Foot problems change social behaviour - but it doesn't have to be that way

Apr 23 2006

They help keep our balance, get us to lunch at our favorite cafe and power the gas pedal as we zoom along the highway, however, we often take our feet for granted until they start to bother us.

With the average person taking 9,000 steps per day -- more than 600 miles each year -- when feet start to hurt or change in shape, it can really impact a person's life. In fact, according to a survey conducted for PediFix Footcare Products, of those people who report having foot issues in the past five years, two out of three report that these foot issues, which range from blisters to bunions and heel pain, have changed the kind of shoes they wear, how active they are, where and how far they walk, and so on.

"Many people will completely alter their lives because of foot problems rather than just getting to the root of what the problem really is," says Oliver Zong, D.P.M., renowned New York City podiatrist and cosmetic foot surgeon. "You may be surprised at some of the little things you can do yourself to help your feet feel better."

Dr. Zong, who is a medical advisor to PediFix Footcare Products, offers the following tips to prevent and comfort common, painful foot conditions:

• Blisters - Fluid-filled pouches on the top of the skin that form when skin rubs against another surface, usually the inside of a shoe, causing friction. Most blisters can be self-treated unless they become infected. The easiest way to prevent blisters is to wear shoes that fit well and are appropriate for the activity; the new PediFix. survey found that 45% of women and 28% of men have worn shoes that caused blisters and pain.
  Break in new shoes by wearing them for one to two hours on the first day, gradually increasing the amount of time with each wearing, however, don't buy uncomfortable shoes with the hope that they will eventually break in - shoes that really hurt in the beginning will most likely still hurt a few months later. Use an over-the-counter product that is self-adhesive and can be cut to fit specific parts of the foot where blisters seem to pop up most.
  Since many blisters occur on the little toe, Dr. Zong suggests, "If your little toe is problematic, which it is for many people, it's advisable to take preventive action, rather than wait for pain. There are over-the-counter products that use a special gel technology that is specifically designed to prevent corns, blisters, ingrown nails and other irritations of the little toe." The special gel technology of these products soothes irritations and allows for natural healing, while absorbing pressure and friction to relieve pinching and cramping. "Forget adhesive bandages - they never stay on the little toe. These unique toe sleeves contain patented gel and are sized to fit the little toe comfortably while wearing most shoes," Dr. Zong adds.
• Bunion - This protuberance (enlargement) of bone and/or tissue around the base of the joint of the big toe is caused by abnormal stress over a period of time. This can result from faulty biomechanics (when the big toe starts moving/bending toward the smaller toes), or, from pointy or poor-fitting shoes. Any crowding of the toes puts pressure on the joint, pushing it outward. Bunions are also associated with various forms of arthritis, which is more common as we age.
  Pain from a bunion can range from mild to severe, with skin and tissues becoming swollen or inflamed. As a result, toenails may begin to grow into the sides of the nail bed, making them more difficult to trim (see "ingrown toenails" below); smaller toes can develop corns or become bent (see "hammertoes"), and calluses may form on the bottom of the foot. It is best to wear comfortable shoes as often as possible and to avoid shoes with narrow points that push toes together in an unnatural fashion. Experts advise seeing a footcare specialist at the earliest onset of symptoms - the first sign of pain or discomfort - in order to prevent severe deformity and progression of the deformity. Severe bunions may require surgical relief.
• Ingrown Toenails - This condition occurs when the nail grows into the surrounding skin, most commonly found on the big toe. Symptoms include redness, swelling, pain and infection. Toenails can become "ingrown" from a toe injury that changes the nail's contour, toe deformities, such as bunions, and high-heel or pointy shoes that apply pressure between the nail and soft tissues, eventually forcing the nail to grow into the skin. Ingrown toenails can also be congenital and are common during pregnancy, caused by added swelling of the feet (making shoes tighter) and extra body weight. Dr. Zong says that treatment typically starts with a daily soaking in a salt bath, or, if accompanied by inflammation, pain or infection, in an antibacterial product, such as povodine iodine solution. Dr. Zong says, "Usually ingrown toenails that are infected have to be removed in a simple in-office procedure. Afterwards, we have patients soak their feet in a therapeutic soak, then apply antibiotic drops." To prevent ingrown toenails, cut nails straight across and do not cut too short, leaving some of the white tip of the nail; trim often and never let them get too long. Wear well-fitting shoes with low to moderate heels and toes that are not too pointy.
• Corns & Calluses - A callus is a thickening of the skin that usually occurs at areas of pressure or friction, such as the bottom or sides of the feet, or ball of the foot. Calluses may also form as a result of a bunion and misaligned toes. Corns are a build-up of dead tissue, usually on the top of or between the toes that is often the result of hammertoes (see below) and is much like a callus. Like calluses, corns are actually the result of bone, rather than skin, problems that cause rubbing. If they become large, pressure from walking, standing or shoes will result in pain. About 40 percent of the population develops a corn on the 5th or "pinky" toe as a result of the toe turning in and/or having one joint instead of two (see blister section above for more discussion of little toes). Treatment varies, depending on the severity of the corn. Small corns can be removed with over-the-counter products, which contain 40 percent salicylic acid, the ingredient doctors recommend most, and can work in a few as two treatments. Dr. Zong says that people with diabetes, neuropathy and circulatory problems should not use corn removers with salicylic acid. Instead, seek the advice and care of a foot specialist.
• Hammertoes - Usually the result of tendon imbalance and/or abnormal motion of the foot that results in the tendons pulling the toes up or an abnormal shape to the foot, such as high or low arches. Shoes then rub on the prominent portion of the toe, leading to inflammation of the joints (bursitis) and eventually corns and painful calluses. Comfortable shoes that accommodate the contracted toe(s) are recommended. There are also a number of over-the-counter products that help with hammertoes, including cushions and toe straighteners that help reduce pain and friction, ease pain and absorb pressure. Severe hammertoes and other foot deformities should also be addressed by a foot surgeon/podiatrist.
• Heel Pain - Many people suffer from sharp pain, aching or stiffness on the bottom of one or both heels, often most intense first thing in the morning or after a period of rest and/or activity. This type of heel pain emanates from deep within the foot, directly on the heel bone or the "fascia," connective tissue of the foot, and is called "plantar fasciitis." About 90 percent of cases of heel pain are the result of plantar fasciitis. Other causes include heel bursas, heel spurs, a broken heel bone, arthritis and more. Rest and staying off the feet is often recommended, though difficult for most people to do. Stretching exercises of the calf muscles may be recommended, as well as eliminating activity that puts too much weight and pressure on feet, such as running or jogging, treadmills, stairmasters, getting up and down a lot, walking up stairs sideways, lifting or carrying heavy objects, weight lifting, etc. Dr. Zong recommends over-the-counter products that support the arch of the foot or help support and comfort painful heels. If pain persists, seek the help of a foot specialist.
• Flat Feet or Arches - A flat foot has a difficult time transferring weight from one foot to the other during normal walking. The lack of rigidity overworks muscles and tendons in the foot and leg, which become more worn out in the attempt to make the foot more rigid. The result is arch and leg "fatigue" or pain after walking, running or even standing in place for long periods of time. Additionally, a flat foot puts extra stress on various joints in the foot and often undergoes arthritic changes in the foot joints. Orthotics sold over-the-counter are a good place to start if you have weak or flat arches. It is important to gently support weak/flat arches, stabilize heels and protect the balls of the feet. In more severe cases of flat feet, surgery may be necessary. Post surgical patients are encouraged to wear orthotics, as well, says Dr. Zong.
• Neuroma - A neuroma is a pea-shaped mass of nerves that is being pinched between two bones of the foot - usually between the third and fourth toes and becomes thickened and painful. Symptomatic of a neuroma is intermittent cramping, burning and numbness that is aggravated by wearing shoes. "The cause of neuroma in most cases is wearing shoes that are too tight," says Dr. Zong. "The first line of defense for treating neuroma of the foot includes wearing shoes that fit properly, with enough room for the toes, orthotics or arch supports. "If these measures are ineffective, more aggressive treatments, such as cryosurgery, ligament release and surgical removal of the neuroma might be necessary," he adds.
• Warts (plantar) - Caused by the human papillomavirus (HPV) that enters the skin through small cuts and abrasions on the bottom/sole of the foot. While warts are essentially harmless and treatable, plantar warts can be quite painful (sharp and burning) when they develop on the weight-bearing areas of the feet - the ball of the foot or heel, for example, and can multiply if left untreated. (They can also be transmitted to other people who come in contact with the infected area since HPV is very contagious.) They are often contracted by walking barefoot on wet, dirty surfaces, such as public locker rooms at gyms or pools. A reasonable first treatment of warts is over-the-counter salicylic acid products, with a 40 percent salicylic acid formula. More stubborn plantar warts may require medical procedures performed by a footcare professional. To avoid plantar warts, avoid going barefoot in public, keep feet clean and dry, change shoes daily, avoid direct contact with warts and treat any new warts quickly to prevent them from spreading.