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Wednesday, September 17, 2014

Why do my feet hurt? Duh........IT'S YOUR SHOES!!!!!!!!!

As a foot and ankle surgeon, I see many people on a daily basis that come into the office with difficulty walking.  The cause of their difficulty stems from many different individualized problems.  However, many people do not realize that their shoes play a key role in why their feet hurt.  Not all shoes are created equally. I am not just bashing high heels here.( as I frequently do because I have a job where I get to wear pajama's(aka scrubs) and sneakers all day)  But many of the shoes we wear can do a real number on our feet.

Did you know that ill fitting shoes can contribute to: hammer toes, bunions, ingrown nails and plantar fasciitis(heel pain) just to name a few?  This can even be worse for the diabetic patient with neuropathy that has loss of their protective threshold.  For this kind of diabetic, an ill fitting shoe can lead to ulcerations and limb loss.  So it is probably no shocker that I spend most of my day educating people on the "right" kind of shoes to wear.

For people with developing ingrown nails, bunions and hammer toes, I try to impress upon them the importance of having enough room in the toe box. As you can see in my wonderful illustration(that is a little sarcasm folks, I'm playing around with doing my own illustrating) that most shoes have a toe box that curves in to put a little pressure on most peoples big and little toes.  Over time, continuing to wear shoes that put pressure on these areas can cause irritation to the nail fold, too much stress on the capsular tissue of  the great toe joint can contribute to a crowding in the toes that may cause hammer toes.  I will take you through each one of these and explain their treatment options.

The ingrown nail is a frequent flyer in a podiatry office.  These patients run the gamut from the 13 year old skateboarder who continues to hit his toe with his board to the 80 year old little lady with the tiniest little shoes on her feet that look like they are going to explode out of them at any second! If the nail is ingrown, I take the time to explain the behavior that most likely is causing the problem.  Repetitive micro trauma for the skater dude and ill fitting shoes for the little old lady.  I am a huge believer that if you don't correct the behavior, you will certainly have the problem again.

Usually the first sign of an ingrown nail is pain to the offending nail border.  This is quickly followed by redness to the nail border and then oozing of  yucky yellow brownish liquid.  It often amazes me at what stage people come in. Some people wait until the toe looks and smells really bad.  My recommendation is if you push on either side of your nail border and it is tender, it might be worth it to get it looked at to prevent all the other infection stuff that goes along with it.

There is a simple in office procedure that we can perform to remove the infected ingrown border permanently.  I always tell patients that, "It's going to hurt to numb the toe and that there is after care involved. They need to soak it it twice a day and keep it covered with triple antibiotic cream and a band-aide. I explain that it is going to ooze yucky stuff and they may not get back into some of their shoes for up to 5 weeks."  I really try and sell this:) But I do explain that it is a great procedure and they will not have to deal with it again.

The topic of shoe gear comes up, as I tell them the only loop hole for this coming back and being their fault is if they wear bad shoes! If they go back into a ill fitting shoe with pressure on the great toe, they will surely suffer the same fate.

I must say, as a female physician, the only time I am very unemphatic to my fellow sisters is when they come into my office wanting their bunions fixed and they have no pain.  As I am not a believer in cosmetic foot surgery, I tend to be not as understanding to the fictitious plight of this type of patient. Plus I don't think anyone ever says, "wow did you see how pretty her foot was!" But shoe gear has been shown to be a proponent of bunions and some people do have pain in their bunion.  A bunion is a deformity of the first metatarsal phalangeal joint otherwise know as your great toe joint.  The toe starts to deviate towards the little toes and the metatarsal head pushes the opposite direction, making many shoes uncomfortable.  As you can see by my stellar illustration to the right, that if you wear a
shoe that cheats a more narrow toe box you will get pain most likely in the areas I have in red.  The bone of the first metatarsal will push back on the shoe and skin causing it to get irritated.  Plus, because the big toe will be pushing to the inside the second toe it has a very good chance of being pushed up and out of the big toe's way.(see the 2nd toe bones below)  This can lead to irritation to the toe and then most likely a hammer toe over time.

Even still, with a deformity like this, shoe gear change may be the answer instead of having bunion or hammer toe surgery.  In the last 13 years of private practice at the Center for Ankle & Foot Care in Clermont, Florida I have treated many people conservatively for these problems.  I always look to a change in shoe gear first and foremost.  What kind of shoes are they wearing? Are they wearing tiny shoes like the little old lady from the ingrown nail? Are they wearing a cowboy boot? Are they wearing a shoe that is all leather with no mesh material?  Many simple tweaks to what we put on our feet can greatly improve how we function day to day with having a deformity like this.

I honestly try the conservative route first on every bunion and hammer toe patient that walks in my office.  If they are having pain or inflammation and redness to the first metatarsal head, I will have them ice and if they can be placed on an anti-inflammatory or steroid for the inflammation, I go that route first. It is only the patient that fails this therapy along with not being able to go a day without pain in the great toe joint and inability to ambulate in any shoe gear without pain, that I consider a good candidate for foot surgery.  From a stand point of patient satisfaction, these are the patients that are happy after bunion or hammer toe surgery. A bunion surgery is no walk in the park for a patient.  When we perform bunion surgery, we must cut the bone and move it in a corrected position(depending on the level of the deformity) and put a screw across it. The patient may be weight bearing as tolerated in a surgical shoe for 6-8 weeks or if their procedure is done at the base of the 1st metatarsal they may be non-weight bearing for 9-12 weeks. Pain and swelling after a bunion surgery is very common and I tell all of my bunion patients that the first two weeks are the worst.

So, again, my recommendation is that you try to change your shoe gear first before contemplating any type of surgery.

What do I recommend for shoe gear? This is a common question from patients and there is no simple answer.  If you have a bunion or hammer toe, going with a shoe that has a mesh material is always going to be superior that an all leather or pleather type shoe, mesh gives and puts less pressure on these prominent bony areas.

Saucony is a nice brand of shoes for those who need a little more room up toward the toes.  Going with this type of shoe in a mesh material reduces the irritation you can get from most shoes that are not mesh. In this type of shoe your are still getting good support of the whole foot still, which is very important.  If my patient is diabetic and suffers from hammertoes or bunions, I always recommend an extra-depth shoe and if they have any calluses on the bottom of their feet I recommend a tri-laminar inserts with offloads to decrease these areas of pressure on their feet to help avoid any ulcerations and potentially limb loss.

Keep an ear out for our next podcast, "2 Pods & a Microphone" where Dr. Henne and I will go over bunions and hammertoes and answer some questions from our listeners about shoe gear and foot surgery.  You can tune in at https://itunes.apple.com/us/podcast/2-pods-a-microphone/id909176500?mt=2 and if you want to ask us a question about this topic feel free to visit our Podcast page at
http://centeranklefootcare.com/id78.html and fill out the quick comment link, if we answer your question on the air you will receive some "2 Pods & a Microphone" swag:)

Look at your shoes, if they have no arch support ditch them or get a really good arch support like our over the counter arch supports for heel pain(shameless plug, but they are really good:) They retail for $63 and go by shoes size you can order your pair on our website   at http://centeranklefootcare.com/









3 comments:

  1. Good to know that the cause of my foot pain might be my shoes. I have tried almost everything besides going to see a doctor to stop the pain. Now I am going to try getting a better fitting pair of shoes. I'll have to try a nice pair of running shoes like you suggest,. Those type of shoes give your foot the most support, and room to relax in. Thanks for the awesome information on foot pain. http://www.podiatrycenterrichmond.com/Service-Areas.html

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  2. Whether working or exercising, we all spend an enormous amount of time on our feet. According to a recent study, three out of four people experience a serious foot problem at least once in their lifetime. We treat in Foot pain, Foot problems, Plantar Fasciitis .Plantar fasciitis treatment, Achilles heel, Bunion, Foot conditions and Heel Pain.

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