The human foot is an incredibly complex structure, comprised of an interconnected network of bones, joints, tendons, and muscles, and as the primary instrument of mobility it must withstand constant use throughout a lifespan. However, the objects we wear to support our feet are often chosen for reasons unrelated to their usefulness, and this can worsen the foot conditions that many people develop over time.
In this episode of Kentucky Health, host Dr. Wayne Tuckson speaks with a Louisville podiatrist to learn about common foot problems and the best ways to treat them. He also visits a Louisville shoe store to have his feet measured and analyzed, and examines several shoes designed to help ease foot pain and provide support.
Dr. Benjamin Schaffer is a graduate of the Illinois College of Podiatric Medicine, and has practiced with Commonwealth Foot and Ankle Center in Louisville since 1982.
Using slides, Schaffer explains the anatomy of the human foot, which contains 26 bones (28 if counting the lower leg’s tibia and fibula). He says that many of the most common foot problems affect the metatarsal bones, which connect the toe bones, called phalanges, to the tarsal bones in the back of the foot such as the heel and ankle. The metatarsals become injured when too much pressure is put on them at the ball of the foot, as they are heavily involved in weight distribution during standing upright, walking and running. This distribution is done through the longitudinal arch of the foot, which also includes muscles and tendons.
If properly constructed, the longitudinal arch allows the foot to support the body’s weight without distress, whether a person is stationary or in motion. But many people suffer from what is called pronation – more commonly known as flat feet – where the arch collapses and provides little to no support for weight distribution.
“When you step down on your foot, it’s supposed to accept the weight,” Schaffer says. “And it’s supposed give a little bit, and serve as a shock absorber, but when you lean forward it’s supposed to be firm so you can push off. And when your foot flattens, it never gets firm, and your whole leg and knee and everything rotate in, and this can cause damage to your knee and hurt your hip, and it can hurt the ankle, since with every step you take, your whole leg is rotating in.”
Foot Problems: Causes and Corrections
Using a series of slides, Schaffer details several common foot problems:
• Corns and calluses: These areas of tough, excess skin form when there is too much friction on an area of the foot. When calluses occur on the bottom of the foot, it is due to an uneven weight-bearing pattern in the metatarsal heads, Schaffer says. Corns on the toe are most often caused by a protrusion in the bone that rubs against a shoe or an adjacent toe.
Schaffer says that if left untreated for too long, corns and calluses can cause open sores in the foot, which can lead to even bigger problems if a person has poor circulation. He says that a person should never try to shave off the corn or callus or rub it down with an abrasive object, but instead purchase proper footwear that takes the pressure off of the affected spot. “Then you can just use lotions to soften the skin, and the corn or callus will go away.”
• Plantar fasciitis: The plantar fascia running along the longitudinal arch is a fibrous tissue that connects the heel to the toes. When a person’s foot collapses too much (pronates), the plantar fascia becomes strained, Schaffer says. Pain can arise in the middle of the arch or in the heel area, and is often most felt when a person stands and/or walks after a period of inactivity. The main remedy for plantar fasciitis is wearing shoes with good arch support, and adding an orthotic insert if needed, Schaffer says. Stretching, injections, and oral medications can also help.
Bone spurs on feet: Schaffer says that bone spurs on the back of the foot near the heel are troublesome in that, similar to corns and calluses, they can cause excessive trauma to the area by rubbing constantly against a shoe. He recommends that patients buy a shoe that cups around the bone spur, but also says that if the bone spur problem persists, a podiatric surgeon will remove it using a small saw.
• Bunions: These deformities occur when a metatarsal bone, often the one connecting to the big toe, begins to shift out of alignment and away from the rest of the foot.
Like plantar fasciitis, bunions are caused by flat feet, and the earlier a podiatrist can spot that condition, the better. “Just like a lot of people have weak eyes, a lot of people have weak ligaments that are supporting their feet,” Schaffer says. “Everybody, when they’re one year old and they start walking, they have a flat foot. Most people develop an arch in the next year or two, but some people never do. And there are shoe inserts, that you can put in your shoe, that are firm, and a lot of them are not even that expensive, and they will stop the foot from collapsing.”
Bunions can also be corrected through surgery, and Schaffer shows an X-ray where one has been realigned by inserting a screw to affix the first metatarsal to the big toe.
• Hammertoe: This occurs when toes bend down permanently, with the toe knuckles protruding. While it may appear that this condition is caused by shoes that are too tight, Schaffer says that it, like many other problems, is caused by flat feet and lack of arch support. “Bunions and hammertoes occur even in civilizations where people don’t wear shoes too much,” he says.
• Problems related to diabetes: Schaffer says that persons with diabetes should pay particular attention to their feet. The main condition that affects diabetics is neuropathy, which is a loss of feeling and/or pain in the extremities due to nerve damage.
Schaffer shows a slide of a person who has an open sore on their big toe, and says that for diabetics, a sore can arise when an area in the foot is exposed to repeated friction that the patient may not even be aware of. “Ulcerations like this picture are, a lot of times, the reasons why people get amputations,” he says. He also advises diabetics not to soak their feet in hot water, because they may not be able to fully sense the hot temperature and will keep their feet immersed for too long.
Shoe Shopping for Foot Health
Schaffer tells his patients to “buy a shoe constructed like a running shoe.” “Even though I’m wearing dress shoes today,” he explains, “they have removable inserts, and I can put a firm arch support in my shoes.”
Dr. Tuckson visits J. Carlton Shoes in Louisville and meets owner John Knotts, who treats him to an “old-time sit and fit,” whereby the length and width of each foot is measured. “About 80 percent of the time, a person has a slight size difference between one foot and the other,” Knotts says.
Knotts then applies a more modern analytic procedure. Using the iStep computer program, he has Tuckson remove his shoes and step on a sensory mat, which transmits biometric information displayed on the monitor. The data show where Tuckson’s personal “pressure points and hot spots” are on each foot.
Knotts and Tuckson look over several shoe options, from dress to casual to athletic. Knotts says that every person has different needs, but that in general, a daily shoe should have a reasonably flat heel, a lot of shock absorption (especially for athletics), some amount of flexibility in the fabric to accommodate corns or bunions, and good arch support. They should also have removable inserts, Knox says, which gives the wearer the option to replace with orthotic inserts that provide more aggressive support.