On Your Toes

By Melanie Stevens

Heart disease. Obesity. Blood pressure. Cholesterol. Bunions?

With so many health concerns to be aware of these days, Americans are most often willing to walk off painful growths on the side of the foot, irritating corns, some mysterious toe fungus, sore arches and other unpleasant foot ailments. According to a recent study conducted by the American Podiatric Medical Association (APMA), 47 percent of the 1,695 men and women who participated in the survey indicated that they had experienced a foot ailment in their lifetime. Of those, one third said they did nothing to treat their conditions but instead chose to live with the pain.

Yet orthopedic surgeon Dr. Dan Lee says if more people understood how foot problems can impact other parts of the body, they might pay more attention to what the pain is really telling them.

“Something as common as a bunion could lead to hip, knee, spinal and even lower back problems,” says Lee, who is an assistant professor at UCSD School of Medicine, Department of Orthopedics. “The bunion is really just the tip of the iceberg. It’s serving as a way for the body to compensate for bigger problems like one leg being longer than the other or something like tendon or ligament damage.”

The ultimate weight-bearing platform and the first to come into contact with surfaces of all shapes and sizes, the foot is a remarkable lower extremity that adapts to a variety of surfaces, preserving the body’s balance and offering flexibility and agility for running, jumping and dancing. Made up of 26 bones and 33 joints, it’s no wonder the foot is so susceptible to a slew of problems, especially as aging boomers adopt more active lifestyles.

But as common as foot problems are these days, it’s important to remember that it’s abnormal to be experiencing the pain.

“One of the biggest problems I see is that too many people think it’s the norm to have foot pain,” says Dr. Donald Triolo, a podiatrist at Alvarado Podiatry Center. “They will run to the doctor at the first sign of a headache or toothache, but they’ll ignore their feet, even if it often keeps them from doing things they love.”

Of the list of problems experienced by the men and women surveyed in the APMA study, the top three treated foot ailments were: Sweaty feet; nail problems and pain at the ball of the foot. And while the immediate causes tend to point to improper footwear, local podiatrists and orthopedic surgeons agree a person’s walk is the source of many—if not most—foot problems.

“The most common causes of foot pain are biomechanical and structural problems like a curvature of the spine that ultimately change the way a person walks,” says Dr. Richard Green, a podiatrist with the San Diego Podiatry Group. “Some of these problems people are born with. It affects the body’s alignment and causes stress and pain in the feet and other parts of the body.”

Inflammatory conditions such as arthritis or infection, tissue disorders, metabolic disorders such as diabetes, and trauma due to injury should also be added to the list of causes, says Dr. Eric Horton.

“There are so many causes to foot pain, that to narrow them down to a small list just wouldn’t be accurate,” says Horton, who is an orthopedic surgeon at Alvarado Hospital. “What’s important here is to learn to listen to your body to figure out if the pain is chronic or short-term. If the pain has been persistent for several weeks, that’s a sign that you need to come in and get it checked out.”

Although footwear is considered more of a secondary cause to chronic foot pain, shoes with worn out and uneven heels and those that lack cushion and support can exacerbate an already existing problem and bring new ones, such as corns and ingrown toenails, to the surface.

According to a recent survey taken by the California Podiatric Medical Association (CPMA), high heels especially contribute to knee and back problems, causing disabling injuries in falls, and creating shortened calf muscles and an awkward, unnatural gait in most women.

Despite an awareness of the consequences, the CPMA study pointed to a recent Gallup Poll that reported that 37 percent of the women surveyed said they would continue to wear high heels even though they did not think they were comfortable and indicated that the heels made their feet hurt.

Triolo says it’s no surprise then that a majority of his patients are women.

“Women’s shoes are so much more damaging than men’s shoes,” he says. “Women also tend to be more aware of and sensitive to the pain, so they’ll eventually come in. I see horrendous corns on toes or calluses on the bottom of the feet, but because they look good, women are more reluctant to change their habits and choose more sensible footwear.”

Although women might be more likely to get themselves to the doctor, men, especially those who are active and have suffered from sports injuries sometime in their lives, are still susceptible to experiencing the same kinds of foot pain.

“Men tend to avoid going to the doctor, so they’ll continue to put it off until the pain is unbearable or if it’s a serious injury like a broken bone,” says Scripps Clinic podiatrist, Dr. Dean Nakadate. “By the time they come in, their problems are really bad.”

Especially around this time of year, doctors are giving words of caution to those they call “the weekend warriors” – men and women wanting to get in shape for the spring and summer seasons in short period of time. Slow and steady exercise is the best preventative health measure a person can take to minimize undue stress on the feet, joints and bones.

Even an activity as simple as walking causes the feet to absorb up to three times the body’s weight. Imagine how running, when feet absorb the shock of five times a person’s weight, can affect the body’s alignment.

Injuries such as Achilles tendonitis, plantar fasciitis (heel pain), injured joints, and broken ankles and toes, not to mention dermatological conditions such as athlete’s foot, are common for the active population, but can be prevented or easily treated if identified early on.

“Foot injuries that go ignored can, over time, turn into conditions like post-traumatic arthritis, chronic ankle instability and adult-acquired flat foot, when the tendons are so fatigued that they eventually collapse,” says Nakadate. “Pain really can be a gift, because it’s letting you know that something’s not right.”

The American Academy of Podiatric Sports Medicine recommends runners and other athletes invest in the proper footwear tailored to their sport of choice to help prevent injury. They should also change their shoes often to prevent against worn-out heels and supports. Warming up and stretching the lower calf and leg muscles before an activity will also increase protection against tendon or ligament damage.

For those already experiencing chronic foot pain, the biggest piece of advice local podiatrists and orthopedic surgeons give is to seek medical attention for the proper diagnosis and treatment.

“If patients do something as simple as a change in footwear and it gets better quickly, then great,” says Nakadate. “But if the pain still exists a week to two weeks later, they really shouldn’t ignore it any longer and get it checked out.” Some doctors encourage the use of arch supports and other orthotic devices to help ease the pain. In some cases it can stabilize a condition and prevent the problem from becoming more severe.

“Custom orthotics really can work,” says Triolo. “If prescribed for the right conditions and they’re made properly, they put the foot in a non-weight bearing position where you would want the foot’s position to be. In many cases, I’ve actually seen orthotics help eliminate the possibility of surgery.”

A rule of thumb when looking into over-the-counter orthotics, he says, is to put them on the counter and push down on the arch. If it’s collapsible, then it’s not going to withstand the pressure and the weight that the body exerts when walking or running.

Shoe inserts can also be helpful for injury prevention because they provide an extra form of shock absorption, especially when performing a high-stress activity such as running, says Michael Ryder, who is a manager of physical therapy for Sharp Rees-Stealy.

When suffering from an injury, Ryder tells patients to slow down and refrain from activity for a time. To help ease the pain, he suggests icing the sore area, elevating it and taking plenty of rest.

If the problem persists, it’s time to see a doctor.

“I tell my patients all the time, ‘see if you can listen to what your body is telling you and do what you can to eliminate that pain rather than trying to walk through it,’ ” says Lee. “We have to remember that normal feet shouldn’t hurt.”