates, times, and estimated distances of your walks, plus other notes, such as routes, milestones, and incidental experiences.

Some Walking Tips:
  • Move at a steady pace, brisk enough to make your heart beat faster. Breathe more deeply.
  • Walk with your head erect, back straight, abdomen flat. Keep your legs out front and your knees slightly bent.
  • Swing your arms freely at your sides.
  • As you walk, land on the heel of your foot and roll forward to push off on the ball of your foot.
  • At least at the beginning, confine your walks to level stretches of flat surfaces, avoiding excessively steep hills and embanked roadways.
  • If you're walking in the evening, be sure to wear clothing with reflective material sewn in, or otherwise attached.
  • Cool down after a long, brisk walk to help pump blood back up from your legs to where it's needed. Here's where some stretching exercises can be helpful. A good one is standing about three feet from a wall, with your hands flat on the wall. Then take five or six small steps backward, maintaining your hand contact with the wall. Repeat the exercise five to ten times.
Racewalking

Racewalking is a very specific technique that's used by walkers for both fitness and competition. It has greater aerobic benefits than healthwalking, since it is faster and increases the heartbeat rate.

If you get to the point where you think racewalking is for you, there are clubs which can be contacted in most places.

Walking Footwear: Comfort and Fit

Choose a good quality, lightweight walking shoe with breathable upper materials, such as leather or nylon mesh. The heel counter should be very firm; the heel should have reduced cushioning to position the heel closer to the ground for walking stability. The front or forefoot area of the shoe should have adequate support and flexibility.

Fit is very important. Go to a reputable store and have both shoes fitted for length and width with the socks you'll be using. (Do this late in the afternoon, since your feet do swell enough during the day to affect your shoe size.) Make sure the shoe is snug but not too tight over the sock. The shoe should have plenty of room for the toes to move around. Several walking shoes have qualified to use the APMA Seal of Acceptance.

Your choice of athletic socks is also important. Sports podiatrists frequently recommend appropriately padded socks of acrylic fiber. Acrylic fibers tend to "wick" away excessive perspiration, which active feet can produce from 250,000 sweat glands at a rate of four to six ounces a day, or even more. Again, there are popular brands of athletic socks which are authorized to use APMA's Seal of Acceptance.

Some Other Tips
  • Check on the shoe width; it must comfortably accommodate the width of the ball of your foot.
  • Make sure you get good arch support.
  • See that the top of the heel counter of the shoe is properly cushioned and does not bite into the heel or touch the ankle bones.
Do You Need A Checkup?

If you are free of serious health problems, you can start walking with confidence. Walking is not strenuous; it involves almost no risk to health. You should, of course, exercise good judgment, not exceed the limits of your condition, and not walk outdoors during extreme weather periods, until you have a good walking program established.

You should, however, consult your family or podiatric physician before you begin a walking regimen. A checkup is suggested, particularly if you are over 60, have a disease or disability, or are taking medication. It is also recommended for those who are 35-60, substantially overweight, easily fatigued, excessive smokers, or have been physically inactive.

One of your physicians will help you determine your proper walking heart rate. Heart rate is widely accepted as a good method for measuring intensity during walking and other physical activities. The formula says that subtracting your age from the number 220 yields your maximum heart rate (beats per minute), and that the proper walking rate is 60-70 percent of that number. For a 50-year-old, that's 220 minus 50 equals 170; 60 percent of that is 102 and 70 percent is 119. Other factors should be considered, though; a physician's advice is the best indicator of your correct rate.

You are now ready to begin a walking program. It is a prescription for a healthier, happier life.

Shoe Tips
  • Check on the shoe width; it must comfortably accommodate the width of the ball of your foot.
  • Make sure you get good arch support.
  • See that the top of the heel counter of the shoe is properly cushioned and does not bite into the heel or touch the ankle bones.

Warts

What are Plantar Warts?

Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions. They can appear anywhere on the skin, but technically only those on the sole are properly called plantar warts.

Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune.

Identification Problems

Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses-which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.

It is also possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart. It is wise to consult a podiatric physician when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis.

Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.

Source of the Virus

The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.

If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading.

Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.

When plantar warts develop on the weight-bearing areas of the foot-the ball of the foot, or the heel, for example-they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.

Tips for Prevention
  • Avoid walking barefoot, except on sandy beaches.
  • Change shoes and socks daily.
  • Keep feet clean and dry.
  • Check children's feet periodically.
  • Avoid direct contact with warts-from other persons or from other parts of the body.
  • Do not ignore growths on, or changes in, your skin.
  • Visit your podiatric physician as part of your annual health checkup.
Self Treatment

Self treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.

Professional Treatment

It is possible that your podiatric physician will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated.

Lasers have become a common and effective treatment. A procedure known as CO2 laser cautery is performed under local anesthesia either in your podiatrist's office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.

Self treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.

Tips for Individuals with Warts
  • Avoid self treatment with over-the-counter preparations.
  • Seek professional podiatric evaluation and assistance with the treament of your warts.
  • Diabetics and other patients with circulatory, immunological, or neurological problems should be especially careful with the treament of their warts.
  • Warts may spread and are catching. Make sure you have your warts evaluated to protect yourself and those close to you.
  • Aging

    AgingMedicine and health awareness have progressed so rapidly since 1900 that life expectancy of the average American has increased by about 30 years.

  • Ankle Sprains

    Ankle Sprains

  • Ankle Fractures

    Ankle Fractures

  • Arthritis

    ArthritisArthritis is a frequent component of complex diseases that may involve more than 100 identifiable disorders. More information is available from the Arthritis Foundation.

  • Athlete's Foot

    Athlete's FootAthlete's foot is a skin disease caused by a fungus, usually occurring between the toes.

  • Bunions

    BunionsA bunion is an enlargement of the joint at the base of the big toe -the metatarsophalangeal (MTP) joint- that forms when the bone or tissue at the big toe joint moves out of place.

  • Diabetes

    DiabetesDiabetes mellitus is a chronic disease that affects the lives of nearly 24 million people in the United States. Additional information is available from the American Diabetes Association.

  • Diabetic Foot Complications

    Diabetic Foot Complications and Amputation Prevention

  • Diabetic Wound Care

    Diabetic Wound CareDiabetes is the leading cause of nontraumatic lower extremity amputations in the United States. Additional information is available from the American Diabetes Association.

  • Foot and Ankle Injuries

    Foot and Ankle InjuriesMany foot problems do not respond to "conservative" management. Your podiatric physician can determine when surgical intervention may be helpful. Often when pain or deformity persists, surgery may be appropriate to alleviate discomfort or to restore the function of your foot.

  • Footwear

    FootwearProper footwear can reduce foot problems.

  • Forefoot Surgery

    Forefoot SurgeryMany foot problems do not respond to "conservative" management. Your podiatric physician can determine when surgical intervention may be helpful. Often when pain or deformity persists, surgery may be appropriate to alleviate discomfort or to restore the function of your foot.

  • Worts

    Warts

  • General Foot Health

    General Foot HealthInformation on General Foot Health

  • Hammertoes

    HammertoesA hammertoe is a contracture- or bending -of the toe at the first joint of the digit, called the proximal interphalangeal joint.

  • Heel Pain

    Heel PainHeel pain has many causes. it is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight.

  • High Blood Pressure

    High Blood PressureIt's important to let your podiatrist know about high blood pressure.

  • Nail Problems

    Nail ProblemsToenails often serve as barometers of our health; they are diagnostic tools providing the initial signal of the presence or onset of systemic diseases.

  • Neuromas

    NeuromasA neuroma is a painful condition, also referred to as a "pinched nerve" or a nerve tumor. It is a benign growth of nerve tissue frequently found between the third and fourth toes that brings on pain, a burning sensation, tingling, or numbness between the toes and in the ball of the foot.

  • Orthotics

    OrthoticsOrthotics are shoe inserts that are intended to correct an abnormal, or irregular, walking pattern.

  • Peroneal Tendon Injuries

    Peroneal Tendon Injuries

  • Posterior Tibial Tendon Dysfunction

    Posterior Tibial Tendon Dysfunction

  • Rearfoot Surgery

    Rearfoot SurgeryMany conditions can affect the back portion of the foot and ankle. Fortunately, many of these problems can be resolved through conservative treatments. However when pain persists or deformity occurs, surgical intervention can often help alleviate pain, reduce deformity, and/or restore the function of your foot or ankle.

  • Tailors Bunion

    Tailors Bunion

  • Toe and Metatarsal Fractures

    Toe and Metatarsal Fractures

  • Walking

    Walking