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FOOT HEALTH CARE
Healthy feet are an important part of a healthy and happy lifestyle. We all have one pair of feet to last a
lifetime and should take care of them. Foot pain is not normal and if you do experience pain or
discomfort have hem look at by a professional.
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Achilles Tendonitis
Ankle Spains
Arthritis
Athletes Foot
Burning Feet
Corns/Callus
Diabetic Foot Care
Diabetic Neuropathy
Dry, Cracked Heels
Flat Feet
Gout
Ingrown Toe Nail
Neuroma
Orthotics
Plantar Fasciitis
Sweaty Feet
Tarsal Tunnel Syndrome
Plantar Warts
Achilles Tendonitis
Achilles tendonitis, enthesis, tenosynovitis, and bursitis are all terms that can
be used interchangeably for the pain associated with the back of the heel.
The Achilles tendon is the co-joined tendon of the gastrocnemius and the
soleus muscle, which form the thickened tendon at the back of the leg as it
inserts into the heel bone.
This structure becomes inflamed and damaged from a variety of mechanical
forces: pronation (inward tilting of the heel) or supination (outward tilting of
the heel); excessive weight; over-use, such as running or tennis or other sport
activities; and sometimes metabolic problems, such as diabetes, arthritis or
even gout can play a major role in inflammation of the achilles tendon.
However, most achilles tendon problems are mechanical in nature.
Treatment options vary, dependent on cause, however therapies may
include stretching exercises, splints, straps, heel pads and orthotic
devices.
Ankle Sprains
A twisted ankle, ankle sprain, inversion sprain or an ankle that rolls over are all terms for injuries to the
human ankle. A sprain refers to the stretching and/or tearing of ligaments (as opposed to straining a
muscle). An ankle sprain results in pain, bruising, swelling and tenderness over the outside portion of
the foot and ankle and occurs following a sudden sideways or twisting movement of the foot.
It can occur during intense athletic activity, such as running and jumping, or it can occur during any
normal activity, such as stepping off a curb, walking on an uneven surface which causes an awkward
step. 90% of ankle injuries usually occur on the outside (lateral side) of the ankle. Medial or inside ankle
injuries occur in 10% of the cases.
Mild ankle sprains can be treated with "RICE" (Rest, Ice, Compression and Elevation). This condition is
usually short duration and will clear up in a few days.
Arthritis
Arthritis is a disabling disease that affects nearly 40 million Americans alone. It is characterized by
inflammation of the cartilage and lining of the body's joints. Symptoms include swelling in one or more
joints, recurring pain or tenderness in any joint, redness or heat in a joint, limitation in motion, early
morning stiffness and skin changes including rashes or growths. The three types of arthritis are
osteoarthritis, rheumatoid arthritis and gouty arthritis. Because each foot contains 33 joints and bears a
tremendous amount of weight and pressure, feet may be more susceptible to arthritis than other parts
of the body.
Athlete’s Foot
Athlete's foot is a common infection of the skin and nails characterized by itching, scaling, redness, and
the formation of small blisters. In general the lesions start between the toes and can extend to the
borders and bottom of the foot. The fungus has the potential to spread to the toenails, causing them to
become thickened, discoloured, and painful. In this case the infection is called onychomycosis . While
this infection is common among athletes, keep in mind that it can affect athletes and non-athletes alike.
Bunion
A bunion is an enlargement at the base of the big toe caused by a misalignment of the joint. This area
may become swollen, tender and painful when wearing shoes.
Causes include:
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Heredity
Biomechanical abnormalities
Neuromuscular disorders
Inflammatory joint disease (arthritis)
Trauma
Congenital deformities
Burning Feet
Burning feet is a common complaint among many groups of people but is more common in the 50 plus
age group. There are many different causes for burning feet but it is most prevalent in diabetics who
often have a mixture of burning feet and loss of sensation on the bottom of the foot.
There are many other causes for this symptom including vitamin deficiency, thyroid dysfunction and
gastric restriction in morbid obesity produce symptoms of burning feet. Some bacterial infections can
also affect the neurological pathways. However, the most common denominator for burning foot
syndrome is usually a diabetic who has been insulin dependent for many years, producing a variety of
secondary complaints such as vitamin deficiency to include thiamin.
Mechanical causes include nerve entrapment syndrome such as tarsal tunnel syndrome, which causes
compression of the nerve as it enters the foot from the ankle. Neuroma pain, a pinched nerve between
the 3rd-4th toes has also been implicated in the symptom of burning feet.
Treatment will vary, depending on the cause of the burning foot syndrome.
Corns/Callus
A callus or corn is a build-up of skin that forms at pressure points or over bony prominences. The cause
may be pressure or repeated friction from skin rubbing against a bony area or an irregularity within
footwear worn.
Diabetic Foot Care
If you are a diabetic, footcare should form an essential part of your everyday concerns....
10 Steps to Healthy Feet
1. Have your feet checked regularly. You should have an annual diabetic foot check at your
podiatry clinic to monitor your foot health.
2. Wear good fitting shoes, diabetic socks, and if appropriate, diabetic orthotics.
3. Check your feet every day. Look in a mirror to see the bottom of your feet. Check for cuts,
scrapes and blisters.
4. Treat cuts, scrapes and blisters immediately. See your podiatrist if a wound does not heal.
Opened wounds could lead to ulcers or worse.
5. Keep your feet clean. Gently wash your feet with soap and water every day. Foot Spas can be
used to soak and wash your feet, but use only warm water. Hot water is not good to use if you
are diabetic. Diabetics can hurt the nerves in their feet, you might not be able to tell if
something is hurting your feet. It's best not to use heating pads or HOT water soaks, since you
could burn your feet without knowing it.
6. Cut your toenails correctly. Cut your toenails straight across the top.
7. Treat athletes foot. Athlete's foot is more common in people who have diabetes, and it can
cause problems. If you have athlete's foot, wear a different pair of shoes every other day. This
lets your shoes dry out.
8. Get proper treatment for thickened skin, calluses and corns. Don't trim or cut these spots as
home with razor blades or other sharp tools.
9. Take action to improve your circulation. High blood pressure, high cholesterol levels and
smoking can harm the circulation in your feet and keep sores from healing.
10. Just being aware and taking action when need be is the best way to keep your feet healthy.
Diabetic Neuropathy
Neuropathy can be characterized by phases:
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Phase I of neuropathy is a tingling sensation in the plantar aspect (bottom) of the foot that may
manifest as a feeling of bugs crawling or bees stinging, and this term is referred to as
formication. This is a very important indicator that loss of sensation is happening.
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Phase II has the symptoms that come more frequently and are more intense.
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Phase III is characterized by a constant burning of the feet that causes disruptions in sleep. This
phase usually requires medication such as pain pills or other medications such as Neurontin.
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Phase IV is characterized by moments of relief. The patient is falsely convinced that their
disease is improving because there are moments of lack of pain; but really what is happening is
that the condition is progressing into
Phase V, which is not total relief of pain but complete loss of sensation. This is the most
dangerous phase and this is when ulcers develop.
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Dry, Cracked Heels
Dry cracking of the heels is a condition of thickening and fissuring (cracking of the bottom part of the
heels). In most people this is a nuisance and a cosmetic problem. But when the problem persists,
especially in diabetes or people with impaired vascular sufficiency, this can lead to a serious medical
problem.
Flat Feet
Flat feet are not necessarily a problem. But people with a flat
foot (or the opposite condition, a highly arched foot) that are
painful, are certainly in need of treatment.
Flat feet and high arches that are associated with ankle, knee or
low back pain are also in need of treatment.
The causes of flat feet are many, but in the older age group
decreased exercise and increased weight add to the mechanical If the width of the instep (AB) at its
disturbances of the foot. Flat feet can also produce conditions widest part is less than 1cm, the foot
is considered as flat (right). If the
known as heel spurs and/or plantar fasciitis.
width of the footprint at its narrowest
part (BC) is less than 1cm, the arch is
The best and first line of defense for a flat foot condition is a
considered high (center). All other
good supportive shoe but the most effective means of
controlling a flat foot or a high arched foot are custom molded footprints are considered "normal"
(left).
orthotics.
Adapted from "The Influence of
Footwear on the Prevalence of Flat
Foot," The Journal of Bone and Joint
Surgery, 74B(4), 1992, pp. 525-527.
Gout
Gout (hyperuricemia or elevated uric acid) is a systemic disorder that affects the
joints, most often the big toe joint. Gout is the end result of a build-up of uric
acid in the blood. The uric acid crystallizes and settles in the joints in the body,
most often in the big-toe joint, causing swelling and excruciating pain.
The onset of an attack of gout can be sudden and vicious. It is not uncommon for
the victim to be awakened by this excruciating pain in the middle of the night.
(Gout is often confused with Osteoarthritis, a condition that is characterized by a
much slower onset of pain, and seems worse after a person has been walking or
running.)
Gout is generally thought to be a hereditary disease, but there are many causes: increased purine intake,
sudden weight loss due to dieting, and/or diuretics can cause elevated uric acid and mimic the symptoms of
gout.
If gout is not treated properly, it can eventually cause permanent changes in the big-toe joint. It is important
to seek medical attention if you suspect the existence of gout. It is encouraging to note that drugs can be
prescribed that will control the uric-acid level in the blood. You need not suffer from gout in this day and age.
Ingrown Toe Nail
An ingrown toenail is a condition in which the nail is cutting into the
flesh. This condition is usually very painful and is often associated with
infection. A nail is ingrown when one or both corners or sides of the
nail grow into the skin of the toe. Irritation, redness, uncomfortable
sensation of warmth, as well as swelling, pain and infection can result
from an ingrown toenail.
Neuroma
Neuroma, which is a pinched nerve and not a nerve tumor, is really
a result of swelling from compression rather than a true growth on
the nerve. Usually these are situated between the 3rd and 4th toes.
Neuroma pain is characterized by sharp lancinating-type pain,
usually when the patient is wearing shoes.
Orthotics made from a cast of the foot are beneficial in relieving
pain of the neuroma (pinched nerve).
Orthotics
Orthotics are devices that are used to control abnormal foot
function. When the foot is not functioning correctly, it will
produce painful areas. The signs and symptoms of altered
biomechanics of the foot are usually registered as pain. An
orthotic can relieve that pain by supporting the ligaments and the
osseous (bone) structures of the feet.
Orthotics come in many different forms. They are made from rigid
materials, metal, plastic, carbon-type materials, and can be
covered or not covered. But they must be made accurately.
Orthotics are used for many conditions, from childhood to adulthood:
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In children, orthotics are used to realign the arch structure, realign in-toeing and out-toeing gait
problems, or to accommodate knee and hip problems.
In the very active age group, such as runners or sports related activities, specially constructed
orthotics are accommodated to the specific sporting event.
Most professional and weekend athletes use orthotics to help increase their performance.
In the older age group, orthotics are also used as an accommodative device for diseased areas of
the foot.
Plantar Fasciitis
Plantar fasciitis affects men and women equally. It is a condition in
which the bottom of the heel is extremely painful.
The condition is usually a result of an inflamed ligament (plantar
fascia) on the bottom of the foot that attaches to the heel bone.
Constant abnormal pulling of this ligament irritates the heel bone and
the body lays down a bone spur as a protective mechanism. The
patient usually complains of pain with the first step in the morning,
some relief following activity, but returning after extended amounts
of time standing or walking.
This condition is a constellation
of many causes; overweight,ill
fitting shoes, bio-mechanical
problems (mal-alignment of the heel), pronation (a complex
motion including outward rotation of the heel and inward
rotation of the ankle) are some of the causes of heel pain.
The number one recommendation for relief of heel pain is
wearing good shoe gear and customized orthotics are also highly
recommended.
Sweaty Feet
Sweaty feet (hyperhydrosis) and smelly feet (bromohydrosis) are two very common, annoying
conditions of the feet. Some cases of excessive smelling or sweating of the feet are systemic
(throughout the whole body) in nature, such as anemia (low blood count) or hyperthyroidism
(overactive thyroid). But most cases have a "local to the foot" cause.
For instance, wearing shoes that have synthetic materials, and socks that are of man made fabric can
both contribute to the production of excessive perspiration and the bacteria growth that causes this
condition. These two conditions set up a condition called athletes foot0. Unfortunately, most shoes are
made of synthetic materials, especially tennis shoes, so if sweaty/smelly feet is a high concern, you will
want to be especially careful when shopping for shoes.
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome -- tarsal: meaning the lower ankle area of the
foot -- is a condition that usually affects the medial (inside) of the
ankle. There are many structures that run through this area, including
tendons, veins, arteries and nerves.
Tarsal Tunnel Syndrome occurs when the posterior tibial nerve, as it
courses under the ligament at the ankle, becomes inflamed for a
variety of reasons, namely: excessive pronation, arthritic problems
such as rheumatoid arthritis, trauma, and even obesity.
The symptoms that are characteristic of this condition are persistent
burning pain, pain that radiates down to the toes and/or up to the
lower leg, and pain that is usually unremitting, in that is does not
subside after weight has been removed from the foot.
Plantar Warts
A plantar wart is a small lesion that appears on the sole of the foot and typically resembles a cauliflower,
with tiny black petechiae (tiny hemorrhages under the skin) in the center. Pinpoint bleeding may occur
when these are scratched, and they may be painful when standing or walking.
Plantar warts are often similar to calluses or corns, but can be
differentiated by close observation of skin striations. Feet are
covered in skin striae, which are akin to fingerprints on the feet.
Skin striae go around plantar warts; if the lesion is not a plantar
wart, the cells’ DNA is not altered and the striations continue across
the top layer of the skin.
Because plantar warts are spread by contact with moist walking
surfaces, they can be prevented by not walking barefoot in public
areas such as showers or communal changing rooms (wearing flip
flops or sandals helps), not sharing shoes and socks, and avoiding
direct contact with warts on other parts of the body or on other
people. Humans build immunity with age, so infection is less
common among adults than children.
Since over the counter preparations rarely work, please discuss the treatment options with the
podiatrist who can also indicate those therapies that have proved the most successful.