Advice on Foot Care

Researchers at the George Institute for International Health at the University of Sydney, Australia conducted a randomized controlled trial with 152 individuals with chronic knee or hip osteoarthritis. The individuals were divided randomly into three groups. One group of 55 individuals had 12 weeks of hydrotherapy class, one group of 56 individuals had 12 weeks of Tai Chi classes and the control group of 41 individuals had no therapy or treatment.

Results: At 12 weeks, individuals participating in the hydrotherapy or the Tai Chi classes had improvements in function and pain compared with the control group. Only the individuals in the hydrotherapy group had significant improvements in the physical performance measures. Improvements in pain and function were sustained in both groups at 24 weeks. Participants in the hydrotherapy group were also more likely to attend the classes, with 81% of the class attending more than half of the classes available. Only 61% of the participants attended more than half of the Tai Chi classes available.

Summary: Physical activity, whether hydrotherapy or Tai Chi, can decrease pain and improve function for those with chronic knee or hip osteoarthritis. Although this study demonstrates more improvement with hydrotherapy, it is unclear if this is a result of participation, or the actually activity.

Fransen M, et al. Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. Arthritis Rheum. 2007 Apr 15;57(3):407-14.

Summer is on it’s way, along with shorts, tank tops, bathing suits, BBQs and, of course, sandals. Sandals, the main choice for footwear during the summer months, are easy to slip on and off and cool enough for those hot summer days. The flip-flop trend has taken off and new styles range from flimspy, flat and casual to high-heeled, high-priced and dressy.

Unfortunately, along with flip-flops come foot injuries. The flip-flop style sandal has almost no arch support and little beyond the two simple straps on the top, attempting to hold the foot on the sole of the sandal. The result is overworked tendons and an over stressed arch. Ankle sprains tendonitis, arch pain, plantar fasciitis, calluses and blisters are all common problems which can also develop as a result of wearing flip-flops. Flip-flops are not the only culprit, many sandals do not offer much arch support or shock absorption and have little material to keep the foot on the sole. The combination of flip-flops and high heels tends to be the most problematic summer sandal choice.

There are many sandals available today which are comfortable, supportive and stylish. When looking for a sandal, following these simple tips: Continue Reading »

Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study.

A new study reveals a link between chronic heel pain, pronated feet and obesity. The study included 80 individuals with chronic heel pain and 80 individuals without chronic heel pain. Body Mass Index (BMI), foot posture (foot position while standing), ankle range of motion, lower limb stress and calf endurance were measured in both groups. Questions on the type of activities and time spent were asked.

Results: The chronic heel pain group had a significantly greater body mass index (BMI), a more pronated foot position and greater ankle dorsiflexion range of motion (movement of the foot up, in relationship to the leg). There was no difference between the groups in the measurements of calf endurance or on reported time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting.

Summary: Obesity and pronation are associated with chronic heel pain and this study reinforces the idea that they may be risk factors in development of chronic heel pain. This study does not show an association between the limitation of ankle joint dorsiflexion and chronic heel pain.

Irving DB, Cook JL, Young MA, Menz HB. Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study. BMC Musculoskelet Disord. 2007 May 17;8(1):41

Ick! This is the normal reaction to the fungal toenail picture. Most people don’t want their toenails to look like this. This picture shows a more severe toenail fungus with discoloration, thickness, flaking, peeling and an abnormal shape.

A dermatophyte is a type of fungus which affects skin, hair and nails. You may be familiar with Digger the Dermatophyte from the horrifying commercial where Digger climbs under a toenail and makes a home with his buddies. But, Digger and the dermatophytes are not the only ones making homes, non-dermatophytes and yeast also can infect the toenails. The fungus causes the nails to first become slightly yellow or white and spotchy. Continue Reading »

1. Inspect your feet: Start at the toenails and look for signs of discoloration, white splotches, black streaks or abnormal thickening and shape. Look in between your toes and make sure you don’t see openings or cracks or a buildup of white, scaly tissue (potential signs of fungus). Look at the structure of your feet, look for lumps or bumps and changes in shape. Any growth on the foot should be seen by your podiatrist. Peeling, dry flakey skin and scaling on the bottom of the feet could be athlete’s foot.

2. Wash your feet regularly: It’s important to wash your feet, your toes and in between your toes and dry them thoroughly.

3. Trim toenails straight across: It’s ok to round a little at the edges to remove that sharp point caused by trimming straight across, but do not trim down the sides of the nail. This is important because it can cause ingrown nails. Do not trim too short, you will end up lifting the nail from the nail bed and cause small breaks in the skin area, leaving you more susceptible to fungus. If you are diabetic or have poor circulation you should not cut your own toenails. Continue Reading »

Pain from neuromas usually occurs in the ball of the foot, hence the term “ball of foot pain”. The pain can be dull and deep, sharp and electrical, shooting pain to the toes, numbness at the toes, tingling, burning or pins and needles sensations. Many describe only a discomfort, like walking on a lump or ball or a bunched up sock. Others will describe a “twang”, like someone strummed on a guitar string, or as if a tendon is moving back and forth. These are all sensations which people can feel when they have a neuroma.

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A recent article in Sports Medicine cited a significant increase in the number of people who are running marathons. The yearly incidence of injuries in marathon runners is reported as high as 90%, but it appears that less experienced runners are the ones who are more prone to injury. More experienced runners are less likely to experience injuries. The risk of injury decreases as the years of experience increase. But, the risk of injury increases once the once a threshold of 40 miles/week is crossed. The most common is injury was to the knee, citing patellofemoral syndrome as the most common. Other common running injuries included plantar fasciitis, meniscal injuries of the knee, achilles tendonitis, iliotibial band syndrome and tibial stress syndrome.

 

Fredericson M, Misra AK. Epidemiology and aetiology of marathon running injuries. Sports Med. 2007; 37 (4-5):437-9.

1. Consider buying your shoes at a specialty running store. The shoes may be a little more expensive, but you should be able to talk with a trained professional who knows about shoes, socks and foot types.

2. Have your feet measured while standing with your socks on. Socks can change the size of your feet enough to make a difference in fit. The measurement should include the heel to toe measurement, the heel to the ball of the foot measurement and the width taken while standing.

3. Make sure the shoe bends at the toes, and only at the toes.

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A bunion is a bone deformity at the great toe joint. The long bone at the inside of the foot moves towards the center of the body. The big toe moves towards the small toes. This movement causes a large bump at the inside of the foot. There is sometimes an associated bone growth or enlargement of bone. The movement of the bones does not happen overnight. This is a long process, which takes years to develop (except in rare cases of trauma).

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Callused feet and toes are common in runners and many times go unnoticed. But, a callus on the heel or the big toe can cause a lot of pain for a runner. The callus can develop an even more painful blister underneath and can limit performance or simply decrease the enjoyment of run. Some rub the area with a pumice stone, some apply cremes and others take a razor blade to the offending callus. Unfortunately, the callus always returns.

Callus tissue is a build of dead skin in response to pressure or friction. The medical term for callus is hyperkeratosis (hi – per – care – uh – toe – sis). A callus is actually a bone problem and a foot mechanics problem, not a skin problem. A foot deformity will cause excess pressure to that area from the shoe or the ground. The body’s natural defense mechanism will kick in and start building up the top layer of skin in response to the excess pressure. This is a protective response from the body in an attempt to prevent the pressure from wearing down the skin layers and resulting in an open sore. The problem is that as long as there is pressure, the body will continue to build up the skin. The continual build up of dead skin can become excessive and painful.

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Millions of runners, in the form of casual joggers, trail runners, sprinters, marathon runners and elite competitors, take to the streets, tracks and trails everyday. People run for health, for fitness, for stress relief and for fun. Despite these differences, all runners are susceptible to foot problems. Common foot and ankle conditions in runners include blisters, foot fungus, ankle sprains, stress fractures, tendonitis and plantar fasciitis. Fortunately, most of these conditions can be prevented and many are easily treated. When foot and ankle conditions are ignored they can become difficult to treat and in some cases resistant to therapy.

Heel pain
Over one million runners will develop heel pain each year. The most common cause of heel pain is plantar fasciitis, which is the result of excess stress through a long ligament type structure in the bottom of the foot. The excess stress causes tearing and results in inflammation and pain. Most people describe pain in the heel at the first step in the morning or upon rising after long periods of rest. Runners may only experience the pain while running, and many state that the pain develops at the beginning of the run and tends to work itself out after about 1 mile, but then returns by the end of the run or at the end of the day. Continue Reading »

It is estimated that over 21 million Americans have diabetes. Serious complications associated with diabetes include stroke, heart disease, blindness, kidney disease, high blood pressure, nervous system diseases and amputations. In 2002 there were 82,000 lower extremity amputation in diabetes. Six individuals out of every 1,000 people with diabetes will have a lower extremity amputation. A slow healing or non healing open sore (known as an ulceration) on the foot is the most common reason diabetics will end up with a foot or leg amputation. Over 2 million diabetics have ulcerations and one in four diabetics with an ulcer will have an amputation. Unfortunately, over 25% of diabetics have not heard of an ulcer.

Treating diabetic ulcers is difficult. Preventing diabetic ulcers is not. Preventing diabetic ulcerations is the key in decreasing the risk of amputation. Other important steps to help in avoiding amputation are decreasing the chance of infection and the development of gangrene. Infections can develop at the site of an ulcer, at an ingrown toenail, from a corn between the toes or from a blister or a callous. Gangrene is the result of poor circulation. Any of the above possible causes of infection can result in gangrene if the circulation is poor. Very few individuals will develop gangrene spontaneously. Most individuals have some sort of trauma or injury that predisposes them to development of an open sore (or ulcer), a blister or an ingrown nail.

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A study in the July/August issue of The Journal of Foot and Ankle Surgery in 2006, has demonstrated that Extracorporeal Shockwave Therapy is an effective and safe treatment for plantar fasciitis.

Extracorporeal Shockwave Therapy (ESWT) has been used for treating medical conditions for many years, but emerged in the mid-90s as a treatment for plantar fasciitis. Shockwave therapy is the production of sound waves, not electrical shocks. The sound waves cause controlled tissue injury at an area of chronic inflammation or degeneration and stimulate a healing response by the body. The treatment was FDA approved for treatment of plantar fasciitis in 2000, but has remained under scrutiny because of conflicting research studies.

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The Strassburg Sock^TM is a comfortable night splint for treating plantar fasciitis, heel pain, heel spurs and tendonitis. The Strassburg Sock is a tubular knit sock with adjustable straps used at night to stretch the plantar fascia and the calf. It is lightweight, breathable and washable. Many people find that the soft night splints are more comfortable than the rigid night splints. The strassburg sock is designed to be pulled on like a sock. The sock fits over the calf and then a strap is connected from the calf to the toes. The strap can then be adjusted and the toes can be pulled back, placing a stretch on the plantar fascia, allowing it to heal in the stretched position.

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