Healthy Living: Foot Ailments
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Fun foot fact: The human foot has 26 bones, 33 joints, 107 ligaments and 19 muscles and tendons.
Not-so-fun foot fact: Three out of four American adults will at some point in their lives experience foot pain severe enough to seek treatment (or at least put them on a quest for sensible shoes).
To be sure, the foot is a complex body part and an engineering wonder, one that can withstand an awful a lot of pressure (up to one-and-a-half times our body weight with every step; four to six times that when we run). But too often it isn’t until they start misbehaving that we give our feet the attention they deserve.
Stephanie Lennon of Newtown loves to hike and ride horses, but for three years she was bothered by persistent pain in her toes. While not debilitating, it was extremely uncomfortable (“If I tried to put on high heels, forget it,” she says), so the 54-year-old finally decided to seek relief.
“I got three opinions before I felt comfortable with the doctor, the diagnosis and the treatment,” she says. A diagnosis of joint degeneration and bone spurs prompted a recommendation of surgery to excise the spurs and shorten the metatarsal bone to give the joint more room to move.
The surgery kept Lennon off her feet for more than four weeks, but she’s back to walking her dogs and looks forward to riding soon.
“The numbness and swelling have gone down, I have to limit my walking, and I’m still not back into my regular shoes,” she says, but so far, she’s pleased with the result. “I hemmed and hawed for a long time, but I’m glad I did it. I am even planning to have the surgery on my other foot. I didn’t want to live like that. I wanted a better quality of life.”
Both podiatrists and orthopedic surgeons say that a lot of mid-life foot pain is due to normal aging, athletic activity later in life and our penchant for fashionable footwear (spike heels and flip-flops being equally to blame). From Achilles pain to warts, the list of foot fails is long so we decided to take a look at a few of the most common conditions.
Some may surprise you.
“There’s something interesting going on here that doesn’t go on in other areas,” says F. Scott Gray, an orthopedic surgeon who specializes in foot and ankle surgery in Ridgefield and Danbury. “We have a peculiar adult athletic community—quite a few adult soccer leagues, a rugby league, tons of adult hockey and baseball players, even an adult football league, and of course runners well into their 70s—and with that, we’re seeing acute and repetitive injuries in adults that 15 to 20 years ago we saw only in younger people. These include osteochondral fractures, foot and severe ankle sprains and post-traumatic arthritis.”
Injuries among weekend warriors run the gamut from minor sprains (usually treated with icing and anti-inflammatory medications) to stress fractures that can put someone out of commission for eight weeks or more—and even require surgery. Gray says that “turf toe” is one of the most painful injuries sustained while playing vigorous plant-and-pivot sports like soccer. It occurs inside the cleat, when the combination of sudden deceleration and hyperextension causes the ligament under the big toe to rupture. “It’s nasty,” says Gray, “and it can be disabling for months.”
Running barefoot is a craze that’s keeping foot specialists on their toes. “They say it’s a more natural way to run,” says Gray, “but the jury’s out as to whether it is better—or just different. We do know this: We’re seeing more stress fractures because there’s no shock absorption, and more puncture wounds, because shoes provide protection. Interestingly, we’re seeing less Achilles tendinitis in barefoot running, though we’re not quite sure why that is.”
Plantar fasciitis is one of the most common conditions for which adults, whether athletes or not, seek treatment. “We see it all the time,” says Daniel Davis, a podiatrist with the Family Podiatry Center in Bridgeport. “It’s a very characteristic pain that patients feel initially in the first five minutes of waking up. It can make you feel as if you’re 95,” he says.
The most common cause of heel pain, plantar fasciitis is caused by straining the ligament that supports the arch. In severe cases, the strain can cause tiny tears leading to debilitating pain and swelling. While far more common in middle age, it also occurs in younger people who are on their feet a lot.
Duanne Simon works as a photographer in the Ethan Allen studio in New Milford, a job that requires her to be on her feet most of the day. Simon, who’s in her mid-50s, says she first noticed mild discomfort five years ago, “after edging the flower beds with the same foot all day.”
She implemented a homegrown remedy. “Rolling my foot on a frozen drink bottle for 15 to 20 minutes three times a day made it ‘go away’ in a couple of months,” she says.
Although the first episode wasn’t directly related to her job, she says that “concrete floors can’t be good for anyone’s feet.” She had a recurrence a year-and-a-half ago. “My foot would bother me for a bit when I got up in the morning, but would get worse throughout the day. I would begin to hobble after sitting and my walking gait was being affected from favoring the heel of the afflicted foot,” says Simon.
Finally, a podiatrist recommended she do stretches and exercises, and wear a night brace that keeps her foot in a flexed position while she sleeps. While this helped a lot, she still had to have a cortisone injection in her heel after a few months. She reports that the combined treatment “totally worked.”
Simon’s experience is fairly common. While Gray sees as many as 800 cases of plantar fasciitis every year, he says that only perhaps 5 percent of them ever require surgery. “It’s something that can usually be managed with a combination of stretching, physical therapy, nighttime splints and/or cortisone injections,” he says. However, in stubborn cases a “small incision and slight nick across the fascia” will bring relief.
Osteoarthritis is what Gray calls an example of “ungraceful aging.”
Also known as degenerative joint disease, it’s the most common type of arthritis, which is an inflammation to the joint that causes a breakdown of cartilage tissues, resulting in pain and swelling.
Given the number of bones and joints in a foot, it’s no wonder that arthritis affects so many. In mild cases, Gray recommends wearing stiff-soled shoes and taking arthritis (anti-inflammatory) medication. Cortisone injections may be in order if less aggressive treatments fail to work. “In severe cases, the gold standard is surgery to fuse the joint,” he says.
Treatment for arthritis of the ankles may also include total joint replacement surgery, and while the procedure has been effective for some, it may not be the best course of action for many.
What does footwear have to do with any of this?
“A lot,” says podiatrist Davis. “I’ve been in the business for 32 years, and let’s just say that the way they make shoes these days ensures I’ll be in business until I decide to retire.”
Davis feels that leather shoes hold an advantage over synthetics of any kind, for the simple reason that “they breathe and stretch.” Sneakers are an overall good choice for most patients because they’re natural shock absorbers. Sandals are better today than they were in the past because they’re “more patient-friendly.” But flip-flops? Quite simply, says Davis, “they are not your best friend.”
Gray takes it a step further: “Flip-flops are dog toys,” he says.
His advice for preventing—or at least minimizing—foot damage is to choose shoes that have good arch support, a fairly flexible sole for stress relief and enough room for your toes.
Finally, a word about orthotics, those fitted inserts that are often prescribed for foot ailments from fallen arches to plantar fasciitis: “They can work to alleviate pain, no question,” says Gray. “And sometimes—say in the case of a competitive track athlete—you really do require a custom fit because of how narrow their shoes are. But there is zero proof that a $500 orthotic works any better than the kind you can buy off the shelf. If Dr. Scholl’s doesn’t work, then the custom insert won’t either.”
A few more common conditions:
• Achilles tendinitis: An inflammation of the Achilles tendon, a common cause of foot or ankle pain.
• Athlete’s foot: A skin disease caused by a fungus that likes to live in warm, dark, humid environments (like shoes).
• Bunion: An enlargement of the joint at the base of the big toe; it often forms when bone or tissue move out of place.
• Corns and calluses: Areas of thickened skin that form to protect the foot from irritation; they’re often caused by rubbing.
• “Pump Bump”: Also known as Haglund’s deformity, it’s a bony enlargement of the back of the heel bone, often caused by wearing pumps.
• Ingrown toenails: Nails that dig painfully into the soft tissue of nail grooves; they often cause irritation, redness and swelling.
• Warts: Soft-tissue conditions caused by a virus; they may appear anywhere on the skin and can be quite painful.
Healthy Living: Foot Ailments