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Good Health and Bad Medicine:
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 Arthritis And Rheumatism

 Feet

 Read More Articles About: Good Health and Bad Medicine

Feet

( Originally Published 1940 )

FOOT disorders are one of the penalties man has had to pay for assuming the upright position. The changes affecting the foot during the long evolutionary process of mankind were probably more rapid than those affecting the rest of the body; which may account to a certain extent for his tendency to foot disorders. Much more important, however, in shaping the destiny of man's feet, was the need for covering them. Although foot troubles have probably always been with us to some extent, they have become multiplied many times in the era of pointed toes and French heels.

A great proportion of foot aches and pains can be attributed directly to the wearing of improperly fitted shoes. More than that, many pains and disturbances in other parts of the body are caused by "weak" feet, flat feet and other foot troubles. Many instances of so-called "arthritis" of the knees, hips, sacro-iliac joints and spine and attacks of lumbago are in reality caused by foot trouble.

Flat Feet

Despite the fact that flat feet are so common, there is yet no agreement among experts as to their cause. All agree, how-ever, that the disorder may be acquired at any period of life after walking has begun.

When an infant begins to walk, its feet may appear flat. Such flatness is, however, more apparent than real, since the arch of an infant is normally somewhat obscured by fat pads.

In adolescence, the rapid increase in weight and the beginning of occupations involving prolonged standing may cause a tendency to flattening. In adults, flattening and pain in the feet may occur when the weight tends to increase above normal. Lack of exercise (walking, running and jumping) also predisposes to flattening because the many muscles that support and give strength to the bony arch of the foot be-come flabby and soft.

In flat feet, the bones in the inner border of the foot drop, and the arch which is normally present, becomes more or less flattened. But a flat arch is by no means an indication of flat feet; the normal height of the arch varies a great deal from one person to another. Unfortunately, many people are treated for flat feet when they are really suffering from painful conditions which are caused by other disorders and which simply happen to occur in a foot which has always had a very low arch. Don't permit a shoe salesman to sell you an arch support or an "orthopedic" shoe simply because you have a low arch. If your feet seem flat and you have had no foot trouble, don't worry about it. An ordinary comfortable shoe is sufficient.

If there is pain and disability of the feet, it may take a good deal of expert discrimination to determine whether the pain and disability are really due to flattening. It is frequently necessary to have an X-ray examination of the feet to ascertain whether there is disease of the bones or joints. Certainly a shoe salesman lacks the knowledge and training to determine the cause of foot troubles, and he should not be permitted to prescribe for them. Arch supports, unless properly fitted, may do more harm than good.

Arch supports must be fitted to individual needs. Ready-made supports do not meet individual requirements and therefore should be avoided. An improperly fitted support may limit the mobility of the joints and interfere with the muscle action of the foot. In order to determine individual needs, a cast of the foot is frequently made. Adequate correction is then possible. An examination by a physician or orthopedic specialist, and possibly an X-ray of the foot, may seem like a large outlay for a minor foot disorder. But in the long run, expert care will save a good deal of discomfort and money. Licensed podiatrists. are trained to recognize and treat the common foot disorders. The competent podiatrist will often insist upon a general physicial examination by a physician before undertaking to treat a foot disorder.

If it has been determined that the feet are abnormally flattened and responsible for pain and disability, there are many measures that can be tried for restoring the integrity of the arch. An arch support may have to be prescribed. Arch sup-ports alone, however, do not cure flat feet. Foot exercises are also necessary. A good one is to roll forward and backward while standing on the outer borders of the feet, the feet pointing inward. Periods of prolonged standing must be avoided.

Painful Feet

Besides flat feet, many other foot conditions cause pain. Even if the arch is sturdy, overweight or obesity will place a burden on the arches and feet that they may not be able to sustain. just as a twenty-ton truck is never mounted on a flivver chassis, so 20o pounds of weight can cause untold discomfort to feet built to sustain a maximum of 120 pounds. For such foot discomfort, the remedy is obviously a carefully planned course of weight reduction.

During a period of prolonged illness, the muscles and ligaments of the whole body, including those of the feet, may become weak and relaxed through lack of use. With the resumption of activity, the feet may require support by an elastic bandage around the instep so that the strain on the arch will not be too great. When the muscles have become stronger, the pain and disability will cease. Exercises of the feet during the convalescent period will accelerate the return of normal muscle tone.

Rheumatism or arthritis may affect any one of the twenty-eight joints of the foot and cause considerable pain. In diabetes and certain other diseases, the blood vessels to the legs and feet may become narrowed. The interference in circulation can cause very severe pain.

The most important cause of painful feet probably is faulty shoes. Women are the chief sufferers, because the shape of the shoes they wear is totally unrelated to the anatomy of the foot. The high narrow heel is especially to be condemned. For foot comfort, the heels should be not more than two inches high and with a base of at least four square inches to insure adequate stability. Toes of shoes should be roomy enough to provide freedom for the toes, both up and down and sideways. The widest part of the shoe should come at the joint of the big toe, and the sole should be wide enough at this point to extend out to either side of the foot and not be overrun by the upper. The inner edge of the sole should be straight, or nearly so. Heels should fit snugly enough to prevent the foot from sliding within the shoe.

When buying, test the fit while standing and while walking. Remember that the various foot-measuring devices can at most give the salesman only a first guess as to the size to try on. Properly fitted shoes should require no painful period of "breaking in." These directions hold for men as well as for women.

With children's shoes it is especially important to make careful examination for proper fit. They should fit comfortably at the time of purchase. A half-inch margin in length will allow for three or four months' growth; a greater margin is not desirable. Light and flexible leathers are better for the feet than the more durable but heavy and stiff leathers. Shoes should be fastened with adjustable laces or buckles, rather than buttons. Sharkskin tops on the toes are desirable to resist scuffing.

Infants do not need leather shoes until they have learned to walk, and the first pairs should be very soft and flexible.

Even people with strong feet and wearing well-fitted shoes sometimes suffer from occasional footache, particularly after a long walk. Soaking the feet in hot water for about 15 minutes followed by a rub or massage with alcohol or oil of wintergreen will give a good deal of relief.

Most foot powders for the relief of sweating, tired feet, including those heavily advertised, contain alum and salicylic acid. A useful mixture for powdering the feet in the morning or after a foot bath consists of i o % or 15% alum and 2% salicylic acid in talcum powder or kaolin, made up by your druggist. (Avoid these drugs if you are sensitive to them.)

Bunions

A bunion is an abnormal protuberance situated usually just behind the great toe joint. Two conditions are generally responsible for this protuberance. First, the front part of the large bone just behind the great toe becomes displaced from its alignment with other similar (metatarsal) bones. The irritation to which this bulging bone is subjected causes the formation of an inflamed sac. The displaced bone (known as hallux valgus) plus an inflamed sac (bursitis) make up the common bunion.

Obviously, if the displacement of the metatarsal bone could be prevented, the development of a bunion would be impossible. Unfortunately, however, man's foot did not adapt itself to evolutionary changes as well as the rest of his body, so that he is born with a foot susceptible to many disorders. If the feet are not abused, and comfortable shoes are worn, the evolutionary weakness of the foot often will not be betrayed. But high-heeled shoes subject the foot to strains frequently beyond its capacity. A "splaying" of the whole front half of the foot occurs whereby the first metatarsal bone becomes displaced from its normal alignment toward the inner border of the foot. Intrinsic evolutionary weakness, plus bad footgear, produces bunions.

If a bunion has already formed, it can be prevented from becoming worse by wearing a comfortable shoe chosen ac-cording to directions outlined above. In minor cases of hallux valgus, the use of correcting springs, straps and pads may be all that is required. Appropriate padding by a skillful podiatrist may be sufficient. If the bunion is painful, it is helpful to wear wide shoes or those especially constructed with pockets inside for the protection of the bunion. Advertised remedies such as pads give, at best, only temporary relief. Improperly fitted pads can increase the damage to the bones and muscles.

If these measures fail, or if the bunion is esthetically objectionable, it will be necessary to resort to surgery.

Hard Corns

These are caused by the pressure of badly fitted shoes. The first step in the cure is necessarily to get a properly fitting shoe and thus ease the pressure. Then use the following treatment: Soak the feet in warm water about 15 minutes; dry thoroughly and apply to the surface of the corn one or two drops of 10% salicylic acid in collodion (many proprietary corn removers are of similar composition); and wear a corn plaster over this. If the corn does not lift out after a few days of such treatment, a podiatrist or physician should be consulted. Because of the risk of infection, removal of corns by cutting should be left to the podiatrist or physician. Many proprietary corn remedies contain an excessively high percentage of salicylic acid. The drug causes maceration or softening of the skin surrounding the corn, thus encouraging infection.

Soft Corns

Soft corns occurring on the inner surfaces of the toes are frequently associated with athlete's foot infections and do not, as a rule, yield to simple home remedies. The services of a physician or podiatrist are generally necessary.

Calluses

These are found on the soles of the feet. There are two varieties. One is probably caused by infection-the other by bad footgear. The first may require X-ray treatment for cure. In order to prevent recurrence it is essential to wear clean and preferably new slippers when walking about the house. Cardboard slippers which can be often renewed are best. The second variety of callus requires a properly fitted shoe, the use of a fitted metatarsal pad and the paring down of the callus by a podiatrist or physician.

Ingrown Toenails

These are frequently caused by the wearing of tight, pointed shoes, tight stockings or improper cutting of the toe-nails. One method of cure is to allow the nail to grow and then cut the nail straight across instead of in a curve. If infection has already set in and the edges are swollen, red and painful, soaking the toe in hot water for 15 minutes will give temporary relief. In persistent and severe cases, a physician's help is necessary.

Perspiring Feet

Moderate foot perspiration is normal. Excessive perspiration may be combated by washing the feet twice daily in tepid water, sponging them with rubbing alcohol and then sprinkling them liberally with a dusting powder. Bismuth formic iodide powder or 1% to 2% salicylic acid in talc are excellent dusting powders. In severe cases, the feet may be swabbed with a 15% solution of aluminum chloride in water. Be sure to allow the solution to dry before putting on stockings or socks. Sometimes excessive perspiration is due to a disturbance in the circulation of the feet and it may be advantageous to seek medical help.

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