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Something’s afoot — Ill-fitting shoes, obesity contribute to problems with your feet

SHARE Something’s afoot — Ill-fitting shoes, obesity contribute to problems with your feet

Add foot problems to the list of ills, such as certain types of cancer and some cases of high blood pressure or heart disease, that are greatly influenced by both heredity and personal choice.

Many of the most common, painful foot problems are inherited. It's not so much a particular gene that's at fault but rather the inherited shape and biomechanics of the foot.

As for choice, there are different views. Some podiatrists say the shoes you wear play a big role in foot problems, although not all agree. They reach consensus, though, on the importance of wearing the right shoe, especially when you have foot problems.

And excess weight is indisputably hard on feet. Often, simply shedding pounds resolves foot problems, says Dr. William Martin, a Logan podiatrist. "Weight is a huge issue. I try to work with the patient on that in a gentle way. The bigger you are, the more problems you are going to have. It puts more pressure on joints, whether the hips, knees, ankles or joints of the feet.

Overweight patients will probably develop arthritis. All that pressure is going to go somewhere. Just losing weight can fix some problems. Heel pain and arch pain can absolutely go away."

Heavy people are more prone to twisting their ankles and suffering arch collapse, Martin says.

"The No. 1 complaint I see is heel pain, plantar fasciitis, and it's related to faulty foot gear," says podiatrist Dr. Ryan Anderson, of Advanced Foot and Ankle in Bountiful. "Most of the patients I see are female, and it's related to their shoes."

Plantar fasciitis is heel pain caused by inflammation from the ligament that holds up the arch.

When podiatrist Dr. Steven Royall of Mountain View Foot Clinic in Salt Lake City talks about foot care, he talks footwear. "Shoes are crucial," he says. "There's such a variety, especially for women. Stiletto heels are job security for me." Shoes need to fit well, and "the stiffer the better" so the shoe does the work, not the foot. The toe box must not pinch or let the foot slide around.

Footwear is not where anyone should skimp, Anderson says. "You don't have to spend a lot to get the right shoes. People spend a lot on other types of apparel, but shoes are the most important thing you wear."

Martin says footwear doesn't cause most of the problems he sees. He divides common problems into four groups: Skin problems include ingrown toenails, athlete's foot, fungal nails and warts. Tendon problems attack the arch, heel and ankles. The third group is nerve related, including neuromas, which are inflamed nerves between the metatarsal heads. And finally, he sees bone deformities such as bunions or hammertoes.

"You can certainly wear the wrong type of shoes. Flip-flops offer no support and may cause pain. But some people wear great shoes and still have problems," he says.

Even when there's a genetic or injury-related basis to foot woes, shoes can play a role in how bad it gets, Anderson and Royall say.

They point to bunions, particularly common in winter when people are wearing closed shoes. Women who wear tight, tapered shoes find those tend to irritate bunions, bony protuberances on the side of the big toe.

While the primary causes of ingrown toenails are trimming the nails too deep at the side and heredity, moving from a tendency to actually having painful problems "usually starts from bad shoes," Anderson says.

Royall says the familial link is so strong with ingrown toenails that "If I see one child in a family, I see all 10. It can be aggravated by improper nail trimming, but you can do everything right and still have ingrown toenails." There's a simple, usually painless in-office procedure that removes or destroys part or all of the nail.

Royall treats many athletes with heel pain, usually associated with plantar fasciitis, caused by overactivity, improper training, bad shoes or shoes that don't match an individual's biomechanics. He says you don't have to be an athlete or wear spiked heels to suffer, either. It can be caused by the flattening out of the foot. But part of the treatment involves choosing the right shoes.

He says that ski boots and high heels and tight-in-the-forefoot shoes contribute to many of the neuromas he treats.

The American College of Foot and Ankle Surgeons says poorly fitting or poor-quality shoes can exacerbate painful spurs, herniation of a tendon, all sorts of tendonitis, ganglion cysts, hammertoe deformities and other problems. It's a major contributor to "pump bump," so named because it's most often seen in young women who wear high heels a lot. The rigid back of the shoe presses on the heel. That bone enlargement can lead to Achilles tendonitis or bursitis, because the shoes create constant irritation, especially in those with high arches or tight Achilles tendons. Women who must wear high heels can get relief from placing heel lifts in shoes or wearing backless or soft-backed shoes.

Shoes alone can cause abnormal wear or friction. That doesn't count feet that flat out hurt because they're pinched or not well cushioned.

And foot problems are not the sole provence of adults. Kids can have major problems, although they're usually different. Lots of kids have inflammation in the growth plate, ingrown toenails, flat feet or feet that turn in. While adults suffer because of weight, pressure and overuse, many childhood foot problems are congenital.

ACFAS says kids suffer from shoes that don't fit well, too. The college publishes a guide to fitting shoes for kids, whose feet can grow up to two sizes in six months. Don't buy shoes that are too big. That can cause the foot to slide forward and put excessive pressure on the toes, it says. You need about a finger's width from big toe to shoe's end.

Tight shoes cause blisters, corns and calluses or worse. Shoes that are too flexible can lead to a pinched nerve between the toes that causes pain, numbness or burning in the ball of the foot, the guide says.

Shoes must offer proper cushioning and arch support, and any wear around the soles on kids' shoes means it's time to toss them. It's important that the toe box flexes easily and the shoes do not bend in the middle of the sole.

Worn-out shoes increase the risk for heel pain, Achilles tendonitis and even sprains and stress fractures.

People of all ages with flat feet need a wide toe box, strong arch support and shock absorption. Lace-up shoes that have room for an orthotic insert if it's needed are best.

One of the finest developments in foot care, Royall says, is specialized shoes. There are shoes designed for runners and others such as those who play basketball, for instance.

There are very good surgeries that can correct some foot ailments, but the podiatrists say they generally first try to resolve them in other ways. That includes antiinflammatory medications, orthotics and, in some cases, an injection "to calm things down," says Martin. Cortisone may be injected into inflamed tendons and joints. For nerves, Martin injects alcohol. Often, those treatments provide a cure. Putting a particular anti-cancer cream on warts makes them go away.

Besides wearing good-quality shoes that fit well, they recommend not going barefoot on hard floors. If feet sweat a lot, it's important to use powder in shoes to absorb it and cut down on athlete's foot or nail fungus. Dry feet need lotion. Socks should be changed daily. Martin counsels stepping out of the shower onto a towel. "No matter what household you're in, there is fungus on the floors in bathrooms and kitchens."

Fungal toenails are a big issue, especially for older patients, Royall says. The pain can be debilitating. He treats them with topical or oral medications. Sometimes the nails are removed or ground back.

While anything that has changed significantly or causes pain should be checked out by a foot specialist, people with diabetes should see a podiatrist at least annually and always wear shoes. Those shoes should fit well, Martin says. If they're too loose, the result is a friction blister. Too tight and there's a possibility of nail trauma that leads to fungal infection.

Diabetics often lose sensation in their feet and don't know when they've got an injury that requires treatment unless they're vigilant in watching for it. They tend to heal more slowly than others. And even seemingly minor injuries that are not cared for can lead to serious problems, even amputation.


E-mail: lois@desnews.com