The human foot is a biological masterpiece. Its strong, flexible, and functional design enables it to do its job well and without complaint – if' you take care of it and don’t take it for granted. The foot can be compared to a finely tuned race car, or a space shuttle, vehicles whose function dictates their design and structure. And like them, the human foot is complex, containing within its relatively small size 26 bones (the two feet contain a quarter of all the bones in the body), 33 joints, and a network of more than 100 tendons, muscles, and ligaments, to say nothing of blood vessels and nerves.
Tons of Pressure
The components of your feet work together, sharing the tremendous pressures of daily living. An average day of walking, for example, brings a force equal to several hundred tons to bear on the feet and lower legs.
Your feet, like other specialized structures, require specialized care. A doctor of podiatric medicine can make an important contribution to your total health, whether it is regular preventive care or surgery to correct a deformity. In order to keep your feet healthy, you should be familiar with the most common ills that affect them. Remember, though, that self-treatment can often turn a minor problem into a major one, and is generally not advisable. You should see Dr. Bruscia when any of the following conditions occur or persist. Athlete’s foot is a skin disease, usually starting between the toes or on the bottom of the feet, which can spread to other parts of the body. It is caused by a fungus that commonly attacks the feet, because the wearing of shoes and hosiery fosters fungus growth. The signs of athlete’s foot are dry scaly skin, itching, inflammation, and blisters. You can help prevent infection by washing your feet daily with soap and warm water; drying carefully, especially between the toes; and changing shoes and hose regularly to decrease moisture. Athlete’s foot is not the only infection, fungal and otherwise, which afflicts the foot, and other dry skin/dermatitis conditions can be good reasons to see Dr. Bruscia if a suspicious condition persists. Blisters are caused by skin friction. Don’t pop them. Apply moleskin or an adhesive bandage over a blister, and leave it on until it falls off naturally in the bath or shower. Keep your feet dry and always wear socks as a cushion between your feet and shoes.
If a blister breaks on its own, wash the area, apply an antiseptic, and cover with a sterile bandage. Bunions are misaligned big toe joints which can become swollen and tender. The deformity causes the first joint of the big toe to slant outward, and the big toe to angle toward the other toes. Bunions tend to run in families, but the tendency can be aggravated by shoes that are too narrow in the forefoot and toe. There are conservative and preventive steps that can minimize the discomfort of a bunion, but surgery is frequently recommended to correct the problem. Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction and pressure from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas. Never cut corns or calluses with any instrument, and never apply home remedies. Foot odor results from excessive perspiration from the more than 250,000 sweat glands in the foot.
Daily hygiene is essential. Change your shoes daily to let each pair air out, and change your socks, perhaps even more frequently than daily. Foot powders and antiperspirants, and soaking in vinegar and water, can help lessen odor. Hammertoe is a condition in which any of the toes are bent in a claw-like position. It occurs most frequently with the second toe, often when a bunion slants the big toe toward and under it, but any of the other three smaller toes can be affected. Although the condition usually stems from muscle imbalance, it is often aggravated by ill-fitting shoes or socksthat cramp the toes. Avoid pressure on the toes as much as possible. Surgery may be necessary to realign the toes to their proper position. Heel pain can generally be traced to faulty biomechanics which place too much stress on the heel bone, ligaments, or nerves in the area. Stress could result while walking or jumping on hard surfaces, or from poorly made footwear. Overweight is also a major contributing factor. Some general health conditions – arthritis, gout, and circulatory problems, for example – also cause heel pain. Heel spurs are growths of bone on the underside of the heel bone. They can occur without pain; pain may result when inflammation develops at the point where the spur forms. Both heel pain and heel spurs are often associated with plantar fasciitis, an inflammation of the long band of connective tissue running from the heel to the ball of the foot.
Treatments may range from exercise and custom-made orthotics to anti-inflammatory medication or cortisone injections. Ingrown nails are nails whose corners or sides dig painfully into the skin, often causing infection. They are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity, and poor foot structure. Toenails should be trimmed straight across, slightly longer than the end of the toe, with toenail clippers. If painful or infected, Dr. Bruscia may remove the ingrown portion of the nail; if the condition reoccurs frequently, Dr. Bruscia may permanently remove the nail. Neuromas are enlarged, benign growths of nerves, most commonly between the third and fourth toes. They are caused by bones and other tissue rubbing against and irritating the nerves. Abnormal bone structure or pressure from ill-fitting shoes also can create the condition, which can result in pain, burning, tingling, or numbness between the toes and in the ball of the foot. Conservative treatment can include padding, taping, orthotic devices and cortisone injections, but surgical removal of the growth is sometimes necessary. Warts are caused by a virus, which enters the skin through small cuts and infects the skin. Children, especially teenagers, tend to be more susceptible to warts than adults. Most warts are harmless and benign, even though painful and unsightly. Warts often come from walking barefooted on dirty surfaces or littered ground. There are several simple procedures which Dr. Bruscia might use to remove warts.
Orthoses, or orthotic devices, are shoe inserts that are intended to adjust an abnormal, or irregular, walking pattern. Orthoses are not truly or solely "arch supports,” though some people use those words to describe them, and they perhaps can best be understood with those words in mind. They perform functions that make standing, walking, and running more comfortable and efficient, by altering the angles at which the foot strikes a walking or running surface. Dr. Bruscia prescribes the use of orthoses as conservative approaches to many foot problems; their use is a highly successful, practical treatment form. Orthoses take various forms and are constructed of various materials. All are concerned with improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain. Foot orthoses fall into three broad categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine functional control and protection
The so-called rigid orthotic device, designed to control function, may be made of a firm material such as plastic, and is used primarily for walking or dress shoes. It is generally fabricated from a mold of the inpidual foot. The finished device normally extends along the sole of the heel to the ball or toes of the foot. It is worn mostly in closed shoes with a heel height under two inches. Because of the nature of the materials involved, very little alteration in shoe size is necessary. Rigid orthoses are chiefly designed to control motion in two major joint complexes of the foot, which lie directly below the ankle joint. These devices are long lasting, do not change shape, and are usually unbreakable. Strains, aches, and pains in the legs, thighs, and lower back may be due to abnormal function of the foot, or a slight difference in the length of the legs. In such cases, orthoses may improve or eliminate these symptoms, which may seem only remotely connected to foot function.
The second, or soft, orthotic device helps to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. It is usually constructed of soft, compressible materials, and may be molded by the action of the foot in walking or fashioned over a plaster impression of the foot. Also worn against the sole of the foot, it usually extends from the heel past the ball of the foot to include the toes. The advantage of any soft orthotic device is that it may be easily adjusted to changing weight-bearing forces. The disadvantage is that it must be periodically replaced. It is particularly effective for arthritic and grossly deformed feet where there is a loss of protective fatty tissue on the side of the foot. It is also widely used in the care of the diabetic foot. Because it is compressible, the soft orthosis is usually bulkier and may well require extra room in shoes.
The third type of orthotic device (semirigid) provides for dynamic balance of the foot while walking or participating in sports. This orthosis is not a crutch, but an aid to the athlete. Each sport has its own demand and each sport orthosis needs to be constructed appropriately with the sport and the athlete taken into consideration. This functional dynamic orthosis helps guide the foot through proper functions, allowing the muscles and tendons to perform more efficiently. The classic, semirigid orthosis is constructed by using laminations of leather and cork, reinforced by a material called silastic.
Various Other Orthoses
Various other orthoses may be used for multidirectional sports or edge-control sports by casting the foot within the ski boot or ice skate boot or roller skate boot, Combinations of semiflexible material and soft material to accommodate painful areas are utilized for specific problems. Research has shown that back problems frequently can be traced to a foot imbalance. It is just as likely that foot problems are brought about by a back imbalance. It's important for Dr. Bruscia to evaluate the lower extremity as a whole to provide for appropriate orthotic control for foot problems.
Warts are one of several lesser afflictions of the foot, which nevertheless can be quite painful. They are caused by a virus, which typically invades the skin through small cuts and abrasions. They are frequently called plantar warts, because they appear most often on the plantar surface, or sole, of the foot. They can appear anywhere on the skin, however, and technically only those on the sole are properly called plantar warts. Children, especially teenagers, tend to be mare susceptible to warts than adults; some people seem to be immune, and never get them.
Most warts are harmless and benign, even though painful. They are often mistaken for corns, which are layers of dead skin that build up to protect an area which is being continuously irritated, whereas a wart is a viral infection. It is also possible that a variety of other more serious lesions, including carcinomas and melanomas, although they are not overly common, can be mistakenly identified as warts. Because of those identification problems, and for pain relief, it’s wise to consult Dr. Bruscia about any suspicious growth or eruption on the skin of the feet. On the bottom of the feet, plantar warts tend to be hard and flat, rough-surfaced, with well-defined boundaries; they are generally fleshier when they’re on the top of the feet or the toes. They are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black.
Source of the Virus
The plantar wart is often contracted by walking barefooted on dirty surfaces or littered ground where the virus is lurking. The virus is also sustained by warm, moist environments, so that warts are often associated with communal bathing facilities – more for the wet surfaces, however, rather than for transmission in water, which probably is rare. If left untreated, warts can grow to an inch or more in circumference, and they can spread into clusters of several warts. Like any other infectious lesion, they are spread by touching and scratching, and even by contact with skin shed from another wart. They may also bleed, another route for spreading. Warts can last for varying lengths of time, which may average about 18 months. Occasionally, they spontaneously disappear after a short time. Perhaps just as frequently, they can recur in the same location. When plantar warts develop on the weight-bearing areas of the feet – the ball of the foot, or the heel, for example – they an be the source of very sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create pain just as intense.
Tips for Prevention
- Avoid walking barefooted, except on sandy beaches
- Change shoes daily
- Keep feet clean and dry
- Check children's feet periodically
- Avoid direct contact with warts – from other persons, and from other parts of the body
- Do not ignore skin growths or changes in your skin
- Visit Dr. Bruscia as part of your annual health check-up