THE FOOT BOOK A Guide to Podiatric Care
OH, MY ACHING FEET! Although we depend on our feet to carry us wherever we want to go, we tend to overlook them. After all, they re all the way at the end of our bodies tucked away in our shoes all day. But when they hurt, they demand attention! And foot problems are among the most common health issues. So, on your way through life from birth to old age, you re likely to have some problems with your feet. Pediatric problems, like toeing in, can appear at birth. Teenage foot problems include warts and athlete s foot. Adult foot problems can be aggravated by too-tight, uncomfortable shoes. Working on your feet all day can aggravate problems such as ingrown toenails. Sports place added stress on your feet. But so do being overweight and out of shape. In older age, foot problems may result from a lifetime of wear and tear. 1998, 1999, 2014, 2016 The StayWell Company, LLC. www.kramesstore.com 800.333.3032 All rights reserved. Made in the USA. 2
THE PODIATRIST AND YOU You are not walking alone! Doctors of Podiatric Medicine (DPMs) are medical specialists trained in the care of the feet. You and your podiatrist can do much to remedy any foot problems you have and help prevent them down the road. Podiatry in the Past Over 200 years ago in Europe, specialists traveled from town to town caring for people s feet. Around the start of the last century, the first schools of podiatry were founded. Over time podiatrists became recognized as the qualified medical professionals they are today. Podiatry Today Podiatry offers state-of-the-art foot care. Podiatric training requirements are similar to those of other types of medical doctors. Podiatrists complete a basic college curriculum before attending a four-year college of podiatric medicine. Science courses in the first two years focus on anatomy and physiology. The last two years focus on prevention, diagnosis, and treatment of foot and ankle disorders and related problems. Most podiatrists go on to postgraduate residencies. Podiatric practice applies the latest techniques and surgical procedures. Podiatrists are the only specialists trained to care exclusively for foot, ankle, and related problems for all ages. Treatment may include hygiene instruction, help with shoe selection, medications, and surgery. A podiatrist will treat your feet to a lifetime of care. Share this booklet with friends and relatives. They ll want to know how to have happy, healthy feet, too! 3
MEET YOUR FEET The foot is a strong, flexible, and complex structure. Your feet help balance and support your entire body weight a big job for two small pedestals! Ball of Arches give foot your feet their basic shape. They help absorb your body s pounding weight. The transverse or metatarsal arch bears most of your weight. The longitudinal arch flattens when you re standing and returns to its curved shape when you re not. Bones provide supportive strength for the whole foot. Altogether there are 26 separate bones in each foot. Talus Tibia Heel bone (Calcaneus) Joints are formed wherever two bones meet. The 33 complex joints in each foot permit great flexibility of movement. A Walk Through Life On our walk through life, our feet undergo many changes. The most critical period is the first three years of life, when the feet are rapidly developing. Transverse arch Longitudinal arch Tendons Toe bones (Phalanges) Fibula Ligaments Muscles of foot Fibula In the womb, a baby s feet begin to form. Problems can arise if the baby is born with feet turned inward. Metatarsals Tibia One-year-olds tend to turn their feet outward for stability when learning to walk. Tendons are tough, fibrous cords that connect muscle to bone. Muscles provide the power needed to move the feet and toes. When a muscle contracts, it pulls on a tendon, which, in turn, moves the bone. Ligaments are flexible bands of fiber that stretch between bones. It takes more than 100 ligaments to hold the entire foot together. Growth plate Nail body Nails protect the tips of the toes from abnormal pressure or rubbing. A nail consists of a body (the part you see) and a growth plate (beneath the surface). Both rest on the nail bed. By age three, most children walk with their feet straight ahead. 4
THE FOOT MEETS THE SHOE Our marvelous feet evolved for flexibility and strength not to be stuffed into shoes! When people roamed the earth barefoot 4,000 years ago, foot problems were not the rule. Today, we need shoes to protect our feet from cold, injury, disease, and hard surfaces. But, too often, we choose shoes for style rather than comfort and function. Remember: Good shoes are part of the good care your feet deserve. If the shoe fits... Unfortunately, most shoes today are too narrow in the front (toe box) for the foot. You can check this by standing on paper and tracing around your bare foot. Compare the outline of your foot with the sole of your shoe. If your shoe doesn t allow enough room for your foot, you can be inviting foot problems. Comfort Choose shoes that feel good on your feet. Avoid wearing high heels for too long, as they can lead to calluses, aggravate bunions, and make back pain more likely. And look for natural materials like leather that let your feet breathe. Function Fit your shoes to the job, as well as the foot. You need good support to stand, walk, or run. Arches that are high or low are variations of normal. But these and other structural issues can lead to foot problems. Low arches (flatfeet) can lead to problems such as corns, calluses, bunions, and painful muscles. High arches often lead to arch pain and hammer toes. Corns and calluses also form. Since problems tend to accumulate over a lifetime, older people tend to have more foot trouble. When you find you have problem feet, it s time to see your podiatrist. 5
THE PODIATRIST S EVALUATION To determine the causes of your foot problem, your podiatrist will evaluate your feet, your body, and your general health. This information helps the podiatrist make a complete and accurate diagnosis. Medical History Because symptoms of diabetes and heart disease may first be detected in the feet, podiatrists need to know the state of your general health as well as the state of your feet. Examination Your feet will be examined closely. The doctor may also manipulate the heel and forefoot to test the range of motion of your foot. Your ankles, knees, and hips may be checked as well. Your podiatrist may watch you as you walk. X-rays Problems on the foot s surface may be due to underlying deformities of the bone. X-rays are often done to check for them. X-rays may be done in the case of an injury. The podiatrist is trained and licensed to take x-rays in the office. Laboratory Tests Tests, such as urine or blood tests, may be done to look for a specific problem or determine whether a general health problem might be present. 6
TREATMENT OF FOOT PROBLEMS Once a diagnosis is made, you and your podiatrist will discuss the best options for you. The goal is not only to treat your current foot problems, but to prevent future problems from developing. Medication Orthotics you. Medications These are corrective devices can help treat inserted inside shoes. They pain or certain are individually molded to types of foot your feet. Measurements problems. These and sometimes images may be pills, are taken to ensure ointments, or the best fit for creams. In some your foot. cases, injections into the foot may be done. Office Surgery Minor surgical procedures can be done in the office. These include removing ingrown nails or warts. These are done using local anesthetic to numb the foot so you feel no pain. Other Surgery Surgery for other problems are done in a surgery facility or hospital. In most cases, you can go home the same day. These procedures are done using anesthesia to make you drowsy or completely asleep. If you need surgery for your problem, your podiatrist will discuss your options with 7
PEDIATRIC PODIATRY Pediatric foot problems can appear very early. The bones in a child s foot are soft and pliable and can be damaged by constricting shoes, clothing, and even bedding. So shoes that fit are especially important for a young child s rapidly growing feet. Since children rarely complain about their feet, parents should be on the alert for foot problems. Check with your podiatrist at the first sign of problems (such as those on page 9), or problems such as walking or standing strangely or excessive stumbling. Help your child get off on the right foot! foot. CHILDREN S SHOES Babies are better off without shoes until they start walking. As soon as a child starts walking, make sure his or her feet have ample room for normal growth. Check shoe sizes often, since shoes even two sizes too small may not cause discomfort! New shoes Don t use hand-me-down shoes. They mold the child s foot to the previous wearer s shape. This can lead to foot problems. What kind? Children s shoes should be sturdy, but they don t have to be expensive. Ask your podiatrist for a recommendation. What size? When you buy new shoes, make sure there s a thumb s width between the end of the longest toe (either first or second) and the end of the shoe. Also make sure the arch of the shoe fits the arch of your child s 8
PEDIATRIC FOOT PROBLEMS Two common children s foot problems are toeing in and flatfeet. Through such treatments as exercises, casting, and orthotics, your podiatrist can help. If the trouble is detected early, your child will have fewer problems later on. Toeing In Most babies begin life with their toes pointing slightly out. However, if an unborn baby lies with its feet pressed against the womb the wrong way, it can be born with its feet turned in. This toeing in can make learning to walk difficult. Tripping often may be an early sign. Casts In some instances, plaster casts can be used to coax a baby s feet into normal position. Just as braces gradually reposition teeth, casts gradually reposition feet. The casts are changed on a schedule until the podiatrist determines that the feet are properly aligned. Exercise Toeing in can often be corrected with simple stretching exercises. The podiatrist can teach parents these exercises to help straighten out a baby s feet. The exercises take minutes a day. They should be done until the problem is corrected. Flatfeet Babies often appear flatfooted. Usually this goes away as the baby begins to stand and walk. But if flatfeet (low arches) remain, they may put added strain on a child s feet and legs. The child may find it hard to keep up with other children. Orthotics Orthotic devices can be used to maintain proper foot support. They can help realign the foot and redistribute body weight. They must be refitted as the child grows. Have Problems Checked If you suspect any foot problems, have a podiatrist examine your child s feet. You may spare your child foot problems later in life. 9
TEENAGE AND ADULT PODIATRY Otherwise healthy teenage and adult feet can develop problems that lead to pain, itching, or other problems. Your podiatrist can diagnose and treat these issues to help restore comfort. 10 Warts Plantar warts are caused by a virus. They often grow painfully into the bottom of the foot. Treatment: Don t risk bathroom surgery or use over-the-counter acids. The podiatrist can remove warts safely with topical acid treatments or office surgery. Partial Removal Ingrown Toenails This painful condition results when the nail grows into the skin. Treatment: The podiatrist may remove some or all of the nail. A normal nail will grow in. To prevent ingrown toenails, cut your nails correctly. Your podiatrist can show you how. Calluses and Corns Underlying bone problems can cause too much rubbing on certain areas. Rubbing causes layers of dead skin cells, creating calluses on the bottom of the foot and corns on the toes. Treatment: Dissolving corns or cutting out calluses at home is not safe. Your podiatrist can trim or protect calluses or corns if they are painful. However, they usually grow back unless the underlying problem is corrected with surgery. Total Removal Fungus Fungus infections of the foot and nails ( athlete s foot ) make skin itchy and scaly and nails thicken and turn color. Treatment: Medication and self-care can help clear the infection. In some cases, minor nail surgery is recommended.
Hammer Toes Problems with the structure of the foot or too-short shoes can make toes buckle. Corns form when these toes rub against the tops of shoes. Treatment: Shoes that allow plenty of room for the toes can help prevent discomfort. Surgery may be advised to treat an underlying problem. Bunions A bunion is an unsightly bump of bone on the side of the big toe. Shoes often irritate them. Corns and calluses may form. Bunions tend to run in families. Treatment: Wearing shoes with a wide toe box and using protective pads can ease the pressure. But surgery is often required to correct bunions. The procedure used will vary depending on your age, the severity of your problem, and other factors. Three common types are shown below: Portion of bone removed Toe repositioned Plantar Neuroma Abnormally positioned metatarsal bones can cause irritation of the nerve between them. A growth called a plantar neuroma results. A plantar neuroma causes pain in the ball of the foot and numbness between the two toes. Treatment: The podiatrist may first try orthotics or cortisone injections. If pain persists, the nerve growth can be removed surgically. Wearing shoes with a wide toe box can help prevent irritation. Fractured surgically Toe repositioned Arthritic joint Plastic replacement 11
Winning Shoes When your shoes don t fit the sport, problems develop quickly. To help your feet withstand the additional stresses of running, look for shoes made specifically for the type of running you do. Buy a quality brand that feels good. Wear them only for your sport. Replace them when they lose their shock-absorbing ability, at least every 400 to 500 miles. SPORTS PODIATRY When you run, your body weight is multiplied two to three times, depending on your speed. Your feet bear this extra weight with every step over 1,000 times per mile for each foot! Since sports ask a lot of your feet, you need to take special care of them. You can prevent most sports injuries by wearing only good shoes designed for your sport and perhaps orthotics, doing stretching exercises before running, and conditioning yourself gradually. Make your feet good sports! Adequate insole cushioning Padded ankle opening Flexible sole Good longitudinal support Stiff heel counter Outflared heel for added stability Orthotics Orthotics may take some of the stress off a runner s foot. After a range-of-motion examination, your podiatrist can prescribe a fitted orthotic for your shoe. Orthotics are not for everybody, but they can improve comfort and guard against damage due to such foot abnormalities as flatfeet and high arches. 12
SPORTS INJURIES Running is wonderful for overall fitness, but the extra stress on the feet can lead to injuries from minor pains and strains to fractures. If you injure yourself, rest. Return gradually to exercise when the pain is gone. If this doesn t help, see your podiatrist for proper diagnosis and treatment. Stretching Exercises Calf and Achilles stretch: Face a wall with your back heel on the floor, feet pointed forward. Lean toward the wall with your back knee straight. Hold for 20-30 seconds. Bend your back knee. Hold for 20-30 seconds. Repeat 5 times each leg. Hamstring stretch: Sit with one leg straight, the other bent as shown. Reach toward the toe of the straight leg with both hands. Hold for 20-30 seconds. Repeat 5 times each leg. Flatfeet Inherited flatfeet may cause aches and fatigue in the feet and calves. Rest can help. So can orthotics. Stress Fracture Cracks in the bone are slow to heal and quick to worsen. A walking cast or special shoe may be needed. Shin Splints Overuse can cause pain and swelling where tendon meets bone in the front or inside of the lower leg. Sprained Ankle Overuse or twisting can stretch or tear muscles, tendons, and ligaments. Treatment may involve a splint, tape or cast. Achilles Tendonitis Doing too much too soon or having tight calf muscles can inflame the area around the Achilles tendon, radiating pain to the heel, ankle, and calf. If you experience any persistent pain or discomfort, stop and make an appointment to see your podiatrist. Heel Spur This refers to heel pain due to bone irritation. A ligament or muscle may be pulled from the heel. If cortisone, taping, and orthotics don t work, surgery may be needed. 13
Nails As toenails grow thick, they are harder to care for. Aging may cause issues with eyesight or trouble reaching the feet. If you have trouble cutting your nails, it s best to let your podiatrist trim them. See your podiatrist for regular foot care. Change in Bone Structure Normal wear and tear, sometimes combined with arthritis, can cause degeneration of the joints. Special shoes, custom-made from a cast of your foot, may help. If the problem is severe and not helped by custom shoes, surgery may be suggested. GERIATRIC PODIATRY As we age, our bodies change. These changes are normal, if not always welcome. With age, toenails grow thicker and the skin gets drier. Corns, calluses, bunions, and other problems are more likely to appear. Pain is not normal, however. If you have issues that keep you from being on your feet, see your podiatrist for help. Loss of Cushioning Aging can cause loss of the pad of fat that cushions the foot. This leads to pain in the ball of the foot called metatarsalgia. In many cases, a soft orthotic can replace the foot s natural cushion. 14
POOR CIRCULATION With aging, blood may not circulate through the body as efficiently as it used to. Since the feet are farthest from the heart, they may be the first to show signs of circulation problems. Older feet can be susceptible to infections, cramps, numbness, and varicose veins. Compression socks or stockings may help improve circulation. Ask your podiatrist about the best type for you. Diabetes or Artery Disease People with diabetes need to take special care of their feet. So do people with circulation disorders like peripheral artery disease. Here are some important tips: Check your feet daily for cuts, cracks, or redness. Report any signs of infection to your podiatrist. Protect your feet with supportive and well-cushioned shoes. Never wear constricting shoes, socks, or stockings. Let your podiatrist treat corns and calluses. Home remedies can be very dangerous for you. Keep on Walking No matter what else you do for your feet, keep walking! Besides being the best exercise you can give your feet, walking improves your circulation, general health, and mood. It s vital to stay on your feet to preserve your health and independence. No matter what your age, your podiatrist can help you make your long life s walk a pleasant one. 15
HOW TO KEEP YOUR FEET HAPPY Wash your feet and dry them well every day. Trim nails with a slightly rounded edge using a clipper or nipper designed for toenails. Don t cut into the corners. Your podiatrist can show you how best to cut. Smooth rough skin with a pumice stone or skin cream. Let your podiatrist remove corns and calluses. Consultant: Bruce M. Dobbs, DPM With contributions by: Marc Brenner, DPM Only wear shoes that fit and feel comfortable. If you have any trouble caring for your feet, let your podiatrist help. Walk as much as you can. Happy trails! 1078 1603