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by Catherine Holden
A guide to common foot ailments and how to keep yours pampered, pretty and protected
Did you know that more than half the body’s bones are in the hands and feet? An average sole walks about four and a half times around the globe in a lifetime, and when garlic is rubbed onto the feet, especially the big toe, it can be tasted in the mouth soon afterwards?
These essential body parts literally carry us from day to day and carry the burden of a body that is not in perfect alignment. By treating our feet correctly, our body’s biomechanical workings improve, and so does our overall wellbeing.
A: Athletes’ foot
This is a fungal infection between the toes and on the soles that is caused by continuous sweating, poor ventilation and not drying your feet properly. Symptoms include itchy feet, and burning and peeling skin. It is highly contagious and can be contracted by using the same surface as someone who is infected, which is why it’s best to wear your own flip-flops in a public shower. To treat, use an anti-fungal medication, keep feet dry, and wear breathable shoes.
B: Bunions
The Health Society of SA defines a bunion as a misaligned bone in the joint, often caused by incorrect foot mechanics. The foot may be too flat, forcing the toe joint to move further than the normal range; the joint may be damaged by arthritis; or an injury can produce a bunion. Some people are simply born with an extra bone near a toe joint. To treat, different shoe styles or orthotics are recommended to control incorrect foot mechanics, or surgery for more severe cases.
C: Calluses and Corns
Calluses are thick, yellowish, hard areas of skin that form in response to recurring friction or pressure. They can get painful and turn into corns, which have a point growing into the foot, if not treated. They’re a result of incorrect footwear, bony prominences, or a foot structure imbalance. To prevent them, buy shoe styles that do not create friction from foot action. To help relieve calluses, the South African Podiatry Association (SAPA) recommends:
▶ Give your feet a break from high heels.
▶ Keep skin supple with foot scrubs or a pumice stone.
▶ Use a foot cream or heel balm with a minimum of 20 percent urea daily.
▶ Consult a podiatrist if the problem persists. Untreated corns and calluses can result in knee, hip or back pain as you unconsciously change your posture to avoid putting pressure on the foot, thereby unsettling the body’s alignment.
D: Diabetes
Podiatrists often see diabetics with foot problems since they can develop numbness and a loss of circulation in the feet. “This numbness and circulation loss puts them at risk for developing open sores on the feet called ulcerations,” says registered podiatrist Chris Delpierre. Since there is decreased sensation, people aggravate chafing and blisters without realising it. Some severe foot ulcers require amputation. Plus, because of high glucose levels, ulcers often don’t heal. So it’s essential for people with diabetes to check their feet daily, to wash and dry well, to wear proper footwear and among other checks, to consult a podiatrist regularly.
F: Flat Feet/Fallen Arches
Flat feet are also called overpronated feet. The reason they look flat is that more pressure is placed on the inside of the foot, causing incorrect joint placement in the knee, hip and opposite shoulder, explains SAPA. Overpronation also causes an imbalance of the muscles in both the lower and upper leg. The inner leg muscles are underdeveloped while the outer leg muscles are overused. This upsets the core balance and alignment of the body and can result in pain and injury.
G: Gait
The way we walk is called our gait. We each have an individual gait which determines the way our feet hit the ground and where the pressure points (and potential problems) are. Podiatrists take this into account when assessing whether your shoes are the best choice for your particular body.
H: Headaches
You might be surprised to hear this, but even some headaches can be cured by attending to your feet. Delpierre explains: “Sometimes backache causes us to tense our neck and shoulder muscles, which in turn causes a tension headache. By having orthotics fitted for the back problem, the headache may be relieved.”
H: High Heels
“High heels cause the centre of gravity to shift forward, placing more weight on the ball of the foot,” says Delpierre. “This can lead to increased callus formation, metatarsalgia (see below) and stress fractures. They also place more stress on the knees and back, increasing the risk of degenerative joint disease such as arthritis. They can cause foot deformities such as hammer toes and bunions, and repeated trauma to toenails squashed into high heels can cause nail pathologies.” Ideally one should choose lower heels for everyday use and work, and save those stilettos for short stints of glamour.
But all is not lost — flat shoes or flip-flops are not much better as they don’t offer any arch support and can cause knee pain as the knees sag inwards leading to problematic hips and uneven alignment — so a slight heel offering arch support is best.
I: Ingrown toenails
Ingrown toenails are very painful and occur when the top left or right corner of the nail grows into the toe’s skin. Untreated, ingrown toenails can result in infection. Most people resort to self-surgery to relieve the pain, which can be dangerous, but podiatrists say there are easier ways of avoiding the irritation in the first place.
Some common causes:
▶ Excessive moisture
▶ Pressure from shoes or adjoining toes
▶ Growth spurts in childhood
▶ Incorrect toenail cutting
▶ Fungal infection under the toe
▶ Trauma to the toe. To treat, consult a podiatrist. They have the correct equipment to safely thin down and re-shape your nails and use local anaesthetic to ensure the procedure is safe and painless.
M: Metatarsalgia
This big word means pain in the ball of the foot. Delpierre says the condition, which is common amongst women, gradually worsens over about six months. It mainly affects athletes since, during running or walking, their body weight is often transferred onto the forefoot. It also affects people with high arched feet because they absorb less shock. Treatment involves stretching the affected muscles and placing a cushioning support in the shoes to achieve better weight distribution.
N: New trainers
The American Orthopedic Foot and Ankle Society makes several recommendations for getting a good fit:
▶ Have your feet professionally measured when they are at their largest: at the end of the day or after a run, walk, game or sport practice.
▶ Wear your workout socks.
▶ Have both feet measured (they can be different sizes).
▶ Try on the shoes, and walk around the store as much as you can. Sizes may vary by manufacturer.
▶ Make sure both shoes fit.
▶ Ensure that the shoe provides at least one thumb’s width of space from the longest toe to the end of the toe.
Kasha Dickie, biokineticist and manager of the Discovery Healthy Weight Programme at the Sports Science Institute of SA, says that in general people who run and do aerobics need shoes with a lot of impact-absorbing cushioning. Walkers need shoes that have extra absorption at the heels, and soles that provide a good roll off the toes. If tennis or squash is your game, shoes that are not too thick and will keep the ankle stable are recommended. It’s important to know your foot type before you choose shoes - see below for our quick foot-type quiz.
O: Orthotics
Orthotics are shoe inserts designed by a podiatrist to correct the imbalances in the body that your feet make up for. A podiatrist will assess your feet and then take a mould of them. Using the mould he will build the orthotics to stabilise the feet and bring the body into alignment. These can make a significant difference to a host of health issues, and should be inserted into the shoes you wear most often (to work, for running etc).
O: Odour
Stinky feet can be embarrassing, but easily rectified. Odour develops when feet are moist and stuck in a confined space for a long time, causing bacteria to multiply. To prevent unsavoury smells, dry your feet thoroughly after washing, and wear shoes of natural fabric, such as leather. If you wear socks, choose cotton or wool. Foot sprays can help to reduce odours, but if the problem persists, consult a professional.
P: Plantar warts
The bottom of your foot is called the plantar side, and can be prone to warts. These look similar to calluses, but with tiny dark spots (ends of capillaries) on the surface layer. Plantar warts can be painful, especially when walking since they grow up into the skin. Doctors use a variety of remedies, depending on severity, including trimming, dressing, salicylic acid patches, and freezing with liquid nitrogen.
P: Podiatry
Podiatrists are healthcare professionals devoted to the treatment of foot and lower limb related disorders. “The scope of practice ranges from the treatment of skin and nail disorders to correcting alignment of the body through the use of prescription insoles, says Delpierre. “Podiatrists are trained to do thorough assessments of the foot which include circulatory, neurological and biomechanical observations. A consultation typically includes taking a thorough history of the condition and relevant medical issues. There should also be an assessment of the foot and lower limb anatomy and, if relevant, observing the foot in motion.”
P: Plantar Fasiiatis
This is probably the most common, and sometimes painful, of all foot problems. It is typically described as a sharp pain in the heel or arch of the foot when getting up in the morning. There are many possible causes, says Johannesburg-based podiatrist Joanne Crawford, including “overuse (too much training, faulty training techniques, long periods of standing), worn or poor quality footwear, wearing the incorrect shoe for the activity you are partaking in, excessive weight gain, and faulty biomechanics”. To treat, rest is recommended as well as anti-inflammatory medication, and a visit to the podiatrist if the pain does not subside.
R: Reflexology
According to Chris Stormer, author of Teach Yourself Reflexology (Hodder and Stoughton), reflexology works around the principles of opening the mind, calming the body and soothing emotions through the reflexes on the feet. These reflexes reflect the entire body in a miniature form. Stormer says there are three main movements in reflexology; the firm technique that eases physical discomfort, the stroking movement which calms emotions, and the feather touch that reassures.
S: Sports injuries
What you think is a bad knee, hip or back due to a sports injury may just be pain from the way your feet land on the ground while performing the sport. Common running injuries, for example, often result from an uneven wearing in one place, due to anatomical imbalances. Many of these issues can be fixed with the correct shoes, and orthotics.
W: Webbed toes
Stormer says that in reflexology webbed second and third toes mean you are a genius!
Y: Yellow Nails
Discoloured toenails could be a sign of infection caused by moisture in shoes and socks.
What type of feet do you have?
Take our quick quiz to determine your foot type, it’ll help you choose the best pair of running shoes for you.
The “wet foot” test:
You’ll need a shallow bowl (or bathtub) with about half a centimetre of water in it and some plain paper. A brown paper bag is best, but anything that won’t absorb the water will work.
Step into the water and get the entire bottom of one foot wet, front to back. Then, while standing, place that foot on the paper and push your weight into the foot. Repeat with the other foot.
You should be looking at one of three things: If you have a normal arch, you will be looking at something that looks a lot like a foot! You’ll see a clear heel, an outer edge that leads to your toes, and an edge that breaks cleanly just in front of your heel and picks up again at the ball of your foot. If you have a high arch, or rigid foot, you will see your heel and then a gap between the heel and the ball of your foot. There will often be no connection at all between the heel and the ball. If you have a low arch, you’re probably staring at a giant foot-like blob where everything from the heel to the toes, on the inside and outside, is connected.
What does this mean for me?
High arch - a high arched foot requires more cushioning
Low arch - a low arch more medial support (support on the inside of the foot)
Tricky toes
Then, take a quick look at your toes. Is your foot longest at the big toe? Is your foot longest at the second toe? Does the ball of your foot seem wide compared to your heel?
Why is this important? According to podiatrist Joanne Crawford, your running shoes should be a size or two larger than casual footwear as the feet may swell, especially on a longer run, and there is a certain amount of sliding of the foot forward within the shoe in running, especially downhill. For some people the third toe may be the longest. Unless there is sufficient space between the end of the longest toe and the end of the shoe (roughly a thumb’s width 1.5-2cm) the runner is at risk of damaging the ends of the toes or the toenails due to the repetitive impact of the toes against the shoe. This low-grade trauma to the nail can result in damage to the growth area of the nail and result in permanently deformed, thickened nails.
“Women’s foot shape tends to be narrower in the heel and broader in the forefoot,” says Crawford. “Most athletic footwear companies accommodate for this by having a range of men’s and women’s shoes. Women with very narrow feet (who take a large enough size as the men’s range starts from about SA 7) may be more comfortable in a men’s shoe.”
“Most important is to try different shoes on, run around the shop in them. If it feels tight in the shop, it’s only going to get worse after 10km!” she says. “For those with very broad feet it’s essential to purchase a broad shoe (some brands of sport shoes have width fittings). The lacing pattern of a sports shoe can be altered to provide for extra space over the ball of the foot or to tighten a shoe around the heel.”
Crawford suggests purchasing running/sport shoes from a specialist running/sport shoe store where the staff are knowledgeable or to see a podiatrist for advice prior to the purchase of sports shoes.
You are now armed and ready to buy a new pair of running shoes!
Test from The New Runner by John Bingham and Jenny Hadfield (Rodale)
To locate a therapist in your area, or for more info:
>South African Podiatry Association on 0861 100 249 or go to www.podiatrist.co.za
>The Allied Health Professions Council of South Africa on 012 329-4001 or go to www.ahpcsa.co.za
>Diabetic Foot Working Group (DFWG) on 011 390 9100 or go to www.dfwg.co.za
>Diabetes South Africa on 011 886 3766/21 or go to www.diabetes.co.za
>The South African Reflexology Society on 021 558 9868 or go to www.sareflexology.org.za
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