Foot Problems

Foot Problems

What's Fitting Is Good
for the Sole

Each day, the typical woman takes as many as 10,000 steps. That's enough walking in your lifetime to circle the world several times over. Unfortunately, much of that globe-trotting is done in footwear designed more for fashion than for function.

The same shoes that give our legs shape, give us height and make us feel young and fashionable can be an Achilles' heel to our feet, causing numerous problems that hound us with pain and age our spirits. According to a 15-year study by Michael J. Coughlin, M.D., an orthopedic surgeon in private practice in Boise, Idaho, 80 percent of foot surgery patients are women, and most of the problems stem from our shoes.

"There's no question that many of the shoe styles that women wear can contribute to debilitating foot problems," says Glenn Gastwirth, D.P.M., deputy executive director of the American Podiatric Medical Association. "And debilitating foot problems make you feel older by robbing you of the vigor and energy you once had. When your feet hurt, you can't perform your normal daily tasks, so you feel worse about yourself."

These problems harm more than just our feet and psyches. "Bad feet can throw your posture out of whack, setting you up for possible knee pain, hip pain, back pain and neck pain," says Marc A. Brenner, D.P.M., a doctor of podiatric medicine in private practice in Glendale, New York.

Tight Isn't Right

So what's wrong with our shoes? Plenty, say experts. "High heels can be terrible for your feet," says Philip Sanfilippo, D.P.M., a podiatrist in private practice in San Francisco. "They can cause your feet to slide forward, making you prone to bunions and other problems. And many women develop shortening of their Achilles tendons from wearing heels for too long. After time, this may result in tightness of the tendon and the inability to wear flat shoes or to walk barefoot without pain."

Pointy-toed shoes--regardless of heel height--are no better, Dr. Sanfilippo adds. "They cram your toes, which can cause corns, blisters and calluses and aggravate bunions." Pointy-toed shoes can also cause neuromas, pinched nerves surrounded by fibrous tissue that can become very painful.

But the most serious problem--resulting in an estimated $2 billion a year in health care costs, according to Dr. Coughlin's study--is that women's shoes are just too tight. One study found that most women with significant foot pain wear shoes that are a full two sizes too narrow. It's not that we all knowingly squeeze our size B's into size AA shoes. Although according to an American Podiatric Medical Association survey, nearly half the women questioned admitted that they purposely wear uncomfortable shoes for appearance' sake, compared with only 20 percent of men.

"What happens is that as we age, our feet become longer and wider, a process called splaying," says Dr. Sanfilippo. "This occurs as the ligaments in our feet begin to collapse and the arches fall due to gravity and wear and tear. This flattens out our feet. Unfortunately, many people aren't aware of this process--which can occur in your thirties or forties--and they continue to wear the same size shoes they've always worn. And that causes the problem."

Pregnancy can make this splaying occur earlier and be more severe. "When a woman is pregnant, she releases hormones that prepare the connective tissue around the birth canal for delivery," says Dr. Gastwirth. "What this does is weaken some of the connective tissue in other parts of the body. So if you're not wearing supportive shoes or you're doing a lot of barefoot walking during pregnancy, this splaying of the foot may be even more pronounced."

Getting Your Feet to Toe the Line

But shoes aren't the only reason for foot pain. Besides causing the feet to splay, the natural aging process also wears the fat pads on the balls of our feet, which cushion our steps and absorb shock. "As we age, these fat pads tend to wear out, just like the padding of a carpet. When it's installed, it's nice and cushy. But after 20 years, that padding can get pretty worn," says Dr. Gastwirth. "It's the same with your feet: The moment you begin to walk, you begin the process of wear and tear that could lead to future foot problems."

Another common problem: loss of moisture in the skin of your feet, which frequently occurs after age 30 and can result in itchy feet and make you more susceptible to athlete's foot and other types of fungus. Some women, especially smokers and those with Raynaud's disease, have circulatory problems that take a toll on the feet, causing a loss of sensation, particularly in cold weather. Says Suzanne M. Levine, D.P.M., adjunct clinical instructor at New York College of Podiatric Medicine in New York City and author of My Feet Are Killing Me, "Any foot older than 25 is an aging foot."

But it doesn't have to be that way. With a little know-how, you can dance around foot problems and breathe new life into tired tootsies.

Foot and Heel Pain: Support Yourself

There are several causes of those "unexplained" pains in your foot or heel, and most are the result of long-term use of your feet. They include fallen arches, Achilles tendon stiffness, plantar fasciitis, which is an inflammation in the bottom of the foot, and heel spurs, which are tiny growths of bone that may form from the constant pulling of ligaments through jumping, walking or running. "Usually, these problems result from overuse of your feet," says Richard Braver, D.P.M., sports podiatric physician for teams at Seton Hall University in South Orange, New Jersey, Fairleigh Dickinson University in Rutherford, New Jersey, and Montclair State College in Upper Montclair, New Jersey. No matter what the cause, here are the solutions.

Get some support. There's no getting around the deterioration of your feet's fat pads, but you can do something about the pain it causes on the soles of your feet. "Wearing high-quality, supportive, cushioning insoles in your shoes can certainly ease some of your discomfort," says Dr. Sanfilippo. These insoles are available at drugstores and sporting goods shops. If the pain is centered on your heel, a heel cup, also sold in these stores, can help prevent excess heel movement and ease pain. But perhaps more important than insoles and heel cups is wearing supportive shoes.

Stretch out your calf. For heel pain, a lot of women find relief by stretching the heel cord, or Achilles tendon, on the back of the foot, says Gilbert Wright, M.D., an orthopedic surgeon in private practice in Sacramento, California. Stand about three feet from a wall and place your hands on the wall. Lean toward the wall, bringing one leg forward and bending at the elbows. Your back leg should remain straight, with the heel on the floor, so you feel a gentle stretch.

Roll away pain. For heel spurs and plantar fasciitis, try massaging the bottom of your foot. "Roll your foot from heel to toe over a rolling pin, a golf ball or even a soup can," advises Dr. Braver. "This eases pain by stretching out the ligaments."

Heat feet in the morning. "If you feel stiffness in your foot when you wake up, heat it to stimulate blood flow," says Dr. Braver. He recommends placing a warm compress or hot water bottle on the bottom of your foot for about 20 minutes.

Ice them in the evening. At nighttime, switch to ice. Suzanne M. Tanner, M.D., assistant professor in the Department of Orthopedics at the University of Colorado Sports Medicine Center in Denver, suggests placing an ice pack on your foot for 20 minutes, removing it for 20 minutes and then reapplying it for 20 minutes. Be sure to wrap the ice in a towel to prevent ice burns or frostbite.

Neuromas: The Big Squeeze

This is almost exclusively a woman's problem because of our tight and narrow shoe styles. "What happens is that the shoe pushes your foot in tighter and pinches a nerve," says Dr. Braver. "But then tissue grows around this pinched nerve, causing a great deal of pain." Neuromas usually occur between the third and fourth toe or along the sole of your foot. In extreme cases, surgery may be required. But before the pain gets that far, here's what Dr. Braver suggests.

Pad it. "Anything that can be done to support the arch will help women with neuromas," says Dr. Braver. "One of the best things you can do is get an arch support pad, available at drugstores, and place it in your shoe. This reduces pressure to the nerve."

Give it the big chill. A nightly application of an ice pack reduces swelling and numbs pain, adds Dr. Braver. Remember to wrap a towel around the ice pack and follow the 20 minutes on, 20 minutes off routine (described in the previous section on foot and heel pain).

Try physical therapy. "Basic massage won't help, but electrical nerve stimulation and therapies that reduce swelling can," says Dr. Braver. You'll need the help of a physical therapist for this. Steroid injections by a doctor can also ease pain.

Corns and Calluses:
Things That Go Bump

Corns are lumps of built-up dead skin that form on the bony areas of your feet, such as the toes. They're caused by friction, usually the result of wearing shoes that are too tight. Calluses are essentially corns on non-bony places. Both can make you feel as though you're walking on pebbles. Unless you have severe, constant pain, in which case you'll need a doctor's care, you can usually remedy these problems by yourself. And here's how.

If it doesn't fit, don't wear it. "If you have good-fitting shoes, you usually won't have corns and calluses," says Jan P. Silfverskiold, M.D., an orthopedic surgeon in private practice in Wheat Ridge, Colorado, who specializes in foot problems.

To make sure your footwear fits, have both your feet measured for length and width each time you shop for shoes, advises Dr. Gastwirth. Be aware that the shape of your foot influences the best style of shoe to purchase. In general, the best styles for the corn-prone include sandals and running and walking shoes, which have roomy toeboxes. "If you must wear heels," Dr. Gastwirth adds, "buy shoes with wide, stable heels that don't exceed two inches and look for comfort-type pumps that provide greater cushion for shock absorption."

Apply a moisturizer. Since corns and calluses result from excessive friction, it's best to keep skin soft and well moisturized. Dr. Levine recommends that you apply a skin moisturizer to your feet immediately after your bath or shower. If your skin is already hardened with corns and calluses, scrape it with an emery board or a pumice stone anywhere from once a day to twice a week, adds Dr. Silfverskiold.

Be careful with the remover. Over-the-counter corn and callus removers (such as Dr. Scholl's) contain salicylic acid, which will erode lumpy lesions on your feet. But be careful: These medications should be applied only to the affected area, since they can burn healthy skin, Dr. Levine says. But don't use products containing salicylic acid if you have diabetes or poor circulation, cautions Dr. Levine. There are non-medicated cushions available (such as Dr. Scholl's Advanced Pain Relief Corn Cushions) that you can use to protect your corns.

Blisters and Bunions:
Bubbles and Bone

Blisters are painful bubblelike rips in the skin that usually fill with fluid because of excessive friction. Bunions are bumps of bone and thickened skin on the side of your foot just below the base of your big or little toe. They can be accompanied by splaying of the foot and drifting of the big toe toward the little toe. Tight shoes, arthritis and heredity can all lead to bunions. As with corns and calluses, wearing properly fitting supportive shoes can prevent blisters and bunions. But if you already have either problem, here's how to fix it.

Pamper or pop 'em. Insoles, moleskin or even little balls of cotton stuffed between your toes can alleviate the immediate agony of blisters and prevent them from recurring. When blisters become too large for pads, however, pop them by pushing the fluid to one end of the "bubble" and pricking that area with a needle that's been sterilized with a flame or rubbing alcohol. After draining the liquid, repeat the procedure 12 hours later, and then again 12 hours after that, to ensure that you've removed all the liquid, advises Rodney Basler, M.D., a dermatologist and assistant professor of internal medicine at the University of Nebraska at Omaha. Don't pull off the skin, but if it has been torn off, wash the sore with hydrogen peroxide or soap and water and apply an antibiotic ointment.

Try a splint. Bunion pain can be relieved with a toe-straightening splint that's available at most pharmacies without a prescription. The most common version is a rubber plug that "pulls" the big toe away from the second toe, easing pain. While moleskin pads are often used by bunion sufferers, they're not as effective as these splints.

Athlete's Foot: Fight the Fungus

This fungus, which leaves feet scaly, itchy, cracked and reddened, can be picked up just about anywhere--especially in warm, moist areas such as locker room floors (hence the name). Once you get it, athlete's foot is hard to get rid of because it thrives in your shoes, but over-the-counter medications are the preferred course of action. Lotions are better than creams, since creams can trap moisture. Still, the best way to deal with athlete's foot is to avoid it. And here's how.

Sock it to 'em. When you take off your socks, rub one up and down the web of each toe, advises Dr. Basler. This helps keep feet desert-dry. If sock rubbing isn't your style, you can use a hair dryer set on the low setting to dry those trouble areas. And if you have a problem with sweating after your feet have been dried, you can roll some antiperspirant on your feet after showering, he adds.

Be a shoe swapper. Try wearing different pairs of shoes as often as possible, says Dr. Basler. That's because shoes are full of moisture after a day of wear and need at least a day's "rest" to dry out. If you don't have many pairs of shoes, spray them with Lysol at the end of the day to help disinfect them and prevent athlete's foot.

Get cooking with baking soda. There are plenty of over-the-counter powders to prevent athlete's foot, but baking soda does essentially the same thing for a lot less money, says Dr. Levine. Just sprinkle it on dry daily to absorb excess moisture.

Ingrown Toenails: Pain That Digs In

All it takes is a teeny bit of nail to cause big-time pain. Once again, tight shoes can contribute to this problem by forcing the nail downward. If your nail is ingrown to the point that you're in constant agony, you may need a doctor to remove it. But here's how to avoid that anguish and keep nails trouble-free.

Cut nails straight across. Leave the half-moons for cloudy nights. The best way to cure an ingrown nail and prevent a new one from forming is to cut the nail straight across, not slightly curved or in a half-moon shape as most people do, says William Van Pelt, D.P.M., a Houston podiatrist and former president of the American Academy of Podiatric Sports Medicine. And don't cut it too short; it should be just over the crease of your nail fold. Be sure to soak your feet in warm water beforehand in order to make the cutting easier.

Take your piggies to market. There are several over-the-counter products that can soften an ingrown nail and the skin around it, thereby relieving pain. Dr. Levine recommends Dr. Scholl's ingrown toenail reliever and Outgro solution as two common brands. Make sure you follow the instructions carefully. Don't use these products if you have diabetes or circulation problems because they contain strong acids that could be dangerous to women with limited sensation in their feet.

Nail Fungus: Avoidance is Best

Nail fungus doesn't hurt. It won't harm your health. In fact, people won't even notice those thick, raggedy-looking toenails if you keep your shoes on. But nail fungus is hard to cure. "There is a race among the drug companies for a cure for nail fungus, and so far, nobody's winning," says Dr. Braver, who tests foot products for one leading company. "If I knew the answer for curing nail fungus, I'd be a very rich man."

Some experts believe that nail fungus is often caused by an immune system problem and aggravated by moisture. So keeping your feet clean and dry is essential for keeping nail fungus at bay. While curing it is difficult and needs a doctor's care, especially if your feet tend to be sweaty, here's how to avoid getting it in the first place.

Loosen up. "One way to prevent nail fungus is to make sure your shoes are big enough that toes have room to breathe," says Dr. Braver. "Runners, dancers and other athletes often get nail fungus because they get micro-trauma to their toes from their toes hitting the front of the shoes. If you can, wear looser shoes."

Apply an antiperspirant. Sweating makes matters worse, so prevent a potential problem by treating your feet like underarms--apply a daily dose of roll-on deodorant, says Dr. Braver. "There is a prescription product called Drysol made especially for this purpose. It's like using a much stronger underarm antiperspirant."

Foot Odor: The Nose Knows

If you wash your feet and change your socks daily but your feet still smell, you're not alone. Here's how to handle foot odor.

Have healthy feet. "Foot odor is usually related to a fungal infection; sweating feet and pimply or peeling skin are the usual warning signs," says Dr. Braver. "So treat foot odor as you would any fungus problem, with an antifungal lotion such as Lotrimin, which is available over the counter."

Spray away the smell. Other ways to kill the smell are to apply Lysol to your shoes and an antiperspirant to your feet, adds Dr. Braver.

Plantar Warts: A Powerful Punch

Like other warts, these 1/4-inch nasties that form on the soles of your feet are caused by a virus, which is probably picked up walking barefoot. The problem with plantar warts, however, is that the pressure of walking flattens them until they are covered by calluses. When the calluses harden, you feel the plantar's punch, which is similar to walking on a pebble. "About 13 percent of all plantar warts disappear on their own, with no treatment," says Dr. Braver. "However, several strains of the wart virus have been known to spread rapidly." He advises aggressive treatment to get rid of the warts before this happens. Try these measures.

Eat your vegetables. "There is substantial evidence that vitamin A helps protect against warts," says Dr. Braver. While vitamin A in supplement form can be toxic, you can get this added protection by eating more yellow or orange vegetables and fruits such as carrots, squash, sweet potatoes, cantaloupe, apricots and nectarines as well as green leafy vegetables such as spinach.

Go commercial. Using an over-the-counter wart or corn remover (such as Occlusal) can rid you of plantar warts, says Dr. Braver. These products are available at drugstores without a prescription.

Don't go barefoot. The best way to avoid plantar warts is to wear shoes or sandals, says Dr. Braver. "It's important to keep the soles of your feet covered, especially when you're around pools and other moist areas that are attractive to the virus." If a family member has a plantar wart, prevent it from spreading by keeping floors and showers clean and disinfected.

See a doctor. If you have tried the above measures for six weeks and notice little improvement, or if the problems are getting worse, see your podiatrist for care. Professional treatment may include freezing or burning the warts and traditional or laser surgical removal methods.