Putting Your Best Foot Forward

A Guide to Foot Care - Introduction

Most of us take our feet for granted.

But our feet are vital to health and mobility, carrying us an average of 184,000 KMs in a lifetime. No wonder foot problems are common. As we get older, these problems can get worse and it is especially important to care for our feet. In older people, foot problems can mean the difference between needing institutional care and being able to live at home.

This guide to proper foot care was prepared for Canada's veteran population but also of interest to Canadians of all ages who want to put their best foot forward. In this guide, you will find some helpful suggestions for treating and preventing common foot problems. It is not intended, however, as a substitute for medical care. If your feet hurt, arrange to see a professional, such as an orthopedic surgeon, podiatrist, chiropodist or nurse.

Structure of the Foot

The foot is made up of 26 small bones bound together by a perfectly constructed network of ligaments, muscles, tendons and cartilage. The muscles are attached to specific parts of the foot by tendons which are elastic and cause movement when the muscles contract. More than a hundred ligaments hold the structures together. The long plantar ligament is the strongest and acts as a trampoline to absorb shock and support body weight. Two main springs or shock absorbers, normally referred to as arches, are key parts of the foot's design. Each spring consists of a row of bones, strong ligaments and cartilage.

Feet are designed to perform two major functions: support and mobility. The heel of the foot serves as a firm pedestal for standing and the toes and front of the foot are used primarily for walking. The flexibility and strength of our feet affect how we walk which in turn affects our posture and how we carry our weight. Neglected feet which become stiff or weak can cause backache, leg cramps and fatigue.

Basic Foot Care

Follow these simple steps to keep your feet happy.

• Examine your feet daily for dryness, breaks in the skin, calluses, etc. Do this in a good light and, if your eyesight is poor, have someone do it for you.
• Use a lanolin moisturizing cream for dry and cracked skin. If your feet perspire, dust lightly with talcum powder. Remove excess cream or powder from between your toes to avoid skin breakdown.
• Wear shoes and socks that fit your feet and are comfortable and change your socks daily.
• Exercise daily.
• Wash your feet every day. Always test the water temperature with your wrist or elbow to avoid burning your feet, particularly if your circulation is poor. Pat - don't rub — your feet dry and be sure to dry between and under the toes.
• Soaking your feet is soothing and beneficial, but never soak for more than ten minutes to avoid dry skin.
• Cut or file your nails straight across and never shorter than the end of your toe. Use nail clippers, scissors, a rounded, diamond-chip nail file or an emery board.

See your doctor right away if you notice any of the following

• an injury that doesn't heal or becomes infected;
• any part of your foot or leg that turns blue or black;
• pain when walking that is relieved by rest;
• reduced sensation to pain or extreme temperatures;
• any unusual coldness, cramping, numbness, tingling or discomfort in your feet.

Common Foot Problems

Diabetes and Poor Circulation

If you are a diabetic or have poor circulation, it is especially important to pamper your feet. Diabetics may have a higher risk of ulcers and infection, be slower to heal and be prone to poor circulation. Signs of poor circulation, which often comes with aging and is common among smokers, are a blue or purplish skin colour, weak or nonexistent pulses in the feet and slow healing of cuts. If these problems are not recognized and treated, they can lead to gangrene and amputation.

For this reason, the following precautions should be taken.

• Check your feet daily for cuts, blisters and cracks.
• Avoid all activities that decrease your blood circulation, such as smoking and crossing your legs or ankles when sitting. In cold weather, dress warmly from your head to your toes since chilling any part of the body decreases circulation.
• Don't use heating pads or hot water bottles as you may burn your feet.
• Wear proper footwear to protect your feet from injury.
• Don't wear tight shoes, socks or stockings.
• Use elastic laces to allow the feet to swell and move freely.
• Exercise every day to improve your circulation and keep your feet healthy.

Athlete's Foot

Athlete's foot is a chronic fungal infection generally found between the toes. The skin is white, peeling and cracked and sometimes becomes itchy, red and infected. If the condition persists, consult a professional who will probably prescribe antifungal medication. Keeping the feet clean and dry, wearing clean, roomy cotton socks, changed daily, and alternating shoes every other day are all helpful.

Plantar Warts

Warts are caused by a virus that enters the skin directly either at pressure points or where the foot has been injured. Sometimes these warts can be mistaken for ingrown calluses on the bottom of the feet. A wart is round and has a crater in the centre. Consult a professional for advice on treatment, shoes, padding, dressing and medication or surgery. Warts are not a do-it-yourself project. The foot can be painfully scarred from improper treatment.

Corns and Calluses

Corns and calluses are thickenings of the skin often caused by poorly fitting shoes and tight socks. Corns generally form on toes and calluses on the bottom of the foot. Corns and calluses can also be caused by faulty weight-bearing, i.e. when the weight is thrown on the second, weaker bone of the ball of the foot. Consult a professional for the treatment of painful corns and calluses. Specially fitted inserts can be effective. Do not trim or pare corns or calluses with scissors or razor blades or use corn remedies, including pads, containing acid which can burn the skin around the corn. Home treatment should be limited to rubbing lightly with a pumice stone or 100-grit sandpaper when the foot is dry and applying a moisturizing cream.

Ulcers

Ulcers of the feet are open sores that do not heal. People with diabetes or poor circulation are particularly prone to ulcers of the feet because the sense of pain and temperature in their feet is diminished so that they are insensitive to excessive pressure and are not aware of the warning signs. Consult a doctor who will, if necessary, refer you to the appropriate professional.

Ingrown Toenails

Ingrown toenails are a painful condition often caused by tight shoes or improperly cut nails. The nail grows into the skin causing the toe to become red and swollen due to infection. Ingrown toenails must be treated by a professional who may have to remove a portion of the nail. To help prevent infection of ingrown toenails, cut or file nails straight across and never shorter than the end of the toe. File any rough edges as they can cut into the next toe and cause problems.

Thick Nail and Loose Nail

Thick nail is any abnormal thickening of the nail. It can cause pressure sores and restricted movement, especially in older people and diabetics. Loose, detached nails are another nail problem, sometimes due to chronic fungus infection or associated with the chronic skin condition psoriasis. Consult a professional for either of these conditions.

Strained Arches

Strained arches, sometimes called fallen arches, are common today due to walking on hard surfaces, such as cement and pavement. Symptoms are tired feet, pain in the legs and low back pain. If you suffer from any of these symptoms, wear well-fitting, comfortable shoes that provide good support and do foot exercises. If the symptoms continue, consult a professional. Special arch supports often relieve the condition. Physiotherapy, such as whirlpool and massage, can also provide relief.

Hammertoes

Hammertoes are caused by a muscle imbalance, possibly inherited, or wearing shoes that are too short causing the smaller toes to buckle. The joints may stiffen permanently in this position. Corns form where the toes rub against the top of the shoes. If the pain persists, consult a professional. Wearing shoes with a deep toe box and a wider fit and using pads to ease the pressure both help.

Hallux Rigidus

This is a type of bunion in which the joint between the big toe and the foot becomes stiff or completely immovable, often causing painful calluses on the sole. Inserts in the shoes can provide some relief but the condition can only be corrected by surgery.

Metatarsalgia

Metatarsalgia refers to pain in the front of the foot aggravated by abnormal pressure. It is usually associated with a high-arched foot or the spreading of the front of the foot with age. It results in a dull burning pain in the ball of the foot. Consult a professional if the pain persists.

Bunions

Bunions are a painful deformity of the foot consisting of a bump at the side of the big toe caused when the big toe angles inward toward the second toe. Bunions, metatarsalgia and hammertoes often occur together. While bunions tend to be hereditary, they are frequently aggravated by wearing tight shoes when young. Consult a professional who may x-ray the feet and

perform surgery to realign the bone or insert an artificial joint. Various shields and pads are available to relieve the pain of bunions and to hold the toe in alignment. Wearing well-fitted shoes and socks and soaking in a warm saline solution, such as Epsom salts, may relieve the pain and discomfort of bunions. The bunion area of the shoe can be stretched in the shoe store.

Heel Pain

Pain in the heel can be caused when the ligament-like structure which runs from the heel to the front of the foot, is torn and partially pulled away from the heel. Consult a professional who will probably treat this with flexible arch supports, a plastic heel cup or foam rubber padding in the shoe. A Cortisone injection sometimes helps. To prevent this problem, wear comfortable, well-fitting shoes that provide good support.

Another painful condition in the heel is caused when the bone at the back of the heel is rubbed by the shoe and becomes inflamed. This can be prevented by padding and massaging the backs of new shoes to soften them before wearing them.

Cracked heels are ustially caused by excessively thick skin. If heel cracks are painful, consult a professional. At early signs of cracking, the heels can be rubbed with a pumice stone or 100-grit sandpaper when the skin is dry, followed by bathing the heels, applying a moisturizing cream and wearing clean cotton socks.

Fatigue Fractures

Fatigue fractures are small fractures of the metatarsal bone. They are often a sign of abnormal weight—bearing on an extra long metatarsal bone, usually the second one. Under the stress, the bone cracks, causing swelling and pain. A professional can treat these fractures with padding and surgical shoes. Keeping as active as possible helps in the healing process.

Digital Neuroma

Pain in the front of the foot, especially when standing or walking, is sometimes due to swelling of a nerve causing it to be pinched between the front ends of the metatarsal bones. Consult a professional. this can sometimes be relieved by a shoe insert or a Cortisone injection. If the pain persists, the swollen part of the nerve can be surgically removed.

Arthritis

The common types of arthritis in the feet are osteoarthritis, rheumatoid arthritis and gout which usually attacks the big toe. Osteoarthritis is due to wear and tear and occurs mainly in older people. Its symptoms include pain, stiffness, swelling and a grinding sensation, particularly after prolonged activity. Rheumatoid arthritis can affect people of all ages and leads to pain and swelling in the joints as well as fatigue, fever and loss of appetite. In gout, the joint of the big toe is red, swollen and painful. People with arthritic feet are also prone to corns and calluses due to restricted movement of the joints in their feet. Consult a professional who may prescribe medication, padding, specially molded inserts or surgery. Wear comfortable, well-fitting footwear, lose weight if necessary and rest during the day if possible.

Treatment

Most of the common foot problems described in this section will require some kind of treatment sooner or later. It is preferable that it be sooner for older people whose circulation has probably slowed down and who could actually lose a foot or a leg due to an untreated infection in the foot.

When you visit a professional, he or she will identify your condition and treatment will take one of the following forms: medication, orthotics or surgery.

Medication can be prescribed as a pill, an injection or a cream.

Orthotics are corrective devices inserted inside your shoe and individually molded to your foot. They are made of a variety of materials, including plastic, leather and sponge. Such inserts adjust the way the weight is distributed and make it possible to live comfortably with many of these foot conditions.

Surgery is sometimes required to correct foot conditions.

Footwear

The foot tends to spread in the front under the body's weight as we get older. Because most shoes are narrower in the front than the foot itself, shoes can contribute to a variety of problems. Why not give yourself the foot test? Put your foot down on a piece of paper and trace around the bottom to see whether the front of your foot is wider than your shoe. If it is, it's time to go shopping for a new pair of shoes.

Proper Fit

• Buy your shoes at a good shoestore where experienced staff can help you to get the best fit.
• Shop late in the afternoon as your feet swell during the day.
• Have both feet measured every time you buy shoes as one is often larger than the other. Try on both shoes and buy them for the biggest foot.
• A properly fitting shoe shouldn t touch the tips of your toes, cramp the width of your foot or slip off the back of your heel. The front of the shoe, or toe box, should be roomy enough to move your toes.
• Break in new shoes gradually to prevent blisters. Don't wear new shoes for more than two hours at a time and, if necessary, protect sensitive parts of your feet with padding.

Good Construction

• Wear shoes appropriate to the activity: sturdy shoes with good support for walking; steel-toed boots for heavy work to protect your feet from injury; jogging shoes for jogging; warm, waterproof boots for winter.
• The upper part of the shoe should be firm enough to provide support and the shoe should fasten securely.
• Heels should be a sensible height. A heel higher than an inch and a quarter (3 cm.) throws the body s weight off centre leading to backaches and muscle cramps in the legs. If you do wear high heels, switch heel heights during the day to ease strain on legs and feet.
• Leather and canvas are the best materials as they are porous and take the shape of your foot.
• Insoles can be inserted in the shoe to absorb the jolts of walking.
• Soles should be strong and flexible and have a good gripping surface.

Care of Shoes

Shoes will be more comfortable if looked after properly.

• Polish new shoes before you wear them to increase their suppleness. Continue to polish frequently and saddlesoap leather shoes once a month.
• When not wearing your shoes, use shoe trees or shapers to keep them in shape.
• Keep your shoes in good repair, replacing worn and broken-down heels which weaken the ankles and cause balance problems.
• If soles are slippery, improve your traction by having a shoemaker put anti-slip material on the soles and heels of your shoes.

Soles should be strong and flexible and have a good gripping surface.

Fitness

Foot Exercises

Simple foot exercises help maintain muscle tone, keep feet from getting tired and protect against cramps. Here are some good ones which can be done every day.

• While sitting down, lift your foot off the ground, hang a purse from your foot and flex your foot to strengthen your ankle.
• Pick up marbles or a crumpled towel with your toes.
• Rock in a rocking chair by pushing off with your toes.
• Stand with your feet about two inches apart and walk in a straight line with all the weight on the outer edges of your feet.
• Raise yourself to tiptoe, then rock back to your heels twenty times.
• Roll your feet over a rolling pin several times a day.
• Cross your legs, point the toe down and move your foot in circles, first clockwise, then counterclockwise. The foot can also be rotated gently in and out and moved up and down at the ankle.

Walking: The Perfect Exercise

Walking is one of the best exercises for older people as it is not strenuous and costs nothing.

By simply walking every day you can:

• improve your circulation and reduce the risk of blood clots;
• reduce heart disease and heart attack and generally increase your heart's efficiency;
• strengthen bones and improve muscle tone;
• control your body weight;
• reduce stress, anxiety and depression;
• think more clearly and creatively.

Other low-impact activities, such as swimming, golfing, cross-country skiing, snow-shoeing and skating, are beneficial to the whole body and, ultimately, the feet. So keep as active as possible and enjoy the benefits of healthy feet.

Acknowledgements

Thanks are due to the members of the Working Group who prepared the basic text. Expert input was provided by Dr. Kenneth Faloon, D.P.M., Podiatrist, Ottawa, representing the Canadian Podiatry Association; Dr. Lloyd C. Bartlett, M.D., F.R.C.S. (C), General Surgeon, Winnipeg, representing the Canadian Medical Association; and Margaret Doswell, B.Sc.N., R.N., Nursing Supervisor, VON, Ottawa, representing the Victorian Order of Nurses. It should be noted that the views expressed are their own and do not necessarily reflect those of the organization which they represent.

Veterans Affairs representatives were A.R.G. (Nancy) McNaught, Departmental Nursing Director and Dr. Bill Robertson, Departmental Medical Director.

Text edited by Jennifer Charles.

Graphic design and illustrations by L.A. Design