 The
healthy human foot is a mechanical marvel. With 26 bones,
33 joints and more than 100 tendons, muscles and ligaments,
the foot is one of the most complex parts of the human
body — yet it's also one of the most abused. To
make matters worse, the average medical student spends
only about two weeks of his or her training focusing
on feet.
Odds are a huge percentage of your
patients are walking on shaky ground: foot trouble can
lead to unnecessary pain in the knees, hips and back.
"A survey showed that 63% of people believe it's normal
to have tired or sore feet at the end of the day. That's
entirely untrue," says William Mirchoff, DPM, a podiatrist
in Victoria, BC.
FOOT
FAULTS
He says most problems come down to faulty mechanics.
"Only one third of the population inherit good foot
mechanics, while the other two thirds of us are walking
around with some level of instability."
Here's a rundown of some of the
most common foot ailments, and how you can help patients
walk away unscathed.
Fungal infections Athlete's
foot is a fungal infection of the skin, characterized
by peeling, itching, redness and burning. Over-the-counter
(OTC) creams and powders are usually quite helpful,
says Dr Mirchoff. "The creams are best to treat the
infection, because they penetrate the skin better, whereas
powders should be used for prevention," he adds. Often,
the fungus will also make its way into the nail bed,
causing the nail to thicken and look chalky yellow.
"If the fungus is embedded only superficially, you can
file the nail and scrape it away, then prescribe topical
treatments like drops, creams or lacquer," explains
Mario Turanovic, DPM, president of the Canadian Podiatric
Medicine Association. "However if the fungus has made
its way deeper into the root of the nail, you have to
use a systemic medication like terbinafine. But it takes
about a year for the damaged nail to clear and nothing
prevents the infection from recurring. Suggest patients
use an antifungal spray when they get out of the shower
to keep the fungus at bay."
Corns and calluses —
made up of compacted, dead skin — are the foot's
defence mechanism against friction and pressure. Dr
Mirchoff says there are really only three things you
can do: trim them down with a file or pumice, avoid
the offending shoes or have them excised surgically.
"It's a lot easier to cut out the shoe than the callus,"
he adds.
Warts are a viral infection
most common in children and teenagers. Dr Mirchoff says
that they usually go away on their own, but if they
don't, liquid nitrogen is ideal. OTC meds like Compound
W are also fine, but it may take longer to heal. If
you're unsure of your diagnosis, Dr Turanovic's got
a helpful trick: if you push on a wart, it won't hurt,
but if you squeeze it, it will.
Bunions are misalignments
of the joint of the big toe, which becomes swollen and
tender and sticks out from the foot, causing the big
toe to angle in towards the others. The condition is
often genetic, but wearing pointy or narrow shoes certainly
doesn't help. "You can play around with different shoes
and orthotics to stop it from getting worse, but it
won't get any better," says Dr Turanovic. "If it's painful,
surgery is really the only way to get rid of it."
Hammertoes are usually caused
by an imbalance between the flexor and extensor muscles
of the toe, causing it to bend in a claw-like position.
As with bunions, ill-fitting shoes can aggravate the
condition. Dr Turanovic says surgery is an option if
you can't get the toe to straighten when you press on
it.
Heel pain is often caused
by increased pressure on the area, usually because of
faulty biomechanics. Stretching of the plantar fascia,
which runs along the bottom of the foot and supports
the arch — causes a bony protrusion, known as a
heel spur, to form.
"Many physicians tell patients
with heel pain to lose weight," says Dr Mirchoff. "But
while a significant number of people with heel pain
are sedentary and overweight, the weight isn't really
the problem," he insists. Heel pads and orthotics are
the best solution.
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