July 21, 1998
After 100,000 Miles, Even Soles on Feet Wear Out
By JANE E. BRODY
here seems to be a week for just about every health problem that afflicts a significant number of Americans. But where is the week for those "poor, poor feet" celebrated in song a generation ago in "The Pajama Game"? Our feet take a beating, bearing our full weight for a lifetime of walking and running, often in shoes that squeeze, rub or deform them.
With age, the shape and condition of our feet change, setting the stage for a host of discomforting problems that can make it difficult to walk. People tell me I don't look my age (57), but there's no lying to my feet, which, according to estimates made by the American Podiatric Medical Association, have endured well over 100,000 miles, probably 200,000 or more. By the age of 50, the association figures, the average American has logged 75,000 miles, and my activity level is hardly average.
And do my feet know it! They have lengthened, growing a size and a half since adolescence, and widened at the forefoot. Three toenails have become weird-looking; I've developed tendinitis on the top of one foot and corns on the balls of both feet. And that's for starters.
I have good reason to believe I am not alone.
A survey conducted in April among 1,000 adults by Yankelovich Partners found that nearly half of Americans at any given time have some type of foot or ankle problem and that for one in five, foot or ankle problems have forced them to alter their activities.
As with shoes, the soles of the feet gradually lose their natural cushioning -- and therefore, their shock-absorbing ability -- because protective fat pads degenerate. Upon reaching the 75,000-mile mark, half the natural padding under the ball of the foot may have been lost, and beyond 75,000 miles the deterioration seems to accelerate, podiatrists say.
The scores of ligaments and tendons that hold together the 26 bones and 33 joints in each foot become stretched, resulting in feet that are wider and longer. Dr. Jonathan T. Deland, foot and ankle specialist at the Hospital for Special Surgery in New York, reports that age increases the risk for an often unrecognized condition called posterior tibial tendon insufficiency. If untreated in its early stages, it can make walking impossible.
You should expect your shoe size to change with age, probably to a size larger at 50 than it was at 20. You may also need a wider width at the forefoot (but probably not at the heel), which may necessitate buying more expensive shoes that are made with a combination -- for example, a C width at the forefoot and a B at the heel. Alternatively, fit the forefoot properly and use pads on either side of the heel (but not a U-shaped insert) to keep the shoe from slipping off the heel.
Toe and joint deformities increase with age. For example, the podiatric association reports that after the age of 50, the incidence of problems like hammer toes, bunions, arthritis in the foot and ankle, and toenail abnormalities increases by 70 percent to 100 percent.
Common Podiatric Problems
The American Orthopedic Foot and Ankle Society describes these as often seen in older people.
- Hammer Toes and Claw Toes:
These deformities result from years of wearing shoes with overly short and narrow toe boxes, the shoes so many women force their feet to endure in the name of fashion. One or more toes eventually curl under the stress, resulting in bony protrusions that develop painful corns when they rub on shoes. While the toes remain flexible, the discomfort can be eased by using a toe pad (sold in pharmacies) and wearing shoes with roomier toe boxes.
These are prominent bony bumps that develop on the side and base of the big toe, again usually the result of years of wearing narrow, pointed shoes and high heels. The toe itself turns inward, and the pressure of the shoe on the bump can cause painful swelling and inflammation. You can protect a bunion with a doughnut-shaped moleskin pad. Wear roomy shoes of soft leather or sandals that do not rub against the bunion. Sometimes custom-made orthotics (shoe inserts) can help. Severe cases may require surgery.
- Corns and Calluses:
These result from pressure of shoes when standing and walking. They most often occur on the ball of the foot and the toes. Doughnut-shaped pads can relieve the pressure, as well as wearing roomier shoes with padded innersoles. If a corn develops between the toes, a piece of lamb's wool can keep the toes from rubbing together. Soak your feet in warm water to soften corns and calluses and then file them down with a pumice stone (never use a razor). Experts are reluctant to recommend over-the-counter acids for corn removal since they sometimes cause complications, especially in diabetics.
- Ingrown Toenails:
These can happen at any age, usually because the nails were trimmed too short or in a curve instead of straight across. Shoes that compress the toes can compound the problem and result in the nail's growing painfully into the soft tissue of the toe. Treat by soaking the foot in warm water twice a day and keeping a small piece of cotton between the nail and flesh. If an infection develops, a doctor may have to prescribe an antibiotic.
- Fallen Arches:
Those who were born with arches can lose them with age as the ligaments that support the arch become too loose or stretched to hold it up. If this results in fatigue or pain in the feet, legs or lower back, custom-made orthotics that support the arch may bring relief.
- Morton's Neuroma:
The nerve sheath between the base of two toes can become irritated and swell, causing burning, cramping, numbness or severe pain that may feel like you just stepped on a nail. The discomfort may force you to stop what you are doing, remove your shoes and massage the area for relief. Surgery, only sometimes necessary, is successful in at least 80 percent of cases, but the neuroma may recur. Usually all that is needed to relieve the irritation is to wear roomier shoes with low heels and place protective pads under the involved area.
Workout for Your Feet
You can foster flexibility in your feet and ankles with a brief series of daily exercises. While sitting on a chair, straighten your knees to raise your feet. Circle each foot to the right 10 times, then to the left. Next, extend and flex your feet by pointing the toes outward then toward your body. Repeat this exercise 10 times. Finally, stand on the balls of your feet and raise yourself up as high as you can, holding the position for a minute, then drop back on your heels. Repeat this exercise 10 times.
If You Have Diabetes
People with diabetes need to be especially careful about foot care because their disease can impair nerve sensations and circulation to their feet and greatly increase the risk of injuries and their ability to heal. Neglected foot problems can lead to amputation. The National Institute of Diabetes and Digestive and Kidney Diseases has produced a very helpful booklet, "Take Care of Your Feet for a Lifetime" (N.I.H. publication number 98-4285), that includes the following tips:
- Check your feet daily for cuts, blisters, red spots and swellings.
- Wash your feet daily in warm -- not hot -- water and dry them thoroughly.
- Apply a thin coating of skin lotion daily to the tops and bottoms of your feet, but not between the toes.
- Keep toenails trimmed straight across and use a pumice stone to smooth corns and calluses.
- Always protect your feet by wearing socks and comfortable shoes that "breathe" (avoid nylon socks and vinyl, plastic and rubber shoes). Keep slippers at bedside.
- Protect your feet from temperature extremes. For example, wear socks at night if your feet get cold and avoid walking barefoot on hot sand.
- Foster circulation through regular exercise, keeping your feet up while sitting, making circles with your feet and wiggling your toes twice a day and not sitting with legs crossed for prolonged periods.
- Call your doctor right away if any foot problem develops that does not begin to heal within a day.
To obtain a free copy of the booklet, write to "Take Care of Your Feet for a Lifetime," 1 Diabetes Way, Bethesda, Md. 20892-3600 or call the message number, 800-438-5383 and leave your name and address and the name of the booklet.
PERSONAL HEALTH is published weekly, on Tuesdays. Click here for a list of links to other columns in the series.
Quick News |
Page One Plus |
Job Market |
Real Estate |
Quick News | Page One Plus | International | National/N.Y. | Business | Technology | Science | Sports | Weather | Editorial | Op-Ed | Arts | Automobiles | Books | Diversions | Job Market | Real Estate | Travel