Step in the Right Direction: Say No to Foot Pain

It’s no surprise that our tootsies often hurt considering that an average day of walking exerts a force on the feet that’s equal to several hundred tons. All that dashing around makes feet more prone to injury than any other part of the body. Studies show that 75 percent of Americans experience problems at some time in their lives. But despite the millions of aching feet out there, many of us don’t seek the medical attention we need for relief. Foot pain is never normal, and you shouldn’t be resigned to teetering around on sore feet. The American Podiatric Association believes that neglect and improper care–including ill-fitting shoes–bring on most foot problems.

Podiatrists to the Rescue

No matter what causes your feet to ache, podiatrists can help. They are health care professionals whose training focuses on the foot, ankle, and the muscles and tendons governing foot function.

After completing the necessary undergraduate course-work, podiatrists complete four years in one of the seven U.S. colleges of podiatric medicine to obtain a Doctor of Podiatric Medicine (DPM) degree. Most DPMs then go on to post-graduate residencies, which last from one to three years.

Podiatric Specialties

• Podiatric Primary Care: Prevention, diagnosis and treatment of podiatric conditions for the family-oriented health care environment. DPMs can be Board Certified in Podiatric Primary Care by the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM).
• Podiatric Orthopedics: Conservative non-surgical treatment of imperfect foot and leg structure and function through the use of special footwear, orthotics (devices that can help maintain proper foot support by realigning the foot and distributing body weight), prosthetic devices, and physical therapy. DPMs can be Board Certified in Podiatric Orthopedics by the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM).
• Podiatric Sports Medicine: The prevention, diagnosis and treatment of lower extremity disorders in athletes.
• Podiatric Surgery: Use of modern operating procedures to the alleviate various foot and ankle problems. DPMs can be Board Certified in Podiatric Surgery by the American Board of Podiatric Surgery (ABPS).
• Podogeriatrics: Treatment of lower extremity disorders in the elderly.
• Podopediatrics: Prevention, diagnosis and treatment of children’s foot and leg problems.

Ways To Find A Podiatrist

Here’s are a variety of sources you can try to gather names:

• Health Pages‘ Listings. Check out our comparative guide to local podiatrists.
• Physicians. Ask for a referral from your primary care physician or any other doctor you respect and see regularly.
• Friends, relatives or business associates. Referrals from people you know are usually based on trust and confidence, which is certainly in your favor. Remember, though, that your contacts’ opinions may be largely based on how they click with the physician’s personality and style. Only a visit with the doctor will reveal if these qualities suit your personal preferences.
• State Podiatric Association. Contact your local Podiatric Association for referrals to podiatrists in your area.
• Hospitals. Reputable hospitals usually offer a referral service that can provide you with the names of staff doctors who meet certain criteria you may be seeking, such as specialty, gender and location. However, the referral service cannot vouch for quality of care.
• Managed care plan. If you belong to a managed care plan, find out what podiatrists are affiliated with it. If you see a doctor outside your plan it could cost you a lot more. Also, ask what information they have available on the doctor’s background and services.

Considerations In Making A Choice

Once you’ve gathered some names, use these guidelines to help you check out prospective doctors.

1. Professional Credentials. Certainly any podiatrist you consider should have graduated from an accredited podiatric school. The only seven in the U.S. are:

• Barry University of Podiatric Medicine, Miami Shores, FL
• New York College of Podiatric Medicine, New York, NY
• California College of Podiatric Medicine, San Francisco, CA
• Ohio College of Podiatric Medicine, Cleveland, OH
• Pennsylvania College of Podiatric Medicine, Philadelphia, PA
• Scholl College of Podiatric Medicine, Chicago, IL
• University of Osteopathic Medicine and Health Sciences College of Podiatric Medicine and Surgery, Des Moines, IA

If you are looking for a podiatric surgeon, orthopedist or primary care specialist, find out if the doctor is board certified. That distinction means the physician has completed a prescribed period of residency in a chosen specialty, has passed oral and written examinations and has handled a minimum number of cases. Although board certification is no guarantee of quality, doctors who’ve passed their boards have met standards above and beyond those required to get a podiatry license. About 36 percent of the 13,800 podiatrists in the U.S. are board certified.

2. Professional Affiliations. The ideal podiatrist is probably affiliated with a good hospital, either as a staff member or as an attending physician, a title that carries with it admitting privileges. A teaching position at a medical school is further indication that a doctor is both well trained and up-to-date.

3. Practice Arrangements and Location. Take into account the doctor’s location and office hours too. If these aren’t convenient, you may put off necessary visits.

4. Personal Manner. Once called “bedside manner,” a doctor’s interpersonal skills and ability to communicate are important. In addition, a doctor should treat you like a partner in your own health care by explaining diagnostic procedures, test results and medications and by answering your questions. You may also prefer a doctor who shares your cultural background and/or speaks your native language. To evaluate a doctor’s personal manner, you will have to schedule an initial visit.

Make The Most Of Your Visit

You can show a desire to be a decision-making partner in your medical care by participating fully in your visit.

2. Be prepared. If it is your first visit, bring a summary of your medical history, including childhood diseases, chronic illnesses, hospitalizations, medications and a health history of your parents. Also bring reports of relevant diagnostic tests, such as x-rays and blood workups (which you can request from your former doctor).
3. Tell the doctor everything about your health and illness. Withholding information may result in an inaccurate diagnosis or inappropriate treatment. For example, diabetes and arthritis can have serious effects on your feet and ankles. If you have either of those conditions, let the podiatrist know immediately.
4. Ask precise questions. The best way to get advice that relates to you, as opposed to the population in general, is to be specific: “How do I…” or “What is the best way for me to…”
5. Take notes. Many patients can’t remember their discussions with a doctor once they’ve left the office. A forgotten bit of information or a recommendation could change the course of your treatment.
6. Remember that you and your doctor are a team. Many patients sabotage their treatments by failing to follow the doctor’s instructions. Skipping doses of medication, or getting back to your exercise routine sooner than recommended can delay healing or further jeopardize your health. On the other hand, if a treatment regimen doesn’t seem to be working or is making you feel worse, don’t hesitate to call the doctor so that appropriate changes can be made. Remember, it is your body and your feet. You are best equipped to describe how you are feeling.

Foot Ailments That Dog Us

Are your feet killing you? Well then, you may be all too familiar with ailments such as athlete’s foot, calluses and corns, hammer toes, ingrown toenails and bunions. Sometimes home remedies can soothe sore feet, but if problems persist, don’t continue to “doctor” yourself. The American Podiatric Association points out that self-treatment often turns a minor problem into a major one. Here are some of the common conditions that plague us.

• Athlete’s foot is a fungal infection that usually starts between the toes or on the bottom of the feet. The fungus can, however, spread to other parts of the body. Signs of athlete’s foot include itchy, scaly skin, and thick, white nails. Ward off infection by washing your feet daily with soap and warm water; drying carefully, especially between the toes; and changing shoes and hose regularly to decrease moisture. A podiatrist may prescribe medication or recommend nail surgery.
• Blisters are caused by skin friction. Don’t break them because you may create an opening for bacteria. Instead, apply a moleskin pad for protection, keep your feet as dry as possible and wear thick socks for extra padding. When the blister pops, leave the broken skin in place, but keep the area clean and apply an antibiotic cream. Cover it with a sterile gauze bandage.
• Bunions are misaligned big toe joints that can become swollen and tender. The deformity causes the first joint of the big toe to slant outward, and the second joint to angle toward the other toes. Bunions tend to run in families, but the tendency can be aggravated by shoes that are too narrow in the forefoot and toe. Wearing wide shoes and protective pads can ease the pressure, but surgery is often required to correct the problem.
• Corns and calluses are caused by underlying bone problems that cause excessive irritation. Where shoes repeatedly rub, dead skin cells pile up, creating calluses on the bottom of the foot and corns on the toes. The American Podiatric Association warns that you should never attempt to cut or dissolve corns or calluses at home. Your podiatrist can trim or protect them if they become painful, but they usually grow back unless the underlying problem is corrected surgically.
• Foot odor results from excessive perspiration from the more than 250,000 sweat glands in the foot. Daily hygiene is essential to keep feet clean. Air out shoes daily to evaporate moisture, and change your socks a couple of times a day. Foot powders, antiperspirants, and soaking in vinegar and water can help lessen odor too.
• Hammertoes buckle into a claw-like position and corns form at the bent joint when these toes rub against the tops of shoes. Claw toes are the result of an inherited muscle imbalance, too-small shoes or a bunion-bearing big toe that slants inward. Usually, the second toe bends into this unnatural shape, but any of the other three smaller toes can be affected as well. Square, open-toed, or prescription shoes may increase comfort. If corns keep growing back, surgery may be advised.
• Ingrown nails result when the corners or sides of nails dig painfully into the skin. They are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity, and poor foot structure. Use toenail clippers to trim nails with a slightly rounded edge. Leave nails slightly longer than the end of the toe and don’t cut into the corners.
• Plantar Neuroma is a condition that occurs when two metatarsal bones-most frequently the third and fourth ones-rub together and irritate a nerve. The resulting enlargement of the nerve can produce pain, burning, tingling, or numbness between the toes and in the ball of the foot. Conservative treatment includes orthotic devices (shoe inserts that help realign the foot and distribute body weight evenly) and/or cortisone injections, but surgical removal of the growth is sometimes necessary.
• Warts are caused by a virus that enters the skin through small cuts. Children, especially teenagers, tend to be more susceptible to warts than adults. Most warts are harmless and benign, though they are unsightly and may be painful. Warts often come from walking barefoot on dirty surface. A podiatrist can dissolve warts painlessly with topical acid treatments or remove them surgically.
• Heel pain is usually caused by a walking stride that exerts excessive stress on the heel bone. Discomfort can also result from poorly made shoes, obesity, a stress fracture of the heel bone, bruises of the fat pad under the heel, or a disease such as rheumatism or gout. To ease heel pain try wearing well-fitted shoes with soft, shock-absorbent soles. Orthotic devices may absorb some of the impact on the heels. A doctor may also prescribe nonsteroidal antiinflammatory drugs, or suggest applying heat and/or cold to the heel. Surgery may be necessary as a last resort if heel pain is severe.
• Heel spurs refer 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 called for.

If The Shoe Fits, Wear It

Your feet bear the brunt of all the time and pressure you put on them every day, but proper footwear can reduce foot problems. Children, women, men, and athletes all have different shoe requirements, which vary considerably across a wide range of activities.

1. Children’s Shoes. When a child begins to walk, shoes are generally not necessary. Allowing an infant to go shoeless indoors, permits the foot to grow normally, develop strength, and aid the grasping ability of the toes. Once children start wearing shoes, it’s necessary to change sizes frequently to allow room for growth. Though fit is the most important consideration, function is also critical. Footwear with crepe or rubber soles helps cushion impact better than dressier, thinner-soled shoes.
2. Women’s Shoes. Many women’s foot problems result from high-heeled shoes (footwear with heels of more than two inches). Podiatrists believe high heels are orthopedically unsound and cause muscle imbalances and postural problems. To relieve the abusive effects of high heels, women can try the following:
   1. Limit the time heels are worn, alternating them with good quality sneakers or flats for part of the day.
   1. Vary heel height. Use a shorter heel the day after you wear a high one.
   1. Pick the right shoe for a particular activity. This is probably as important a factor in the choice of shoes as any. So, for example, if you’ll be doing a lot of walking, wear comfortable flats with adequate support.
   1. Perhaps the best shoe for women, from an orthopedic viewpoint, is a walking shoe with laces (not a slip-on), and a relatively wider heel with a rigid and padded heel counter, no more than a half or three-quarters of an inch in height.
3. Men’s Shoes. The best shoes for men are good quality oxfords, shoes ordinarily associated with wing-tip or cap designs. Also suitable are slip-ons, dressy loafers, and low, dress boots.
4. Shoes for work. Men and women should match the shoes they wear to the type of work they do. Office workers should have three to five pairs of shoes for business hours – general oxfords and loafers for men; pumps and oxfords for women. Cushion-soled shoes that give good support are essential for those who spend most of their working days on their feet.
5. Workers in heavy industry need protective foot gear, such as safety shoes and boots, which are waterproof or water-resistant and have insulated steel toe caps and soles made of materials that don’t conduct electricity and help prevent injuries or reduce the severity of injuries that do occur.
6. Shoes for Athletics. Different sports activities call for specific footwear to protect feet and ankles. Sports-specific athletic shoes are a wise investment for serious athletes, though perhaps a less critical consideration for the weekend or occasional athlete. Probably an even more important consideration is the condition of the shoe – don’t wear any sports shoes once they start to wear down.

Podiatrists note that athletic footwear should be fitted to hold the foot in the position that’s most natural to the movement involved. For example, a running shoe is built to accommodate the impact that concentrates on the forefoot, while a tennis shoe is made to give relatively more support to the ankles and permits sudden stops and turns. Because of the many intricate maneuvers involved in sports and the added strain they put on the feet, athletic shoes should be carefully fitted with just as much attention as everyday street shoes.

It is widely accepted that a regular regimen of walking is physically rewarding. Here again, footwear with proper support is most important. Choose a good quality, lightweight walking shoe with breathable upper materials, such as leather or nylon mesh. The heel counter should be firm, the heel positioned closer to the ground for walking stability. The front or forefoot area should have flexibility, and plenty of room for the toes to move around. Also important: cushioned heels and soles for resilience on hard surfaces and traction on slippery ones.

Shoe-buying Tips: Go For the Ahhhh, Not the Ouch

• Have your feet measured while you’re standing.
• Always try on both shoes, and walk around the store.
• Since feet are seldom precisely the same size, always buy for the larger foot.
• Don’t buy shoes that need a “break-in” period – shoes should be comfortable immediately.
• Don’t rely on the size of your last pair of shoes. Your feet do get larger, and lasts (shoemakers’ sizing molds) also vary.
• Shop for shoes later in the day; feet tend to swell during the day, and it’s best to be fitted when they are at their largest.
• Be sure that shoes fit well – front, back, and sides – to distribute weight. Be sure the widest part of your foot corresponds to the widest part of the shoe.
• Select a shoe with a leather upper, stiff heel counter, appropriate cushioning, and flexibility at the ball of the foot.
• Buy shoes that don’t pinch your toes, either at the tips, or across the toe box.
• Try on shoes while you’re wearing the same type of socks or stockings you expect to wear with the shoes.