Health Secrets	UPDATED: Tuesday, June 24, 2008
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Put your best foot forward

Posted on Monday, June 30, 2008

By Wendy J. Meyeroff
THE ERICKSON TRIBUNE

By the time you reach age 65, your feet have walked about 65,000 miles. Yet feet don’t always get the kind of care they need.

“People don’t realize their whole body will suffer if their feet are not functioning properly. The joints higher up will have to compensate, leading to ankle, then knee, and eventually lower back problems,” says Terry Cooke, D.P.M., a podiatrist (foot specialist) at Charlestown, an Erickson-built and -managed community in Catonsville, Md.

Basic foot care
“Foot hygiene includes trimming toenails regularly and using pumice stones—not corn removal pads—to fight corns and calluses,” says Robert Araujo, D.P.M., Erickson Health podiatrist at Riderwood, an Erickson-developed community in Silver Spring, Md.

Older adults’ health problems can sometimes prevent them from handling their own foot care. “Poor vision could make it hard for you to see what you’re doing,” says Mark Samuelson, M.D., Erickson Health physician and medical director at Linden Ponds, an Erickson-built and -managed community in Hingham, Mass.

“Other health issues that older adults face, including diabetes, circulatory problems, and nerve conditions, not only cause foot problems, they make the patient unaware of foot pain,” Samuelson says. Even a simple cut could lead to infection for someone with diabetes. Regular visits to a podiatrist can keep minor foot injuries from becoming major issues.

Structural problems
“A major myth is that bunions are caused by poor-fitting shoes. They aren’t; they’re caused by an inherited weakness in the foot that allows a bump (the bunion) to develop on the side of the foot over time,” says Gerald Travers, D.P.M., a foot and ankle surgeon in Colorado Springs, Colo., and a spokesperson for the American College of Foot and Ankle Surgeons.

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Bunions can lead to hammertoes. “The bunion causes the big toe to turn in toward the others. As it changes position, it causes the second toe to contract and stick upward. That’s a hammertoe. As it gets rubbed by other toes, socks, and shoes, pressure spots form,” Travers says.

If the shoe fits
Ill-fitting shoes are at the root of many foot problems. Even though they don’t cause bunions or hammertoes, bad shoes can aggravate them.

“Women’s shoes generally are not made for the human foot. Pointed-toe shoes jam toes together and high heels push the foot too far forward,” Travers says.

“Although men and women have about the same percentage of bunions, women tend to suffer from them more.” Special shoe inserts called “orthotics” can help some people wear stylish shoes while protecting their feet, but proper fit is key. Ask your podiatrist if they know a shoe store with an experienced shoe fitter.

“Even after taking your measurement, a good fitter brings you multiple sizes. A 6 ½ might be the right size in one shoe, but you’ll need a 7 in another,” Travers says. Other keys to getting good shoe fit:

■Have your feet measured regularly. The size of your feet changes as you age.

■Most people have one foot larger than the other, so measure both feet and fit to the larger one.

■Fit at the end of the day when your feet are the largest.

■When you stand, there should be ⅜” to ½”between your longest toe and the end of the shoe.

■ Do not expect too-tight shoes to “stretch” to fi t.

Treatment options
Corns and calluses need to be trimmed properly. For nail fungus, you may need a prescription medicine or simply an over-the-counter remedy. Plantar warts, caused by a virus, may go away naturally; if not, a doctor can freeze them off using liquid nitrogen. Remember that not walking properly can also lead to foot problems. Ask your podiatrist about getting advice on better posture and walking. A balance program could help.

A note on surgery
“Foot surgery is fairly complication-free for the vast majority of older adults. Their key issues are circulation and the ability to heal well. If you’re taking a blood thinner or have diabetes, both can have an impact, but if your surgeon knows, he can make adjustments,” Travers says.

Travers doesn’t believe in rushing into foot surgery. “There are other options available,” he says.

“Better shoe padding, wider shoes, and bunion shields to cushion the area are just three other ways to treat bunions. For hammertoes, a shoe with a higher ‘toe box’ [the portion of the shoe the toe occupies] alleviates pain by decreasing friction on top of the foot,” Cooke says.

With these and the other alternatives mentioned here, you and your feet are likely to be happier together.