A healthy, pretty foot.

Until 1949 when the millennium-long tradition was finally outlawed, most Chinese women had their feet broken and bound for life in order to adopt a desired pointed “lotus” shape. That practice sounds repugnant to modern women, thus it makes it even more surprising that a growing number of women are subjecting their feet to major surgical procedures for no other reason than to be able to walk in stilettos. 

Major Foot Surgeries Solely For Cosmetic Reasons 

Some of the surgeries include: 

Toe shortening - A bone segment is removed
Toe lengthening – The bone is cut and lengthened with an implant
Toe straightening – Bone near the joint is removed to fix a curl
Toe slimming – The bone is shaved
Foot padding – Filler or fat is injected into the ball of the foot
Foot narrowing – The entire foot is reduced in width 

Although some of these procedures are carried out to assist patients with deformed or injured feet, the recent boom in their popularity is strictly cosmetic: Women want their feet to look better in expensive shoes, or to be able to walk more comfortably on heels that can exceed four inches in height and place the foot at an extremely unnatural angle which is often greater than 45 degrees. 

The Desire For Carrie Bradshaw Feet 

The desire to have feet which could feature in Sex In The City protagonist Carrie Bradshaw’s ultimate Manolo Blahnik fantasy is driving thousands of women to undergo surgeries without considering the serious consequences. In a recent issue of the Wall Street Journal, I warned that these women “want to look their best and they don’t understand the risks.“ 

26 Bones & 30 Joints Designed To Hold Up Your Entire Body 

Both the American Orthopaedic Foot and Ankle Society, and the American Podiatric Medical Association which represents nearly 9 out of every 10 podiatrists in the United States, and have adopted strong positions against these forms of cosmetic surgery. The human foot is a delicate assemblage of 26 major bones and 30 joints, and these organizations do not believe that women’s aspiration to look good on a Saturday evening balances out the risk of lifelong pain and permanent deformities which may require several corrective operations. Some women are rendered unable to walk properly at all from these ill-advised cosmetic surgeries. 

Foot Surgeries Are Being Considered In The Breast Augmentation League 

Enchanting women by the allure of operations which are hyped under fanciful names such as The Cinderella Procedure, aesthetic foot surgeries are flourishing in the moneyed canyons of Beverly Hills and many of the country’s elite enclaves such as Manhattan and Miami Beach. Lulled into a false sense of confidence by the apparent ease of breast augmentation surgeries, women fall into the trap of believing that their feet can have an equally easy makeover: while failing to consider that feet are designed to bear the weight of the entire body through a wide variety of strides, and are not to be modified to fit fashion. 

Unlike breasts, you have to walk on your feet!

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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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Can Correct Toes Help You?

Invented by podiatrist Ray McClanahan, Correct Toes realigns your toes to their natural position to achieve optimal foot health, and in doing so, claims to prevent and cure foot problems (such as hammertoes and bunions).  

Correct Toes is a sturdy toe-spacer made of medical grade silicon that gently, painlessly positions your toes in a more natural, more correct position.

McClanahan states that he has before and after photos showing the success of Correct Toes and clinical proof, but did not provide that for this review. He also states he is in the process of doing a clinical study to prove Correct Toes effectiveness.

Lack of clinical data does not mean a product does not work; in fact, when it comes to foot products such as arch supports, most companies’ claim their supports are beneficial but rarely provide any proof. One would think with all the money Dr. Scholl’s has, it is about time they provided some proof of the benefits of Gellin.

Unlike other toe-spacing products such as Yoga Toes, Correct Toes doesn’t just stretch your toes apart but puts them in their normal, physiologic position. Correct Toes is also compact enough that you can wear it in shoes—albeit you will need a shoe with a large, wide toe box. Lastly, Correct Toes is less expensive than Yoga Toes.  

When I asked McClanahan’s associate, Dr. Robyn R. Friedman how Correct Toes work, this was her reply:

Dr. McClanahan’s treatment approach is based largely on his experiences in west Africa, where there are some of the world’s greatest runners.  Being a competitive runner himself, Dr. McClanahan was interested in their training methods.  He was amazed to note that these top-notch runners train predominantly barefoot or in minimal footwear, and also they experience  a very low rate of injury, estimated to be about 3% (versus 65-75% of runners in the US.)  This low rate of foot (and knee, hip, lower back) ailments is seen elsewhere in the world where people are predominantly unshod or use predominantly flip-flops or sandals. 

Among the many conclusions that Dr. M drew from his experiences, one of them was that have strong, spaced toes is essential to proper foot health and maximally efficient gait, and most Americans, who have spent a lifetime in footwear that has elevated heels and tapered toe boxes, have lost this essential structural integrity that we were born with. 

The goal of Correct Toes is to return the toes to their appropriate and correct positioning, which would be the very shape of the foot we were born with – widest at the ends of the toes, with the toes spaced, straight, and strong.

So the mechanism of action: Correct Toes work in a similar way to how braces work for the teeth.  They place the toes into alignment and slowly and progressively allow the muscles and other tissues to adapt and strengthen accordingly.  But unlike with orthodontia, we’re simply trying to return the feet the their natural shape, the shape that had at birth, and the shape that would have remained if we had spent a lifetime either barefoot or in shoes that were sufficiently wide (in the toe box) and flat.

How long does it take to see results?  This varies, depending on many factors, such as the patient’s age, tissue elasticity, extent of the deformity, level of compliance (with using Correct Toes, wearing only wide & flat footwear, doing extensor stretches and other relevant stretches), how often the product is used in weight-bearing activity, and so on. 

Patients usually report feeling different/better/slightly sore right away or within a few days.  To actually see physical changes (the angle of the hallux valgus improving, or hammertoes starting to straighten), may take 3-6 months, with continuously progressive change over a year or two.  I like to remind patients that it took many, many years of wearing footwear with tapered toe boxes and heel elevation for our foot architecture to change from the strong, spread toes we were born with to the current architecture, and as such, positive changes will also require some time.  But it’s worth it, because the approach has a life-time of positive implications.

Intuitively, I agree with much of McClanahan’s theory. Certainly, just forcing people to wear shoes with a wide, non-constrictive toe box is going to help let the toes spread out. Further, for most people, their foot problems are likely due to wearing ill-fitting shoes.

I found Correct Toes comfortable, but using them for a few days did not yield any significant, measurable results. But, I did not really expect to see changes in such a short time. Correct Toes is a long term, conservative, natural method of addressing foot pain and deformities of the toes.

Oddly, few clinical studies exist on using spacers, splints or splinting to affect change in adult feet and toes. In one study of a toe splint, after 3 months, pain decreased but there was no improvement in digital alignment.

McClanahan claims structural change can occur in 3 to 6 months of use. I am not sure if the analogy to our teeth is correct. Our toes and feet are composed of bones, ligaments, capsular tissues, and muscle. Teeth only have to contend with the gums to hold their position. Further, given that dental braces are worn for anywhere from one and half to three years, I suspect Correct Toes would probably need to be worn for much longer six months to see structural changes—though McClanahan does allude (above) to the fact that changes occur for one or two years.

Certainly, Correct Toes, in theory, can gently stretch tight ligaments and muscles, pushing them toward their more correct positions. Again, I would love to see a clinical study on Correct Toes—just to gain some insight into how long this process would take.

I do find the idea of repositioning the toes, non-surgically, fascinating, and I see nothing wrong with wearing Correct Toes for six months or even a year or more to avoid surgery. (McClanahan did not say if he expects people to wear Correct Toes when asleep.)

Final Thoughts on Correct Toes

Most people want instant gratification and sadly, will not put a spacer on their foot for 3 months, let alone a year or more. However, for those who are willing to persist with wearing Correct Toes, it may be a great, simple, non-surgical solution to their foot pain, problems, and deformities.

To learn more about Correct Toes visit NW Foot & Ankle.

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Foot Articles on the Web

Here is my pick of the latest, greatest foot, ankle and podiatry related articles on the web:

Pregnancy is a bundle of joy, but not for your feet! Podiatrist Scott Kilberg has written a great review of the effects of pregnancy on our feet. Check out Foot Problems During Pregnancy and for more from Dr. Kilberg, visit his blog My Aching Foot.

Shin splints eventually affects just about every runner and Podiatrist Andrew Schneider has written a good synopsis on this common problem. His blog also has some of the best writing about our feet and ankles that you can find. Check out Dr. Schneider’s superb writing and and learn about shin splints HERE.

Bunions are among the top podiatry problems we see. Podiatrist Jennifer Feeny has written a good review – Bunions: A Pain in the Foot. Her blog can be found HERE. If you want to know when a Bunion is Not a Bunion, check out Dr. Marybeth Crane’s article HERE.

If you want to dance, you may have to pay the piper – or the podiatrist! Dance takes a toll on the feet. For a great introduction to foot pronation and how it can be the cause of your knee pain, read Lisa Howell’s How to Understand Overpronation and Knee Pain If You Have Flat Feet.  

Speaking of Flat Feet, there is a basic introduction to flat feet and Choosing the Best Running Shoes at the Running Shoe Guru.

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Is Dr. Nirenberg a real doctor? Hear what Seinfeld has to say:

Podiatrists, or Doctors of Podiatric Medicine (DPM), are, in fact, real physicians.

Podiatrists specialize in treating foot and ankle problems. Podiatrists treat all problems related to the foot or ankle, and the variety of cases is endless. However, the most common problems I see are:

• Heel and/or arch pain

• Ingrown toe nails

• Bunions (bumps on the inside of the big toe)

• Hammertoes (bent toes)

• Flat feet

• Foot or ankle arthritis

• Fungal toenails

• Sores (ulcers)

• Infections

• Sprains and fractures

• Ankle pain or weakness

• Nerve problems and neuropathy (numbness, burning, or tingling)

• Shin splints

• Gout

• Athlete’s foot

• Sports medicine and diabetics foot problems

• Children’s foot problems

• Swelling or discoloration

• Plantar warts

• Arthritis of foot and ankle

• Heel spurs

• Arthritis

• Tendonitis

• Blisters

• Corns and Callouses

• Moles, cysts, tumors or lesions

When to Call a Podiatrist:

1. You Have Foot or Ankle Pain

Some aches and pains in our feet or ankles may go away in a day in a two; others do not, and that is when you need to go to a podiatrist.

Many people who see me for a painful foot or ankle have had pain for several days or weeks, but some have been limping around for several months or even over a year!

Pain is the body’s way of telling us something is wrong. Don’t ignore it.

However, not all people with foot or ankle problems have pain. For example, diabetics who have neuropathy (a deterioration of the nerves of their feet) may fracture a bone or develop an infection or sore on their foot and not have any pain.

Recently, I had a patient with diabetes come to see me complaining of a small sore on the bottom of their foot; an x-ray revealed a needle inside the foot.

Because the patient had very little feeling in her feet she didn’t know she had stepped on anything sharp.

In all patients, foot and ankle problems can quickly become serious, but diabetics are especially at risk.

Diabetics who don’t seek podiatric care promptly often develop gangrene and need a toe or the whole foot amputated.

Prompt treatment is essential. All diabetics or anyone else with decreased feeling in their feet need to have any foot or ankle problems checked by a podiatrist immediately.

2. You Notice Changes in Your Feet

Some people may notice one foot swelling or flattening.

Diabetics and others with neuropathy may not have pain, however these are the people most at risk for a particularly serious problem called charcot arthropathy.

In charcot arthropathy, the bones of the foot weaken and slide out of position, and may actually break through the bottom of the foot, leading to infection and even amputation.

For other patients, a rapid flattening of one foot may mean the main tendon holding up their foot has torn.

It is a good guideline for anyone who notices swelling, redness, increased warmth, or a change in the shape of his or her foot or ankle to see a podiatrist promptly.

3. You Find Something Abnormal On Your Foot or Ankle

A podiatrist should check any lumps, bumps, cysts, tumors, or moles on your foot or ankles. These problems are usually harmless, but occasionally they can be cancer and life threatening.

Final Thoughts on Foot and Ankle Problems

If you have a foot or ankle problem or pain, the best advice I can give you is: Don’t wait for it to go away—it may not.  

If you experience persistent pain, notice changes in the shape or color of your feet, or find an abnormality, then see your podiatrist right away. To learn more about podiatry, podiatrists, and podiatric medicine, visit the website of the American Podiatric Medical Association

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Our feet take a beating.

We put in long hours, walking an average of seven to ten miles a day.

We tread on artificial surfaces such as asphalt, concrete and tile, often carrying a briefcase, purse, baby or laptop—and for some of us all four!

And with each step two to three times our body weight comes down on our feet, not to mention the strain of jogging, stair stepping or high impact aerobics.

So what can you do to keep your feet healthy, beautiful and strong enough to make it through the day?

I hear this question often as a podiatrist and more often from female patients, which doesn’t surprise me, since women experience four times more foot problems than men.

Fortunately, both men and women can do simple, inexpensive things to care for their feet, and when your feet feel great, your whole body will too. Consider the following five ”musts” for healthy, beautiful feet.

1. Use a good moisturizer

The skin of your feet is increasingly prone to drying out as you age. Dry skin is not only ugly but can crack open and possibly become infected, especially in diabetics or those with poor circulation. A good moisturizer can soothe dry skin.

The secret to finding a good moisturizer is not by price; more expensive doesn’t mean better.

Read the ingredients and avoid products with alcohol or alcohol derivatives.

Generally, lotions contain alcohol to make them absorb faster, but the alcohol hinders the product’s ability to moisturize your skin.

The best dry skin products tend to be creams without alcohol. These are gooier and absorb slowly, so I recommend applying them just before going to bed.

2. Keep your feet dry

This may seem to contradict using moisturizer, but dampness around your feet, specifically between your toes, can be a breeding ground for bacteria.

When washing your feet, be sure to dry them well, especially between the toes.

Towels can pick up bacteria or fungus, especially if they are damp or dirty, so wash them often with bleach or hot water and never use the towel that dried your feet on the rest of your body or face.

A good tip to keep feet, and especially toes, free from moisture is to use a foot powder enriched with zinc or menthol, or even both. A sprinkle a day will not only keep toes from perspiring, but also lessen odor.

3. Beware of nail polish and acrylic nails

Men can skip this tip, but women should heed it. Nail polish and acrylic nails trap moisture, increasing the chance of fungus infecting toenails, causing the nails to thicken and turn yellow or, in severe cases, black.

Toenail fungus can also infect the surrounding the skin and in some cases, particularly when the person is diabetic or has poor circulation, can lead to the loss of a toe or even the foot.

Some women who notice their toenails beginning to darken or yellow from fungus cover the nails with polish to hide them; ironically, this only makes the problem worse.

Am I saying you shouldn’t wear nail polish or acrylic nails? Not at all. Nail polish or acrylic nails can cheer up the ugliest of feet, don’t cost a lot and are generally among the safer pleasures for your feet.

When using nail polish or acrylic nails think of them like a dieter having a scoop of ice cream: occasionally it is okay, but not every day.

If you have a special event, feel free to wear nail polish or acrylic nails; just remove the polish or fake nails when you get home. The more your nails can “air out” the better.

4. Wear sensible shoes

This seems obvious, but many people choose style over comfort (one study showed that 88 percent of women have at some point knowingly squeezed their feet into shoes that were too small).

Like eating that fattening scoop of ice cream, wearing Jimmy Choos or other stylish shoes occasionally, for brief periods usually won’t cause problems.

However, wearing ill-fitting shoes too often can cause the toes to crunch up, possibly causing permanent deformities, pinched nerves, corns, calluses or other problems.

People with diabetes or poor circulation need to be especially careful, as these problems can result in serious infections.

The secret to making sure shoes fit properly is to shop for them late in the day when your feet are likely most swollen.

When you walk in the shoes you try on, try to avoid the soft, plush carpet found in most shoe stores. If you’re in a mall, leave the shoe store and walk on the mall’s tile floor.

Most importantly, if shoes hurt in the store they will hurt when you get them home–a shoe should never need to be “broken in.”

5. Check your feet daily

The last tip to taking care of your feet is more common sense than secret. Check your feet every day.

It’s amazing how many people don’t look at their feet; or if they do see a problem or have pain, they shove their foot into a shoe and try to forget about it.

When examining your feet, watch for any blisters, redness, swelling or open sores, and be sure check between the toes as this is a common area for infections to start. A good way to see the bottom of your feet is to use a mirror.

If you find a foot or ankle problem, see a podiatrist promptly.

Most foot and ankle problems are easy to take care of when caught early. The biggest complaint I hear from my patients is, “I wish I had come to see you sooner.”

Your lifetime of healthy, beautiful feet

Your feet work hard all day long, and they need a little care to remain strong.

When you use these tips to take care of your feet, they can be healthy, beautiful and ready to carry you anywhere.

To learn more about podiatry, podiatrists, and podiatric medicine, visit the website of the American Podiatric Medical Association

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Bunions, Flat Feet & Weak Ankles

Most of us don’t think about our feet until they hurt.

Even then, we limp around hoping the pain will go away. But with two to three times our body weight pushing down on each foot with every step, it usually doesn’t.

Fortunately, you can do a few things for relief.

1. Wear Only Great-Fitting Shoes

In one study, 88% of women admitted that at some point they knowingly squeezed their feet into shoes that were too small.

Further, as we age, our feet tend to become larger, but most people insist on wearing the same shoe size they wore years ago.

In addition to making sure your shoes fit properly, make sure they have a good arch support and that the heel counter—the area that wraps around your heel—is firm and strong.

2. Feet Need Exercise, Too

I can hear the couch potatoes now:  “My feet get enough exercise.”  Perhaps, but walking to the fridge or standing in line at McDonald’s isn’t exactly exercise.

Most people agree our entire body needs exercise, but few people think about keeping their feet in shape.

Yet, with the average person walking over a hundred thousand miles in their lifetime, feet need all the help they can get.

Foot exercises tone, stretch, and strengthen feet, while alleviating fatigue, soothing soreness, and increasing blood flow.

3. Take the Plunge

Nothing soothes sore, aching feet more than a relaxing footbath.

You can use a bathtub or plastic basin, or for some serious relief, I recommend buying a massaging footbath.

Make sure the water is warm, not hot (I’ve seen patients soak in water so hot they received second-degree burns).

Add good quality bubble bath to the water; and for those who are not diabetic or have poor circulation, adding Epsom salts is great, too.

4. Moisturize Your Way to Healthier Feet

Good moisturizers can sooth dry, irritated skin.

The secret to finding a good moisturizer for your feet is not by price; more expensive doesn’t mean better.

Read the ingredients and avoid products with alcohol or alcohol derivatives—the best dry-skin products tend to be creams without alcohol.

These are gooier and absorb slowly, so I recommend applying them just before going to bed.

5. Nailing Down Nails

Caring for your nails will go a long way in helping to alleviate foot problems.

Long, jagged, and thickened toenails can catch on socks or pantyhose, dig into adjacent toes, or suffer injury by pressing against the inside of our shoes.

In my practice, I have seen unkempt nails lead to blisters, infections, ingrown toenails, and even gangrene.

When trimming your toenails, follow the contour of the toe and avoid cutting into the corners. Smooth any rough edges with a nail file.

Final Thoughts on Aching Feet

Caring for your feet is your responsibility. However, when problems don’t go away, become serious, or if you have diabetes or poor circulation, get professional help and see a podiatrist.

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Painful Hammertoes & Fungal Toenails

Eighty percent of people, at some point in their lives, have a foot problem that requires medical care.

However, many people let their problems persist and worsen untreated.

Here is a list of the most common foot problems I see in my practice that you can watch for to ensure the health of your feet.

Heel Pain

Heels get a bad rap. The dictionary defines a heel as a dishonorable person, and the term “Achilles’ heel” refers to a fatal weakness.

The reality is your heels are quite strong, though no other part of your foot malfunctions more. Heel pain is the number one reason people come see me.

Heel pain can be very complicated and may have a variety of causes, including a stress fracture, pinched nerve, bone cyst, or tumor.

Most patients with heel pain believe they have a heel spur.

This may be part of the problem, but the most common cause of heel pain—whether or not a heel spur is also present—is inflammation of the largest ligament in our foot, the plantar fascia. In doctor-speak, this problem is called plantar fasciitis.

 Treatments for plantar fasciitis range from custom-made arch supports (called orthotics), to simple stretching exercises, to the revolutionary, high-tech shockwave treatment. 

Nerve Problems

 Burning, numbness, tingling, or shooting pain in your feet or ankles often means something is wrong with a nerve.

Nerve problems are common in feet, so if you have one, don’t get nervous. Most of the time, the treatment is relatively simple.

The main nerve problems I see are:

• Morton’s Neuroma

Not to be confused with Morton’s Steakhouse—which may cause a full stomach—Morton’s neuroma causes cramping, tingling (a feeling of pins and needles), burning, or shooting pain in the toes or ball of your foot.

A neuroma is a painful growth on a nerve that forms when the nerve becomes irritated.

Treatment for neuromas consists of using a special arch support, called an orthotic, and sometimes injections are needed. Surgery is rarely necessary.   

• Tarsal Tunnel Syndrome

Almost everyone has heard of carpal tunnel syndrome in the 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 your foot.

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.   

• Neuropathy

Neuropathy literally means a “disease of the nerves,” and it affects millions of people each year. Persons with neuropathy often experience loss of sensation, burning, tingling, or shooting pain.

The number one body part affected by neuropathy is the feet. Persons with diabetes are those most afflicted with neuropathy, but it also occurs in people with thyroid problems, vitamin deficiencies, alcoholism, and some types of arthritis.

Neuropathy has many treatment options and some people might opt for a new, somewhat controversial, procedure that involves surgically freeing up the nerves to restore normal sensation to their feet.

Arthritis of the Foot and Ankle

Degenerative joint disease, osteoarthritis, or just plain old “Arthur” is a deterioration of the joints between our bones.

When Arthur visits people’s feet or ankles, many believe they just have to live with it. This is far from the truth. The reality is podiatrists have many techniques to alleviate arthritis, including a high-tech, tiny arthroscopic camera that can remove arthritis from sore ankles.    

Nail Problems

I am not talking about rusty nails on your garage floor, but ingrown toenails and fungal toenails. Ingrown toenails occur when the edge of the nail grows deep into the flesh of the toe.

These are painful and can become infected. Fortunately, a brief, in-office technique can alleviate ingrown toenails, often permanently.

Fungal toenails are another story, and usually require a long course of medication.

Bunions

These are protrusions of bone or bumps that form on the inside of the foot at the joint at the base of the big toe.

If you wear ill-fitting shoes, don’t blame them for bunions—blame your parents. Bunions are inherited. However, poor footwear can contribute to the formation of a bunion.

Numerous conservative treatments, such as trying wider shoes or foot soaks, can alleviate painful bunions, though getting rid of them requires a short, outpatient surgical procedure.

Other Big Toe Problems

• Hallux Rigidus

With hallux rigidus, the big toe may look normal; however the inside of the joint at the base of the big toe is deteriorated and painful.

Sometimes the big toe won’t bend. Like bunions, simple treatments can lessen the pain, but in on some cases surgery is necessary.

• Gout

Known as the “rich man’s disease,” gout doesn’t just affect the rich. Gout is a type of arthritis that most often occurs in the joint at the base of the great toe, causing redness, swelling, and pain.

Some patients have said the pain was so severe that they couldn’t stand the bed sheet resting on their toe. Other patients describe less intense symptoms.

Gout occurs when too much uric acid is present in your body. Uric acid is a natural chemical that your body manufactures, and you ingest in certain foods, like pork, beer, or liver.

Treatment consists of altering your diet to limit the amount of uric acid you ingest, and if that isn’t enough, medication is prescribed.

Corns and Callouses

Corns have nothing to do with plants that grow ears. Painful corns (and callouses) are a build-up of hard, dead skin that often occurs due to an abnormal bony prominence or a bone out of position.

Corns occur on toes and callouses are found on the bottom of the foot.

Contracted toes (hammertoes) cause corns to form, and callouses form when a bone or bones are out of position. Treatment of a corn or callous depends on what is wrong with the bone underneath them.

Final Thoughts on Common Foot Problems

These are the top foot and ankle offenders, but the list of problems I see in my practice is endless. If you have foot or ankle pain or another problem, the best thing you can do is have it checked by a podiatrist.

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28 year old woman with a bunion and hammertoe

Not everyone goes to the doctor when they have a medical problem, and when many people do go, they don’t always seek out the best trained doctor for their problem. Today, medicine is very specialized. There are entire medical journals and textbooks for every part of the body: head, stomach, veins, and yes, feet. That is where podiatrists come in.

What is a Podiatrist?
Podiatrists or Doctors of Podiatric Medicine (DPM) are physicians who specialize in the treatment of foot and ankle problems. Most podiatrists have spent at least three or four years studying the basic sciences in a university or college after graduating high school, then studied four more years at a school of podiatric medicine, and then most go on to do foot and ankle residencies for two to three additional years or in some cases, even more.

What Kinds of Problems Do Podiatrist Treat?
Podiatrists treat all problems related to the foot or ankle, and the length is endless. However, the more common problems I see are heel pain, arch pain, ingrown toe nails, bunions (bumps on the inside of the big toe), hammertoes (bent toes), flat feet, foot or ankle arthritis, fungal toe nails, sores (ulcers), infections, sprains and fractures, ankle pain or weakness, nerve problems and neuropathy (numbness, burning, or tingling), shin splints, gout, athlete’s foot, sports medicine and diabetics foot problems, children’s foot problems, swelling or discoloration, plantar warts, dry skin, and moles, cysts or tumors.

When Should I Call a Podiatrist?
Some aches and pains in our feet or ankles may go away in a day in a two; others do not, and that is when you need to go to a podiatrist. Many people who see me for a painful foot or ankle have had pain for several days or weeks, but some have been limping around for several months or even over a year! Pain is the body’s way of telling us something is wrong. Don’t ignore it.

Some people with foot or ankle problems never have pain. For example, diabetics who have neuropathy (a deterioration of the nerves of their feet) may fracture a bone or develop an infection or sore on their foot and not have any pain. Recently, I had a patient with diabetes come to see me complaining of a small sore on the bottom of their foot; an x-ray revealed a needle inside the foot. Because the patient had very little feeling in their feet they didn’t know they had stepped on anything sharp.

In all patients foot problems can quickly become serious, but diabetics are especially at risk. It is not unusual for diabetics who don’t seek podiatric care promptly to develop gangrene and need a toe or the whole foot amputated. Prompt treatment is essential. All diabetics or anyone else with decreased feeling in their feet needs to have any foot or ankle problem checked by a podiatrist immediately.

Some people may notice one foot swelling or flattening. Diabetics and others with neuropathy may not have pain, however these are the people most at risk for a particularly serious problem called charcot arthropathy. In charcot arthropathy the bones of the foot weaken and slide out of position and may actually break through the bottom of the foot, leading to infection and even amputation. For other patients, a rapid flattening of one foot may mean the main tendon holding up their foot has torn.

It is a good guideline for anyone who notices swelling, redness, increased warmth or a change in the shape of his or her foot or ankle to see a podiatrist promptly.

Lastly, a podiatrist should check any lumps, bumps, cysts, tumors or moles on your foot or ankles. These problems are usually harmless, but occasionally they can be cancer and life threatening.

Final Thoughts on Foot and Ankle Pain
The most common complaint I hear from my patients is, “I should’ve come to see you sooner.” If you have a foot or ankle problem, the best advice I can give you is, don’t wait for it to hopefully go away—it may not.

To have Dr. Nirenberg look at your foot or ankle problem, visit Friendly Foot Care.

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