High Risk Feet

The beneficial effects of sports activity on the heart and lungs and overall conditioning are well documented. So are the positive mental effects. Yet, sports activities demand much of the body's stamina and agility. Many parts of the body undergo considerable stress during play. Feet, which provide all-important mobility, are high on this overworked list!

Neither serious athletes nor "weekend" athletes can fully avoid an injury list that includes ankle sprains, pulled muscles and ligaments, tendinitis, stress fractures, blackened toenails, bone bruises, calluses, blisters and others.

But there are some good habits and practices that both serious and recreational athletes can take to avoid or minimize injury.

Do's

1. Do specific flexibility and warm-up exercises, including those for your feet and ankles, prior to your sport. Muscle and tendon injuries may result from insufficient flexibility or lack of warm-ups before running or activity. Stretching before play is a must, and stretching after activity will make you feel less stiff the next day.

   Before playing, warm-up by jogging a short distance, walking briskly, jumping rope, riding a stationary bike, or running in one place for a few minutes. Your muscles will then be ready to begin gentle stretching. Use a sustained stretch (as in yoga). After your sport, "cooling down" with gentle stretching and exercising is also better for you.

2. Strengthen surrounding muscles (the ones that aren't used much in your sport), to prevent injuries, and muscle imbalance. In running for example, the front thigh muscles and the front leg muscles often need strengthening.
3. Powder your feet and shoes. This will absorb moisture, reduce friction and lessen the chance of a fungus infection. Convenient, cool and drying foot sprays are now available.
4. Wear wool socks, cotton-wool blends or one of the newer semi-synthetic athletic socks that wick moisture away from your feet. These let the feet breathe more easily. Avoid 100-per-cent cotton socks. Change your socks after activity.
5. If you have a blister or a friction problem, use Vaseline and gauze. Wearing thick and cushioned socks designed for your sport or two thinner layers of socks may help prevent blisters and add comfort. (If it is a water blister, clean with antiseptic solution, puncture with sterile needle to let water out, and leave skin on, as the skin acts as a protection. Then cover with gauze and tape.) Moleskin may be placed over the gauze for added comfort. Try to assess and correct the cause, which may be tight shoes, foot imbalances, etc.
6. Always use the right shoe for the right sport, as shoes are designed with function in mind. For example, don't wear running shoes to play tennis; wear a court shoe.

Don't's

1. Don't try to "work through" foot or ankle pain. Stop and evaluate the problem and do seek medical attention.
2. Don't attempt to do "too much too soon." Build up your level or duration of activity gradually to strengthen your foot and ankle muscles to handle the pressure exerted on them.
3. Never take pills to mask foot pain - seek professional attention to treat the cause of the problem.
4. Don't attempt a 100-per-cent workout if you are just back from a layoff or foot or ankle injury. Restoration of flexibility and muscle strength takes time.

In Case of Injuries

Remember "RICE"! Injuries should be treated as soon as possible after they have occurred. Use the principles of RICE, which stands for rest, ice, compression and elevation.

• Rest the injured area.
• Apply crushed ice packs to the injured area immediately after the injury has occurred (A bag of frozen peas works nicely, too.)
• Secure snugly with 6-inch elastic bandage for compression.
• Elevate the injured part above the level of the heart.
• Remove ice pack after 10 minutes and rewrap with elastic bandage.
• Repeat icing procedure every one to two hours as needed.
• If pain and swelling persist beyond 24 to 48 hours, seek professional attention. Also, do not neglect minor injuries or try to "play through" an injury as this can result in further disability and a longer lay-off may result.

Injuries such as a possible fracture, tendon rupture or ankle sprain require immediate emergency care.

Prevention

Many foot problems can be aggravated by sports. Inflammation, stress and strain won't necessarily mean one has to stop playing altogether. A proper assessment and appropriate treatment by a podiatrist may pave the way to pain-free playing.

Acute injuries are not always the cause of problems. Nor are shoes always the cause of foot problems.

Often a foot imbalance will result in overuse or "wear and tear," leading to problems. Calloses, tendinitis, sore areas, or any continual foot pain may mean that you have a structural imbalance of the bones of the feet. A visit to a podiatrist can help treat the injury and prevent it from progressing . You may be able to get back into your sport sooner than you think! Neglecting a problem however, often results in increased damage and further disability.

Be Prepared!

Participation in sports requires the acceptance of the possible risk of injury. However, the incidence and severity of injury can be kept at a minimum by a number of precautions: developing endurance, strength, flexibility and agility by physical training and having the best protective equipment. As far as the feet and legs are concerned, prevention is the key to comfort.

Source: BC Association of Podiatrists, Canadian Podiatric Medical Association

You worry about your children's teeth, eyes, and other parts of their body. You teach washing, brushing, and grooming, but what do you do about your child's feet? Those still-developing feet will have to carry the entire weight of the body through a lifetime.

Many adult foot ailments, like other bodily ills, have their origins in childhood and are often present at birth. Periodic professional attention and regular foot care can minimize these problems in later life.

Neglecting foot health invites problems in other parts of the body, such as the legs and back. There can also be undesirable personality effects. The youngster with troublesome feet walks awkwardly and usually has poor general posture. As a result, the growing child may become shy, introverted, and avoid athletics and social functions. Consultation between the podiatrist, pediatrician, and other medical specialists helps to resolve these related problems.

Your Baby's Feet

The human foot - one of the most complicated parts of the body - has 26 bones and is laced with ligaments, muscles, blood vessels and nerves. Because the feet of young children are soft and pliable, abnormal pressure can easily cause deformities.

A child's feet grow rapidly during the first year, reaching almost half their adult foot size. This is why foot specialists consider the first year to be the most important in the development of the feet.

Here are some suggestions to help you assure that this development proceeds normally:

• Look carefully at your baby's feet. If you notice something that does not look normal to you, seek professional care immediately. Children do not outgrow deformities. You should not wait until the child begins walking to take care of a problem you've noticed earlier.
• Cover baby's feet loosely. Tight covers restrict movement and can retard normal development.
• Provide an opportunity for exercising the feet. Lying uncovered enables the baby to kick and perform other related motions that prepare the feet for weight-bearing.
• Change the baby's position several times a day. Lying too long in one spot, especially on the stomach, can put excessive strain on the feet and legs.

Starting to Walk

It is unwise to force a child to walk. When physically and emotionally ready, the child will walk. Comparisons with other children are misleading, since the age for independent walking ranges from 10 to 18 months.

When the child first begins to walk, shoes are not necessary indoors. Allowing the youngster to go barefoot or to wear just socks helps the foot to grow normally and to develop its musculature and strength, as well as the grasping action of toes. Of course, when walking outside or on rough surfaces, a baby's feet should be protected in lightweight, flexible, properly fitting footwear.

Growing Up

As a child's feet continue to develop, it may be necessary to change shoe and sock size every few months to allow room for the feet to grow. Although foot problems result mainly from injury, deformity, illness or hereditary factors, improper footwear can aggravate pre-existing conditions. If possible, shoes or other footwear should not be handed down.

Walking is the best of all foot exercises. Carefully observe your child's walking pattern. Does the child toe in or out, have knock knees, or other gait abnormalities? These problems can be corrected if they are detected early.

The feet of young children are often unstable because of muscle problems that make walking difficult or uncomfortable. Remember that lack of a complaint by a youngster is not a reliable sign. The bones of growing feet are so flexible that they can be twisted and distorted without the child being aware of it. A thorough examination by a podiatrist may detect an underlying defect or condition that may require immediate treatment or consultation with another specialist.

Going barefoot is a healthy activity for children under the right conditions. However, walking barefoot on dirty pavement exposes children's feet to the dangers of infection through accidental cuts and to severe contusions, sprains or fractures . Another potential problem is plantar warts , a condition caused by a virus which invades the sole of the foot through cuts and breaks in the skin. They require protracted treatment and can keep children from school and other activities.

Be careful about applying home remedies to children's feet. Preparations strong enough to kill certain types of fungus can harm the skin.

Whenever you have questions about your child's foot health, contact a podiatrist in your community.

Footwear

Whether parents like it or not, part of a child's image revolves around footwear. Expensive sneakers have become fashion statements as much as athletic equipment. But for good foot health, the condition of the shoe is more important than the price tag or brand name.

Podiatrists agree it's sometimes better to buy a child two less expensive pairs of shoes than a single expensive pair, so the shoes can be rotated, to avoid rapid wear deterioration. Excessive wearing of the outsole, loss of shoe counter support, or wearing out in the mid-sole indicate it's time to replace the shoes.

Because a child's feet are constantly growing, it is important to allow at least one finger's width from the end of the longest toe when buying shoes. Remember, proper fit is very important. You can have the best shoe in the world, but if it doesn't fit right, it doesn't do its job.

In the shoe store, children should put on both shoes with their athletic socks and the laces tied for several minutes to properly check the shoes' fit. Shop for shoes in the afternoon, when the feet are naturally slightly swollen.

In young children, an "all purpose" sports shoe works well for most sports. A running-specific shoe is not suitable as an all purpose shoe; moving laterally in a running shoe is more difficult and presents greater risk of injury for children. After the age of 10, sport-specific shoes can help improve performance and protect the feet. With the exception of the running shoe, a degree of crossover between sporting shoes is usually not harmful to the feet of a child athlete.

Rubber cleats are not usually necessary for children under 10. They can be useful on a soft-field sport such as soccer, particularly if the field is wet and slippery, as is often the case on the West Coast. However, a word of caution: cleats generally don't have the same shock absorbency as running shoes. Also, a cleated shoe places the foot in a position where the heel is lower than the toes (it's similar to walking uphill). Many children are playing soccer year-round, often three or more times a week. Cleats focus pressure on the heel, causing stress that can result in inflammation and pain over time. If cleats are worn, podiatrists recommend molded shoe rubber cleats rather than the screw-on variety. Metal baseball spikes can be dangerous and should not be used until the teenage years.

Growing Bones and Ligaments

The immature bones of children are different from those of adults. The "growth plates" in children's bones do not finish closing until age 15 to 17 in boys and 13 to 15 in girls. When stressed, these plates are more susceptible to injury than the tendons and ligaments that support the joints. Ligaments tend to "give" before bones in adults.

Podiatrists warn repetitive overuse can cause inflammation of the growth plates. They advise parents to promote diverse physical activities for their children rather than one sport. This is especially important with individual sports such as running, gymnastics, and tennis, which require long hours of practice.

Statistics show children who concentrate on just one sport for long hours at a time are setting themselves up for injuries. Because of the susceptibility of bones with open growth centres to overuse injuries, sponsors of the Boston Marathon recently increased the minimum age to participate from 16 to 18.

A sports medicine podiatrist can offer a thorough examination of the entire lower extremity, and identify a leg length imbalance, weakness or biomechanical imbalances that may need to be addressed to prevent injuries on the athletic field.

Injuries and Treatments

Sports-related foot and ankle injuries are on the rise as more children actively participate in sports. Parents should be concerned about children's involvement in sports that require a substantial amount of running and turning, or involve contact. Protective taping of the ankles is often necessary to prevent sprains or fractures. Parents should consider discussing these matters with their family podiatrist if they have children participating in active sports.

Many children suffer from mild "torsional" imbalances, commonly known as in-toeing and out-toeing. Most children outgrow these imbalances without medical treatment. However, if a child has obvious torsional imbalances, he or she may be more susceptible to injury. If that is the case, keep a close eye out for foot and ankle injuries associated with sports activity. Foot injuries commonly seen in very active children include:

Ankle sprains - In older children, stretched or torn ligaments in the ankle, known as sprains, are more common than fractures. A sprain may cause extensive swelling around the ankle just like a fracture. Immediate treatment is crucial to quick healing. A podiatric physician can provide treatment as well as recommend balancing and strengthening exercises to restore coordination quickly.

Fractures - Fractures from overuse in child-athletes are commonly seen in podiatric medical offices. Growth plates are particularly susceptible to injuries, but mid-shaft fractures of the bone also occur. If a fracture is not severe, rest and immobilization may be the best treatment. More complicated injuries may require casting or surgical correction. If swelling and pain persist, see a podiatrist.

Sever's disease - Sever's Disease is commonly seen in children who play soccer. It is often felt as pain behind the heel caused by inflammation of the apophysis, a growth plate where a tendon is attached to the bone. Rest, ice and heel lifts are usually prescribed.

Shin splints and stress fractures - Shin splints are microtears or inflammation of the anterior leg muscles, as are Achilles tendon pulls in the posterior region of the leg. Again, rest is most important in healing these injuries. If pain is persistent, see a podiatrist, who can recommend strengthening exercises, certain shoes, or if indicated, prescribe custom-made shoe inserts known as orthoses.

A Word to Parents

All parents want to see their children do well in sports. But putting too much pressure on a child to become a star athlete may result in both physical and emotional injury to the child. A child should enjoy playing a sport, but if forced, could be turned away from all sports for a lifetime.

Especially with individual sports such as swimming, figure skating, and gymnastics that require long hours of practice every day, be certain the child's heart is in the endeavour, not just yours. When it comes to sports, overzealous parents can potentially do their children more harm than good.

Source: B.C. Association of Podiatrists, American Podiatric Medical Association

Diabetes mellitus is a chronic disease that affects the lives of about 200,000 British Columbians. According to the B.C. Ministry of Health Services, in the next 10 years, 325,000 British Columbians will have the disease. What's startling is that one in three British Columbians with diabetes don't know that they have the disease. Many people have diabetes for up to seven years and have already begun developing complications before they are diagnosed.

The disease is marked by the inability to manufacture or properly use insulin, and impairs the body's ability to convert sugars, starches, and other foods into energy. The long-term effects of elevated blood sugar (hyperglycemia) are damage to the eyes, heart, feet, kidneys, nerves and blood vessels.

Symptoms of hyperglycemia may include frequent urination, excessive thirst, extreme hunger, unexplained weight loss, tingling or numbness of the feet or hands, blurred vision, fatigue, slow-to-heal wounds, and susceptibility to certain infections. People who have any of these symptoms and have not been tested for diabetes are putting themselves at considerable risk and should see a physician without delay.

Part of keeping your diabetes in control is testing your blood sugar often. Ask your doctor how often you should test, and what your blood sugar levels should be. Testing your blood and then treating high blood sugar early will help you to prevent complications.

The socio-economic costs of diabetes are enormous. Diabetes accounts for 12 per cent of B.C.'s health care expenditures. Half of those costs are from diabetes complications, which are largely preventable. Two out of every five British Columbians with diabetes will develop a complication. Sadly, there are more than 1,000 amputations each year in B.C. Additionally, British Columbians in the prime of their life are six times more likely to have a heart attack or stroke because they have diabetes.

Podiatrists can help people with diabetes manage this disease more closely, improving their quality of life. While there is no cure for diabetes, there is hope. With a proper diet, exercise, medical care, and careful management at home, a person with diabetes can keep the most serious of the consequences at bay and enjoy a long, full life.

Comprehensive diabetes management with your health management team (family physician, podiatrist, optometrist and ophthalmologist, dietician and community health diabetes nurse) could:

• Reduce kidney disease by up to 56 per cent
• Reduce strokes by up to 44 per cent
• Reduce eye disease by up to 76 per cent
• Reduce diabetes deaths by 33 per cent
• Reduce BC's 1,000 amputations per year

How Do You Get Diabetes?

According to the Canadian Diabetes Association, the exact cause of diabetes is not yet known, although scientific advances show more and more promise every day. It is a hereditary disorder, and certain genetic indicators are known to increase the risk of developing diabetes. Type 1, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, afflicts five to 10 per cent of diagnosed cases of diabetes. This type occurs most frequently in children and adolescents, and is caused by the inability of the pancreas to produce the insulin needed for survival. Type 2, previously called noninsulin-dependent diabetes mellitus or adult-onset diabetes, affects the other 90 to 95 per cent of all diagnosed cases of diabetes, many of whom use oral medication or injectable insulin to control the disease. The vast majority of those people (80 per cent or more) are overweight; many of them are obese, as obesity itself can cause insulin resistance.
Certain characteristics put people at a higher risk for developing Type 2 diabetes. These include:

• A family history of the disease
• Obesity
• Prior history of developing diabetes while pregnant
• Being over the age of 40
• Being of Asian, Polynesian, Aboriginal, African or Latin American descent

People of Aboriginal descent are three to five times more likely than the general population to have or develop diabetes. Two-thirds of First Nations people with diabetes are women. Aboriginal women have more than five times the rate of diabetes compared to women in the general population and men have more than three times the corresponding rate for men.

The Role of Your Podiatrist

Because diabetes is a systemic disease affecting many different parts of the body, ideal case management requires a team approach. The podiatrist, as an integral part of the treatment team, has documented success in the prevention of amputations. The key to amputation prevention in people with diabetes is early recognition and regular foot screenings, at least annually, from a podiatrist.

In addition to these check ups, there are warning signs that you should be aware of so that they may be identified and called to the attention of the family physician or podiatrist. They include:

• Skin colour changes
• Elevation in skin temperature
• Swelling of the foot or ankle
• Pain in the legs
• Open sores on the feet that are slow to heal
• Ingrown and fungal toenails
• Corns and calluses
• Dry cracks in the skin, especially around the heel

Wound Healing

A diabetic ulcer is a common occurrence with the diabetic foot, and should be carefully treated and monitored by a podiatrist to avoid infection, which could lead to amputation. Poorly fitted shoes, or something as trivial as a stocking seam, can create a wound that may not be felt by someone whose protective sensation is diminished. Left unattended, such ulcers can quickly become infected and lead to more serious consequences. Your podiatrist knows how to treat and prevent these wounds and can be an important factor in keeping your feet healthy and strong. New to the science of wound healing are remarkable treatments including skin grafts, the use of enzymatic debriding agents and platelet-derived growth factors.
If You Have Diabetes Already . . . DO:

Inspect feet and toes daily.

Check your feet every day for cuts, bruises, sores or changes to the toenails, such as thickening or discolouration. If age or other factors hamper self-inspection, ask someone to help you, or use a mirror.

Wash feet daily.

Using mild soap and lukewarm water, wash your feet in the mornings or before bed each evening. Test the water temperature with your elbow, because your feet and hands may be affected by loss of protective sensation. Dry carefully with a soft towel, especially between the toes, and dust your feet with talcum powder to wick away moisture. If the skin is dry, use a good moisturizing cream daily, but avoid getting it between the toes.

Lose weight.

People with diabetes are commonly overweight, which nearly doubles the risk of complications.

Wear thick, soft socks.

Socks made of an acrylic or wool blend are well suited, but avoid mended socks or those with seams, which could rub to cause blisters or other skin injuries.

Stop smoking.

Tobacco can contribute to circulatory problems, which can be especially troublesome in people with diabetes.

Cut toenails straight across.

Never cut into the corners, or taper, which could trigger an ingrown toenail. Use an emery board to gently file away sharp corners or snags. If your nails are hard to trim, ask your podiatrist for assistance.

Exercise.

As a means to keep weight down and improve circulation, walking is one of the best all-around exercises for the diabetic patient. Walking is also an excellent conditioner for your feet. Be sure to wear appropriate athletic shoes when exercising. Ask your podiatrist what's best for you.

See your podiatrist.

Regular checkups by your podiatrist-at least annually-are the best way to ensure that your feet remain healthy.

Be properly measured and fitted every time you buy new shoes.

Shoes are of supreme importance to diabetes sufferers; poorly fitted shoes are involved in as many as half of the problems that lead to amputations. Because foot size and shape may change over time, everyone should have their feet measured by an experienced shoe fitter whenever they buy a new pair of shoes.

Try shoes on near the end of the day. New shoes should be comfortable at the time they're purchased and should not require a "break-in" period, though it's a good idea to wear them for short periods of time at first. Shoes should have leather or canvas uppers, fit both the length and width of the foot, leave room for toes to wiggle freely and be cushioned and sturdy.

Don't go barefoot.

Not even in your own home. Barefoot walking outside is particularly dangerous because of the possibility of cuts, falls, and infection. When at home, wear slippers or sandals. Never go barefoot.

Don't wear high heels, sandals and shoes with pointed toes.

These types of footwear can put undue pressure on parts of the foot and contribute to bone and joint disorders, as well as diabetic ulcers. In addition, open-toed shoes and sandals with straps between the first two toes should also be avoided.

Don't drink in excess.

Alcohol can contribute to neuropathy (nerve damage), which is one of the consequences of diabetes. Drinking can speed up the damage associated with the disease, deaden more nerves, and increase the possibility of overlooking a seemingly minor cut or injury.

Don't wear anything that is too tight around the legs.

Panty hose, panty girdles, thigh-highs or knee-highs can constrict circulation to your legs and feet. So can men's dress socks if the elastic is too tight.

Never try to remove calluses, corns or warts by yourself.

Commercial, over-the-counter preparations that remove warts or corns should be avoided because they can burn the skin and cause irreplaceable damage to the foot of a diabetic sufferer. Never try to cut calluses with a razor blade or any other instrument because the risk of cutting yourself is too high, and such wounds can often lead to more serious ulcers and lacerations. See your podiatrist for assistance in these cases.

Sources:B.C. Association of Podiatrists, Canadian Diabetes Association, BC Ministry of Health Services, Statistics Canada, Health Canada, American Podiatric Medical Association

More than 50 per cent of British Columbians will experience some type of foot problem in their lives. What's more, if you are female, you are vulnerable to four times as many foot problems as men, particularly if you usually wear high heels.

There is a need for women to pay more attention to foot care and avoid subjecting themselves to unnecessary foot problems, particularly those that might be caused by improper footwear and hosiery.

High Heels: Use and Abuse

The wearing of high-heeled shoes is a prime example of women inviting foot problems. Podiatrists see no value in high heels (generally defined as pumps with heels of more than two inches). They believe them to be unsound, citing medical, postural, and safety faults of such heels.

They know, for example, that high heels may contribute to knee and back problems, disabling injuries in falls, shortened calf muscles, and an awkward, unnatural gait. In time, high heels may cause enough changes in the feet to impair their proper function. Most women admit high heels make their feet hurt, but they tolerate the discomfort in order to look taller, stylish and more professional. In a Gallup Poll, 37 per cent of the women surveyed said they would continue to wear high heels, even though they did not think them comfortable.

Toward Greater Comfort

If women persist in wearing high heels, there are ways to relieve some of the abusive effects. The best solution is to limit the time you wear them. Try alternating with good-quality oxford-type shoes or flats for part of the day. High heels that are too tight compound the abuse. It's always best to buy shoes in the afternoon, since feet tend to increase in size later in the day.

Fortunately, women have other heel-size choices. They don't have to endure pain at the expense of their foot health. The key is wearing the right shoe for the right activity - and that means varying heel height and determining what height is most suitable.

For example, there are comfortable and attractive "walking" pumps (also called "comfort" or "performance" pumps) for women for work and social activities. The shoe manufacturers who have introduced them seek a marriage of fashion considerations and comfort, offering fashionable pumps with athletic shoe-derived construction, with reinforced heels and wider toe room. They are using space-age materials, like long-lasting memory cushioning that acts as a shock absorber. And the soles are more pliable.

Several companies have designed woman's footwear for specific athletic activities.

Perhaps the best shoe for women, from a medical point of view, is a walking shoe with ties (not a slip-on), a Vibram type composition sole, and a relatively wider, lower heel, of no more than a half or three-quarters of an inch in height - even though such a shoe may not be widely acceptable in the work place.

What about Stockings?

Women who regularly wear nylon pantyhose are also inviting foot problems. Nylon is occlusive - it doesn't breathe - and the heat that it generates and traps causes excessive perspiration. A warm, damp area is an ideal place to encourage fungal infections such as athlete's foot. (Pantyhose aren't the only apparel that cause excessive perspiration; the dress boots and shoe boots many women don in cold weather shouldn't be worn all day in an office.) Nylon, which tends to be abrasive, is even more so when it's damp; in a tight shoe that's already irritating, it offers little protection against blisters. Support hose, because they're so much tighter, can be the worst culprits of all.

Inexpensive nylon pantyhose can also cause forefoot problems, because the stretch mechanism constricts normal expansion of the foot when walking, and may pull the toes backward when the pantyhose ride up. The cramping and pressure of the hose can contribute to ingrown toenails and hammertoes. A better quality nylon or other fabric will provide a better fit, and the better the fit, the less likely it is that cramping will occur. Women's feet have grown larger because of improved health care and nutrition. The one-size-fits-all stocking no longer is the universal answer, if it ever was. Attention to proper fit is essential.

Pregnancy

Pregnant women need to observe good foot health to prevent pain and discomfort. Since the body undergoes changes and acquires a new weight-bearing stance, women should wear shoes with broad-based heels that provide support and absorb shock. Additional body weight also calls for more support, to prevent foot "breakdown."

The expectant mother often experiences more than ordinary swelling of her feet and ankles, which can aggravate existing foot conditions and promote inflammation or irritation. Pregnancy also triggers the release of hormones, which enhance laxity in ligaments and can contribute to foot strain.

To help alleviate foot strain, pregnant women should elevate and rest their legs often. They may also consider stretching and beginning a supervised exercise program to strengthen key areas. If problems develop, she should see a podiatrist, who will perform a physical examination, evaluate and treat associated foot problems, and may prescribe support hose or othotic devices, if required.

Women Over 65

Older women have more trouble with their feet than younger ones, for the simple reason that fat pads on the bottom of the feet tend to deteriorate in the aging process. They can alleviate some foot problems by wearing properly fitted, well-constructed shoes—shoes which provide cushioning and have a soft, flexible upper that will conform to the shape of their feet. They also need leather shoes, which "breathe" and can reduce the possibility of skin irritation. Soles should be lightweight, with enough flexibility and shock-absorbing quality to provide solid footing and not be slippery. Low-heeled shoes provide greater stability, more protection for the feet, and greater comfort. As older women commonly have circulatory problems, they need to keep their feet warm in cold weather to prevent frostbite or chilblains, a small, red swelling on the skin that can itch and become painful.

Women's Foot Afflictions

Whether the sources are congenital problems, foot abuse, high heels, poorly fitting shoes, or other maltreatment of the feet, women are subject to a number of afflictions involving the feet (most of which can also occur to men):

Achilles tendinitis: inflammation of the Achilles tendon, the link between the calf muscle and heel bone. Those who wear high heels regularly can expect to acquire shortened tendons; switching to low heels for strenuous physical activity without appropriate warm-up exercises creates an ideal scenario for achilles tendinitis.

Bunions: misaligned big toe joints, which become swollen and tender. Bunions tend to be hereditary; however, biomechanical imbalances and shoes that are too narrow in the forefoot and toe may aggravate them.

Hammertoe: a condition in which the toe is contracted in a claw-like position. Although the condition usually stems from muscle imbalance, it is often aggravated by ill-fitting shoes, socks or hosiery that cramp the toes.

Metatarsalgia: general pain in the ball of the foot. It is often caused by wearing high heels.

Neuromas: enlarged, benign growths of nerves, most commonly between the third and fourth toes. They may stem, in part, from ill-fitting shoes, resulting in pain, burning, tingling or numbness between the toes and in the ball of the foot.

Plantar fasciitis: inflammation of the long band of connective tissue running from the heel to the ball of the foot; a main cause of pain at the rear of the foot. This condition is sometimes caused by shoes that cramp the feet, especially in the arch area.

Pump bump (Haglund's deformity): a bone enlargement at the back of the heel bone, in the area where the Achilles tendon attaches to the bone. The deformity generally is the result of faulty biomechanics causing increased motion of the heel bone against the shoe counter.

Source: B.C. Association of Podiatrists, American Podiatric Medical Association

Medicine and health awareness have progressed so rapidly since 1900 that the life expectancy of the average Canadian has increased by about 30 years. Older persons have become an increasingly significant proportion of our total population - and their numbers are growing rapidly as Baby Boomers age.

Mobility is a vital ingredient of the independence and active lifestyle that is cherished by our aging population. Foot ailments make it difficult or impossible for them to work or to participate in social activities.

According health statistics, impairment of the lower extremities is a leading cause of activity limitation in older people. As if foot problems weren't enough of a nuisance, they can also lead to knee, hip and lower back pain that undermine mobility just as effectively. U.S. studies indicate that one-fourth of all nursing home patients cannot walk at all and another one-sixth can walk only with assistance.

Mirror of Health

The human foot has been called the mirror of health. Podiatrists, or Doctors of Podiatric Medicine (DPMs), are often the first to see signs of such systemic conditions as diabetes, arthritis and circulatory disease in the foot. Among these signs are dry skin, brittle nails, burning and tingling sensations, feelings of cold, numbness and discoloration. Always seek professional care when these signs appear.

Foot Problems Can Be Prevented

For reasons that are difficult to fathom, many people, including a lot of older people, believe that it is normal for the feet to hurt, and simply resign themselves to enduring foot problems that could be treated.

There are more than 300 different foot ailments. Some can be traced to heredity, but for an aging population, most of these ailments stem from the cumulative effect of years of neglect or abuse. However, even among people in their retirement years, many foot problems can be treated successfully, and the pain of foot ailments relieved.

Whether due to neglect or abuse, normal wear and tear causes changes in feet. As persons age, their feet tend to spread, and lose the fatty pads that cushion the bottom of the feet. Additional weight can affect the bone and ligament structure. Older people, consequently, should have their feet measured for shoe sizes more frequently, rather than presuming that their shoe sizes remain constant. Dry skin and brittle nails are other conditions older people commonly face. Finally, it's a fact that women, young and old, have four times as many foot problems as men, and high heels are often one of the culprits.

Observing preventive foot health care has many benefits. Chief among them are that it can increase comfort, limit the possibility of additional medical problems, reduce the chances of hospitalization because of infection, and lessen requirements for other institutional care.

Keep Walking

Studies show that care for a bedridden patient costs much more than care for a patient who is able to walk. In their private practices and in foot clinics, podiatrists are providing services designed to keep older people on their feet, and they serve in hospitals and nursing homes across British Columbia.

Records indicate that amputations and other forms of surgery due to infections or circulatory problems of the feet, many brought about by diabetes, have been significantly reduced in recent years because of early diagnosis and treatment.

Foot Health Tips

• Properly fitted shoes are essential; an astonishing number of people wear shoes that don't fit right, and cause serious foot problems.
• A shoe with a firm sole and soft upper is best for daily activities.
• Shop for shoes in the afternoon; feet tend to swell during the day.
• Walking is the best exercise for your feet.
• Pantyhose or stockings should be of the correct size and preferably free of seams.
• Do not wear constricting garters or tie your stockings in knots.
• Never cut corns and calluses with a razor, pocket knife, or other such instrument; use over-the-counter foot products only with the advice of a podiatrist.
• Bathe your feet daily in lukewarm (not hot) water, using a mild soap, preferably one containing moisturizers, or use a moisturizer separately. Test the water temperature with your elbow, because your feet and hands may be affected by loss of protective sensation.
• Trim or file your toenails straight across.
• Inspect your feet every day or have someone do this for you. If you notice any redness, swelling, cracks in the skin, or sores, consult your podiatrist.
• Have your feet examined by a podiatrist at least once a year.

Source: American Podiatric Medical Association