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Best Feet Forward

posted by Jeff DeLott, D.P.M.
filed under general postings
Oh, the agony of the feet. Not only do these poor appendages have to support our weight, but they're also subjected to years of neglect, ill-fitting shoes, and high-impact exercise. It's no wonder that a whopping 75 percent of us will experience foot problems at some time in our lives. The good news is that most are easy to diagnose and treat. Here, five of the most common complaints and the steps that you can take to give your dogs their day.


Heel Pain


Discomfort due to inflammation and/or microtears of the plantar fascia, a band of connective tissue that runs from the heel to the ball of the foot. A bone spur develops when the increased pull on the heel bone causes new bone formation.

Causes: Structural abnormalities that produce abnormal motion or hyperpronation (excessive rolling inward of the feet); an increase in daily activities or change in training routine; recent weight gain; nonsupportive shoes.

At-home Rx: Ice feet for 10 minutes two or three times a day (fill small paper cups with water and freeze; massage one into heel area, peeling the cup as the ice melts), and stretch the ankles and plantar fascia as often as possible. (One stretch to try: Standing with ball of feet on step, extend heel toward bottom step until a stretch is felt in the arch.) Over-the-counter shoe inserts can add support; heel cups work to cushion and redistribute weight.

In office: Taping the bottom of feet or making custom inserts can provide targeted support; corticosteroid injections, nonsteroidal anti-inflammatories, whirlpool or ultrasound treatments will ease the pain and inflammation. As a last resort, the plantar fascia may be surgically released from its attachment and the spur removed.

Blister

A fluid-filled pocket under the skin.  Causes: Tight or ill-fitting shoes that cause heat buildup and friction. Increased perspiration or running in the rain also can bring on blisters.

At-home Rx: If the "roof" of the blister is intact, clean it with an antiseptic solution like Betadine or alcohol. Using a sterile 18-gauge needle, puncture the blister at a 25- to 35-degree angle from the skin. Express the fluid, leaving the deflated skin intact so it can reattach to underlying tissue. Apply antibiotic ointment, gauze, and a bandage. If the blister's roof is torn, gently remove the dead skin and cleanse the area with diluted hydrogen peroxide or soapy water. Apply antibiotic ointment and bandage. Repeat 2 to 3 times daily until healed. Blister busters include reducing friction by wearing thicker socks (ones that wick moisture away from skin) and applying padding or petroleum jelly to blister-prone areas. Also, buy sport-specific shoes, making sure there is a thumb's-width space between the end of your longest toe and the end of the shoe.  In office: A blister that has become red and infected or won't heal requires drainage under sterile conditions. Shoe modifications may be made to reduce pressure on the area.


Bunion

An enlargement of the head of the first metatarsal—the bone directly behind the big toe—which forces the toe to angle inward toward the other toes. 

Cause: Heredity (which can cause hyperpronation and produce muscular imbalances), trauma, and arthritic or neuromuscular conditions. 

At-home Rx: Soak, ice, and elevate foot (to decrease swelling); pad prominent bony areas to reduce the pressure from footwear; wear wider shoes and/or supportive inserts.

In office: If pain increases, a physician can prescribe oral anti-inflammatories, steroid injections, or ultrasound treatments to reduce inflammation, and/or orthotics (molded shoe inserts) to improve gait. The last resort: surgery to realign the big toe, cut off protruding bone, and clean out the joint.


Ankle Sprain

An injury that causes stretching or tearing of the ligaments that connect the three bones of the ankle joint and swelling. 

Cause: The most common sprain is an inversion injury, or a sudden turning inward of the ankle. This causes damage to the ligaments on the lateral side of the ankle. 

At-home Rx: Ankle sprains should always be professionally evaluated to determine severity and rule out fractures. For Grade I sprains, or minor stretching of the ligaments, R.I.C.E. (rest, ice, compression, and elevation) should provide relief. 

In office: For a Grade II sprain or a partial tear, immobilization, followed by physical therapy and bracing, will be necessary. A Grade III sprain, in which there is complete rupture, will require long-term immobilization and possible surgical repair.


Neuroma

Enlargement and thickening of the covering of a nerve in the foot. This produces a burning sensation and/or shooting pain—usually between the third and fourth toes. 

Cause: Structural abnormalities in your foot and increased pronation cause the metatarsal heads to compress the nerve structures running between these bones. Activities like running and jumping can exacerbate the condition. 

At-home Rx: Wear wider shoes and supportive shoe inserts (e.g., Dr. Scholl's Dyna-Step); rest. 

In office: If pain persists, a physician may administer a steroid injection, prescribe custom orthotics, or develop special metatarsal pads. If conservative treatment fails, surgery may be required to excise the inflamed portion of the nerve.

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