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Orthotics and Prosthetics
Orthotics and Prosthetics
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. These symptoms are not normal.
Pain in the feet can trigger pain in the legs, hips, and back. Some foot problems can even signal a larger disease. 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. 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.
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. 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.
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.
The optimal approach is to prevent ulcers from occurring through tight blood sugar control and regular visits to an endocrinologist. People with diabetes should also see a 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 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. 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. 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, but your shoe size can change as you get older because the feet can spread and lengthen.
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, 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.
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. Washing the feet with a wash cloth or similarly abrasive product is important because it helps remove the dead skin, bacteria, and fungus. If you can't reach your feet during a shower because of obesity, arthritis, or instability, use a long-handle brush like a shower back brush.
People who want to soak their feet should use warm, soapy water. Soaking feet in Epsom salt can cause excessive drying of skin. 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.
Do not soak feet in very hot water as that can result 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.
Most ingrown toenails are due to improper nail clipping. Toenails should be trimmed straight across and not too short."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. Check to see that salons and their employees are licensed. Ask how they clean their tubs and instruments and how often. 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 medical specialist.
Exercise Right
Wearing inadequate and worn-out shoes is a common mistake for athletes. Running shoes should be discarded after 200 miles to 400 miles of use and they should fit correctly. There should be a thumb-width of length between the longest toe and the end of a shoe. Failure to wear the correct shoe size can result in runner's toe, calluses, ingrown nails, fungal nail infections, and hammertoe deformities.
People also should purchase the right shoe for the sport. Many injuries occur because someone is wearing a running shoe while playing basketball.
Another common cause of athletic injuries is doing too much too soon. Both overuse training habits and worn-out shoes could result in stress fractures, heel pain or heel spur (plantar fasciitis) or shin splints. It is important to start out slowly and increase distance, duration, and pace gradually.
Walking or jumping on hard surfaces and failing to stretch and do warm-ups may also cause shin splints, plantar fasciitis, and heel spurs. There is no solid evidence to confirm that stretching actually decreases the likelihood of injuries, but it makes sense to maintain flexibility through gentle stretching, especially following exercise.
Orthotic Devices
Orthotic devices are intended to make the feet more comfortable, minimize stress on the foot, or improve an abnormal or irregular walking pattern. An orthotic device could be a conservative approach to a foot problem, a preventive measure to avoid problems, or a useful support after foot surgery.
According to the American Academy of Orthopaedic Surgeons, orthotic devices commonly used include bunion shield pads, arch pads for people with a flat foot, and heel inserts for people with plantar fasciitis. These devices are sold over-the-counter (OTC) at drugstores and sporting stores. They can be custom made and also sold by podiatrists, physical therapists, or orthotic companies.
Consumers might try a less expensive OTC orthotic device first, but if the problem doesn't go away after six weeks, you may need to seek a professional consultation and a custom orthotic may be indicated. People who are at risk for developing wounds or who have an unusual foot shape tend to need a custom orthotic. To create a custom orthotic, a plaster cast is taken of your foot and sent to a laboratory.
Most orthotic devices are considered "Class I exempt" by the FDA. This category means they are exempt from pre-market notification requirements. But they still must be manufactured under a quality assurance program, be suitable for intended use, be adequately packaged and properly labeled, and have establishment registration and device-listing forms on file with the FDA. Legally marketed Class I devices are subject to the least regulatory control because they present minimal potential for harm to the user. But when orthotic devices make a new health claim or a claim for certain treatments, or use a fundamentally different technology, they must go through FDA clearance.