Everyone's Health

Steps can be taken to keep healthy feet

'Oh, my feet. My poor, poor feet,” the waitress's lament in “The Most Happy Fella,” is increasingly heard among aging and physically active Americans.

In college, my shoe size was 5. Forty-odd years and thousands of miles walked or run later, I was walking with my college roommate when she glanced at my feet and exclaimed, “Those look like clown shoes!”

Yes, indeed, my sneakers are now a size 7, with a strong arch and a wide, high toe box to accommodate my spreading forefeet, a hammertoe and an incipient bone spur on my left foot, and a tender big toe with a chronic nail fungus on my right foot.

If your feet are still healthy, you'd be wise to take precautions now to keep them that way. These are some of the common problems that can befall aging or mistreated feet.

Bunions: Bony protrusions that form at the base of the big toe result from a misalignment or repositioning of foot bones, forcing the big toe to turn toward the other toes. A similar, albeit smaller protrusion known as a bunionette can form at the base of the little toe.

While heredity can play a role – for example, you may have been born with flat feet or low arches – a more common cause is frequent wearing of shoes with a pointed forefoot that squeezes your toes, or high heels that force your toes too far forward in the shoes.

Bunions can hurt a lot if a shoe presses on them. Wear shoes with a wide toe box and perhaps use a bunion cushion (sold in drug stores) to protect the tender protrusion. Arch supports or orthotics sometimes help. There should be half an inch between the end of your longest toe and the tip of the shoe. Avoid high heels and shoes that are pointed, narrow, tight or too short.

An inflamed bunion can be treated with ice, anti-inflammatory medication and perhaps ultrasound. Surgery is a last resort. The operation, which involves realigning foot bones, has a high potential for complications, and it can take several months before normal walking is possible.

Hammertoes: When a small toe bunches up like a claw, the tip of the toe assumes a hammerlike position, hence the name of this deformity. Among age-related causes are arthritis and shoes that are too narrow or too short. Painful corns can form if a hammertoe rubs against the top of the shoe.

Once a hammertoe forms, it is not possible to reposition it yourself, but you can wear shoes with a roomier toebox or use a foam pad to protect the raised part of the toe. If pain persists, the next step may be in-office surgery to snip a tendon or remove pieces of bone, followed by about a month's recovery wearing a splint and a special shoe.

Morton's neuroma: This enlarged nerve, more common in women than men, causes pain, burning, tingling or numbness on the ball of the foot or between the toes. A tennis-playing friend who had one said it felt as if he were stepping on a nail. It, too, can result from wearing shoes that are too tight. If treatment with protective pads, orthotics, anti-inflammatory drugs and corticosteroid injections does not bring relief, injections of ethyl alcohol or vitamin B-12 may help. If not, surgery may be necessary.

Plantar fasciitis: This is an inflammation of tissue in the bottom of the foot. The usual symptom is heel pain, typically at its worst upon awakening. It most often results from walking with a gait that puts excessive pressure on the heels or from years of walking, running or jumping on hard surfaces. Arthritis and shoes with inadequate heel cushioning are other causes.

Untreated, plantar fasciitis can result in a heel spur. Treatments include temporarily modifying one's activities, exercises that stretch the leg muscles, wearing night splints to keep the foot bent at the ankle, steroid injections and switching to shoes with better heel cushioning. A custom-made orthotic that supports the arch and reduces outward turning of the back of the foot may help treat the problem and prevent a recurrence.

Tarsal tunnel syndrome: The burning pain and numbness in the feet typical of this syndrome result from entrapment of a nerve. Causes, in addition to overuse trauma, include deformities of the foot and lesions that press on the nerve. Treatments include anti-inflammatory drugs, the use of corrective orthotics and local injections of corticosteroids.

Hallux limitus: This condition, also called hallux rigidus and frequently seen in older men, is a chronically painful limitation of movement of the first toe joint that can make walking a challenge. Arthritis and trauma are common causes. Treatment may involve applying a toe bar to the sole of the shoe or using an extended foot orthotic to support the toe joint. Anti-inflammatory drugs and physical therapy may also help.

Nail fungus: Nails that become infected with a fungus become thick and discolored, break easily, may cause pain and may fall off repeatedly. Two oral prescription drugs – itraconazole (Sporanox) and terbinafine (Lamisil) – taken for several months, may eventually clear the infection in about half the people who take them. The drugs can be toxic to the liver. Lamisil cream can keep the infection under control but cannot cure it.

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