Your Pedicurist Could Be Your Foot's Best Friend

Pedicurists have had a bad rap lately. They have been accused of not sterilizing their instruments properly, leading to infections in their clients’ feet. When I heard about these pedicure-related infections, I contacted a local pedicure school. I quickly found—to my relief—that sterilizing instruments was not a problem. However, in talking with the teachers and students I realized that these professionals were on the front lines of looking at feet and were the ideal people to spot foot problems or cancer in the foot early.

Now, I lecture regularly to pedicurists on common foot problems to watch for, including certain kinds of cancer that may show up in the foot first.

For some people, their pedicurist looks at their feet more than anyone else–including themselves. In fact, some people have difficulty seeing between their toes or under their feet and the person best suited to check all these areas, is their pedicurist.

Checking your feet regularly for any suspicious moles, masses or other lesions is very important. A mole may be nothing to worry about or could be melanoma, a type of cancer.

Melanoma starts as a small mole, lesion, or freckle. When melanoma occurs on the foot it is usually not caught until it is too late, often resulting in the loss of the foot or leg, and even death. Each year more than 8,000 people die from melanoma—nearly one death every hour.

Fortunately, when caught early, most people with melanoma survive. Melanoma does not discriminate. It occurs in the young and old, in African-Americans and in Caucasians, and in males and females. Though, Caucasians or fairer-skinned people are at higher risk.

Always have any suspicious lesions, masses, pain, or swelling, thoroughly checked by a good podiatrist.   

Diabetics should watch their feet for any pain, sores, infections, abnormal sensation, or color changes. The smallest sore, blister, or infection can quickly accelerate to a severe problem or gangrene, and quickly lead to the need for amputation of a toe, the foot, or even the leg. Studies show that one in five diabetics will endure an amputation. Sadly, most of these amputations are preventable, if caught early. As a general rule, diabetics should have any foot or ankle problem checked by a podiatrist.

Recently, I was interviewed about my efforts to enlist pedicurists in spotting serious foot problems early. Read the whole story by CLICKING HERE.

Lastly, the next time you choose a pedicurist, you may want to find someone who a basic knowledge of foot problems. It could just save your life.

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I know most people think their feet get enough exercise, but walking—even a lot—in supportive shoes, does NOT exercise your feet. It may exercise your legs and your triceps, but not the 18 muscles in each arch of our feet or  many of the other muscles entering our feet.

Supportive shoes, arch supports, and orthotics allow our feet to function without needing to work most of our foot muscles. As the saying goes, use it or lose it. Worse, without strong muscles our feet are at risk for injury.

In general, shoes are detrimental to feet. Scientists and doctors have known about the effects of footwear on our feet for over 50 years, but most of the public believes feet require expensive, supportive shoes. In fact, in 1949 The Journal of the National Association of Chiropodists published “Survey of Feet in China and India That Have Never Worn Shoes.” The researchers concluded:

“People who have never worn shoes acquire very few foot defects, most of which are painless and non-debilitating. Shoes are not necessary for healthy feet and are the cause of most foot troubles. Footgear is the greatest enemy of the human foot.”

Clearly, the first step to healthy feet is to give up supportive shoes—or at least limit the amount of time your feet are in shoes.

By simply walking barefoot, you will start to use your foot muscles and your feet will soon become stronger. (Note: Only healthy people should give up their shoes. Persons with diabetes, poor circulation, impaired sensation or other serious problems should wear shoes.)

The best way to wean off supportive shoes and increase barefoot activity is by going slowly, and by supplementing barefoot activity with foot exercises.

Now, there are two sources for foot exercises. One is the book Fantastic Feet by Aliesa George and the other is the FootBook by Dr. Paul Conneely.

Fantastic Feet and the FootBook are both great little books with plenty of photographs and detailed, easy to understand instructions. Fantastic Feet is for the public, written in layperson’s terms. The FootBook is for physicians, written in medical terms. Some of the exercises in the books are the same but many are different, and for those who are serious about their foot health, both books offer unique and highly beneficial exercises.   

These books provide a superb workout for your feet, ankles, toes and arches. In fact, many of the exercises will benefit your entire lower extremity! From each book you can choose a handful of exercises that suits your needs and soon you will be on your way to healthy, strong feet.

References:

FootBook

Fantastic Feet

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Is this the Barefoot Walker’s Dress Shoe?

Vivo Barefoot Gives Balances Protection with Barefoot Benefits

More importantly, the Vivo Barefoot shoe provides basic protection for your foot, decent grip against the ground and mild foot support, but still lets your foot “feel” the ground. The best way to transition to minimalist or barefoot running or walking hasn’t been defined, but for those looking to make the leap, Terra Plana’s Vivo Barefoot may be the best way to go.

Vivo Barefoot Shoe's Removable Insole

To help with the transition to barefoot, the shoe is incredibly flexible to let your foot bend and flex naturally, has no added heel to throw your body forward, a thin sole, and the Vivo’s insole is removable. I recommend that those people who are new to barefoot activity wear the Vivo with the insole for a while, and then, as their feet adjust, they remove the insole.  As an aside, I removed the insole within a day or two to improve that great barefoot feeling (though, the insole was very comfortable).  

Vivo Barefoot Shoe's Sturdy Tread

A Minimalist Shoe that Feels GREAT

Speaking of comfort, this shoe has what it takes! It feels great on your feet. And, as a podiatrist, I liked the nice wide toe-box (that area at the front of the shoe). Plus, the roomy shoe let my foot breath (something that most shoes do not!).

Final Thoughts on Vivo Barefoot Shoe

The Vivo is a great shoe for stimulating barefoot activity that you can wear unobtrusively while at work, weddings and shopping. It is also a great intermediate shoe to help you on your journey toward barefoot walking or running. 

I give the Vivo Barefoot my top rating — 5 Toes Up 

Links of Interest:

Barefoot and Grounded Vivo Review

Barefoot Runner Vivo Review

Barefoot Walking Lifestyle Vivo Review

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What is the best shoe for children?

Myths and false information abound about children’s shoes, and the footwear industry and even some pediatricians are not much help. The good news is once you understand what makes children’s feet unique, finding the right shoes—often inexpensively—for kids is easy.

At birth, the newborn’s foot is soft and flexible, and is loaded with fat. That fat cushions and protects our feet, but when we start to walk, the fat begins to disintegrate. In the coming decades, due to everyday walking—not to mention, perhaps tight fitting shoes—that fat will wear away allowing our foot bones and their rough edges to dig into our skin, often causing corns, callouses, blisters and other painful conditions. Ironically, feet are the only body part that loses fat as we age, yet it’s the one place we need it. I’ve often mused that perhaps some day we’ll go for a tummy tuck and walk out with plump, happy feet.

Besides fat, a newborn’s bones, muscles and ligaments, are incredibly soft and pliable. This is good and bad. It’s good because a baby that is born with a deformed foot often doesn’t need surgery. A brace or a cast can “push” the foot into its correct position. The downside of such a flexible foot is that if parents choose the wrong shoes or footwear for their children, they could create a deformity for their child.

Don’t be in a hurry to buy shoes for your child; wait until your children begin to walk, usually at 11 to 15 months of age. Even then, the MOST IMPORTANT THING TO DO IS KEEP SHOES OFF YOUR CHILD’S FEET AS MUCH AS POSSIBLE.

I cannot emphasize this enough! The best “shoes” for your children is no shoes!

Allowing kids to walk barefoot on various surfaces, especially mildly uneven ones like you find in most backyards, fosters development of their foot’s muscles, ligaments, and balance.

Shoes Can Harm Your Child’s Feet

To see the effect shoes have on feet, scientists compared American feet to those of African natives who had never worn shoes. Most natives’ had a straight big toe, whereas the Americans’ big toe tilted toward the second toe, often causing a bunion—a bump on the inside of the foot. This deformed big toe is due, in part, to shoes curving inward at the toes, presumably to give feet a slender, pointed appearance.

Am I saying shoes are bad for your child’s feet? Yes! However, we need them though to prevent injuries and for warmth. The key is to make sure children only wear them when absolutely necessary.

Socks can also be a deforming force as well, limiting a baby or toddler’s ability to spread and wiggle their toes, and develop their toe muscles. Young children should only wear socks when in shoes. If you need to keep your child’s feet warm, use soft, loose fitting booties.

When shopping for shoes, choose a shoe with ample room for the child’s toes to move. I recommend a finger’s width of space at the tips of the toes, and to help your child avoid developing bunions, the shoe should have as little curvature as possible at the big toe. Look for shoes made of natural, breathable fabrics such as leather or canvas that are soft and pliable—just like your child’s feet. You want the foot protected but it should also “feel” the ground.

The traditional baby shoe with its stiff upper and hard sole is the worst thing for young feet. 

Parents notice when their child outgrows a shirt, but not always when their shoes are too small. Children’s feet grow at different rates so the time to buy new shoes varies greatly. I’ve seen kids grow an entire shoe size in a month. If your child starts pulling off their shoes, it could mean they’ve outgrown them.

Lastly, consider shopping at a shoe store that specializes in children’s feet and has the expertise to ensure a proper fit.

Final Thoughts on Children’s Shoes

Shoes are not healthy for your child’s foot. However, they are necessary. The key is to make sure you buy a barefoot-friendly shoe and keep it off your child’s feet as much as possible.

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Is it time to take off your shoes?

Few people would deny that exercise is good for us, and our feet. Now, mounting evidence suggests that exercising the foot’s arch muscles can not only strengthen our feet, but may even increase the height of our foot’s arch.

Our feet are one of the most muscle-rich areas of our body. In fact, there are 18 muscles within the arch of our feet, with additional muscles originating in our leg, inserting into the arches.

It is well known that the more a muscle is worked, the stronger it becomes. Of course, the converse is also true (we have all heard “use it or lose it”).

Now, breakthrough research by Headlee and Fiolkowski shows that when the muscles within the arches of our feet weaken, the arches will actually lower and become flatter.

If the foot’s arch decreases when our foot muscles weaken, it reasons that strengthening the muscles in our foot will raise the arch. Anecdotal evidence from runners who run barefoot shows this to be the case. These barefoot runners relate stronger arches and higher arches. Research by Robbins supports these findings.

Robbins showed radiographic changes in the feet of runners who gave up their shoes and began to run barefoot. In his study, the bones that make up the ball of the foot were shown—radiographically—to move closer toward the rear of the foot. That is, barefoot activity shortened the length of the foot’s arch. Robbins paper did not say the arch increased in these barefoot runners, but when the foot’s arch shortens, it height must rise.

Recently, Mark’s Daily Apple commented on the beneficial effects of exercise on feet, and I second it. Shoes lessen the need for and use of most of our foot’s muscles. As a result, the muscles weaken and the arch will weaken.

It’s time to take off your shoes and start exercising your feet.

I have written previously about foot exercises HERE.

The best foot exercise is barefoot activity — walking, running and playing barefoot! Barefoot activity is the best way to strengthen the muscles of your feet (assuming that you have good health — that is, you are not diabetic or plagued with poor circulation or other ailments). 

Like any exercise, start slow. Let your foot muscles gradually adapt to barefoot activity, and only go barefoot in safe environments – there’s no point having good foot muscles if there is a nail in your foot!

References:

Fiolkowski P, Brunt D, Bishop M, Woo R, Horodyski M. Intrinsic pedal musculature support of the medial longitudinal arch: an electromyography study. J Foot Ankle Surg. 2003 Nov-Dec;42(6):327-33.

Headlee DL, Leonard JL, Hart JM, Ingersoll CD, Hertel J. Fatigue of the plantar intrinsic foot muscles increases navicular drop. J Electromyogr Kinesiol. 2008 Jun;18(3):420-5. Epub 2007 Jan 8.

Robbins SE, Hanna AM. Running-related injury prevention through barefoot adaptations.Med Sci Sports Exerc. 1987 Apr;19(2):148-56.

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The purpose of shoes is to protect feet and provide warmth. Beyond these basics, some shoes are a fashion accessory, while others supposedly help us run faster, walk better, tone our legs, or even alleviate foot ailments.

Comparing the feet of people who did not and currently do not wear shoes with those who wore shoes and currently wear shoes provides insight into the consequences of wearing shoes.

1. Shoes Weaken Bones in Our Feet

According to renowned anthropologist Erik Trinkaus of Washington University, humans began habitually wearing shoes 40,000 years ago. He reached this conclusion by examining the toe bones of people who lived in the range of 10,000 to 100,000 years ago and found that at 40,000 years ago, the bones became less robust. That is, when humans began wearing shoes the bones in our toes (digits 2 to 5) became less thick and strong; or in other words, the toe bones became more delicate and smaller.

Bones adapt to the loads placed under them. In response to increased loads (or forces), bones become stronger and thicker. Conversely, if the loading on a bone decreases, the bone will become weaker and thinner (Wolff’s Law).

Wearing shoes changes how we walk and how weight (or the ground’s loading force) spreads out across the bottom of our feet. Trinkaus describes our toes as being large and robust for most of human history, but suddenly with the wearing of shoes, they became “wimpy.”

Essentially, shoes limit the peak force on our toes by distributing loading across the entire forefoot and shoes eliminate the traction role of our toes. The result is weaker bones, leaving them at increased risk for fractures or other problems.

Shoes don’t just limit the peak forces on toes, they change the way our feet work. The actually working of our feet is referred to as the foot’s biomechanics and within shoes, our feet function differently. Essentially, shoes alter the foot’s natural motion. 

2. Shoes Limit and Alter the Normal Motion of Our Feet

Changing the way our feet work, can lead to problems. Earlier we discussed how supportive shoes obviate the need for many foot muscles to the point where, during normal walking, they are not used. Muscles that are not used weaken. Weak muscles on the bottom of our feet increase pronation motion (Headlee et al). Up to a point, foot pronation is normal. Too much pronation or over-pronation can cause foot pain, problems, and deformities. 

Sebastian Wolf at the University of Heidelberg compared foot motion of children 8 years old when barefoot and in shoes and found significant differences in biomechanics. Wolf found that shoes impaired the foot’s normal motion and shoes limit the normal widening of the forefoot while walking.

Interestingly, Wolf found that the foot’s need to widen while walking was more limited in the average commercial children’s shoe than in a much thinner, more flexible shoe even though the width of both shoes in the forefoot was identical.

Previously, the culprit for many foot ailments (such as Morton’s Neuroma or hammertoes) has been the tight-fitting shoe. Based on Wolf’s findings, perhaps we need to add to add to “tight-fitting,” the inflexible shoe and the thick-soled shoe.

In October of 2009, foot and shoe data from the prestigious Framingham Study of 3,378 subjects over the years 2002 to 2008 found past shoewear use in women was associated with hindfoot pain. Meaning, even if a woman’s shoe is not causing foot pain now, it could later—even after the woman has long stopped wearing the shoe.

Specifically, the Framingham study states:

“Young women should make careful choice regarding their shoe type in order to potentially avoid hindfoot pain later in life.”

The Framingham study faults the use of high heel shoes and encourages women who persist in wearing these types of shoes to perform stretching exercises to decrease the likelihood of foot pain occurring later.

Beyond altering the normal motion of our feet, wearing shoes can actually change the normal structure and shape of our feet. 

3. Shoes Deform Our Feet

Overwhelming evidence shows that wearing shoes deforms our feet. Foot deformities can potentially cause pain and other problems.

Udaya Rao at the Department of Orthopaedic Surgery, Kasturba Medical College, Karnataka, India compared flatfoot deformity in children (age 4 to 13) who wore shoes with those unshod. He found the incidence of flatfoot was 8.6% in those who wore shoes and 2.8% in those who did not wear shoes.

Further, Rao discovered that flatfoot occurred most often with children who wore closed-toe shoes and less often when children wore sandals, slippers, and least in those children who walked barefoot. He concluded that shoe wearing in childhood is detrimental to the development of the foot’s normal arch.

Simon Mays in the Physical Journal of Anthropology published a study on bunions. Bunions are painful protrusions of bone on the inside of our feet and are associated with the big toe drifting toward the other toes. Mays states that the majority of bunions result from wearing shoes; few are hereditary.

Mays says bunion deformities are rare in non-shoe wearing populations until the people start wearing shoes. Then the incidence of bunions rises sharply.

Further, Mays says that incidence of bunions in a population is related to the type of shoes worn. In populations wearing more constrictive Western-style shoes as opposed to loose-fitting footwear, the incidence of bunion deformities increased.

Kristiann D’Aout compared barefoot and shoe-wearing populations and found differences in both foot shape and the peak pressures under the foot. Barefoot peoples have wider feet and exhibit more equally distributed peak pressures. Shoe-wearing peoples had narrower feet and showed higher focal pressures at the heel, big toe and ball of the foot.  These higher peak pressures put the foot at more risk for injuries, such as metarsalgia, capsulitis, fracture or tendonitis.   

Further, Dr. Bernhard Zipfel at the University of the Witwatersrand has dedicated his academic career to the evolution of the human foot. Zipfel’s research paper “Shod versus unshod: The emergence of forefoot pathology in modern humans?” concluded that shoes were a factor in the development of foot pathology. 

Ways to Protect Our Feet from Shoes

Dr. Lynn Staheli, Director of Orthopedics at Children’s Hospital and Medical Center in Seattle asserts that, optimum foot development occurs when barefoot.

Clearly, in general, shoes are not good for the development of our feet. The best shoe merely protects feet from the environment.

When it comes to toddlers and children, the best advice I can give parents is try to have their children go barefoot as much as possible. I cannot emphasize this enough!

Of course, going barefoot is not without risks. Parents must find areas where it is safe to walk without shoes. Further, when possible have your child walk barefoot on uneven terrain to encourage his or her feet to use as many muscles as possible.

During times when children must wear shoes, choose the most flexible, barefoot-like shoe you can find. If my child had to wear a shoe, I would put them in soft shoe or even a sandal or flip-flop before a big, stiff well-padded running shoe.

For the shoe-wearing adult who has healthy feet and no concomitant medical problems (i.e. diabetes or poor circulation), to stop wearing shoes suddenly, would likely cause foot pain and problems.

These adults should start by SLOWLY transitioning to less supportive, more barefoot-like shoes. They should look for shoes with a wide toe-box (wide around the toes) and less stiff, more flexible shoes. Some shoes that help simulate barefoot activity while providing some degree of protection include, Vibram Five Fingers, Nike Free and Terra Plana’s Vivo Barefoot.

In addition, adults transitioning out of stiff, supportive shoes should do foot strengthening and stretching exercises. Years of wearing supportive shoes will have weakened many of the small muscles in the arch, ball and toes of the feet, and these muscles need to get strong again. Gradually, these adults should begin barefoot activity.  

Lastly, persons with foot problems, such as impaired sensation (i.e. diabetics), poor circulation or other problems or deformities should not go barefoot or try barefoot-like shoes without first checking with their podiatrist. 

Where Do Podiatrists Stand on Shoes?

The American Podiatrist Medical Association (APMA) has issued a statement on going barefoot, entitled “Podiatrists Urge Americans to Think Twice Before Going Barefoot.” You can read the APMA’s statement by clicking HERE. 

Final Thoughts on Shoes and Foot Problems

Podiatrists are quick to point out that there are people who have never worn shoes and suffer from foot pain and problems, including flatfeet, bunions, hammertoes and other problems. This is true.

Foot deformities and problems are not always due to wearing shoes, and can occur due to a myriad of reasons: congenital, ligamentous laxity, rheumatoid arthritis, obesity, structural factors within the foot (metatarsal head shape, first ray hypermobility), over-pronation, trauma, diabetes, polio, vascular problems and the list goes on.

When it comes to foot deformities and foot problems, shoes are one possible factor. Shoes may be part of the problem for a particular person or the whole problem.  

Interesting Links:

Take Off Your Shoes and Walk

Parents for Barefoot Children

Naturally and Healthy Barefoot Activities

Why Shoes Make Normal Gait Impossible

Living Barefoot

References:

Dufour AB, Broe KE, Nguyen US, Gagnon DR, Hillstrom HJ, Walker AH, Kivell E, Hannan MT. Foot Pain: Is Current or Past Shoewear a Factor? Arthritis Rheum. 2009 Sep 29;61(10):1352-1358.

Headlee DL, Leonard JL, Hart JM, Ingersoll CD, Hertel J.  Fatigue of the plantar intrinsic foot muscles increases navicular drop. J Electromyogr Kinesiol. 2008 Jun;18(3):420-5. Epub 2007

Mays SA. Paleopathogical study of hallux valgus. Am J Phys Anthropol. 2005 Feb;126(2):139-49.

Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br. 1992 Jul;74(4):525-7.

Staheli LT. Shoes for Children: a review. Pediatrics. 1991 Aug;88(2):371-5.

Trinkaus E. Anatomical evidence for the antiquity of human footwear use. Journal of Archaeological Science, Volume 32, Issue 10, October 2005, Pages 1515-1526.

Tinkaus E, Hong S. Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir. Journal of Archaeological Science, 35(7):1928-1933.

Wolf S, Simon J, Patikas D, Schuster W, Armbrust P, Döderlein L. Foot motion in children shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes. Gait Posture. 2008 Jan;27(1):51-9. Epub 2007 Mar 13.

Zipfel, B., Berger, L.R. 2007. Shod versus unshod: The emergence of forefoot pathology in modern humans? The Foot. 17: 205-213

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Treating Corns Wrong Could Lead to Serious Problems

Deidre writes:  I tried to get rid of two corns, one on each of my second toes. First, by using a drugstore corn remover medication and then with a tca peel. Now both my toes are extremely darker than all the other toes (my toes look burnt) and the corns are still there. I now wear better shoes and i scrub it everyday, but nothing.

Dr. Nirenberg replies:

A corn on our toe or between our toes can be very painful, and can interfere with our ability to walk normally. However, corn remover products are not always the best solution and may, in fact, prove harmful.

When a corns forms on our toe it is usually the result of an abnormality or misalignment of the bones inside the toe. The bone under the area of the corn may be abnormal and may have a spur or some other kind of growth, or the toe itself may be bending (contracting) and you may have a mallet toe or hammertoe deformity. A deformity of the toe or misalignment of the bones causes pressure on the skin from within and rather than the skin breaking open, it toughens and forms the corn (to protect it). A hammertoe (or mallet toe) is the number one cause of corns on the toes. Often patients may have several hammertoes, but not all of them will have a corn.

Corns can also form in response to pressure from outside our foot, such as when a tight-fitting shoe rubs on the toe. Again, the skin will toughen and the corn will protect the skin from the opening.

Many drugstore remedies for corns use a medicated solution to soften and remove the corn. These “medications” are usually an acid that burns away the corn. Putting acid on a corn (or burning the corn) will make the corn look burnt, as you describe. The problem is, if you use too much acid it can burn through the skin. In my podiatry practice, I have even seen patients put on so much acid that it burned to bone and/or caused infection or gangrene. Some patients have needed the toe amputated. Essentially, the acid does not stop after destroying the corn and goes through the good tissue, resulting in gangrene or infection in the toe or worse, the bone.

The other problem with using these remedies is that the patient is not addressing the corn’s cause: the bone. At best, the acid is briefly alleviating the corn. Without addressing the bone beneath the corn, the corn is likely to return. For all these reasons, I advise patients never to use drugstore medications for corns.

Whether your corns are due to hammertoes, mallet toes, spurs or other bone problems, you do not have to live with them.

The best treatment for corns is to pad them with moleskin, wear loose fitting shoes and have a good podiatrist examine your foot. The podiatrist will take an x-ray and you will immediately see how the bone is causing the painful corn or corns. From there, the doctor will explain the treatment options for the corn.

Additional Information:

Wikipedia

Mayo Clinic

Photos

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Metatarsus Adductus

Jon writes: 

Ok I’m 18 and I have metatarsus adductus. I was treated for it when I was younger but I did not do anything. It does not really affect my athletic ability too much. Sometimes I feel like I’m off balance. Other then that, I was just wondering if there’s a cure for it since it’s noticeable.

Dr. Nirenberg replies:

Metatarsus adductus (met adductus) is a deformity where the forefoot turns inward, and you are born with this deformity. It is not common. A podiatrist should be able to spot this problem fairly easily.

The best time to treat metatarsus adductus is early – when the child is an infant. At birth our bones are pliable and the podiatrist will treat this deformity by placing the child’s foot in a cast that gently nudges the foot back into its correct position.

If an adult has pain or problems associated with metatarsus adductus (med adductus), most podiatrists would recommend trying a special arch support called an orthotic. Orthotics help balance the foot by placing it in a more normal position.

If an orthotic does not work, then one would need surgery to “fix” the problem. The good news is that most adults with metatarsus adductus do not have a lot of problems and surgery is rarely necessary.

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I have gone barefoot nearly my entire life. When I wear shoes, sandals or boots, my feet get so hot, sweaty and then start to swell until I am barefoot again. Often even sandals will make them sweat and swell. Other than get a doctors note to go barefoot, what else can I do?

Dr. Nirenberg replies:

I love that you have gone barefoot nearly your entire life! That is great, and generally, going barefoot is very healthy for our feet. Unfortunately, at some point, we are forced to wear shoes and for the sweat glands on our feet this is a problem.

Our feet are not meant to be confined to shoes–the more you are barefoot, typically the better.

When a foot is entombed in dark, secure shoe, the sweat of our feet has nowhere to go—it can’t evaporate. Often, bacteria can fester, leading to foot odor and infections. (Sweat in itself does not have a odor but the bacteria cause the odor).

In areas of the world where people do not wear shoes, sweaty feet and for that matter, foot odor, is rarely a problem.

Our feet our loaded with sweat glands. In fact, our feet have a higher concentration of sweat glands than any other part of our body. Some people’s feet can secrete up to half a pint of perspiration a day! The medical term for over-active sweat glands is hyperhidrosis.

Excessively sweaty feet (hyperhidrosis) can cause athlete’s foot, blisters, foot odor, infections, and can be just plain irritating.  

What Causes Our Feet to Sweat Too Much?

Excessively sweaty feet may be due to hormonal imbalance, thyroid problems, or your genetics. Hot weather can worsen sweaty, wet feet, though I have seen the problem occur in the winter too.

As mentioned above, shoes are a big part of the problem. Make sure your shoes are breathable as possible. In general, avoid shoes with synthetic materials such as vinyl, plastic or nylon. Wear leather shoes if possible.

How Can I Treat My Sweaty Feet?

1.Sprinkle a good foot powder, one with zinc, in your socks.

2.Use a good spray anti-perspirant on your feet, such as Gold Bond Foot Spray

3. Wash your feet daily. This doesn’t mean standing in the shower and letting the water hit your tootsies! Use antibacterial hand soap and wash your entire foot, including between the toes. Then dry your foot completely (and dry between the toes).

4. Wear good socks that wick moisture away from your feet, and change the socks twice a day.

5. Whenever possible, do not wear shoes or socks—go barefoot and let the air at your feet.

6. Wear different shoes each day–let the shoes air out, preferably in sunlight, and spray the inside of your shoes each day with Lysol. Lysol does not kill all germs, but it does kill many of them.

What Can a Podiatrist Do For Excessively Sweaty Feet?

If your sweaty feet persists, a podiatrist can prescribe topical medications to lessen the sweating.

If you have severe hyperhidrosis, some podiatrists will inject botox into your foot. Yes, you heard right! Botox can help your feet, though I doubt this is something our new, upcoming government run healthcare will pay for (or your current insurance). Botox does stop feet from sweating and it will last several months.

I hope this helps. Let me know how your feet do.

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Since I was 14, I have had plantar fasciitis. I did not know I had it until a pediatrician told me a year later.

The year before I ran in a marathon through the downtown capital of Georgia. In gym class, I ran for twenty minutes with no significant pain afterwards. A year after my diagnosis, I have walked for long distances and a long time like 10 miles and about 10 hours. All the while, I never felt any severe pain except some moderate burning and a little swelling in my foot. And I did not wear the most supportive shoes.

I have never felt pain at my heel, but above it where the arch begins and beneath the ball my foot. The burning would always subside after walking or running for long periods of time. When my foot burned or swelled I iced and rested it later. As soon as the pain went away for a while I got back to my usual exercises, walking, running, or playing sports.

I have not had physical therapy and any home remedies such as stretching, wearing orthotics, and icing I have done, but not consistently. Only until the pain subsided.

Is it too late to go to physical therapy? Is it too late for me to recover from plantar fasciitis because of all the stress I put it through?

Dr. Nirenberg’s reply:

Plantar Fasciitis

Plantar fasciitis is one of the most common problems I see, and the number one cause of heel pain. Plantar fasciitis occurs with the ligament on the bottom of our heel and foot—the plantar fascia—becomes enflamed.

The plantar fascia becomes irritated when the biomechanics of the foot malfunction and foot pronates excessively. All feet pronate, which is a complex motion that involves the heel turning outward during ambulation. Often, feet that pronate will have a low arch, but pronation can occur on occasion in persons with a normal or even high arch.

This malfunctioning foot biomechanics can cause a host of problems, including the plantar fascia to want to pull away from your heel bone or even tear (yank a handful of hair from your scalp and you will begin to understand the pain of the plantar fascia pulling away from the heel bone).

Plantar fasciitis can also cause pain in the arch of the foot. However, the fact that you relate burning, makes me suspicious that you have plantar fasciitis. I don’t want to doubt your pediatrician’s medical exam, but it sounds like you may have tarsal tunnel syndrome.

Plantar Fasciitis

Tarsal Tunnel Syndrome

Almost everyone has heard of carpal tunnel syndrome in our hands, but few people realize the same problem occurs in our feet. Tarsal tunnel syndrome may cause burning, tingling, shooting pain, or a cramping sensation in our foot, particularly in the arch and the ball of the foot. Some people will fell like the ball of the foot or arch is swollen.

The good news is that there is a light at the end of this tunnel. Tarsal tunnel syndrome is often easily treated with orthotics, injections, or a short, outpatient procedure.

Both tarsal tunnel syndrome and plantar fasciitis respond to orthotics and physical therapy, and so I would recommend these as a first step.

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