Search

Of course cosmetic treatments are good for morale, but because most of us take the ability to walk for granted, in-depth foot care is often overlooked. Feet exist to enable us to walk, run, balance and generally hold our skeletons up. They can accommodate great changes and will adjust their shape and structure depending on the task we are doing.

The foot is split into three main areas, the forefoot, the mid foot and the hind foot. Between them they contain over 100 muscles, ligaments and tendons, 26 bones (14 of which are in the toes) and around 33 joints, all combining to form a fairly complex structure. They also contain about a quarter of a million sweat glands, which might explain why so many people have such problems managing foot odour. On average humans will take enough steps in their lifetime to walk around the globe 4 times. 10,000 steps each day is now the generally accepted target for everyone in order to remain moderately active. When we run, the pressure exerted on our feet can exceed 4 times that of our body weight.

 Feet typically change in shape and size during our lifetime. It is not unusual for a person to have to buy a bigger size shoe as they age as the structures within the foot relax and spread. When buying new shoes, it might be sensible to buy them in the afternoon since our feet may then be at their biggest, ensuring the most comfortable and appropriate size is purchased. For some people it's the sad case that literally every step hurts. For the elderly, current best practice suggests a professional foot-health check at least once a year. The state of your patients' shoes or appearance of their ankles may indicate when trouble is brewing. I see a number of problems over and over again and I believe that poor foot health is a good indicator of how well the patient looks after him or herself generally. It may be that evidence of poor foot health could reveal further symptoms of more serious neglect or illness.

Oedema

Oedema is often seen in the elderly, and also pregnant women. With the elderly it's best practice to check whether it's associated with other symptoms, such as shortage of breath. The health professional might eliminate the obvious causes of oedema such as lack of exercise or peripheral vascular damage and may point out to the patient that one of the most commonly accepted causes of oedema is sleeping in the chair. It may therefore be sensible to keep the legs elevated – above the heart if possible. Or it may also require a referral of the patient to the GP if a diuretic is required. In pregnancy comfort is of the essence, thus good quality comfortable footwear is essential. Choosing shoes that can expand with the women's feet with either velcro or laces is recommended. If the arches of their feet are suffering and seem to be falling, it will be beneficial to be wearing shoes with a much supported arch, possibly including the use of orthotic devices or insoles to add cushioning and protection. Pregnant women should also ensure they take sufficient rest breaks during the day, when there is opportunity to elevate feet and help reduce swelling. This is not to say pregnant women should necessarily sit down all day, as walking and swimming are widely accepted to be excellent ways of remaining active without causing stresses on the body.

Cracked Heels

A source of great embarrassment and discomfort for many people can be cracked heels. A crack or fissure might be due to having excessive dry skin. Many people may simply be more prone to dry skin as the sweat glands in the feet do not excrete as much as they once did. Cracked heels can be more common in people who habitually wear open backed shoes and sandals - therefore more commonly seen in women. Sometimes the person may have a developmental disorder such as flat feet, an abnormal stride and step pattern, or may have heel spurs, which can all cause problems with the heels including dry skin and cracking. Other widely accepted possible causes include being overweight, standing for long periods, smoking and diabetes, which can compromise the oxygen and nutrient supply to the tissues.

There are many products available designed to treat cracked heels and the more reputable brands can be very effective. Additional generally accepted best practice prevention measures include:

• Not having bath water too hot as this can have a drying effect on the foot
• Applying a good quality moisturiser at least once a day to keep dry skin at bay 
• Using a pumice stone or other device designed for eliminating dry skin can be very useful if a layer of hard skin has developed. Eradicating it before it can progress into cracks should help keep feet soft and smooth
• For those who like to wear sandals, keep the wear time short and apply extra moisturiser

Varicose Veins

Varicose veins can affect all sections of the population. A simple, generally accepted technique is for patients to lift their feet and rotate ankles several times a day; keep moving and wear support stockings, especially if their job requires a lot of standing.

Ingrowing Toenails

Despite the fact that they're so small in relation to the rest of us, ingrowing toenails can cause great distress. They are most common in the big toe. Ill-fitting shoes and poor nail cutting can predispose the nail to grow in to the toe skin. The inflamed tissue is prone to infection. Generally accepted best practice treatment include give advice re cutting nails, potentially treat infection with antibiotics and if there are recurrent problems consider wedge resection of the nail under local anaesthetic. Nails should always be cut straight across and not too short.

Toenails are very prone to fungal infections so feet should be washed frequently and always dried carefully. Fungal nail infections are often caused by an untreated fungal skin infection, such as athletes foot. The fungus spreads to the nail and can grow underneath the nail where it continues to multiply. These infections may be prevalent in patients with other conditions such as diabetes, heart or vascular disease where the circulation to the feet can become depleted. They are also more likely to develop in hot or humid climates where feet do not have a chance to cool. If a fungal infection does present there is a number of effective over the counter preparations, on which pharmacists can advise .

Plantar Fascitis

Other common foot problems which cause pain when walking include Plantar Fascitis which is generally accepted as the most common cause of inferior heel pain. The pain may be worse when taking first few steps after getting out of bed and is usually unilateral. It is due to inflammation in the Planta Fascia and usually settles in less than 6 weeks. Best practice treatment options include advising shoes with arch support, soft heels and heel padding, achilles tendon stretching exercises, potentially non steroidal anti inflammatory drugs, steroid injections and in some cases referral for secondary orthopaedic opinion.

So you can see feet are not just slabs of meat and should be given as much care as other parts of our bodies.

 

This article is the sole work of the author and does not necessarily reflect the views of Johnson & Johnson Medical Limited or any of its affiliated business or companies, nor does the publication of this article on the CareMail website comprise an endorsement of its contents, for which Johnson & Johnson Medical Limited and its affiliated businesses and companies accept no responsibility. In particular no such Johnson & Johnson entity shall be liable for any damages or injury resulting from any reliance placed on any information provided in this article or for any possible inaccurate or misleading data or statements contained therein.

CareMail Home►

• Back to Article Library

Related Articles