Step by step: Full fitness starts at the bottom with feet

Thursday, May 9, 2002 | 8:24 a.m.

Spring is a time when many, regardless of their age, slip into last year's shorts and grudgingly examine their physique.

Trips to the gym, morning sit-ups and evening strolls are common remedies used to tone sagging proportions.

But the American Podiatric Medical Association in Bethesda, Md., would like people to consider an area of their bodies that is often overlooked: their feet.

According to the association of foot specialists, which in April finished a monthlong foot-health campaign, our feet carry our bodies 75,000 miles by age 50.

Despite the exasperating duty, the complex structures comprised of 26 bones, 19 muscles, 107 ligaments and 33 joints are often forced into ill-fitting or worn-out shoes, doctors say.

In many cases, foot health is rarely considered.

"They're probably the most ignored part of our bodies, until something happens," Dr. James Fausett, a Las Vegas podiatrist, said.

Roughly 75 percent of Americans experience foot problems, according to APMA. Bunions, heel pain (a problem caused by too much pressure on the heel), ingrown toenails, corns and callous are among the most prevalent complaints. Athlete's foot is also a common ailment.

While bunions and hammertoes are mostly hereditary conditions, proper-fitting shoes can help alleviate the pain caused by them, Fausett said.

For example, he said, "If you have a bunion that's hurting,look for wide, comfortable, soft shoes."

Half of Fausett's patients are hospitality workers in the hotel and gaming industry who are on their feet for most of their shifts.

Among those workers, he said, heel pain and bunions are a big complaint. Major causes of heel pain can be improperly fitting shoes, abnormal walking gaits, injury and obesity.

The APMA estimates that more than 2 million Americans receive treatment for heel pain each year.

A good preventative measure for heel pain, Fausett said, is to avoid gaining excessive weight.

"We rarely almost never see a thin person with heel pain," he said.

Though padded inserts and insoles, sold over the counter, which provide cushion in shoes, do have potential to make the heels of a thin person feel more comfortable, the inserts will do nothing for someone who is overweight, Fausett said.

"In looking for a shoe, look at the cushion, the way the shoe bends," Fausett said. "If it bends in the arch, it's a terrible shoe. It should bend in the ball of the foot, near the toe."

Shoes worn too tight can cause corns and bruising under the toenails.

Podiatrists suggest that people shop for shoes in the afternoon or evening because feet swell during the day.

"If there's any discomfort, don't assume that you'll break in the shoe," said Anthony Borgia, a podiatrist at the Southern Nevada Foot & Ankle Center, which has offices in Las Vegas and Henderson. "You need to walk around in the store feeling comfortable before you purchase the shoe."

Toenail trims

Dr. David Krulewitz, a podiatrist at Rainbow Medical Foot Center on Spring Mountain Road, said he sees at least a few people each day who suffer from heel pain.

But just as common among his patients are ingrown toenails, which are nails that become embedded in the soft tissue surrounding the nail. In most cases the tissue becomes irritated, swollen and red. The problem can lead to infection.

Ingrown toenails are caused by improper clipping of the nails. It can easily be prevented by trimming toenails straight across the toe rather than rounding the nail by trimming down the corners, Krulewitz said.

Once infected, the APMA suggests soaking the infected area in warm salt or soapy water. This should be followed by putting a bandage over the infection.

"If there is a problem that doesn't heal within three to five days, it's not going to go away and the person needs to get in" to see the doctor, Krulewitz said.

Over-the-counter remedies should be avoided, and diabetics with ingrown toenails should see a podiatrist.

Patients with chronic ingrown toenails may have to have a portion of the nail permanently removed.

"Lets face it, your feet are your foundation," Krulewitz said. "Nothing about the foot, for the most part, is going to be life threatening. It's a matter of comfort. When your feet hurt you're pretty miserable. It's a quality-of-life issue."

Marion Swartz, a Las Vegas resident and patient of Krulewitz, agrees.

The 55-year-old developed heel pain (also known as plantar fasciitis) five years ago, and was so uncomfortable that she had difficulty walking and was temporarily unable to wear shoes.

"Whenever I walked I had a shooting pain," Swartz said. "It was like an electrical shock was going through my foot.

"The heel was very sore," she added. "It felt like a big black and blue (bruise). I was basically walking on the side of my foot."

Swartz said that a shot of cortisone alleviated the pain. The problem returned a year ago and again it was treated with cortisone.

The cause of the pain, she said, is unknown.

Summer soles and fungi

Las Vegas podiatrist Marcus Singel said that during the spring and summer months, he sees a lot of calloused heels on patients who regularly wear sandals and walk barefoot at the pool.

A thick, waxy, yellow layer of skin builds up where the skin on the bottom of the foot connects with the skin on the back and sides of the heel.

"They (the heels) get really dry and really hard from the friction," Singel said. "Those cracks can go down very deep and can get very painful."

Ultimately it could lead to an infection, he said.

Applying lotion with 20 percent urea cream to the heel two-to-four times a day can help prevent dry heels, Singel said. The best time to apply the cream is when a person finishes showering, or steps out of a pool or bath.

Lotion that contains urea cream can also be applied at night to treat the dry skin, if the heel is then covered with plastic wrap and slipped into a sock.

Those with severe callous can apply Polysporine or Neosporin, then cover the area with a bandage.

Diabetics who have lost the sensation in their feet are most at risk for severe calloused skin because they do not realize that there is a problem. Most doctors recommend that diabetics see a podiatrist rather than treat foot problems on their own.

Singel said that diabetics should always check their feet and avoid walking barefoot because they can unknowingly step on sharp objects. They also should shake out their shoes before slipping into them.

"I've had patients come in with objects stuck in their feet," Singel said.

Fun and fungi

Podiatrists say athlete's foot is another common problem during spring and summer, when temperatures are high and people are most active.

Nylons worn in closed-toe shoes, rubber boots, work boots and athletic shoes made from artificial material enable perspiration and don't allow the feet to breathe, Singel said.

A cotton sock can help absorb the moisture. Powders, such as the nonprescription Stiefel Zeasorb, which is applied directly to the feet, will help keep feet dry, he added.

Singel suggests wearing a shoe with a stiff counter (reinforcement in the back of the shoe) to support the foot, and fitting the shoe to the longest toe. (The longest toe is usually the one next to the big toe.) A shoe should extend 1/4 of an inch to a 1/2 inch beyond the toe, he said.

Alternating shoes regularly, so that the shoe has a day to dry out, is another recommendation from local podiatrists.

"Always change shoes and always change socks," Fausett said. "Bathe your feet each day. Look at your feet to see if anything has changed, such as discoloration or cracks in the nail."

Athlete's foot won't go away on its own, he said. Over-the-counter anti-fungal medication works well for the average person. However, Fausett said, often people don't use the medication long enough.

"The medication should be applied for up to two months after the signs go away," he said.

Faussett said he sees five to 10 fungus cases each year in which the patient's skin has cracked open and bled to the point where the person has to stay off his or her feet.

"They've usually given up on work and say, 'I can't do this any longer.' " When your feet hurt you're pretty miserable."

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