Feet

Feet

During a lifetime of trekking upstairs and down, outdoors and in, over hill and down dale, we tread the equivalent of four times around the earth.

Given that our feet get that kind of workout, we ought to show some respect. But in practice women squish them more than they care for them.

Consider Cinderella''''s story. Prince Charming rediscovers Cinderella because she has the daintiest feet in town. The evil stepsisters seem all the uglier just because they have--oh no!--big feet. This is just the kind of story that gives perfectly normal foot size a bad name--and makes a virtue of dainty little toes stuffed in triple-petites.

As if fairy tales weren''''t bad enough, consider the time-honored tradition of foot binding. In China, where minuscule feet (called Golden Lotuses) were considered wonderful, the most prized bound feet were just three inches long. To achieve these pedestals of perfection, a girl''''s toes were bent under and bandaged to her foot. Only the big toe was left free. The little girl grew up with bones that were permanently deformed. But at least she had tiny feet.

That was then; this is now. Nobody seriously believes that small feet are the signs of perfect prettiness. Do they?

Well, if not, how come "the fashion shoe is a slowly deforming device?" according to S. W. Balkin, D.P.M., attending assistant professor of podiatry, podiatry section, in the Department of Orthopedics at Los Angeles County­University of Southern California Medical Center. Over a lifetime of wearing high heels and tight shoes, each set of five toes assumes the triangular shape of pointed toe boxes. "It''''s analogous to foot binding," he says.

The fact is, women pay dearly for fashion. Ninety percent of the surgery on common foot problems such as bunions and hammertoes is done on women, notes Carol Frey, M.D., director of the Orthopedic Hospital of Los Angeles Foot and Ankle Clinic and a researcher on the Women''''s Shoewear Council of the American Orthopaedic Foot and Ankle Society.

Also, women are much more likely than men to suffer from neuroma, an inflammation and thickening of nerves between the toes. In fact, more than 90 percent of people with neuroma are women. "The modern fashion shoe is to blame. Not weight, work or heredity," says Dr. Balkin. "The sad fact is that these conditions are nearly 100 percent preventable, yet once they have gotten severe enough, they require lifetime care or surgery."

Many women over age 65 have worn pointy-toed pumps for much of their lives, and their feet pay the price: These women have 3½ times more corns and calluses and 13 times more bunions than men.

But maybe that will change.

These days, females are wearing more sensible foot gear, at least some of the time, according to James McGuire, D.P.M., director of physical therapy and instructor in the Department of Orthopedics at the Foot and Ankle Institute of Pennsylvania College of Podiatric Medicine in Philadelphia.

In roomier shoes feet spread more comfortably, and fewer bones are scrunched. Not surprisingly, the roomier footwear is resulting in the foot assuming a more natural size.

"The average size of women''''s shoes has grown from 6½ to 8½ in the past 25 years," says Carl Barone, owner of Carl''''s Shoes in Moorestown, New Jersey, and a shoe salesman for some 50 years. But you can still have problems if the shoe doesn''''t fit right.

If the Shoe Doesn''''t Fit

"My feet are killing me" is a common expression--but it''''s usually the shoes that are doing the damage, especially for women.

Orthopedic experts estimate that ill-fitting shoes provoke 75 percent of our foot problems, including bunions, hammertoes, neuromas, corns and calluses and blisters. Here''''s how they happen.

Bunions. A bunion is a bony growth that forms on the joint at the base of the big toe. An inflammation begins on the side of the toe joint, and gradually the metatarsal bone moves outward as the big toe starts to move inward. That lumpy side growth of bone, combined with the dislocaton of the joint, creates the problem.

Hammertoes. When a pointed shoe squeezes the big toe and the smallest toe toward the middle, the toe in the middle may get forced upward, resulting in a hammertoe.

Neuromas. If you wear high heels, the foot position pressures the toes into the toe box of the shoe. If the toe box is pointed and tight, a bone at the base of each toe (usually at the base of the third and fourth toes) sometimes rubs. It''''s the rubbing action that eventually inflames and thickens the nerve between them, causing a neuroma. Irritated neuromas cause burning and cramping.

Corns and calluses. These are created where an ill-fitting shoe rubs the foot too much. They''''re thickened nubs or clumps of dead skin cells--more protection than a problem when they start, but they become painful when they get too big. Corns are smaller and usually form on top of the toe or in between toes. Calluses are bigger and usually form on the bottom of the foot. They can be caused by shoes that have inadequate padding under the foot.

Blisters. Usually a temporary problem, blisters are caused by rubbing between the toes or between the foot and shoe.

What''''s Good for the Sole

There are ways to assuage almost any foot complaint. Here''''s what foot care specialists recommend.

Stretch this little piggie. "In a way, hammertoes are part of being human," says Melanie Sanders, M.D., chairwoman of the Women''''s Shoewear Council and an orthopedist in Indianapolis. "To walk upright, you roll across your foot from heel to toe. That pushes your toes upwards, pulling the normal padding upward with them. High heels worsen that tendency," she says. "But you can counterbalance that movement you do all day long."

Dr. Sanders suggests stretching your toes. First, sit down on a low stool or a pillow on the floor and place one foot flat on the floor. Then, "put your finger right where the hair on your toes tends to grow and push each toe down firmly, so that you feel the stretch on top of your foot. Hold it down for 30 seconds. Do each toe. Then go back and do them again. You can do it while you''''re watching the news. It takes four or five minutes."

"Do it daily if your feet are bothering you," Dr. Sanders says. "For maintenance you just need to do it two or three times a week."

Sleep with a splint. After a day under pressure from shoes, bunions often ache. If you have a bunion that''''s kicking up, try using a foot care product called a night splint. It works while you sleep. You can get a night splint from an orthopedist or podiatrist, according to Dr. Sanders.

The night splint is a small apparatus with a plastic piece that fits the big toe. An elastic strap pulls the big toe into a straighter, more normal position. "The new position helps relieve the pressure and takes the strain off the area around the bunion," he says.

Check your seams. Athletic shoes are generally good for your feet. But women who have bunions should double-check the construction of their cross-trainers and step or aerobic shoes, according to Dr. Sanders. "Some sneakers have a little fashion seam that goes right across the top of a bunion." Because the seam doesn''''t stretch, you get an area of high pressure over the bunion.

Prick a blister. Blisters happen when you break in a new pair of shoes or when you do too much walking in the wrong shoes. A blister can make you miserable.

You probably won''''t want to walk or work out very much until the blister heals. In the meantime, though, "you don''''t need to wait for it to get big. You can drain it as soon as you see it," says Rodney S. W. Basler, M.D., assistant professor of internal medicine (dermatology) at the University of Nebraska Medical Center in Omaha.

Sterilize a needle with the flame of a match or rubbing alcohol. Then pierce the blister at its edge. Press it to drain as much fluid as you can, but don''''t remove the blister''''s roof.

"Drain it every 12 hours," says Dr. Basler. "That appears to bring about the fastest healing."

Size Things Up

Though choosing the proper shoe would clear up most kinds of foot pain, choice is never easy. One foot is generally bigger than the other. In fact, when the Women''''s Shoewear Council surveyed 356 women from around the country, they found that 66 percent of them had one foot larger than the other.

Despite the imprecise nature of foot size, you can make a well-considered shoe selection if you''''re prepared. Here''''s how.

How to Make a Sizer
To make a handy shoe sizer, all you need are a pencil, plain cardboard (shirt cardboard is fine) and scissors. Here''''s how it''''s done To measure the sizer, stand normally, with one foot on a sheet of plain cardboard, so the ball of your foot is spread to its full width. Then mark the dimensions on either side of your foot. Measure both feet this way and use the widest measurement for your shoe sizer. Measure a rectangle that''''s as wide as your foot by 1 inch. If your foot measures 3½ inches wide, for example, draw a long rectangle that is 3½ inches by 1 inch.	Adjoining the first rectangle, measure a second rectangle that equals your widest measurement minus ¼ inch. So if the first rectangle is 3½ inches by 1 inch, the one next to it will be 3¼ inches by 1 inch. Then, right next to that, draw another rectangle that equals your first measurement minus ½ inch. (So this would be 3 inches by 1 inch.) After you''''ve finished measuring, cut out the shoe sizer with a pair of scissors. Take along all three sizers the next time you go shoe shopping. Measure the shoe width as shown--using the largest sizer for athletic shoes and either of the smaller ones for dress shoes.

Make yourself a shoe sizer. "The main issue in shoes is their width," says Dr. Sanders. Eighty-eight percent of women wear shoes that are one or two sizes too narrow, the Women''''s Shoewear Council found. To prevent this, make a handy shoe sizer at home, then bring it to the shoe store.

Account for swelling. Since your feet swell during the day, you should measure for your shoe sizer in the afternoon. Late in the day, after you''''ve been walking around, is also the best time to shop for shoes, since that''''s when your feet are largest.

Shop with your sizer. Take along the sizer whenever you go shopping for any kind of shoes, says Francesca M. Thompson, M.D., assistant clinical professor of orthopedic surgery at Columbia University College of Physicians and Surgeons in New York City and a member of the Women''''s Shoewear Council.

Your athletic shoes should be as wide as the widest measurement on the sizer. For dress shoes use either of the two smaller measurements. Don''''t go any narrower than the smallest width, she cautions.

Check the nation. Shoe sizes are inconsistent today because 88 percent of American shoes are made outside the country, says Barone. Each country makes shoes according to its own standards of size. That means you always need to try shoes on. A size eight from Brazil, for instance, is not necessarily the same size as an eight from Italy.

Remeasure as you age. Once you have reached adulthood, your feet don''''t grow, but they do change. By the time you''''re in your thirties, changes in the ligaments--bands of tissue that join the bones in the sole of your foot and raise the arch--allow your foot to collapse. And your foot begins to spread, or "splay."

"That spread is often responsible for an increase in shoe size of one to two sizes during your lifetime," says Dr. McGuire. In general, your feet are likely to increase in size during and after a pregnancy, because of the body''''s response to increasing demands. In addition, there''''s a hormone called relaxin that causes the ligaments to relax in the last month of pregnancy--and as the ligaments in your feet relax, your feet may get larger.

Exercise can also make a difference. "Aggressive exercise may make your foot meatier and bigger," he says.

To monitor your changing feet, measure them every three years, suggests Dr. Sanders. And revise your shoe sizer accordingly.

Styling Sensibly

Despite the bonanza of comfortable athletic shoes--and even some comfortable pumps--it''''s still all too easy to stray into Sore Foot Gulch. Here are some pointers to keep you safe from painful shoes.

Round it off. Whether you buy a flat or a heel, look for shoes with a rounded toe box instead of a deforming pointed toe box. There''''s a simple test to see whether a shoe is rounded enough. Hold the bottom of the left shoe against the sole of your right foot as shown in the illustration at left. Then hold the bottom of the right shoe against the sole of your left foot. If either shoe fails to cover your foot''''s sole, the shoes are undersize. Pick a larger size or another style and test again.

Strap your heel. In order to get a shoe wide enough for your foot, you may have to buy one with a little too much heel room. "The heel doesn''''t spread with age the way the balls of your feet do," says Dr. Sanders.

Try a shoe with an adjustable heel strap. That way, you can get one with ample toe room, then cinch in the strap to prevent slippage.

Or pad it. If you have a favorite pump with the right size toe box, but it''''s a little too slippery on your heel, try a heel pad, suggests Dr. Sanders. It has done the trick for many of her patients, she says.

Healing Your Heel Pain

In terms of body parts, "the heels are the first things to hit the ground," says William Case, P.T., president of Case Physical Therapy in Houston, Texas.

Heel pain most often comes from an inflammation of the plantar fascia, the main ligament that stretches across the bottom of the foot from heel to toe. When you overuse your foot or pronate (turn the foot inward when you walk), you may irritate and inflame the ligament. If you do that often enough, a bony growth called a heel spur sometimes develops at the point of injury.

Pain from an inflamed ligament or a heel spur feels worst in the morning and diminishes as the day goes on. But the correct shoe insert can cure most heel pain, according to David Alper, D.P.M., visiting professor of podiatry at Northeastern University in Boston. So it''''s worth shopping in the foot products section of a drugstore or sport supply store.

Here are some foot soothers to look for.

Lift with a cup. You can get a heel cup that goes under the back of your foot to relieve some of the pressure on the ligament. Or find a foam insole that cushions the entire foot. Either one may relieve heel pain.

You might also get relief from inserts called orthotics, which cushion your heel and align and control your foot when you walk. Unfortunately, orthotics don''''t work in pumps or high heels because of the way the shoes are designed.

Flex your leather. Before you toss out a too-tight shoe, try using a shoe stretcher, suggests Dr. Sanders. It''''s a device you can buy in a full-service shoe store or a shoe repair shop starting at around $11.

The stretcher looks like the front part of a shoe tree. Some have round, ball-like attachments that allow you to stretch specific sites--where the shoe presses against a bunion or corn, for instance.

You can use the shoe stretcher alone or maximize its effectiveness with a liquid lubricant available at the shoe repair shop or a drugstore. It works best on leather shoes, because they have greater give than most vinyl and are less likely to be damaged by the product. (In fact, some experts say you shouldn''''t use the product on vinyl at all, because you''''ll ruin the shoes--despite what the product label says.) Apply the shoe-stretching liquid to the inside of your shoe. Then position the shoe stretcher and gently tighten it to press against the inside of the shoe. Let the shoe stretch overnight or longer.

Steps toward Prevention

If you don''''t want to turn into one of the 43.1 million Americans with feet that hurt, here are some basic all-purpose guidelines to follow.

Aaaaahhhh! Nothing feels better when your feet are sore or tired than a foot massage. Here''''s one you can do yourself, as recommended by Edith Malin, a shiatsu practitioner and a teacher at the International School of Shiatsu in Doylestown, Pennsylvania. Perform the full routine on your right foot and then switch to your left, instructs Malin. Here are the steps to follow to give yourself a complete foot massage.

1. Sitting on the floor on a mat or pillow, grasp your right foot above the ankle with your right hand. Circle your foot five times to the right, using a full range of motion, then five times to the left.

2. Pull back the five toes of your right foot with the five fingers of the right hand--just enough to make the sole feel a little tighter. With your right foot in this position, lightly pound the bottom with your left fist. Hold your fist as if you were knocking on a door. Lightly pound up and down your foot three times.

3. With your left hand knead the bottom of your right foot. Use a rocking motion and go up your foot from the heel to the top of the ball.

4. Place both thumbs on the top of your right foot. Clasp the underside of your foot with your fingers. Starting in the center of the bottom of your foot, press and hold your foot with your fingers for several seconds. Then slide your fingers a couple of inches up the center and hold the press again for several seconds. If the spot feels tender, hold it a little longer. Continue until you reach the base of your toes. Repeat the motion along both sides of the same foot, one side at a time.

5. Put your hands together, palms facing each other, and lace your fingers. Place your right foot between both hands, with the bottom of your foot on your left palm and your right palm on top of your foot. The tips of your toes are in the laced part of your fingers. Stabilize the top of your foot along your big toe with your thumbs. Using your hands, quickly bend your toes back and forth across the widest part of your foot about 12 times. Then squeeze your toes in between both of your hands.

6. Press your fingertips in between the bones on the top of your right foot. You can stabilize the bottom of your foot with your thumbs. Rub gently and deeply all around the top of your foot. Do this massage slowly and thoroughly.

7. With your right thumb and index finger grasp your right big toe and rotate it around its joint. Squeeze your big toe at its base, then pull it gently but firmly from the base to the tip, sliding your fingers off the end. Repeat with the next toe until you''''ve done all the toes of your right foot.

8. Lifting and dropping your right leg quickly, pound the floor lightly with the back of your heel 12 times. Now repeat steps 1 through 8 with your left foot.

Wear running shoes. You don''''t have to run to wear running shoes. Many experts tout them as the best all-around shoes for foot support, because the heel is so thick and stable. "It''''s better than any other kind of athletic shoe," says Bruce Lebowitz, D.P.M., director of the podiatric clinic of the Johns Hopkins Bayview Medical Center in Baltimore.

Even if your workplace forbids sneakers on the job, you can do what many businesswomen do--wear them to and from work and at home and play.

Date your sneakers. As the padding in your athletic shoes ages and wears down, your feet start to do double duty in the shock-absorption department. Worn-out shoes sneak up on you; they get old before you know it, and the once-comfortable athletic sneaker may cause real foot problems.

You can keep track of your own athletic shoes, though. Just note the date of each new pair you buy. If you run 25 miles or more a week, replace them every 2½ to 3 months, says Gary M. Gordon, D.P.M., director of the running and walking clinic at the Joseph Torg Center for Sports Medicine at Hahnemann University Hospital in Philadelphia. If you take three or more aerobics classes a week, you''''re wearing out the padding at about the same rate. So you should also replace those sneakers every two to three months. With a lighter aerobics schedule, replace them every four to six months.

That may seem like a heavy sneaker toll, but it''''s worth it for pain-free feet. "If you wear worn-out sneakers, your foot pain will come back," warns Dr. Lebowitz.

See also Skeletal System