May 10, 2010
Dr. Caroline Gannon
Diseases, disorders and disabilities of the foot or ankle affect the quality of life and mobility of millions of Americans. However, the general public is unaware of the important relationship between foot health and overall health and well-being.
Plantar fasciitis, which is irritation and swelling of the thick tissue on the bottom of the foot, is one of the most common orthopaedic complaints relating to the foot. The plantar fascia is a thick band of tissue that covers the bones on the bottom of the foot. This fascia can become inflamed and painful in some people, making walking more difficult.
Risk factors for plantar fasciitis include:
- Foot arch problems (both flat foot and high arches)
- Sudden weight gain
- Tight Achilles tendon (the tendon connecting the calf muscles to the heel)
A typical patient is an active man age 40-70. Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On X-ray, heel spurs are seen in people with and without plantar fasciitis.
The most common complaint is pain in the bottom of the heel, usually worst in the morning and improving throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest. Typical physical exam findings include:
- Mild swelling
- Tenderness on the bottom of the heel
Conservative treatment is almost always successful, given enough time. Treatment can last from several months to two years before symptoms get better. Most patients will be better in nine months. Initial treatment usually consists of:
- Anti-inflammatory medications
- Heel stretching exercises
- Night splints
- Shoe inserts
If these fail, putting the affected foot in a short leg cast (a cast up to but not above the knee) for three to six weeks is very often successful in reducing pain and inflammation. Alternatively, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing.
Some physicians will offer steroid injections, which can provide lasting relief in many people. However, this injection is very painful and not for everyone. In a few patients, non-surgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.
Nearly all patients will improve within 1 year of beginning non-surgical therapy, with no long-term problems. In the few patients requiring surgery, most have relief of their heel pain.
Diabetic foot issues
High blood glucose from diabetes causes two problems that can hurt your feet:
- Nerve damage in your legs and feet. With damaged nerves, you might not feel pain, heat or cold in your legs and feet. A sore or cut on your foot may get worse because you do not know it is there. This lack of feeling is caused by nerve damage, also called diabetic neuropathy. Nerve damage can lead to a sore or an infection.
- Poor blood flow. The second problem happens when not enough blood flows to your legs and feet. Poor blood flow makes it hard for a sore or infection to heal. This problem is called peripheral vascular disease, also called PVD.
Make sure you wear shoes that fit well. Let's say you get a blister from shoes that do not fit. You do not feel the pain from the blister because you have nerve damage in your foot. Next, the blister gets infected. If blood glucose is high, the extra glucose feeds the germs. Germs grow and the infection gets worse. Poor blood flow to your legs and feet can slow down healing. Once in a while a bad infection never heals. The infection might cause gangrene. If a person has gangrene, the skin and tissue around the sore die. To keep gangrene from spreading, a doctor may have to do surgery to cut off a toe, foot or part of a leg.
What can I do to take care of my feet? Look at your feet every day to check for problems.
- Wash your feet in warm water every day. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet. Dry your feet well, especially between your toes.
- Look at your feet every day to check for cuts, sores, blisters, redness, calluses or other problems. Checking every day is even more important if you have nerve damage or poor blood flow. If you cannot bend over or pull your feet up to check them, use a mirror. If you cannot see well, ask someone else to check your feet.
- If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.
- File corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower.
- Cut your toenails once a week or when needed. Cut toenails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.
- Always wear slippers or shoes to protect your feet from injuries.
- Always wear socks or stockings to avoid blisters. Do not wear socks or knee-high stockings that are too tight below your knee.
- Wear shoes that fit well. Shop for shoes at the end of the day when your feet are bigger. Break in shoes slowly. Wear them one to two hours each day for the first few weeks.
- Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet.
- Tell your doctor right away about any foot problems.
- Your doctor should do a complete foot exam every year.
- Ask your doctor to look at your feet at each diabetes checkup. To make sure your doctor checks your feet, take off your shoes and socks before your doctor comes into the room.
- Ask your doctor to check how well the nerves in your feet sense feeling.
- Ask your doctor to check how well blood is flowing to your legs and feet.
- Ask your doctor to show you the best way to trim your toenails. Ask what lotion or cream to use on your legs and feet.
How can my doctor help me take care of my feet?
What are common diabetes foot problems?
Anyone can have corns, blisters and other foot problems. If you have diabetes and your blood glucose stays high, these foot problems can lead to infections.
- Corns and calluses are thick layers of skin caused by too much rubbing or pressure on the same spot. Corns and calluses can become infected.
- Blisters can form if shoes always rub the same spot. Wearing shoes that do not fit or wearing shoes without socks can cause blisters. Blisters can become infected.
- Ingrown toenails happen when an edge of the nail grows into the skin. The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. You can also get an ingrown toenail if your shoes are too tight. If toenail edges are sharp, smooth them with an emery board.
- A bunion forms when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows big. This spot can get red, sore and infected. Bunions can form on one or both feet. Pointed shoes may cause bunions. Bunions often run in the family. Surgery can remove bunions.
- Plantar warts are caused by a virus. The warts usually form on the bottoms of the feet.
- Hammertoes form when a foot muscle gets weak. Diabetic nerve damage may cause the weakness. The weakened muscle makes the tendons in the foot shorter and makes the toes curl under the feet. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Hammertoes can cause problems with walking and finding shoes that fit well. Hammertoes can run in the family. Wearing shoes that are too short can also cause hammertoes.
- Dry and cracked skin can happen because the nerves in your legs and feet do not get the message to keep your skin soft and moist. Dry skin can become cracked. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse.
- Athlete's foot is a fungus that causes itchiness, redness and cracking of the skin. The cracks between the toes allow germs to get under the skin and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse. The infection can spread to the toenails and make them thick, yellow, and hard to cut.
Tell your doctor about any foot problem as soon as you see it.
How can special shoes help my feet?
Special shoes can be made to fit softly around your sore feet or feet that have changed shape. These special shoes help protect your feet. Medicare and other health insurance programs may pay for special shoes. Talk with your doctor about how and where to get them.