Feet, fabulous feet
Reproduced from Issue 123 of Arthritis Today
Feet are not something that most of us think about for much
of the time – until they go wrong and become painful then we think
about little else. A special Arthritis Today report
on how we need to put our feet first.
Our feet take quite a pounding over the years so it's hardly surprising that they sometimes let us down. Most people take more than two million steps on them every year, and walk more than 115,000 miles in a lifetime – that's four times around the world.
We cram them into shoes that are too tight, too high or too pointed (at least women do, more on that later). Sports people kick balls with them; dancers go en pointe on them. We walk, run and jump on them, expecting our feet to act as shock absorbers for the rest of our body – in short we subject them to enormous pressure.
Instead of neglecting our feet we could look after them better and feel the benefit when we get older. That's what the Arthritis Research Campaign's ( arc 's) Feet First winter awareness campaign is all about. And at this damp, chilly time of year, chilblains, often caused by shoes that are too tight, are a painful reminder that our feet need plenty of TLC.
As well as being a common cause of sports injury and falls in the elderly, arthritis can also affect the feet. For example, about eight out of ten people with rheumatoid arthritis find it affects their feet, and people with over-flexible joints (sometimes called hypermobility or double-jointedness) can also have aches and pains in their feet. Osteoarthritis, the typical 'wear and tear' arthritis is very common in the feet, affecting one in five of all adults, and as many as two-thirds of people over 60.
arc takes research into foot problems very seriously. It is supporting a new programme dedicated to research into the foot and ankle at the University of Leeds, which aims to improve the scientific understanding of this important and troublesome part of the body.
Fashionable footwear and feet
Contrary to widely held belief, there's no hard and fast evidence
to prove that wearing bad shoes is the only cause of foot problems,
such as bunions, clawed toes or ingrown toenails. But there is evidence
of some link, and certainly anyone who has an underlying problem
with the internal mechanical structure of their feet will find that
wearing bad shoes will make matters considerably worse. Women are
twice as likely to get bunions as men and it's women who tend to
wear more constrictive shoes than men. This probably accounts for
the fact more than 75 per cent of podiatrists' patients are women.
However, shoes are not the only factor in the development of bunions,
and between 60 and 80 per cent of bunions run in families, emphasizing
the complex link between inherited foot structure - which we probably
inherit from our parents, and the compounding effects of poor footwear.
"Fashion, not comfort is often the primary factor in determining what shoes people wear," say the Society of Chiropodists and Podiatrists. Tony Redmond, academic podiatrist at the University of Leeds, and the UK's first lecturer in rheumatological podiatry, funded by arc , concurs. "High heels are a great fashion accessory emphasizing the shape of the calves and bottom, but from the point of view of the foot high heels are a disaster," he says.
"Wearing high heels shortens the Achilles tendon, causing restriction in ankle movement, and jams the toes into the front of the shoe, which can cramp and deform them." One recent study published in the prestigious journal, The Lancet , suggests that high heels may even be implicated in the increased prevalence of osteoarthritis of the knee in women, and there is little doubt that high heels can also cause back pain.
"Of course, most women know already that high heels are bad for their feet, and simply make the choice to continue wearing them, hoping the consequences will not be too dire. The message we need to get across is that some compromise will at least minimise the price that women have to pay for beauty."
Tony recommends limiting the wearing of high heels to times when the minor gains in appearance are really worth the short-term pain (and long-term damage), and limiting the height of the heel to less than a couple of inches, except for very special occasions.
It's also important to wear the right shoe size. Sports podiatrist Trevor Prior reckons that 90 per cent of his patients wear shoes that are too small. Slip-on shoes, such as court shoes have to be worn tight, otherwise they wouldn't stay on the foot, but ideally there should be one centimetre between the big toe and the end of the shoe. Lace ups or shoes with straps are better.
Trainers are generally recognised to be excellent for feet. They might not be sartorially elegant, but they are usually well designed and incorporate advanced techniques and materials to provide the foot with a comfortable and hygienic environment. "Trainers aren't suitable for all social occasions but contrary to the historical perception of mouldy sweaty old sneakers, a pair of soft soled, roomy trainers, rotated with other shoes, can provide your feet with a welcome break from time spent crammed into less accommodating footwear," adds Tony Redmond.
Ten top feet tipsThere are several steps you can take to help your feet give you a lifetime of service.
|
Common foot problems
Feet can vary in shape from long and thin to short and broad, and from flat arched to very high arched. For most people such variability causes no more trouble than needing to shop around to find shoes that fit one's own particular foot type; for others, though, the shape of their feet can cause more significant troubles.
Aches and pains can occur in any of the joints or structures in the feet, but the most widely recognised is the bunion , also known as hallus valgus . Bunions are bony lumps on the side of the foot at the base of the big toe, caused by shoes combining with faulty internal foot mechanics with the result that the big toe is pushed towards the other toes. As the bony lump grows, inflammation in the skin underlying the bunion can cause significant pain. The deforming forces may also cause lesser toes to become clawed, a condition also known as hammer toes , which can be treated by surgery if painful. Painful bunions may be relieved by changing to more roomy footwear or with bunion pads, but for some people surgical correction becomes the only option.
Other common problems are calluses , areas of hard skin arising because of high pressure or friction damaging an area of skin, and athlete's foot is common in people with hammer toes, which causes itching and sometimes a red rash. Athlete's foot is common in people with hammer toes because the toes are squeezed together providing a warm, moist environment which encourages the infection. As long as you are healthy you can manage most of these minor problems yourself at home, although you are best asking the advice of your GP, podiatrist or pharmacist first.
Foot problems associated with arthritis
If you have arthritis, your feet can be affected in a variety of ways. In inflammatory arthritis such as rheumatoid, psoriatic and reactive arthritis, and ankylosing spondylitis, joints can become deformed, resulting in wide feet with areas of high pressure, painful calluses (also called callosities ) and in more extreme cases, foot ulcers. Pain in the ankles and heels can arise from the joints themselves or from the muscles and tendons. The most common cause of discomfort around the heel is inflammation in the fibres under the heel bone, leading to a condition called plantar fasciitis , which can also occur in people without arthritis. In people with rheumatoid arthritis, inflammation in the ankles can cause the heel to drift outwards, which destabilises the rest of the foot. arc research has shown that early treatment may slow down this mechanical change and help reduce the resulting painful symptoms.
Osteoarthritis in the feet is common, but often less problematic than osteoarthritis of the big joints like the hips and knees, although it can lead to deformities, or pain in affected joints. Osteoarthritis in the feet is often the result of previous damage from sprains or fractures. People with hypermobility – which affects one in six women aged under 25 – have excessively flexible joints which sometimes leads to aches and pains in the leg and foot as the muscles try to compensate for the lack of stability.
The knock-on effect
Problems in the feet can have a knock-on effect on other joints. "There's a linked mechanical chain – or in other words your foot bone IS connected to your shin bone, and so on," explains consultant rheumatologist Dr Philip
Helliwell. "Abnormalities in the foot will require adaptations elsewhere. So for example if the foot is turned outwards then the shin bone will turn inwards to correct this, and this in turn will put a strain on the hip and knee."
Another important effect of a defective foot is on the spine. "The normal foot is an efficient shock absorber, but an abnormal foot will allow more shocks to get through to the knee, hips and spine," adds Dr Helliwell. "The foot also plays an important role in balance, providing information to the brain and muscles of the legs – which is why foot problems are a risk factor for falls in the elderly."
Children's feet
It's especially important to look after children's feet while they are growing. Heels of any great height should be avoid in children's shoes, as there is considerable evidence that raising the heel alters the mechanical relationships in the human foot and could deform the growing bones. In the longer term, the toes can claw and a bunion may form, but even in the short term shoes that are too tight can also cause blisters on the heel and big toe, and may contribute to ingrown toenails. Shoes should always be roomy enough to allow space for growth, and a finger's width of growing room beyond the big toe is essential when buying new shoes for children.
"Parents are often told by well-meaning shoe shop assistants that there is something wrong with their children's feet, such as flat feet, high arched feet, pigeon toes, or overlapping toes, and we spend a lot of time reassuring them that there is no problem, that these variations are quite normal," explains Dr Helen Foster, paediatric rheumatologist at the Freeman Hospital in Newcastle, which runs a big paediatric physiotherapy clinic.
"There's no doubt though that teenage girls who wear too tight shoes are more likely to get bunions, or if they wear high heels and they already have underlying problems – they may be overweight for example – they get knee pain. There needs to be a balance between what's fashionable and what's good for the feet. The two don't always go together but there is some common ground – trainers for example, which some teenagers like to wear all the time."
What do podiatrists do?
If you can't look after your feet yourself you may need to see a professional. The first step is usually a GP, who may refer a patient on to see a podiatrist, rheumatologist or an orthopaedic surgeon. (The term podiatrist is now replacing the more old-fashioned chiropodist, but it means the same thing).
There are about 20,000 podiatrists in the UK, but only 7,500 are registered with the Health Professions Council – make sure you find someone who is registered. Many work within the NHS, but foot health services provided under the NHS vary around the country, so you might have to find a private practitioner if you are not eligible. Treatment offered by state registered podiatrists includes routine care of nails and calluses, advice on footwear and exercise, evaluation of foot problems, prescriptions of foot orthoses or other insoles, and management of acute and chronic aches and pains in the feet.
arc research and feet
arc is playing a major role in developing the development of better foot care by funding numerous initiatives at the new Foot and Ankle Studies in Rheumatology (FASTER) programme at the University of Leeds. It funds Tony Redmond's five year lectureship, and two further project grants to trial the effectiveness of advanced 'functional' foot orthoses in controlling symptoms in people with hypermobility syndrome, and in rheumatoid arthritis.
Functional orthoses, usually made of moulded plastic are intended to alter the function of a joint in the foot or ankle, and are popular with podiatrists, some physiotherapists and many patients, despite limited evidence for their effectiveness. These two studies should go some way to evaluating their usefulness. These are among a number of research projects developed by Tony Redmond, podiatrist and MRC Clinician Scientist Fellow Jim Woodburn and rheumatologist Dr Philip Helliwell.
Foot notes
|
For more information about feet and shoes go to the Society of Chiropody and Podiatry's website on www.feetforlife.org or the British Footwear Association on www.britfoot.com. arc 's booklet Feet, footwear and arthritis is available from head office.
