Focus On Feet

By David C. Whiteside

Feet are not glamorous. Though we put them through miles of walking, hours of standing and other untold punishments, we generally take them for granted. That is, until they start to hurt. Anyone who has had foot pain will tell you: If your feet hurt, you hurt all over.

Eighty per cent of people will at some time in their life experience a problem with their feet, from an infarcted ingrown nail to a limb-threatening diabetic ulceration. Foot ailments can affect the very young to the very old in all sorts of ways. The spectrum of foot problems seen and treated by a chiropodist (foot specialist) is wide.

The incidence of foot problems depends on many things. Overall general health plays a big part in determining who may one day develop problem feet.

People with diabetes, for example, are more likely to have poor circulation to their feet. This, coupled with neuropathy, or a lack of sensation, can lead to major problems. Having a small stone in your shoe is normally quite bothersome and causes you to stop what you are doing. If you have diabetes and neuropathy, however, this pain is not felt, and it may lead to skin breakdown and ulceration. Lower-limb paralysis can also result in the inability to recognize when a foot problem is beginning.

With decreased circulation, chance of infection is high and healing is low. It is essential not to take your feet for granted. Those people who have lost a foot or lower leg to the effects of diabetes will appreciate this. Taking extra special care of the remaining foot is essential.

Any condition which results in abnormality in gait is also likely to affect the feet. People with cerebral palsy, multiple sclerosis or post-polio syndrome are often prone to foot problems. Abnormal gait can cause an abnormal pressure distribution to the sole and the sides of the feet. This may result in chronic callus buildup, resulting in a great deal of pain -- which makes walking even more painful. Tendonitis and adaptive foot deformities may also develop.

The good news is that many foot afflictions can be prevented with a few basic principles and some good, old-fashioned common sense. And with proper care and treatment, many serious foot ailments can be treated without even visiting your local foot specialist.

By far, the most important thing you can do for your feet is to be aware of them. This means looking at them carefully, every day. If you are unable to see the bottoms of them, use a small mirror placed on the floor. If you have a visual disability or are otherwise unable to see your feet properly, ask someone to look at them for you.

Be on guard for any bruising, bleeding, infection or sore spots. If you see something worrisome, contact a chiropodist or your family doctor right away. Catching something before it turns into something worse is the key to preventing serious foot maladies.

Wear white cotton socks to provide protection and keep feet dry, as cotton is a natural fibre that will absorb moisture. Also, any cuts or breaks in the skin will be more evident on a white sock.

Wash your feet daily with a mild, non-medicated soap. Never soak feet any longer than 10 minutes. Dry well between the toes. Apply cream daily to dry skin -- but not between the toes.

If you do have to cut your toenails, cut them straight across, never down the sides. File the nails straight across with an emery board. Regular filing will maintain nails at a comfortable length.

Never cut corns or calluses with a razor blade or apply medicated corn removers.

We step a staggering 4,000-10,000 times a day over a variety of terrains. In an average lifetime, our feet will travel between 240,000 and 320,000 kilometres. That’s six to eight times around the world! The types of shoes we wear have to support us with maximum support, thereby optimizing foot function.

The types of shoes worn are even more important if a gait abnormality is present. A shoe store with a knowledgeable staff is of the utmost importance. Don’t get hung up on price or brand names. The best shoes, if not fitted properly, may lead to problems down the road.

Here is what to look for in a good shoe:
- laces or Velcro straps to prevent the foot from sliding in the shoe;
- rounded or squared toe to allow room for the natural shape of your foot;
- enough depth in the box area for the toes to fit comfortably;
- upper (top of the shoe) made of natural breathable or vented materials to prevent a buildup of moisture;
- no seams or wrinkles in the inside lining to cause blisters or irritations;
- strong heel counter to cup and support the heel and help stabilize the foot;
- low heel (under 1.5 inches) with a broad base, for stability; and
- sole made of flexible, cushioned non-slip material to absorb shock.

Shoe fitting is best done at the end of the day when your feet are swollen. When fitting shoes:
- Insist on having both feet measured in length and width.
- If you wear a prescribed orthotic, inform the salesperson, and wear it during the fitting.
- The heel should fit snugly. If you can fit a finger behind the back of your heel, the shoe is too loose.
- Allow a thumb’s width of extra length at the toes to give them plenty of room.
- Take your time -- spend at least five or ten minutes walking around the store to ensure a good fit.

Sometimes "off the rack" shoes are not good enough for people with significant foot deformities. A custom-made shoe can be prescribed by a chiropodist to accommodate these individuals. In addition, a custom-made, prescription orthotic device may be indicated to help the foot to function better, thereby relieving pain and discomfort.

Chiropodists are regulated foot specialists trained to treat diseases, disorders and dysfunctions of the foot. For a chiropodist near you, check the yellow pages or contact the College of Chiropodists of Ontario at (416) 542-1333.

(David Whiteside, B.Sc., D.Ch., is the staff chiropodist at St. John’s Rehabilitation Hospital, Toronto. He also practises at the York Foot and Ankle Clinic in Aurora, Ontario.)