Q: What causes flat feet? Is it a common condition?
A: Flat feet are a common condition, estimated to occur in approximately 20 to 30 percent of the population. There are many reasons why an individual may have a flat-foot condition.
First, there may be a rare congenital defect, which is present at birth, such as vertical talus, which manifests as a rigid rocker-bottom flat foot. But, generally, most infants and toddlers do have flat feet because the arch structure has not yet developed. The development of the arch normally occurs during early childhood after 3 years of age.
In the 10- to 14-year-old range, a cause may be a condition called tarsal coalition. This is an abnormal connection between two bones in the foot which leads to a painful, spasticity (stiffness) of the peroneal tendon.
As we age, there are many reasons why an individual may develop a flattening of the arch, which is known as an acquired flat foot. These causes are developmental and include:
- Connective tissue disorders, such as rheumatoid arthritis.
- Endocrine disorders such as diabetes mellitus.
- Tight Achilles tendon.
- Dysfunction of the posterior tibial tendon; when the tendon on the inside of the ankle loses its functionality.
Finally, the hereditary or genetic predisposition to a flat foot is also a possible cause.
Q: What symptoms might someone with flat feet experience?
A: Symptoms are varied and depend upon the cause of the flat foot, the individual’s activity level and the type of footwear that is worn. An individual may present to the office with heel or arch pain (plantar fasciitis), Achilles tendinitis, pain in the subtalar joint or ankle discomfort. Patients will often have several symptomatic areas, have difficulty with exercise, and may even have knee, hip or back pain.
Q: When should someone with flat feet see a Podiatrist?
A: Typically a patient will not seek professional treatment unless they are symptomatic, except for those times when a parent may be concerned with their child’s foot structure or function. The question arises: If someone has a flat foot will they be symptomatic or develop problems later in life? The answer to this is, not everyone will develop issues later on. With that being said, medical treatment should be sought if one is symptomatic with pain or if the flat foot condition is severe (a significant rolling inward of the foot and ankle during walking).
Additionally, if one has noticed a change in their foot structure such as a sudden collapse of the arch or has a medical condition with decreased sensation
to their feet (such as in diabetes mellitus), there are sufficient studies that show the initial evaluation and periodic follow-ups with a podiatrist may help
prevent further complications.
Q: What are some easy solutions that people can try?
A: Wearing well structured shoes and sandals that provide adequate support to the arch structure of the foot. It is important to understand that one size does not fit all. Some flat foot cases may require custom-made orthotics, an ankle/foot brace, special shoes and in extreme cases, surgery.
Q: When is surgery necessary for flat feet?
A: Surgery is an alternative when conservative measures have not provided a satisfactory relief from pain and discomfort. Additionally, patients who are at risk for chronic breakdown or ulcerations on the bottom of their feet due to the complete loss of the arch structure are good candidates for surgical intervention to prevent further complications. For the most part, however, conservative and non-surgical treatment plans will be effective in the majority of cases.
What if you feet sweat and burn profusely? You wash them every day and change socks/shoes several times a day. You have tried every athlete’s foot remedy at doctor’s advice, and nothing works. What could this be?
This is a common problem seen during the winter months, especially in teenage boys. The hormones are working overtime, they are in thick socks and lace-up shoes for school and their feet are getting wet from the rain . Not to mention when they are playing rugby or soccer- the socks and boots get soaked.
Plantar hyperhidrosis is the medical term for excessively sweaty feet. It is a common problem and rarely linked to any underlying disease.
It can be a significant problem, interfering with a person’s quality of life. Sweaty feet can become a breeding ground for bacteria and lead to significant foot odour as well as fungal skin infections that lead to a burning sensation of the feet.
The skin of the human foot can make more sweat per square inch than the skin of any other part of the body. This is because the skin of the foot has more
sweat glands per square inch than the skin of any other body part.
Moisture accumulation is most commonly associated with heating of the foot and poor ventilation of the shoe. In addition, it is normal for dead skin cells
to exfoliate or slough from the skin constantly.
The skin of the feet is no different from the skin of the rest of the body except that dead skin cells from the feet accumulate with sweat in a closed area. In this environment, fungi and bacteria that are usually present are able to grow and thrive. This overgrowth can lead to foul odours and burning.
Most foot fungi reside on the soles of the foot and between the toes. This is where one would expect most of the burning to be localized. Burning and itching of the feet is most likely due to skin infection with fungi.
This is more severe than the fungi simply being on the skin surface and is commonly referred to as athlete’s foot or Tinea Pedis. The skin can look relatively normal to the untrained eye.
Consider seeing a podiatrist to verify the diagnosis. For many there will be benefit from weeks of treatment with topical anti-fungal medication. Some will need prescription oral anti-fungal agents.
Stinky feet are caused by overgrowth of bacteria. Interestingly, a skilled diagnostician can identify the type of bacteria from the smell. Cheesy smells are linked to specific types of bacteria, vinegarlike smells to others and rotten garbage smells to yet other bacteria.
Some people report that a change in diet, while not affecting sweating, can reduce foot odour. They recommend a diet lower in processed carbohydrates and
higher in complex carbohydrates and higher in proteins.
Common measures should be taken to treat excessive sweating of the feet:
• Wash the feet daily with warm water and an antibacterial soap. Dry the feet thoroughly with a dry and soft cotton towel, especially between the toes.
• Use a shoe spray designed to reduce the smell and accumulation of bacteria and fungi. In severe cases, a trial of an underarm antiperspirant sprayed or
applied to the feet is reasonable.
• Use foot powder to dry the feet. • Wear thick socks, so they can absorb and wick away the moisture and help ventilate the feet.
• Use 100% cotton or 100% wool socks. Avoid, synthetic socks and stockings (polyester or nylon) as they can worsen the problem.
• Change socks several times a day.
• Wear shoes with adequate ventilation. Avoid plastic or nylon shoes. When not wearing shoes, let them air out in an area where dry air is circulating.
Serious problems that can cause excessive sweating and burning of the feet include diabetes with diabetic neuropathy and peripheral vascular disease. A
physician can easily exclude these diagnoses.
Please consult a Podiatrist or other medical professional before undertaking any self diagnosis or treatment.
It is important to keep your feet clean and as dry as you can. However, the sole of the foot contains thousands of sweat glands so feet which have been kept hidden away in winter shoes and boots during cold and rainy days are prone to problems because warm, dark moist places encourage such as athlete’s foot, fungal nail infections and verrucas. On top of this, bacteria that cause smelly feet flourish on warm, moist skin.
Make sure your shoes and socks are made from natural fibres and try and let your feet ‘breathe’ as much as possible.
The simplest way to deal with sweaty feet is to use a foot powder or antiperspirant. However, this may be insufficient in some people who have truly sweaty feet and have a condition called hyperhidrosis.
The most important thing is to vary the type of shoe and heel that you wear in order to reduce the repetitive strain on any one particular area of the foot. A low-heeled shoe will help with Achilles tendon problems and also plantar fasciitis.
Heel pain (called plantar fasciitis) can be caused by summery shoes such as flip-flops or ballet pumps. If you suffer from any of these see your Podiatrist.
If you have bunions (an enlargement of tissue around the big toe) or hammer toes (when your second, third or fourth toes are permanently bent) winter shoes can be very unforgiving. If you are having regular problems seek advice from a Podiatrist who will be able to give you different treatment options, and recommend a surgeon if needed.
Thick cracked skin on the heels is very common and the best way to deal with this is to start off with a visit to your Podiatrist who will remove the hard skin, and then advise on a home maintenance regime, which will involve the use of a foot cream (Gehwol foot care products).
Home maintenance will also include regular use of pumice to keep the skin smooth. Make sure the foot is nice and dry and gradually file the skin. If you are diabetic the skin loses its ability to sweat which is very important in naturally moisturising your feet and preventing cracking. If you have also lost skin sensation, these cracks may not be noticed or healed and this can lead on to significant problems. In this situation it is essential that you see a Podiatrist (chiropodist) regularly for your foot care rather than taking it on yourself. This is also true if you have circulatory problems in your feet.
Make sure you cut your toenails properly as painful conditions can occur without care.
Keep your nails trimmed. Undercutting the end of the nail in this way increases the risk of the nail edge growing forward into the nail – a so-called ‘in-growing toe nail’. Cutting them too short also encourages this to occur.
Thickened, yellow, brittle nails are a sign of a fungal nail infection. Treating this infection can be very difficult and it is best to make sure that you get nail clippings sent off to the lab before starting any anti-fungals.
Identification of the exact cause and targeted anti-fungal treatment increases the chance of success but beware as this can take several months. Sweaty feet make this more difficult.
It’s a good idea to have a regular foot care routine to keep you feet healthy.
If you are diabetic, make sure you inspect them regularly, especially if you have lost the feeling in them.
Firstly wash your feet in warm water, preferably with an anti-bacterial soap. Make sure you dry them thoroughly, especially between the toes as the skin here is prone to a fungal infection called athlete’s foot. When dried, moisturise your feet.
Hard skin can be rubbed with a pumice stone when you are washing your feet. Severe hard skin on the sole is usually down to excessive pressure and you really ought to see a Podiatrist (chiropodist) to have this removed or protected with insoles.”
A verruca on the other hand has a dark centre and is more discrete. It is caused by the human papilloma virus.
Scaly, itchy feet can be due to athlete’s foot and it is actually quite common for this to be resistant to treatment with the standard over-the-counter preparations.
If this is the case you should see you GP as oral medications may be required.
Make sure that you treat your socks and shoes with powder as well as these can harbour the fungus and cause re-infection.
Please seek professional advice if you are diabetic, have circulatory problems, or want more information.
Whether you take a leisurely jog or sprint to the finish line in a marathon, running is great exercise. In fact, running is one of the easiest and most popular sports among non-professional athletes.
Running offers many benefits, including improved cardiovascular and respiratory function, weight loss, reduced cholesterol and increased muscle and bone strength, as well as a healthier mental outlook. But with any sport or activity comes the risk of injury.
Runners of all levels are at risk for significant injuries to their hips, knees, legs, ankles and feet. One of the best ways to prevent injury is to avoid injury. By taking simple precautions and watching for signs of potential problems, individuals can prevent or minimize many injuries.
The majority of injuries are caused by excess — running too far, too fast or too often. In addition to strains and sprains, blisters and cramps, some of the more common injuries include:
· Hip and thigh injuries — Bursitis, stress fractures, and hamstring pulls or tears are typically caused by inflammation and strain from overexertion or
improper running techniques.
· Knee injuries — Patello-femoral syndrome, more commonly called “runner’s knee” is characterized by a dull ache or sharp pain under or around the kneecap and is often accompanied by a grinding sensation when the knee is bent then straightened. Iliotibial Band (ITB) Syndrome can also produce inflammation and pain in and around the knee.
· Leg injuries — Shin splints or medial tibial stress syndrome is a cumulative but painful condition resulting from too much force being placed on
the shinbone (tibia) and surrounding tissues.
· Ankle injuries – Sprains vary in severity but typically result in pain, swelling and bruising. Achilles tendonitis is a painful inflammation in the back of the ankle, which if left untreated, can lead to a ruptured tendon.
· Foot injuries — Plantar fasciitis, which can cause sharp pain or a dull ache in the bottom of the foot near the heel or in the arch, is typically caused by poor foot structure, inadequate running shoes or a sudden increase in the distance run. Improper shoes and downhill running can also cause painful Runner’s toe.
The good news is that these injuries are treatable, but more importantly can be prevented or minimized by following some basic training guidelines and running techniques.
Some tips to help you
Invest in a good pair of running shoes. Running in worn out shoes is a prime cause of many injuries. Make sure to replace them when you’ve logged about 600 kms.
Stretch regularly before and after you run to avoid tightening of muscles. Be sure to include stretches for the hips, thigh, hamstring, calf and ankle, as well as the back.
Perform warm up exercises such as light jogging or sprinting prior to engaging in a full run.
Include cross training in your overall exercise regimen to help strengthen a wide range of muscles. Consider activities such as weight-training, swimming,
calisthenics or those exercises that use muscles in slightly different ways.
Avoid overtraining – and overexertion. Doing too much, too soon and too quickly can lead to injuries. A good approach for beginners may be to start with a
run/walk technique, alternating thirty seconds of running with thirty seconds of walking for about twenty to thirty minutes, three times a week. Gradually,
increase the length of running segments while keeping them at a manageable pace.
· Stay hydrated especially in warmer weather. Drink at least 1 ½ cups of water 10-15 minutes before running and every 20 minutes during.
· Run on smooth, even and softer surfaces whenever possible. For example, asphalt roads are a better choice than concrete sidewalks.
· Watch for the warning signs of injury. If you begin to experience pain or swelling, stop running and seek medical attention. Depending on the type and extent of injury, treatment may include RICE – Rest, Ice, Compression and Elevation; taking anti-inflammatory medication (aspirin or ibuprofen); and taking time off from running.
– Seek professional advice from a Podiatrist if you are injured or have any concerns