Foot Pain

Foot Pain

If the Shoe Fits--Wear It

The best advice about avoiding foot pain comes from Cinderella: if the shoe fits, wear it--and if it doesn't, don't! Women have four times the foot problems men do, largely because of the design of our shoes.

Squeezing toes, which are roughly semioval, into unyielding leather triangles causes the corns, calluses, blisters and bunions that prompt Americans to spend nearly $5 billion on specialized foot-care treatment.

In one study of 356 women by Carol Frey, M.D., associate clinical professor of orthopedic surgery at the University of Southern California at Los Angeles, 80 percent of the women's feet hurt, which is no wonder, since 88 percent of them wore shoes that were too small. The reason for this may be revealed in another survey, conducted for the American Podiatric Medical Association: 98 percent of the women interviewed agreed that having healthy feet is important, yet 32 percent of them reported having shoes that were uncomfortable but looked good.

There are more than 300 foot ailments, which is not surprising considering that your two feet have 52 bones, 230 ligaments and 38 muscles. Though a tendency toward some foot problems like bunions and ingrown toenails is hereditary, they may not appear until you tempt Fate with ill-fitting shoes or gain weight. There's really no reason for this, since modern materials require little breaking in, and you don't always have to sacrifice comfort for style if you get the right fit.

Don't ignore problems with your feet, says Bruce Lebowitz, D.P.M., director of the podiatric clinic at the Johns Hopkins University School of Medicine/Francis Scott Key Medical Center in Baltimore. The consequences of doing that can be serious. People whose feet hurt carry themselves differently to avoid pain, but this can throw joints out of alignment and lead to problems in the ankle, knee, hip and back. Besides, when your feet hurt, you can't think of anything else.

Corns: Banish the Bumps

If shoes chafe, the body responds by thickening the skin over the bones. Hard corns usually appear on the little toes, and soft corns occur between toes.

Keep toes loose. Avoid corns by wearing shoes that are loose enough but still fit properly. Avoid tight shoes without a high toebox at all costs, advises Terry Spilken, D.P.M., adjunct faculty member of the New York College of Podiatric Medicine in New York City and author of The Dancer's Foot Book. You can treat hard corns yourself by rubbing a pumice stone or podiatry file over them, he says. You may also use over-the-counter nonmedicated corn pads, unless you have diabetes or poor circulation.

Moisture irritates soft corns, so keep your feet dry. Put lamb's-wool between your toes to absorb moisture and prevent toe-to-toe pressure.

Bunions: Coping with a Curving Joint

Bunions occur when the big toe angles toward the little toes instead of straight forward. A bump forms on the large joint of the big toe. It can rub against the shoe, causing pain and swelling. Although the bone structure that predisposes people to bunions is inherited, women get them at four to five times the rate men do, mainly from wearing high heels with pointed toes, Dr. Spilken says. Bunions are also irritated by tight shoes. According to a study of 2,100 foot surgeries by Michael J. Coughlin, M.D., a Boise, Idaho, orthopedist, 94 percent of the bunion surgeries involved women, many of whom wore tight shoes. Here's what to do about your bunion.

Shield it. Many bunions are eased by comfortable footwear or bunion shields that you can buy at the drugstore, so try changing your shoes before taking stronger measures, advises Dr. Frey.

Consider surgery. If walking and wearing shoes are too painful, corrective surgery to reduce the size of the protrusion or to straighten the toe may be necessary. But don't have it done unless you plan to change your footwear, says Dr. Frey, because if you go back to pointed shoes, you'll get another bunion.

Hammertoes: Straightening the Bend

Hammertoe, a deformity that makes the toe curl down, usually happens on the second toe, often to get out of a bunion's way. But more than one toe on a foot can curve in this way. Women with high arches are more susceptible to hammertoes because of the effect of the arch on the tendons. Here's how to fight back.

Use your marbles. If the hammertoe is still flexible, you can strengthen the tendons by picking up 20 marbles with your toes three times a day, suggests Dr. Frey.

Ask about rerouting. As a last resort, there is surgery to reroute the tendon or remove part of the bone to straighten the toe. Ask your doctor if this procedure is for you, says Dr. Frey.

Ingrown Toenails: Getting Rid of the Pain

Instead of growing straight out of the nail bed, ingrown toenails curve downward, into tender skin. The wounds that result open the door to bacteria, which can lead to painful--and potentially dangerous--infections.

While improper nail cutting and shoes that press on toes didn't start the problem, which is generally hereditary, both exacerbate ingrown toenails. Most people make matters worse by cutting their nails too short at the corners, leaving sharp edges that pierce the skin. Here's some advice for coping.

Don't cut corners. "Resist the temptation to dig into the corners. You can round toenails with a file, but don't lift the nail," says Dr. Lebowitz. Some foot doctors advise people to soak their feet to soften the nail, then tuck a piece of soft cotton beneath the nail to "train" it to grow out straight. Others don't recommend this, fearing that if there's a break in the skin, you might push bacteria into an open wound, which can lead to infection--so be careful if you try this. Epsom salts baths can help, though, because the salts draw out infection.

Treat infection carefully. If an ingrown toenail becomes infected, wash it well, cover with an antiseptic ointment like Neosporin and cover it with a bandage, says Dr. Spilken. If the pain isn't gone overnight, see your podiatrist: An infection in your toe can spread up your leg, causing a serious problem. In severe cases, your podiatrist can perform minor surgery to cauterize the nail so it won't grow into the nail bed. This procedure can be done in the office. If you are diabetic or have poor circulation, see your podiatrist immediately if you have an infection; otherwise you could lose a toe or limb if gangrene sets in.

Morton's Neuroma: Playing Down the Pinch

Morton's neuroma happens when two toe bones--generally between the third and fourth toes--rub together and pinch a nerve, which can then build up extra nerve tissue. Neuromas occur 90 percent more frequently among women, mainly from wearing tight shoes. To prevent neuromas, be sure your shoes don't cramp your toes. Here's what to do if you have one.

Cushion your foot. According to Dr. Frey, many patients get better after six months of conservative treatment. Ask your doctor where you can find metatarsal pads or Spenco sole liners, which cushion the foot so you don't pound on the nerve. The pads or liners can be fitted by your doctor.

Try medications or injections. Serious neuromas that don't respond to liners or pads are treated with nonsteroidal anti-inflammatories (both prescription and nonprescription), cortisone injections to reduce swelling, and surgery, Dr. Frey says.

Plantar Warts: Cleansing Your Sole

The same group of viruses that causes warts elsewhere in the body--the papova viruses--lead to plantar warts, which appear on the sole of the foot. When you walk, the wart is compressed in the skin, which makes it very painful. Plantar warts don't cause cancer, nor do they grow into the muscle, but they can get larger and spread to other places.

Some people appear to be more susceptible to plantar warts than others, since, as Dr. Frey puts it, "that virus is everywhere!" Here's how to cope.

Zap them. Methods your doctor will use to treat plantar warts include removing them with acid or a laser or freezing them. Surgery is also possible in severe cases, but there is a chance of scar formation, says Keith L. Wapner, M.D., director of the Division of Foot and Ankle Surgery at Thomas Jefferson University Hospital in Philadelphia.

Don't go barefoot. Since the virus that causes warts thrives in warm, moist environments such as locker room showers and the decks of swimming pools, the American Podiatric Medical Association recommends wearing shoes to prevent contact.

Plantar Fasciitis: Relax the Pain Away

If you have plantar fasciitis, you'll feel pain under the arch or at the front inner part of the heel, often first thing in the morning or after you've been sitting for a while. This injury to the soft tissue that connects the heel bone to the bones of the ball of the foot happens to women who usually wear high heels and then suddenly stop--during summer vacation, for instance, when they spurn high heels for sandals. The heel tissue can't adjust to the difference in shoe height, so it gets injured. Walking on hard, flat surfaces can cause problems, too. Try these remedies.

Relax your feet. Rather than making drastic changes in footwear, let the tissue relax by wearing moderate heels, an inch to an inch and a half in height, advises Dr. Lebowitz.

Stretch and massage. Stretch the Achilles tendon frequently and use ice massage for the pain, says Dr. Wapner. Since inflamed tissue tends to cause the foot to contract, he prescribes night splints that keep feet in a stretched position.

Pump Bumps: Relief Can Be a Lift Away

Women who wear high heels get "pump bumps"--pain and swelling on the heel near the Achilles tendon--when the heel bone rubs against the rigid back part (counter) of the shoe. Women with abnormal heel bones, such as those with Haglund's disease, are especially vulnerable, but anyone can have similar symptoms from wearing tight shoes. Here's what to do.

Avoid rigid shoes. Don't buy shoes that have hard counters, warns Dr. Lebowitz. You can also wear over-the-counter heel lifts or create a custom cushion for the back of your heel: Paint the bump with crayon or marker, then place a commercial heel cushion in the back of the shoe. Wear the shoe for five or ten minutes, then remove it and cut away the area of the cushion where the paint left an impression.

Get professional help. If nothing helps, a foot surgeon may have to file down the heel bone, but some people have problems with Achilles tendinitis after this operation. Ask your doctor what your chances of a painless recovery are before an operation.

Getting Some Support From Orthotics

Many podiatrists recommend custom-made arch supports called orthotics for several foot conditions, including hammertoes, bunions and arch and heel pain.

Orthotics give the feet support and straighten them out, so they will sit properly in shoes. But some foot doctors question the expense--which can run over $300. Doctors also wonder whether they really help, since you can't use some of them in fashion pumps.