Podiatrists' Secrets for Foot Health

• How To Avoid Orthotics
  
  
• Why Retail Orthotics Can Do More harm Than Good
  
  
• How To Avoid Surgery
  
  
• How To Extend the Life of Your Shoes
  
  
• How To Stay Active When Your Feet Say "Stop!"
  
  
• How Painful Ingrown Nails Can Be Painlessly Treated
  
  
• Pronation/Flat Feet

How To Avoid Orthotics

1. Switch to soft-soled walking shoes rather than slip-on dress shoes.
   
   
2. Try an over-the-counter arch support such as SpencoR or BirkenstockR to see if this helps.
   
   
3. Try cushioned heel pads from sports stores.
   
   
4. For sore arches, try applying 3 or 4 strips of adhesive tape under the foot: Start at one side, go under the foot and come up 1 or 2 inches on the opposite side. (Remove at night to let the skin breathe.)
   
   
5. When someone tries to sell you orthotics, ask them what other treatment modalities they can suggest first.
   
   
6. Get a second opinion from a podiatrist.
   
   
7. Consider physiotherapy along with podiatric treatment and see if this offers permanent solutions.
   
   

Why Retail Orthotics Can Do More Harm Than Good

1. If someone was truly a foot specialist , they would be working in private practice or clinical settings — not a retail store where they cannot make a medical diagnosis. They may be missing the true problem or incorrectly treating your existing problems.
   
   
2. In an attempt to support the arch, many orthotics from retail settings create too much pressure, particularly at the big toe joint. Continuous jarring over the thousands of foot strikes occurring with daily walking can result in subtle repetitive changes that can lead to traumatic arthritis.
   
   
3. Many orthotics from a retail setting give you some support under the arch but do not fully control the mechanics of the foot. Therefore, existing deforming forces may still take place and your problem can slowly progress since the foot is not being controlled adequately. Stores that sell orthotics want to make a sale. Your optimum foot health may not always be of primary concern to the retailer. If you are sold orthotics and you don't need them, they may be "over-correcting" your foot position which can lead to other problems.
   
   

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How To Avoid Surgery

When it comes to foot surgery, most procedures are elective. That means you may not have to do it at all.

1. Consider getting a second opinion if somebody suggests surgery to you.
   
   
2. Podiatric surgery in the 90's often means no scalpels or no incisions. For example, crooked toes (hammertoes) can often be straightened with a tiny puncture and a tendon release in an office setting. This surpasses general anesthetic, large incisions, fusion of bone with pins and cast, etc.
   
   
3. Bone spurs can often be removed with minimal incision surgery. A tiny puncture is used and a small rotating burr files down the bone spur. This is another alternative currently being performed in podiatric offices.
   
   
4. Removal of warts doesn't have to be a painful ordeal, especially at the bottom of the foot. New laser techniques allow for vaporization of warts with far less post-operative discomfort and without residual painful scars resulting. You can walk right after the procedure. Avoid having warts excised.
   
   
5. Ask your podiatrist if there are other ways to avoid surgery with the use of accommodative padding or various modalities in order to reduce pressure from a painful spot on the foot.
   
   
6. Office foot surgery can be postponed until it is convenient for you, rather than convenient for the doctor performing the procedure.
   
   
7. If someone calls your surgery "minor", it may be minor to them but not to you.
   
   

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How To Extend the Life of Your Shoes

1. Both sports shoes and dress shoes will last longer if you undo the laces each time you take them off. This saves the heel counter and maintains the stability of the shoe.
   
   
2. Runners: If the foot beds inside your shoes are removable, consider replacing them after about 200 miles. This gives more cushioning to the foot and the shoe lasts longer.
   
   
3. Try rotating your shoes and not wearing the same pair from one day to the next. In fact, even switching shoes in the middle of the day gives your feet a break and the shoes get a chance to air out. If your shoes are wearing out excessively, then you may have a foot imbalance and orthotic devices, if made properly, would prevent the excessive shoe wear.
   
   
4. Buy good quality running shoes rather than flimsy shoes and the better quality will last longer, and feel more comfortable.
   
   
5. For runners, consider using two pairs of running shoes, one pair for rainy or muddy conditions where you would perhaps wear them one third of the time, and a new pair for drier conditions, where they can be worn the rest of the time.
   
   

How To Stay Active When Your Feet Say "Stop!"

If you and your body want to run or play sports, but your feet hurt too much:

1. Try to pinpoint the sore area, determine if shoes aggravate the problem or if simply standing aggravates the problem.
   
   
2. Then try to determine if pads will relieve pressure. Pharmacies sell moleskin and other pads that can be used if there is pressure on a toe from a shoe. Placing pads around the sore spot on a toe or the ball of the foot ca relieve pressure. (Don't use medicated pads, as they damage surrounding skin.)
   
   
3. If you're an active, healthy person with good circulation and a spot on your foot is sore, try applying some ice or frozen peas for about 5 minutes at a time. Don't rush to buy orthotics just because someone in a store tells you that you need them! They are not a cure-all, and the diagnosis and cause of your problem should be determined by a podiatrist first.
   
   
4. See a podiatrist to determine the cause of your problem. In most cases the doctor can apply pads or use other treatment to relieve pressure and enhance comfort right on the spot.
   
   
5. Consider changing sports temporarily to maintain your level of fitness. For example, if running hurts, consider swimming or cycling until you recover.
   
   
6. Don't let nagging problems persist hoping they will go away. There's no need to fear a visit to a foot doctor's office when it comes to foot problems. Treatment is usually painless and often relief is immediate.
   
   

How Painful Ingrown Nails Can Be Painlessly Treated

Many people with a painful ingrown nail will avoid going to the doctor for fear of painful treatment. Some fear having the whole nail removed or some equally drastic and horrible treatment. Usually, a podiatrist's treatment is virtually painless!

With neglect, ingrown nail problems tend to worsen and an infection will often result. If left untreated, the infection can progress down to bone and become even worse. Here are some things to consider:

1. Some physicians may recommend antibiotics when there is an ingrown nail. The nail acts like a foreign body and penetrates into the skin. A podiatrist will simply clip away a segment of the nail that is digging into the skin and usually this is a painless procedure. The relief is dramatic and immediate. Often antibiotics aren't needed.
   
   
2. A couple of soakings of the toe in lukewarm water and 3 or 4 tablespoons of Epsom salts often clears up any remaining infection once the offending nail border is clipped back.
   
   
3. At a later date, a corrective procedure with a laser can be performed by a podiatrist where a segment of the ingrown nail is removed. The growth cells are destroyed so the ingrown portion of the nail doesn't come back. Therefore, the remaining portion of the nail is left to grow normally without the painful, ingrown side. You can walk right after the procedure
   
   

Pronation/Flat Feet

Feet that flatten out upon standing are referred to as pronated. Pronation means that the ankles roll in towards each other and the arches flatten.

Some people have a fairly high arch when they are sitting, but as soon as they stand up, their feet collapse.

Is Pronation a Bad Thing?

No and Yes. Pronation is required when we walk so that when the heel strikes the ground, the foot rolls in to absorb shock and to adapt to the supporting surface, particularly on uneven surfaces. Therefore, pronation is a normal, necessary component of walking.

It becomes a bad thing when the foot remains pronated throughout the walking cycle. Therefore, the heel strikes the ground and pronates to absorb shock, but then at the midstance phase of the walking cycle, the foot has to reposition to become a rigid lever for pushing off effectively with every step. If the foot remains collapsed or pronated, then muscles and tendons will strain and the foot shows excessive signs of wear and tear.

What Are The Problems Associated With Pronation?

Commonly, people experience generalized pain or fatigue in their feet, or sometimes arch pain or even heel pain. When you stand up first thing in the morning and your heels are sore, this is because the foot is bearing weight, pronating and the band that extends from the heel to the ball of the foot stretches and pulls excessively as the foot collapses. Pronation can cause enlarged toe joints (bunions), pinched nerves (neuroma), callous formation at the ball of the foot, heel pain, arch pain, ankle soreness or even lower leg or knee pain.

How Do The Feet Affect The Rest Of The Body?

If your feet collapse or pronate, then the lower legs rotate inwards and the knees are affected. The knee cap can move side-to-side which creates a problem called "runner's knee" or "patellofemoral syndrome". Furthermore, if the feet collapse, then the muscles and tendons extending from the lower leg down to the foot stretch or strain excessively (often referred to as "shin splints").

How Is Pronation Caused?

Pronation becomes evident around the age of 3 or 4. When children first start to walk, their feet are quite flat and there is a fat pad under the arch, and this is normal. By the age of 3 or 4, children's feet should be stable.

However, because of tilting of the bones of the foot, this problem may remain as children grow and as a result, the bones of the feet strike the ground on an angle and so the feet compensate and roll in. This is the pronation that we commonly see in childhood. If left untreated, then children go on to develop with pronated feet which can result in problems in adulthood.

If adults that have bunions for example, had been treated as a child, then the bunions could have been prevented from progressing. Often the foot structure is inherited, but by correcting the foot mechanics, the problems that result from the inherited foot structure can be prevented.

What Can Be Done About Pronation?

Many years ago doctors used to recommend wedges, arch pads or other types of "cookies" or modifications to the shoe. Research in podiatric biomechanics for the past 25 years has demonstrated that shoe modifications are not enough. Orthotic devices are used to correct biomechanical abnormalities of the foot. Orthotics are prescription inserts that are worn comfortably in the shoes and they are made following a plaster cast of the foot.

What Types Of Orthotics Are Best?

Many stores and clinics are now treating feet with shoe inserts, even though they are not foot specialists. Orthotics have been so successful in the podiatry profession that many with little training on the foot have decided to treat foot pain as a side line. One should be careful where they get orthotics. Retail stores or booths at trade shows or malls make what they call orthotics on the spot. Basically all they are doing is taking a tracing of your foot, or getting an imprint and you wind up with an off-the-shelf device which is no more than an arch support that you would buy in a drugstore. These may provide a bit of support or temporary comfort, but they do not control the mechanics of the gait cycle. They are not true "orthotics".

Arch Supports from drug stores may provide some temporary relief or insoles from sporting shops may control pronation to a degree. However, they are not specific enough to precisely control the foot motions during the walking cycle.

Plaster Casts

Podiatrists use plaster casts of the feet in their corrected position in order to exactly control the mechanics of the walking cycle. A plaster cast enables a laboratory to fabricate an orthotic device that is made exactly to your foot and in this way it will be comfortable. The best available orthotics are made by prescription with a plaster cast of your feet.

Avoid Foam Impressions For Orthotics

Many allied health workers make what they call an orthotic and have you step in a foam box. This is quick and easy for them and not messy. However, by stepping in a foam impression, a deviated position of the foot is captured and hence adequate control of the foot mechanics cannot be achieved. There is quite a bit of guesswork involved since these orthotics are usually made from a standard stock size item. It's best to avoid orthotics made from a foam impression.

What About Computerized Orthotics?

Many places are now using a computerized gait analysis. They have you step on a pressure pad and a digitalized read-out of your footprint is seen on a screen. This is very impressive and will show where there are pressure points on the foot. This computerized gait analysis helps to make the person that is using it look like they really know what they are talking about when it comes to the feet, even if they know very little about podiatric medicine!

Caution however: The orthotics that are made after this computerized gait analysis are in fact basically an off-the-shelf device of a standard stock size to match your shoe size and to approximate the height of the arch. The devices are not made by a computer, and it is only the gait analysis that is computerized. This gait analysis basically confuses the issue and it makes it appear as though you are getting computerized orthotics. You are not, and as a result the correction or control of the foot mechanics may be limited or ineffective.

Bottom Line

If you are having problems with your feet and your feet are pronated, you are best off having your feet looked at by a podiatrist in order that proper correction can be achieved for the many years of walking that you have ahead of you.