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PODIATRY
THE ADULT FOOT - FOOT CONDITIONS & TREATMENTS
This introduction to the adult foot has been prepared by the American Orthopaedic Foot and Ankle Society, a group of doctors who have special interests and training in the problems of the foot and ankle. Its members are medical doctors who, after completing medical school, have taken at least five additional years of training in orthopaedic surgery with additional special training in the care of the foot and ankle.
The Normal Foot
The height of arches and the shape of the toes vary from person to person. It is the deviation from normal arches and toe position that lead to foot problems. (There are 26 bones plus 33 joints in the human foot.)
Skin Problems
Sweaty feet can cause rashes and eczema. Wearing nylon socks in plastic shoes or tightly fitting shoes may not allow the feet to dry properly and can aggravate the problem. Changing socks every day and letting shoes dry out between wearings can help eliminate smelly feet. Wearing thick, soft cotton socks helps draw moisture away from the feet. True Athlete's foot is a rash, often between the toes, caused by a fungus infection. Athlete's foot will usually respond to treatment with anti-fungal powders and lotions along with good foot hygiene. Poorly fitting shoes causes most calluses, corns, and blisters. Poor shoe fit can aggravate other foot problems and result in irritation which may require medical attention.
 Toenails
Ingrown toenails often result from trimming the nails too short, particularly at the sides. You should trim your toenails straight across, allowing adequate length to project beyond the skin at the toenail margins. Cuticles should be pushed back with an orange stick or hindu stone and rarely cut.
First Aid
 Pay attention to cuts and bruises of the foot. Like any other injury, they should be cleansed and dressed. Generally, minor wounds need little attention. If a wound starts to spread, particularly in lacerations of the sole of the foot, you should consider an emergency visit for stitches.
Puncture wounds are a serious matter and can be dangerous. Nails and the like do not have to be rusty to cause lockjaw (tetanus), or to cause an infection in the foot. You should wear foot protection when walking out-of-doors. Even at the beach, you may encounter hidden obstacles, like glass. Lockjaw is best treated by immunization protection before you injure your foot. You should have a tetanus booster shot every three to seven years.
Fractures and Sprains
Stubbed toes can be more than just a minor nuisance. If you experience swelling, discoloration, or a persistence of some pain beyond 2 to 3 days, you may have a fracture. Neglected fractures, particularly of the large or great toe, can result in painful foot problems and need early evaluation.
Ankle sprains are common, foot sprains less so. If you experience persistent pain and swelling about the foot that interferes with walking, you may need X-rays to determine if you have a fracture.
FOOT CONDITIONS
Bunions
"Bunions," the common name for hallux valgus, is a prominent bump of the great toe at the outer edge of where it joins the foot. This bump is sensitive to pressure caused from wearing shoes that fit too tight. Shoes that are pointed and too narrow squeeze the great toe causing it to drift toward the little toes.
 TREATMENT: Wearing sandals and bunion shoes can help. Often wearing a pad, available from a drugstore foot counter, will relieve symptoms. If pain persists or shoe fitting is difficult, and the bump is quite noticeable, you should discuss this problem with your physician. Some bunions need surgical correction.
There are many operations for bunions, often named for the orthopaedic surgeon who developed the procedure: McBride, Keller, Mitchell, Lapidus to name a few. Most not only remove the bump, but correct what causes the bunion so that it does not grow back. Your orthopaedic surgeon will discuss with you what procedure, if any, is appropriate.
Corns and Hammer Toes
Most corns result from pressure when the skin is squeezed between the bones and shoes. Corns can appear over almost any bone of the foot, but most commonly over misshapen, hammer toes.
 Here the hammer toe causes continued pressure which results in skin irritation and corn formation. Sometimes you will need surgery to relieve the underlying pressure, but a toe pad from a drugstore can treat a mild problem. If the problem persists, your physician can decide if you need surgery. Again, as with bunions, changes in shoewear will often be all you need.
CAUTION: All swellings of the great toe are not bunions. For example, gout strikes thousands of Americans. This special type of arthritis can be diagnosed only by medical examination and laboratory testing. Diet and special medications can treat gout.
Warts
Warts can look like corns, but tend to occur without pressure from shoes. Warts are the skin's reaction to chronic virus infection. These raised and painful sores, often on the sole of the foot, will sometimes respond to pads and over-the-counter ointment, but often need medical attention.
CAUTION: Not all painful sores are warts. Reaction to injury, hidden slivers, and old puncture wounds can also result in painful sores. Dark brown or black warts can indicate a type of cancer and should be immediately examined by your physician.
Heel Pain
 Pain both below and behind the heel often results from an irritation of the tissues, nerves, or bone of the heel. Called heel spurs, this condition usually indicates a strain and only rarely, a serious bone or nerve problem. Runners and other athletes who subject the arch to strain, may develop heel pain. A direct blow to the heel can also result in this problem (never crush tin cans with your foot).
TREATMENT: Rest, heat and change of shoewear will often suffice. If the pain persists, your physician will probably prescribe medication, and shoe mod)fication and specific stretching exercises. In a more serious case of heel pain, your physician will prescribe injections. Rarely is surgery necessary.
Neuromas
 Irritation to a nerve can cause it to swell. This condition, known as a neuroma, can occur anywhere in the body. In the foot, walking and shoe pressure can lead to painful neuromas. The most common neuroma, called Morton's neuroma, occurs on the bottom of the foot between the toes. Here, a small nerve to the toe becomes pinched between the toe joints, toe knuckles and the shoe. Neuromas can occur in other places on the foot, often from injury to skin nerves. Pressure from shoes may cause neuromas to become painful.
TREATMENT: A change in shoewear, use of pads, and avoidance of irritating activity can help treat a neuroma. Your physician may also recommend medication and injections. If symptoms persist, you may need surgery to release or remove the nerve.
Diabetes
Diabetes and certain other medical conditions which similarly affect the nerves, cause special foot care problems. In some people, diabetes will result in nerve damage. When this happens, the nerves no longer perceive pain and therefore do not warn us of injury. This is particularly true in the foot.
With diabetes, the body's poor defense against infection, and diabetes' damage to blood circulation complicates the problem. Poorly protected from infection by weakened body defenses, and loss of circulation, the foot and toes become more vulnerable to injury.
Patients with diabetes must exercise extreme caution. Properly fitting shoes can help protect your feet and avoid injury. Any injury, no matter how minor, deserves careful attention. You also must always exercise great caution in trimming toenails. Avoid trimming corns and calluses.
Do:
- Inspect feet daily for pressure spots
- Inspect shoes for folds and nails
- Bathe feet daily
- Tell shoe salesperson you are diabetic
- Change shoes at least once a day
- Ask your physician to check your feet
- Make sure toenails are trimmed
- Go barefoot
- Use corn removers
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Practice Good Foot Hygiene and Toenail Care
Having your nails done used to mean paying a visit to your local manicurist. Today, as often as  not, it means seeing a pedicurist. Salons now do one pedicure for every three manicures. As little as 15 years ago, manicures outsold pedicures 10 to one.
Concerns about feeling good probably contribute as much to this trend as concerns about looking good. With the return of women to the workforce, tired and sore feet have become more commonplace and so has the concern with healthy feet. That's why, in addition to traditional enamels, pedicures now include reflexology massages to relieve tension throughout the body, warm paraffin wax to moisturize, and exfoliation (or scaling) techniques to smooth skin. Salons and cosmetic companies even offer masks to smooth, moisturize and refresh the foot.
As with any other treatment, you should take proper precautions. Not all pedicures are safe, nor do they all give good results. To ensure a safe and effective pedicure, the American Orthopaedic Foot and Ankle Society suggests the following:
- Soak your feet in warm soapy water for approximately 10 minutes. This helps soften and clean skin and nails.
- After the foot soaking, gently remove calluses with a pumice stone, Hindu stone or emery board. This gets rid of dead skin cells as well as calluses. Some body scrub products can help exfoliate dead skin between pedicures. Many pedicurists will cut or shave calluses with razors. However, it is not legal or safe for an unlicensed practitioner to cut the skin and definitely not recommended.
- Push back the cuticles with an orange stick or a Hindu stone. A normal part of the nail, cuticles offer protection from bacteria and infection. Cuticles clearly overhanging the nail margins should be trimmed carefully. Any trimming which goes further than the nail margin or draws blood is unsafe.
- Trim toenails straight across rather than in a curved pattern. This helps prevent ingrown toenails, allowing the straight edge of the nail to advance as one unit. Cutting the toenails in a curved pattern allows the recessed edges to grow into the skin. The pedicurist should take care not to trim the nails too short since this also can promote ingrown toenails. The toenails should be trimmed just enough so that you can see a few millimeters of skin just beyond the nail margin. Nails should not overhang the edge of the toe.
- Refine the nail edge with an emery board, maintaining the straight edge.
- Apply cream and moisturizing lotion to the skin and nail margins. You can find several creams and foot masks on the market specially formulated for the feet.
- Massage the cream or lotion into the feet. A foot message can help relieve tension and tired, aching feet. You can get a good massage at home by rolling your feet back and forth over a rolling pin. Reflexologists believe that points on the foot correspond to other body parts and ailments can be relieved through reflexology. They believe the ball of the foot has a connection to the lungs, the heel to the lower back, and the great toe to the head. Although no scientific research exists to back up these claims, reflexology does seem to produce positive results in some people. People with significant medical problems should consult with a medical doctor.
- Apply nail polish remover to the nails to gently remove excess lotion. This allows nail polish to adhere better to the nail. A pedicurist usually will apply polish as a base coat, then one or two coats of color, and finally a clear topcoat.
- Space your pedicures apart by approximately eight weeks.
After applying the finishing touches, relax and put your feet up. They look good. And if, you've followed these guidelines, your feet will feel good, too.
Watch Out for These Red Flags
If any of these symptoms are present, it is time to see an Orthopaedic Foot & Ankle Specialist:
 Pain that persists for more than 72 hours.
- Swelling of one leg or foot that persists for more than 24 hours.
- Pain which increases with exercise or walking.
- Pain at rest or with elevation of the legs.
- Sudden progression of a foot deformity.
- Any infection.
- Development of a blister or ulcer on the foot which you did not feel occurring or which is not healing.
- A unilateral flattening of the arch.
- Loss of sensation.
Above Information From: http://www.footcaremd.com/fc_a_footfitness12.html
Additional Areas Of Intrest For Happy, Healthy Feet:
PODIATRY
CONFUSED ABOUT FOOT DOCTORS?
SHOE TIPS FOR HEALTHY FEET
FOOTWEAR RECOMMONDATIONS
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