online edition - PRO Sports Club

podiatryBy Dr. Mari Adad DPMAs we get older, there are some issues that can be problematic regarding feet.Issues usually revolve around foot injuries inconjunction with sports activities; Neuromas,Achilles tendonitis, sometimes heel and archpain, and in some cases metatarsal or toe fractures.Neuromas are nerve scar tissue usually involving the 3rd and 4th toes.Numbness is the initial sensation. If left unchecked it can progress to a hot,burning feeling between the toes. This condition is usually brought on by highheeled,narrow toe box shoes. Basically, any shoe that places more pressureon the toes or too narrow a shoe would aggravate or create more scar tissuearound a nerve. To avoid this, it is important to have proper shoe fit and, ofcourse, avoid high-heeled and narrow toe box shoes as much as possible.Prevention of injuries such as Achilles tendonitis, heel and arch pain, andstress fractures can be achieved with proper shoes for the feet and for thespecific sport. Example, don’t use running shoes for aerobics or any courtsports. One’s biomechanics of the feet can also play a role. Today there aremany different shoes for different foot types. It is important to wear a shoethat will address one’s biomechanical faults. Pre-made arch supports may benecessary for those with hard-to-fit feet, and in the more severe cases custommolded orthotics may be necessary.Skin problems may start to surface (this is inaddition to the above problems). Conditions suchas athlete’s foot, fungal nails and warts may bemore common. This usually has a lot to do with a weakening immune systemin combination with more contact with other people in and around the gymsand swimming pools.Athlete’s foot and fungal nails are usually caused by the same organism. Itis important to keep your feet clean and dry. Fungus likes dark and dampenvironments. Avoid walking barefoot in common traffic areas at a health clubor swimming pool. If your feet perspire more than average, socks are a keyfactor. Brands such as Thorlo, Wigwam, Wrightsock have synthetic materialsthat help wick away moisture from the skin. It is also important to not wear thesame shoes every day. Allow shoes to dry over 24 hours before using themagain. Powder in your socks will also reduce moisture build up. Treatmentscan include topical or oral (pills). Any topical for the nail can take up to oneyear of treatment, whereas the pills need only be taken for three months. Forathlete’s foot, topical creams are the mainstay but need to be used for aboutfour weeks.Foot deformities start to manifest themselvesmore noticeably, especially if poorly fitting shoeswere worn most of the previous years. By far themost common ailment that I see is heel pain (plantar fasciitis). This conditionis mainly a result of a poorly supportive shoe in combination with weightbearingloads. Good support shoes are the key to avoiding this problem. Otherdeformities include bunions, hammertoes, and ingrown nails. In order to avoidor prevent these deformities from developing or progressing, proper shoe fitand properly supportive shoes are crucial. As mentioned above, some feetrequire more than a good shoe can offer. Wearing custom molded orthoticshelps reduce bunion pain and is a mainstay for plantar fasciitis healing. Butagain, if one were to focus on how to prevent these problems, by far, shoe fitis number one. With regard to ingrown nails, if it is not caused by injury ortight shoes, it may be caused by a fungus infection of the nail. Fungus causesthe nail to get thick and it changes its shape. So treating the fungus wouldbe helpful, or a nail corrective procedure could be performed. Certainly aproperly fitting shoe would prevent pressure on the ingrown nail.Another less common problem, but a limiting one, is osteoarthritis (OA) ofthe great toe joint. This is a result of wear and tear of the joint. This occursgenerally all over the body as well. The feet, however, take a lot of beating,and thus many joints of the feet can get arthritic. To prevent early joint wearin the feet, again, proper shoe fit and type is crucial. Anything to provide thefoot with less trauma will help. Orthotics play a very important role in providingproper function of the joints of the foot. These usually avoid excessive wearand tear of the joints. Most treatments for OA involve oral medications thatcan be harmful to the stomach lining. An alternative treatment is a series ofinjections of synthetic joint fluid (Supartz, Hyalgan, or Synvisc). This is labeledas joint fluid therapy and provides pain relief as it coats the joint. It has beenin use for knee joint arthritis over the last 10 years. It can be used in otherjoints of the foot and ankle, as well. It usually provides pain relief for up to sixmonths with minimal to no side effects.38 PRO PULSE SEPTEMBER-OCTOBER 2006