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Columbia St. Mary’s provides
sensitive and expert podiatric care for
adults and children. We feel our
patients deserve to have accurate
information and reliable resources
available in order to make good choices
about their foot and ankle care. As you
navigate through this site you will find
a wealth of information about podiatry,
foot and ankle ailments and available
treatments.
Most foot problems can be treated fairly
easily, but when a more serious
situation arises, Columbia St. Mary’s
podiatrists take a comprehensive
approach to your treatment. We will
involve your primary care provider,
infectious disease experts, bone
specialists, physical therapists—whoever
is necessary to ensure your complete
recovery.
Our goal is to educate each patient and
begin a relevant treatment program with
the highest quality of care available.
Whatever your foot and ankle trouble,
we'll work together to find the answers
that will comfort you and bring you
relief.
Columbia St. Mary's offer podiatric care
at the following clinics:
Kevin
Broaddrick, DPM
Columbia
West
10950 W. Capitol Dr.
Wauwatosa, WI 53222
Phone: (414) 464-4460
Jason
Boudreau, DPM, CWS, FACFAS
Prospect
Medical Commons
2311 N. Prospect Ave.
Milwaukee, WI 53211
Phone: (414) 319-3150
Jason
Boudreau, DPM, CWS, FACFAS
Columbia
St. Mary's Ozaukee Hospital
Seton Professional Building
13133 N. Port Washington Rd.,
Suite 206
Mequon, WI 53097
Phone: (414) 319-3150
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Seventy-five percent of
Americans will experience foot
health problems of varying
degrees of severity at one time
or another in their lives.
-
The foot is an intricate
structure containing 26 bones,
33 joints, 107 ligaments and 19
muscles and tendons.
-
The average person takes 8,000
to 10,000 steps a day. Those
cover several miles, and they
all add up to about 115,000
miles in a lifetime—more than
four times the circumference of
the globe.
-
Walking is the best exercise for
your feet. It also contributes
to your general health by
improving circulation,
contributing to weight control,
and promoting all-around well
being.
-
Shopping for shoes is best done
in the afternoon. Your feet tend
to swell a little during the
day, and it's best to buy shoes
to fit them then. Have your feet
measured every time you purchase
shoes, and do it while you're
standing. When you try on shoes,
try them on both feet; many
people have one foot larger than
the other, and it's best to fit
the larger one.
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.
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 usually caused by the way we
walk, or our inherited foot type,
perhaps our shoes or other sources.
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, non-medicated 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.
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
non-surgical 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.
At Columbia St. Mary’s, we may recommend
these treatments:
-
Padding and 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.
-
Medications -
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.
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.
Surgical Options
Pain and any deformities are
significantly reduced in the great
majority of patients who undergo bunion
surgery. The surgery will remove the
bony enlargement, restore the normal
alignment of the toe joint, and relieve
pain. Postoperative orthoses or
supportive devices may be recommended to
improve foot function.
Each day, with every step you take, your
big toe bears a tremendous amount of
stress —a force equal to about twice
your body weight. Most of us don't
realize how much we use our big toe. We
tend to take it for granted, unless a
problem develops. One problem that
afflicts the big toe is called hallux
rigidus, a condition where movement of
the toe is restricted to varying
degrees. This disorder can be very
troubling and even disabling, since we
use the all-important big toe whenever
we walk, stoop down, climb up or even
stand. If you have pain and/or stiffness
in your big toe, you may have this
condition.
What is Hallux Rigidus?
Hallux rigidus is a disorder of
the joint located at the base of the big
toe. It causes pain and stiffness in the
big toe, and with time it gets
increasingly harder to bend the toe.
"Hallux" refers to the big toe, while
"Rigidus" indicates that the toe is
rigid and cannot move. Hallux rigidus is
actually a form of degenerative
arthritis (a wearing out of the
cartilage within the joint that occurs
in the foot and other parts of the
body).
Because hallux rigidus is a progressive
condition, the toe's motion decreases as
time goes on. In its earlier stage,
motion of the big toe is only somewhat
limited—at that point, the condition is
called “hallux limitus.” But as the
problem advances, the toe's range of
motion gradually decreases until it
potentially reaches the end stage of
“rigidus”—where the big toe becomes
stiff, or what is sometimes called a
“frozen joint.” Other problems are also
likely to occur as the disorder
progresses.
Symptoms
-
Pain and stiffness in the big
toe during use (walking,
standing, bending, etc.)
-
Pain and stiffness aggravated by
cold, damp weather
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Difficulty with certain
activities (running, squatting)
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Swelling and inflammation around
the joint
-
Calluses at the inside part of
the big toe or other irritations
caused by the limited joint
motion.
As the disorder gets more serious,
additional symptoms may develop,
including:
-
Pain, even during rest
-
Difficulty wearing shoes because
bone spurs (overgrowths)
develop.
-
Dull pain in the hip, knee, or
lower back due to changes in the
way you walk
-
Limping, in severe cases
What Causes Hallux Rigidus?
Common causes of hallux rigidus are
faulty function (biomechanics) and
structural abnormalities of the foot
that can lead to osteoarthritis in the
big toe joint. This type of
arthritis—the kind that results from
“wear and tear”—often develops in people
who have defects that change the way
their foot and big toe functions. For
example, those with fallen arches or
excessive pronation (rolling in) of the
ankles are susceptible to developing
hallux rigidus.
In some people, hallux rigidus runs in
the family and is a result of inheriting
a foot type that is prone to developing
this condition. In other cases, it is
associated with overuse—especially among
people engaged in activities or jobs
that increase the stress on the big toe,
such as workers who often have to stoop
or squat. Hallux rigidus can also result
from an injury—even from stubbing your
toe. Or it may be caused by certain
inflammatory diseases, such as
rheumatoid arthritis or gout.
Diagnosis of Hallux Rigidus
The sooner this condition is diagnosed,
the easier it is to treat. Therefore,
the best time to see a podiatric surgeon
is when you first notice that your big
toe feels stiff or hurts when you walk,
stand, bend over, or squat. If you wait
until bone spurs develop, your condition
is likely to be more difficult to
manage.
In diagnosing hallux rigidus, the
podiatric surgeon will examine your feet
and manipulate the toe to determine its
range of motion. X-rays are used to
determine how much arthritis is present
and to evaluate any bone spurs or other
abnormalities that may have formed.
Treatment: Non-Surgical
Approaches
If your condition is caught early
enough, it is more likely to respond to
less aggressive treatment. If fact, in
many cases, early treatment may prevent
or postpone the need for surgery in the
future. That's why it is important to
see your podiatric surgeon when you
first begin to notice symptoms.
Treatment for mild or moderate cases of
hallux rigidus may include one or more
of these strategies:
-
Shoe modifications
- Shoes that have a large toe
box should be worn, because they
put less pressure on your toe.
Stiff or rocker-bottom soles may
also be recommended. Most
likely, you'll have to stop
wearing high heels.
-
Orthotic devices
- Custom orthotic devices may
improve the function of your
foot.
-
Medications -
Nonsteroidal anti-inflammatory
drugs (NSAIDs), such as
ibuprofen, may be prescribed to
help reduce pain and
inflammation.
-
Injection therapy
- Injections of corticosteroids
in small amounts are sometimes
given in the affected toe to
help reduce the inflammation and
pain.
-
Physical therapy
- Ultrasound therapy or other
physical therapy modalities may
be undertaken to provide
temporary relief.
When is Surgery Needed?
If conservative treatment fails, then
surgery may be the only way to eliminate
or reduce pain. There are several types
of surgery that can be utilized to treat
hallux rigidus. These surgical
procedures fall into three categories:
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Some procedures simply "clean
up" the joint. The surgeon
removes the arthritic damage
from the joint as well as any
accompanying bone spurs to
eliminate pain and minimize
jamming at the joint.
-
Other procedures clean up the
joint and realign the metatarsal
utilizing a cut in the bone.
These procedures are designed to
preserve and restore normal
alignment and function of the
joint as well as reduce or
eliminate pain.
-
More aggressive procedures are
used when the joint cannot be
preserved. These may involve
fusing the joint, or removing
part or all of the joint and, in
some cases, replacing it with an
implant, such as is done for the
hip or knee. These procedures
eliminate painful motion in the
joint and provide a stable foot.
The procedure that is used to correct
hallux rigidus depends on many factors,
including the cause of the condition and
the severity, as well as the patient's
age, occupation and activity level.
A hammer toe deformity is a contracture
of the toe(s). In this condition, the
toe is bent at the middle joint, so that
it is buckled or hammered. Initially,
hammer toes are flexible and can be
corrected with simple measures but, if
left untreated, they can become fixed
and require surgery.
People with hammer toes may have corns
or calluses on the top of the middle
joint of the toe or on the tip of the
toe. They may also feel pain in their
toes or feet and have difficulty finding
comfortable shoes.
Causes of Hammer Toes
Hammer toes result from shoes that don’t
fit properly or a muscle imbalance,
usually in combination with one or more
other factors. Muscles work in pairs to
straighten and bend the toes. If the toe
is bent and held in one position long
enough, the muscles tighten and cannot
stretch out. Shoes that narrow toward
the toe may make your forefoot look
smaller. But they also push the smaller
toes into a flexed (bent) position. The
toes rub against the shoe, leading to
the formation of corns and calluses,
which further aggravate the condition. A
higher heel forces the foot down and
squishes the toes against the shoe,
increasing the pressure and the bend in
the toe. Eventually, the toe muscles
become unable to straighten the toe,
even when there is no confining shoe.
Treatment for Hammer Toes
Conservative treatment starts
with new shoes that have soft, roomy toe
boxes. Shoes should be one-half inch
longer than your longest toe. (Note: For
many people, the second toe is longer
than the big toe.) Avoid wearing tight,
narrow, high-heeled shoes. You may also
be able to find a shoe with a deep toe
box that accommodates the hammer toe.
Or, a shoe repair shop may be able to
stretch the toe box so that it bulges
out around the toe. Sandals may help, as
long as they do not pinch or rub other
areas of the foot.
Your doctor may recommend that you use
commercially available straps, cushions
or non-medicated corn pads to relieve
symptoms. You should try to avoid all
medicated corn pads as they usually do
more harm than good. If you have
diabetes, poor circulation or a lack of
feeling in your feet, avoid any forms of
self-treatment and visit a podiatrist.
Hammer toes can be corrected by surgery
if conservative measures fail. Usually,
surgery is done on an outpatient basis
with a local anesthetic. The actual
procedure will depend on the type and
extent of the deformity. After the
surgery, there may be some stiffness,
swelling and redness and the toe may be
slightly longer or shorter than before.
You will be able to walk, but should not
plan any long hikes while the toe heals,
and should keep your foot elevated as
much as possible.
Heel pain is one of the most common
disorders treated by podiatrists.
Usually it occurs beneath the heel or
behind the heel. If it hurts under your
heel, you may have one or more
conditions that inflame the tissues on
the bottom of your foot:
-
Plantar Fasciitis
(subcalcaneal pain) -
Doing too much running or
jumping can inflame the tissue
band (fascia) connecting the
heel bone to the base of the
toes. The pain is centered under
your heel and may be mild at
first but flares up when you
take your first steps after
resting overnight.
-
Heel Spur -
When plantar fasciitis continues
for a long time, a heel spur
(calcium deposit) may form where
the fascia tissue band connects
to your heel bone. Your doctor
may take an X-ray to see the
bony protrusion, which can be
1/4" or longer.
Plantar Fasciitis
When your first few steps out of bed in
the morning cause severe pain in the
heel of your foot, you may have plantar
fasciitis (fashee-EYE-tiss). It’s an
overuse injury affecting the sole or
flexor surface (plantar) of the foot. A
diagnosis of plantar fasciitis means you
have inflamed the tough, fibrous band of
tissue (fascia) connecting your heel
bone to the base of your toes.
You’re more likely to get the condition
if you’re a woman, if you’re overweight,
or if you have a job that requires a lot
of walking or standing on hard surfaces.
You’re also at risk if you walk or run
for exercise, especially if you have
tight calf muscles that limit how far
you can flex your ankles. People with
very flat feet or very high arches are
also more prone to plantar fasciitis.
The condition starts gradually with mild
pain at the heel bone. You’re more
likely to feel it after (not during)
exercise. The pain classically occurs
again after arising from a midday lunch
break. If you don’t treat plantar
fasciitis, it may become a chronic
condition. You may not be able to keep
up your level of activity and you may
also develop symptoms of foot, knee, hip
and back problems because of the way
plantar fasciitis changes the way you
walk.
Treatment for Plantar Fasciitis
Rest is the first treatment for plantar
fasciitis. Try to keep weight off your
foot until the inflammation goes away.
You can also apply ice to the sore area
for 20 minutes three or four times a day
to relieve your symptoms. Often a doctor
will prescribe nonsteroidal
anti-inflammatory medication such as
ibuprofen. A program of home exercises
to stretch your Achilles tendon and
plantar fascia are the mainstay of
treating the condition and lessening the
chance of recurrence, along with proper
arch supports.
About 90 percent of people with plantar
fasciitis improve significantly after
two months of initial treatment. You may
be advised to use shoes with
shock-absorbing soles (like a walking or
running shoe) or fitted with a temporary
arch support. Your foot may also be
taped into a specific position. If the
taping or temporary arch supports are
helpful, then you are a candidate for
custom-molded arch supports, also called
orthotics.
If your plantar fasciitis is extremely
swollen and tender, your doctor may
inject your heel with steroidal
anti-inflammatory medications
(corticosteroid). If you still have
symptoms, you may need to wear a walking
cast for 2-3 weeks or positional splint
when you sleep. In a few cases, you
might need surgery to release your
ligament.
Heel Spurs
Patients with heel spurs
usually have the same complaints as
those with plantar fasciitis. This is
due to the fact that the heel spur is
actually a result of the continuous
strain on the plantar fascia. Therefore,
the treatment of heel spurs is the same
as the treatment for plantar fasciitis.
In about 10 percent of patients, the
heel spur may be impinging on a nerve or
may actually be fractured. Therefore,
after exhausting the above-mentioned
treatments, surgery may be necessary to
remove the spur.
If you have pain behind your heel, you
may have inflamed the area where the
Achilles tendon inserts into the heel
bone (retrocalcaneal bursitis). People
often get this by running too much or
wearing shoes that rub or cut into the
back of the heel. Pain behind the heel
may build slowly over time, causing the
skin to thicken, get red and swell.
You might also develop a bump on the
back of your heel that feels tender and
warm to the touch (Haglund's deformity).
The pain flares up when you first start
an activity after resting. It often
hurts too much to wear normal shoes. You
may need an X-ray to see if you also
have a bone spur.
Treatment includes resting from the
activities that caused the problem,
non-steroidal anti-inflammatory
medication and wearing heel lifts or
open back shoes.
If your heel pain is not getting better
with conservative treatment, then a
surgical procedure may be necessary to
remove the bump or bone spurs.
If you sometimes feel that you are
“walking on a marble,” and you have
persistent pain in the ball of your
foot, you may have a condition called
Morton’s neuroma. A neuroma is a benign
tumor of a nerve. Morton’s neuroma is
not actually a tumor, but a thickening
of the tissue that surrounds the digital
nerve leading to the toes. It occurs as
the nerve passes under the ligament
connecting the toe bones (metatarsals)
in the forefoot. Morton’s neuroma most
frequently develops between the third
and fourth toes, usually in response to
irritation, trauma or excessive
pressure. The incidence of Morton’s
neuroma is 8 to 10 times greater in
women than in men.
Signs and Symptoms
Normally, there are no outward signs,
such as a lump, because this is not
really a tumor. The chief complaint is
usually burning pain in the ball of the
foot that radiates into the toes. The
pain generally intensifies with activity
or wearing shoes. Night pain is rare.
There may also be numbness in the toes,
or an unpleasant feeling in the toes.
Runners may feel pain as they push off
from the starting block. High-heeled
shoes, which put the foot in a similar
position to the push-off, can also
aggravate the condition. Tight, narrow
shoes also aggravate this condition by
compressing the toe bones and pinching
the nerve.
Diagnosis and Treatment
During the examination, your physician
will feel for a palpable mass or a
"click" between the bones. They will put
pressure on the spaces between the toe
bones to try to replicate the pain and
look for calluses or evidence of stress
fractures in the bones that might be the
cause of the pain. Range of motion tests
will rule out arthritis or joint
inflammations. X-rays may be required to
rule out a stress fracture or arthritis
of the joints that join the toes to the
foot.
Initial therapies are nonsurgical and
relatively simple. They can involve one
or more of the following treatments:
-
Changes in footwear
- Avoid high heels or tight
shoes, and wear wider shoes with
lower heels and a soft sole.
This enables the bones to spread
out and may reduce pressure on
the nerve, giving it time to
heal.
-
Orthotics -
Custom shoe inserts and pads
also help relieve irritation by
lifting and separating the
bones, reducing the pressure on
the nerve.
-
Injection - One
or more injections of a
corticosteroid medication can
reduce the swelling and
inflammation of the nerve,
bringing some relief.
Metatarsalgia (Capsulitis) is a general
term used to denote a painful foot
condition in the metatarsal region of
the foot, the area just before the toes,
more commonly referred to as the
ball-of-the-foot. Metatarsalgia
(ball-of-foot-pain) is often located
under the 2nd, 3rd and 4th metatarsal
heads. These joints have a capsule
around them to hold in the joint fluid
and lubricate the joint for motion.
Excessive pressure to the joint can
cause inflammation of the joint and
capsule. The patient usually relates
pain at the joint itself, and states
that it sometimes feels like their "sock
is bunched up" or it feels like their
standing on a "pea".
Causes
With this condition one or more
of the metatarsal heads become painful
and/or inflamed, usually due to
excessive pressure over a long period of
time. It is common to experience acute,
recurrent, or chronic pain with this
common foot condition. Ball-of-foot pain
is often caused from improper fitting
footwear, most frequently in women’s
dress shoes and other restrictive
footwear. Footwear with a narrow toe box
(toe area) causes the ball-of-foot area
to be forced into a minimal amount of
space. This can inhibit the walking
process and lead to extreme discomfort
in the forefoot. Other factors can cause
excessive pressure in the ball-of-foot
area that can result in metatarsalgia.
These include shoes with heels that are
too high or participating in high impact
activities without proper footwear
and/or orthotics. Also as we get older,
the fat pad in our foot tends to thin
out, making us much more susceptible to
pain in the ball-of-the-foot. Often
times, the second metatarsal may be much
longer than the others, resulting in
excessive pressure on the joint as well.
Treatment and Prevention
The first step in treating metatarsalgia
is to determine the cause of the pain.
If improper fitting footwear is the
cause of the pain, the footwear must be
changed. Footwear designed with a high,
wide toe box (toe area) and a rocker
sole are ideal for treating
metatarsalgia. The high, wide toe box
allows the foot to spread out while the
rocker sole reduces stress on the
ball-of-the-foot. Unloading pressure to
the ball-of-the-foot can be accomplished
with a variety of foot care products.
Orthotics designed to relieve
ball-of-foot pain usually feature a
metatarsal pad. The orthotic is
constructed with the pad placed behind
the ball-of-the-foot to relieve
pressure, and redistribute weight from
the painful area to more tolerant areas.
Other products often recommended include
gel metatarsal cushions and metatarsal
bandages. When these products are used
with proper footwear, you should
experience significant relief.
Ankle sprains are common injuries that
occur when ligaments are stretched or
torn. The ankle sprain is the most
common athletic injury. Nearly 85
percent of ankle sprains occur
laterally, or on the outside of ankle
joints. Sprains on the inside ligaments
are less common.
Many sprains occur when participating in
sports, or by twisting the ankle when
walking on an uneven surface. Some
individuals, due to their bone structure
or foot type, are more prone to ankle
sprains.
The ankle joint is made up of three
bones. The bones are called the tibia,
fibula, and talus. These bones form a
socket in which the ankle joint moves.
The tibia, fibula and talus are
connected to each other by ligaments.
When an ankle is sprained, a ligament is
stretched, partially torn or completely
torn.
Ankle sprain symptoms vary depending on
severity. Often, the ankle is tender,
swollen and discolored. The ankle can be
quite painful to touch. Walking is
usually hampered and may become
difficult depending on the severity of
the sprain. A feeling of instability may
occur, especially in severe ankle
sprains when ligaments are torn. Ankle
sprains are classified by "types" and
range from mild to moderate to severe.
Classifying ankle sprains helps the
physician diagnose the specific
structures involved in the injury. This
also helps determine appropriate
treatment plans for each type of ankle
sprain. Type I ankle sprain, the least
severe, occurs when ligament fibers have
been stretched or slightly torn. Type II
sprain occurs when some of these fibers
or ligaments are completely torn. Type
III, the most severe, occurs when the
entire ligament is torn and there is
significant instability of the ankle
joint.
Fractures of the ankle bone or outside
the foot bone may be present after any
type of ankle sprain. Fractures require
immediate diagnosis and attention for
appropriate treatment. Therefore, X-rays
are required to evaluate all sprains.
Occasionally, more sophisticated testing
is necessary to examine soft tissue
injuries. For example, computerized
tomography (CT) and magnetic resonance
imaging (MRI) give detailed views of the
bone and soft tissue structures around
the ankle joint. Once the diagnosis is
made, the podiatric surgeon recommends
appropriate therapy.
Treatment for Ankle Sprains
Initial treatment includes
rest, ice, compression and elevation
(RICE). The "RICE" method promotes
healing, decreases pain, and reduces
swelling around the ankle joint. In more
severe cases, non-weight bearing
activities are encouraged and crutches
may be recommended. Compression may be
achieved with an elastic bandage,
splint, short leg cast or brace,
depending on severity. Compression
eliminates motion around the ankle
joint.
The ability to walk or participate in
other weight-bearing activities during
the healing process depends on the
severity or type of ankle sprain. This
is determined by your doctor once the
diagnosis is made. Most ankle sprains
heal in three to eight weeks. In more
severe cases, ligaments may require more
healing time to promote ankle stability.
Repeated ankle sprains may cause chronic
instability, interfering with walking or
sports activities. In this case, the
physician may recommend a surgical
procedure to tighten or create new
ligaments around the ankle joint to
re-establish stability of the ankle
joint.
Conservative treatment of many foot and
ankle problems often promotes pain
relief. For example, ankle strengthening
exercises following the injury help
prevent recurrence of injury. Most of
these exercises can be done at home
after appropriate instruction. Ankle
supports and braces or taping around the
ankle joint is especially helpful for
individuals participating in sports.
Treatment for Ankle Fractures
If the fracture is stable (without
damage to the ligament or the ankle
joint), it can be treated with a leg
cast or brace. Initially, a long leg
cast may be applied, which can later be
replaced by a short walking cast. It
takes at least six weeks for a broken
ankle to heal, and it may be several
months before you can return to sports
at your previous competitive level. Your
physician will probably schedule
additional X-rays while the bones heal,
to make sure that changes or pressures
on the ankle don’t cause the bones to
shift.
If the ligaments are also torn, or if
the fracture created a loose fragment of
bone that could irritate the joint,
surgery may be required to "fix" the
bones together so they will heal
properly. The surgeon may use a plate,
screws, staples or tension bands to hold
the bones in place. Usually, there are
few complications, although there is a
higher risk among diabetic patients
Afterwards, the surgeon will prescribe a
program of rehabilitation and
strengthening. Range-of-motion exercises
are important, but keeping weight off
the ankle is just as important.
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, one of
the most serious conditions that they
treat. The key to amputation prevention
in diabetic patients is early
recognition and regular foot screenings,
at least annually, from a podiatric
physician. At Columbia St. Mary's,
diabetic foot care and limb salvage is
one of our specialties.
Foot problems are a leading cause of
hospitalization for the eight million
persons in the United States who have
been identified as having diabetes
mellitus. Expenditures related to
diabetic foot problems total hundreds of
millions of dollars annually. It is
estimated that 15 percent of all
diabetics will develop a serious foot
condition at some time in their lives.
Common problems include infection,
ulceration, or gangrene that may lead,
in severe cases, to amputation of a toe,
foot or leg. Most of these problems are
preventable through proper care and
regular visits to your podiatric
physician. At Columbia St. Mary's, we
can provide information on foot
inspection and care, proper footwear,
and early recognition and treatment of
foot conditions.
Causes of Foot Problems
Foot problems in persons with
diabetes are usually the result of three
primary factors: neuropathy, poor
circulation, and decreased resistance to
infection. Also, foot deformities and
trauma play major roles in causing
ulcerations and infections in the
presence of neuropathy or poor
circulation.
Neuropathy (Nerve Damage)
Your ability to detect sensations or
vibration may be diminished. Neuropathy
allows injuries to remain unnoticed and
untreated for lengthy periods of time.
It may cause burning or sharp pains in
feet and interfere with your sleep.
Ironically, painful neuropathy may occur
in combination with a loss of sensation.
Neuropathy can also affect the nerves
that supply the muscles in your feet and
legs. This ‘motor neuropathy’ can cause
muscle weakness or loss of tone in the
thighs, legs, and feet, and the
development of hammertoes, bunions, and
other foot deformities.
Poor Circulation
Persons with diabetes often have
circulation disorders (peripheral
vascular disease) that can cause
cramping in the calf or buttocks when
walking. The symptoms can progress to
severe cramping or pain at rest, with
associated color and temperature changes
(the feet may turn bright red when
hanging down and constantly feel cold).
Also, the skin may become shiny, thinned
and easily damaged. A reduction in hair
growth and a thickening of the toenails
might also be present.
Poor circulation, resulting in reduced
blood flow to the feet, restricts
delivery of oxygen and nutrients that
are required for normal maintenance and
repair. Healing of foot injuries,
infection or ulceration is affected.
Peripheral vascular bypass operations
may avert lower extremity amputation.
Infection
Persons with diabetes are generally more
prone to infections than non-diabetic
people. Due to deficiencies in the
ability of white blood cells to defend
against invading bacteria, diabetics
have more difficulty in dealing with and
mounting an immune response to the
infection. Infections often worsen and
may go undetected, especially in the
presence of diabetic neuropathy or
vascular disease. Often, the only sign
of a developing infection is unexplained
high blood sugar, even without fever.
The combination of fever and high blood
sugar often warns of a severe infection
requiring hospitalization. Lesser
degrees of infection are often treated
on an outpatient basis.
Ulcers of the Foot
An ulceration or ulcer is
usually a painless sore at the bottom of
the foot or top of the toes, resulting
from excessive pressure at that site.
Ulcers frequently underlie a
pre-existing corn or callus that was
allowed to build up too thickly. Trauma
from heat, cold, shoe pressure, or
penetration by a sharp object are also
potential causes. Neuropathy allows the
lesions to develop because the normal
warning sense of pain has been lost and
they go unrecognized. Continued pressure
or walking on the injured skin creates
even further damage and the ulcer will
worsen. The open sore will frequently
become infected and may even penetrate
to bone.
Treatment relies on early recognition of
the ulceration by a podiatric physician,
avoidance of weight bearing activities
such as walking, avoidance of wearing
"closed-in" shoes, and early
intervention. Besides local wound care,
dressings and antibiotics, other
measures may be necessary to adequately
relieve pressure on the area. When use
of crutches, a wheelchair, or rest is
not feasible, plaster casts, braces,
healing sandals, or orthoses (special
shoe inserts) can be used to protect the
foot while it heals. If circulation is
inadequate to allow healing, your
podiatric physician may refer you to a
vascular surgeon for appropriate
evaluation and possible vascular
reconstructive surgery.
Once an ulcer has healed, it is
important to continue to see your
podiatric physician regularly. Special
footwear and inserts may be recommended
to protect your feet and prevent new or
recurrent lesions from developing.
Foot Surgery in the Diabetic
Patient
Realizing the potential danger of foot
deformities in the diabetic patient,
corrective foot surgery is an option
when you are in generally good health
and have good circulation. Most
deformities progressively worsen over
time as do the effects of neuropathy and
vascular or circulatory disease. When
foot deformities cannot be managed
effectively with conservative care,
surgery may be indicated.
Podiatric surgery is often "same day"
surgery under local anesthesia to
minimize potential complications. In
some cases, such as in the presence of
an active ulceration, hospitalization
may be necessary to properly monitor
your postoperative progress.
Surgery may also be required to heal an
ulceration or to eradicate some
infections, especially those involving
the bone. Your cooperation is an
important part of your care. You must
guard against injury and provide the
daily care necessary to maintain the
health of your feet.
Footwear Guidelines
Shoes must always fit comfortably and
have adequate width and depth for the
toes. Leather shoes easily adapt to the
shape of your feet and allow them to
"breathe." Athletic shoes, jogging shoes
and sneakers are usually excellent
choices if they are well fitted and
provide adequate cushioning. Your
podiatric surgeon may recommend "extra
depth" shoes, custom molded shoes to
adapt to your particular needs, or
orthotics to provide cushioning and
support.
-
Always check your shoes for
foreign objects or torn linings
before putting them on.
-
New shoes should be worn for
only a few hours at a time, and
you should take care to inspect
your feet for any points of
irritation.
-
Socks should be well fitted
without seams or folds. They
should not be so tight as to
interfere with circulation.
Well-padded socks can be very
protective if there is an
abundance of room in your shoes.
-
Avoid wearing open-toed shoes or
sandals until you have discussed
this with your podiatric
surgeon.
-
Above all else, do not walk with
bare feet.
Foot Care Guidelines
-
Inspect your feet daily for
blisters, bleeding, and lesions
between your toes.
-
Use a mirror to see the bottom
of your foot and heel. If age or
other factors hamper
self-inspection, ask someone to
help you.
-
Do not soak your feet unless the
temperature of the water is
lukewarm, and not as hot as you
can stand it. (95°-100°
Fahrenheit).
-
Avoid temperature extremes—do
not use hot water bottles or
heating pads on your feet.
-
Wash your feet daily with warm,
soapy water and dry them well,
especially between the toes.
-
Use a moisturizing cream or
lotion daily, but avoid getting
it between the toes.
-
Do not use acids or chemical
corn removers. Do not perform
"bathroom surgery" on corns,
calluses, or ingrown toenails.
-
Trim your toenails carefully and
file them gently.
-
Have a podiatrist treat you
regularly if you cannot trim
them yourself without
difficulty.
-
Contact your podiatric physician
immediately if your foot becomes
swollen or is painful, or if
redness occurs.
-
Do not smoke. Tobacco can
contribute to circulatory
problems, which can be
especially troublesome in
patients with diabetes.
-
Learn all you can about diabetes
and how it can affect your feet.
-
Regular checkups by your
podiatric physician—at least
annually—is the best way to
ensure that your feet remain
healthy.
Diabetes is reaching epidemic
proportions in the United States. During
the past decade, there has been an
increase of 33 percent with the diabetic
population currently topping 16 million
people. There are many complications
associated with diabetes including
kidney, heart, vision, circulatory and
foot problems. The good news is that
many of these potential problems can be
minimized as a result of life style
changes, medications and other
preventive care.
Amputations, or partial amputations, of
the feet and legs are also growing at an
alarming rate. In fact, it is the
leading cause of non-traumatic
amputation in the United States.
Recently a task force was created by
officials from Medicare, the American
Podiatric Medical Association and the
American Diabetes Association in order
to explore ways to reduce the number of
amputations in the diabetic populations.
The number of these lower extremity
amputations grew by 28 percent in just
the past several years. However, it has
been determined that over half of these
amputations could have been prevented by
timely conservative foot care.
We are authorized Medicare suppliers to
evaluate, prescribe and dispense high
quality, extra-depth shoes and three
pairs of removable protective shoe
inserts per calendar year. Many diabetic
patients qualify for this benefit and
Medicare will pay 80 percent of the cost
for the shoes and insoles and your
supplemental insurance may pay the other
20 percent.
Medicare established the diabetic
footwear benefit to lower the incidence
of diabetic foot complications such as
ulceration and amputation in the
diabetic population. Due to the
preventive nature of this program, a
patient may qualify for shoes and
inserts without a history of any foot
complications.
To qualify for the benefit, the
following criteria must be met:
-
The patient has type I or type
II diabetes mellitus (diagnosis
codes 250.00-250.93) either
insulin dependent or dietary
controlled.
-
The patient has one or more of
the following conditions:
a) Previous amputation of the
other foot, or part of either
foot.
b) History of previous foot
ulceration of either foot.
c) History of pre-ulcerative
calluses of either foot.
d) Peripheral neuropathy with
evidence of callus formation of
either foot.
e) Foot deformity of either
foot, such as bunions,
hammertoes, flat feet, etc. (At
this time Medicare has not
stated what type of foot
deformity needs to be present.
However, you may infer that it
would be a deformity that could
cause a problem if the patient
was not wearing a properly
fitted shoe and molded insert.)
f) Poor circulation in either
foot.
-
The certifying physician who is
managing the patient's systemic
diabetes condition has certified
that:
a) The indications listed in (1)
and (2) are present.
b) The physician is treating the
patient under a comprehensive
plan of care for his/her
diabetes.
c) The patient needs diabetic
shoes.
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.
An ingrown toenail 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 other appropriate treatment.
At Columbia St. Mary’s, we can 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, we can perform a
procedure to permanently prevent ingrown
nails. The corner of the nail that is
ingrown, 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 infection of the nail, or
onychomycosis, 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.
At Columbia St. Mary's, we can detect a
fungal infection early, culture the
nail, determine the cause, and form a
suitable treatment plan, which may
include prescribing topical 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. We 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, which 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 problems can often be
successful.
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, also may mimic
athlete's foot.
Symptoms
The signs of athlete's foot, singly or
combined, are drying 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 layers of the skin.
Topical or oral antifungal drugs are
prescribed with growing frequency. In
mild cases, 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.
If an apparent fungus condition does not
respond to proper foot hygiene and self
care, and there is no improvement within
two weeks, seek professional treatment.
If a fungus is the cause of the problem,
a specific treatment plan, including the
prescription of antifungal medication,
applied topically or taken by mouth,
will usually be suggested. If the
infection is caused by a secondary
bacteria, antibiotics, such as
penicillin, that are effective against a
broad spectrum of bacteria may be
prescribed.
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.
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.
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.
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
At Columbia St. Mary's, it is possible
that we 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. The procedure can be
performed under local anesthesia either
in your podiatrist’s office surgical
setting or an outpatient surgery
facility.
-
Look carefully at your baby's
feet. If you notice something
that does not look normal to
you, seek professional care
immediately.
-
Provide an opportunity for
exercising the feet.
-
Lying uncovered enables the baby
to kick and perform other
related motions which prepare
the feet for weight bearing.
-
Change the baby's position
several times a day. Lying too
long in one spot can put
excessive strain on the feet and
legs, especially on the stomach.
Starting to Walk
It is unwise to force a child to walk.
When physically and emotionally ready,
the child will walk. Comparisons with
other children are misleading, since the
age for independent walking ranges from
10 to 18 months.
When the child first begins to walk,
shoes are not necessary indoors.
Allowing the youngster to go barefoot or
to wear just socks helps the foot to
grow normally and to develop its
musculature and strength, as well as the
grasping action of toes. Of course, when
walking outside or on rough surfaces,
babies' feet should be protected in
lightweight, flexible footwear made of
natural materials.
Growing Up
As a child's feet continue to develop,
it may be necessary to change shoe and
sock size every few months to allow room
for the feet to grow. Although foot
problems result mainly from injury,
deformity, illness, or hereditary
factors, improper footwear can aggravate
preexisting conditions. Shoes or other
footwear should never be handed down.
The feet of young children are often
unstable because of muscle problems
which make walking difficult or
uncomfortable.
Sports Activities
Millions of American children
participate in team and individual
sports, many of them outside the school
system, where advice on conditioning and
equipment is not always available.
Parents should be concerned about
children's involvement in sports that
require a substantial amount of running
and turning, or involve contact.
Protective taping of the ankles is often
necessary to prevent sprains or
fractures. Parents should consider
discussing these matters with their
family podiatrist if they have children
participating in active sports.
Sports-related foot and ankle injuries
are on the rise as more children
actively participate in sports.
Advice for Parents
Problems noticed at birth will not
disappear by themselves. You should not
wait until the child begins walking to
take care of a problem you've noticed
earlier. Remember that lack of complaint
by a youngster is not a reliable sign.
The bones of growing feet are so
flexible that they can be twisted and
distorted without the child being aware
of it.
Walking patterns should be carefully
observed. Does the child’s toes point in
or out, have knock knees, or other gait
(walking) abnormalities? These problems
can be corrected if they are detected
early. Going barefoot is a healthy
activity for children under the right
conditions. However, walking barefoot on
dirty pavements exposes children's feet
to the dangers of infection through
accidental cuts and to severe
contusions, sprains or fractures.
Another potential problem is plantar
warts, a condition caused by a virus
which invades the sole of the foot
through cuts and breaks in the skin.
They require protracted treatment and
can keep children from school and other
activities.
Be careful about applying home remedies
to children's feet, as many can cause
irritation and damage to the feet.
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.
Preventing Foot Problems
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.
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.
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