Health: Soles on Ice

Though we use them everyday for nearly every activity, most of us notice our feet only when things go wrong. Then, foot pain and other problems can send a patient hobbling to the podiatrist. Many podiatrists here are certified by the American Board of Podiatric Surgery. "The quality of podiatrists in the area is really high," says Naples-based podiatrist Dr. John A. Crist.

No matter what your complaint, advances in the field and an ever-improving understanding of foot physiology have led to improved diagnosis, treatment and prevention of many mobility maladies.

Help for heels

The general term heel pain, a common complaint, encompasses two conditions: plantar fasciitis, basically abrasion and microtearing in a ligament that attaches at the heel bone; and heel spurs, an abnormal bone growth that often occurs with the former ailment.

Many sufferers notice the problem as they take their first steps in the morning or after they have been off their feet for a while, when the ligament has had time to shrink and tighten. Dr. Alphonse Tribuiani, with Southwest Florida Ankle and Foot Care Specialists in Fort Myers, calls the sensation "a spike of pain."

Pain in this condition is not necessarily localized in the heel. A number of factors can contribute to the problem: standing or walking a lot, gaining weight, or simply changing from carpeted to tiled floors. Many times the problem is caused by shoes that don't properly support the arches. Dr. Christopher Paladino, of the Foot and Ankle Care Center of Naples, Bonita Springs, and Marco, cites flip-flops and some sandals as the worst offenders.

After an initial diagnosis, many podiatrists will start with special strapping for the foot that extends partially up the leg and is worn at night to stretch the tendon. After a week, the patient feels relief in about 90 percent of cases, estimates Dr. Therese Hixon of the Foot and Ankle Management Group in Naples. After that, the device is no longer needed if the patient wears shoes with support.

Stubborn pain may need more aggressive therapy, such as cortisone shots, or in some cases, physical therapy or even surgery. But even in the case of the last, endoscopic techniques allow surgeons to work more precisely, and often patients are immediately ambulatory, with full recovery within only a month or so.

Foot deformities

Foot deformities include problems such as bunions and hammertoes, arthritic changes of the bone that don't go away without attention. These conditions are often genetic in origin, says Crist, although they can also be caused or exacerbated by improper gait or shoe wear. Big offenders are the pointy-toed shoes favored by many professional women, which unnaturally compress the feet.

A bunion is an inflamed swelling, often to the side of the big toe, that distorts the shape of the foot and can cause serious pain. Hammertoes occur when muscles and tendons on the top or bottom of the foot overcompensate for an incorrect gait, causing them to pull up on the toes, bringing them upward; or to pull down, curling them underneath.

Many podiatrists will first attempt to direct a patient's shoe choices toward more comfortable, supportive, less constricting gear that may relieve pain and discomfort. More persistent cases may require surgery. In the past, surgeries to correct bunions could be "joint destructive," says Crist, meaning there was partial removal of healthy cartilage and joint tissue, and recovery was long. Now patients are often able to get back on their feet immediately. "A complete understanding of the deformity has led to better surgical techniques over the last 30 years," Crist says.

Tribuiani has had what he calls "phenomenal" results from a "slightly invasive" procedure, as he calls it, known as a T and C (tenotomy and capsulotomy), in cases of "soft" or "pliable" hammertoes, when the toes will straighten when pushed. By nicking the tendon and stretching the toe straight, he can often correct the deformity.

Nail problems

Many fungal infections thrive in a dark, moist environment. The inside of a hot, sweaty shoe fits the bill perfectly, making toenail infections a common complaint. They can cause the nails to thicken, discolor, become brittle or ingrown, and generally become "very, very painful," says Hixon. The problem can be augmented by shoe pressure or trauma to the nail. Most doctors start with a topical treatment or oral medication, and then cut the damaged part of the toenail back to kill the fungus.

Common complaints

A neuroma occurs when nerves between the toes are pinched or irritated, causing a balloon or swelling in the nerve. One solution has traditionally been a steroid injection, which shrinks the diameter of the nerve and reduces the likelihood of reirritation. More persistent cases may require neurectomy surgery, in which the nerve itself is cut.

Young people with growing pains may be experiencing them from the ground up. Paladino says still-forming heel bones may become irritated or inflamed, especially in active children. Treatment involves icing the area, and possibly immobilizing the foot. Shoes with a heel lift may also help.

Many foot complaints are of the accidental variety: cuts and assorted bumps and bruises. Living in a beach town can increase the likelihood of this sort of trauma-especially for beach goers who step on shells or stingrays. Your best defense against such injuries is shoes, of course.

Diabetics present a slew of foot-care challenges, and foot health is often a first indicator of diabetes. An unhealed sore on the foot and numbness or tingling may be warning signs. Many local podiatrists work closely with endocrinologists and vascular and heart specialists to help patients with diabetes monitor and care for their overall health.

Diabetics should not soak their feet, as this may invite problems related to fragile skin, according to Dr. R.S. Sharif of the Foot & Ankle Clinic in Naples. Also, they shouldn't cut their own nails, but have them cut by a professional. "Improperly trimmed nails can lead to infection and serious problems," he says.

Fitting shoes

The best way to treat your feet, according to podiatrists, is to select appropriate shoes. Comfort over fashion should be the guiding principle, although in recent years even orthopedic footwear has become sleeker and more attractive. "In the old days they had these clunky Herman Munster shoes," jokes Paladino.

If you plan to try on shoes, doctors recommend that you go at the end of the day, when your foot is slightly larger. Buy a shoe a half-size bigger than your foot, says Tribuiani. Make sure the shoes have proper arch support and are comfortable in the store. "Pressure [on your foot] within the store when buying a shoe is probably going to mean pain three hours later," warns Crist.