Taking care of your feet

The human foot has 26 bones, 33 joints, and more than 100
tendons, muscles, and ligaments. With such a complex structure, a lot
can go wrong. While some foot problems are inherited, many occur
because of years of wear and tear.

Signs of foot trouble include pain, excessively dry skin, thickened or
discolored nails, swelling, redness, and unusual sensations. "Consumers
should know that these symptoms are not normal," says Joshua Kaye,
D.P.M, a podiatrist in Los Angeles. "Whatever the problem is, don't
bury it in your shoe and hope it will go away."

Pain in the feet can trigger pain in the legs, hips, and back. Some
foot problems can even signal a larger disease, which is why the
American Podiatric Medical Association (APMA) suggests that people take
their socks off when they go to their primary care physician for a
regular checkup. In a recent APMA survey of more than 600 people, 73
percent said their feet were not routinely inspected at doctor visits.

Toenails that are rounded inward instead of outward could signal iron
deficiency anemia. Kidney disease, heart disease, high blood pressure,
and circulatory problems can cause the feet to swell. Tingling or
numbness in the feet and slow-healing wounds could be signs of diabetes
or other serious diseases, according to the APMA. Chronic stiffness in
the toes could be a sign of arthritis.

"Changes in the structural appearance of the foot can also be signs of
abnormalities such as tendon rupture, rheumatoid or osteoarthritis, or
neuropathic disease," says Barbara Buch, M.D., acting clinical deputy
director of the Food and Drug Administration's Division of General,
Neurological and Restorative Devices.

Diabetes and the Feet

According to the American Diabetes Association, about 20 million people
in the United States have diabetes, a disease in which the body does
not produce or properly use insulin. But while nearly 15 million have
been diagnosed with diabetes, another 6 million people are unaware that
they have it.

"A problem that seems minor for many people, like a fungal infection or
sores on the feet, can become catastrophic in someone with diabetes or
other circulatory problems," says Jonathan Wilkin, M.D., former
director of the FDA's Division of Dermatologic and Dental Drug
Products. Diabetes is the leading cause of non-traumatic foot
amputations each year.

People with diabetes may experience neuropathy in the feet, a condition
that affects the nerves and the ability to feel pain and heat or cold.
"Someone without sensation in the feet can literally step on a nail and
not know it," says Amir Assili, D.P.M, a podiatrist in Gaithersburg,
Md. Assili says a 28-year-old man who came in complaining of a loss of
sensation in both feet was diagnosed with diabetes soon after.

Another major foot problem linked to diabetes is poor blood
circulation. High levels of blood sugar damage the blood vessels,
making them less able to supply the skin and other parts of the body
with blood. Poor circulation interferes with the ability to heal and
raises the risk of infection. Minor cuts or even cracks from dry skin
can turn into ulcers, small red sores that can become deep and
infected. Foot amputations may be necessary when an infection reaches
bone and spreads beyond a manageable extent.Doctors normally treat
diabetic foot ulcers by cleaning them and applying wound dressings, or
with surgical debridement, which removes contaminated tissue from a
wound to prevent infection. In severe cases, reconstructive procedures
that reshape the foot may be needed to prevent undue pressure on the
foot.

During the past few years, the FDA has approved new products to treat
chronic foot ulcers that are not responding to standard methods.
Examples are Apligraf, made by Organogenesis Inc. of Canton, Mass., and
Dermagraft, made by Smith and Nephew in La Jolla, Calif.

"The optimal approach," Assili says, "is to prevent ulcers from
occurring through tight blood sugar control and regular visits to an
endocrinologist." People with diabetes should also see a podiatric
physician at least once a year and practice the basics of good foot
care that apply to everyone--wearing comfortable socks and shoes and
maintaining foot hygiene. Those who have been diagnosed with decreased
circulation or neuropathy with loss of protective sensation should be
seen by their podiatric physician more frequently.

Feet should also be checked daily by the patient or family members for
any cuts and sores. "Early detection is important because a problem can
quickly turn serious," Assili says. People with diabetes and other
circulatory problems should never try to treat their own feet, because
of the risk of infection.

Shoes Make a Difference

As stylish as they may be, high heels and shoes that squeeze the feet
are linked to a host of foot problems. Painful bunions, which are
misaligned toe joints, are much more common in women than men. Poorly
fitting shoes don't cause bunions, but can aggravate existing ones.

Some people with bunions can eliminate pain with conservative
approaches such as wearing bunion pads, avoiding high heels, and buying
comfortable shoes that are shaped like their feet and that provide more
toe room.

Other common problems from tight shoes include nerve growths called
neuromas, corns, calluses, blisters, and hammertoes, a condition in
which the toes are bent like a claw.

"Shoes should be comfortable right when you buy them," says Jane
Andersen, D.P.M., a podiatrist in Chapel Hill, N.C. "You should be able
to wiggle your toes. And shoes should have a strong sole that flexes at
the ball of your foot."

Consumers also should make sure that they're wearing the right size.
"Most adults don't have their feet measured when they buy new shoes,"
Andersen says, "but your shoe size can change as you get older because
the feet can spread and lengthen."

Buch says one way to ensure that you get the right shoe size is to
stand on a blank piece of paper and trace the outline of your feet on
the paper with a pen at home. "Your shoe choice should completely cover
the outline of your foot," Buch says, "with no lines showing outside
the shoe when the shoe is placed on top of the outline you traced."

Foot Hygiene

The foot has more than 250,000 sweat glands. It's the mixture of sweat
and bacteria in our shoes and socks that makes feet smelly. "Clean, dry
feet can lower the risk of both foot odor and fungus infections," says
Kaye.

Feet should be washed every day with soap and lukewarm water,
especially between the toes, and then dried completely with a soft
towel. Any mild soap or antibacterial hand soap works fine.

"People spend a lot of time shampooing and conditioning their hair and
applying soaps and lotions to their body, but then probably don't spend
10 seconds washing their feet," Kaye says. "Washing the feet with a
wash cloth or similarly abrasive product is important because it helps
remove the dead skin, bacteria, and fungus." For patients who can't
reach their feet during a shower because of obesity, arthritis, or
instability, Kaye recommends using a long-handle brush like a shower
back brush.

People who want to soak their feet should use warm, soapy water, Kaye
says. "Soaking feet in Epsom salt can cause excessive drying of skin,"
he says. "This is an important consideration for diabetics or with
those who have existing dry or fragile skin. Consider soaking feet in
warm water with a small amount of liquid dishwashing solution that has
skin softeners. There is no benefit in soaking feet in Epsom salt
compared to regular table salt."

Some people tell Kaye they soaked their feet in very hot water because
they were trying to kill bacteria. He says, "Unfortunately, that type
of home treatment often results in skin burns. If someone is diabetic
or has poor circulation, hot water bottles or heating pads also
shouldn't be used on the feet."

Applying moisturizing lotion on the feet after bathing can alleviate
dry skin. "During dry winter months, apply a small amount of lotion a
few times per day," Kaye says. "Inexpensive generic creams are usually
equally effective as expensive brand-name products."

Kaye estimates that half of the ingrown toenails he treats are due to
improper nail clipping. "Toenails should be trimmed straight across and
not too short," he says. "Many people incorrectly cut the corners,
leaving a small point of nail that then grows into the skin or they
accidentally cut the skin."

People who pamper themselves with a salon pedicure also need to make
sure that proper cutting and safety measures are followed. In the last
few years, there have been reports of infections linked to nail salon
whirlpool footbaths that hadn't been properly cleaned or disinfected.

Andersen suggests that people check to see that salons and their
employees are licensed. "You could ask how they clean their tubs and
instruments and how often," she says. "Some people bring their own
instruments." People with diabetes should exercise caution when having
salon treatments, and may be advised by their physicians to avoid
treatments by anyone other than a trained podiatric or medical
specialist.

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