Oak Park Podiatry (708) 763-0580	Advanced Physical Medicine, S. Chicago (773) 776-3166
Advanced Physical Medicine, S.E. Chicago (773) 994-0417

Walking and Your Feet

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Dr. Bender published the following article about the difficulties women suffer with their feet in the 2008 "Women's Health Journal Watch. "

Women's Foot Complants
The most common foot ailments in women are onychomycosis, Morton neuroma, stress fractures and plantar fasciitis.

A variety of foot conditions plague women more often than men. Many are aggravated by the shoes that women wear but also can be caused by loss of bone density as women age. The most common foot ailments in women are onychomycosis, Morton neuroma, stress fractures and plantar fasciitis.

Onychomycosis
A fungal infection of the toenails, onychomycosis most often is caused by dermatophytes (Trichophyton rubrum and T. mentagrophytes) or yeasts and molds, primarily Candida. Although diagnosis often is based on the clinician's judgment, acceptable methods for confirming fungal involvement include use of dermatophyte test medium or a potassium hydroxide test. Onychomycosis results in cosmetically unacceptable nails that are dystrophic, lytic, thick, painful and discolored. The condition can develop as a consequence of tinea pedias, trauma to the nail, an immunocompromised state, or pedicures (removal of the cuticle creates microtears that allow fungus to enter the nail). Treatment options include debridement, oral or topical antifungal therapies, or permanent removal of the toenail with a chemcial or surgical matrixectomy. Simple removal of the toenail without treatment of the fungus will lead to regrowth of the fungal nail. Combination therapy is the most successful approach; for example, results of a 2006 study showed that oral terbinafine plus nail debridement led to higher mycologic cure rates than did treatment with oral terbinafine alone (68% vs. 63%).

Morton Neuroma
This condition develops from enlargement of the third common digital branch of the medial plantar nerve. Pressure from the corresponding third and fourth metatarsal heads and adjacent deep transverse metatarsal ligament causes pain in the third intermetatarsal space. Burning or sharp, shooting pain to the corresponding toes and the sensation of walking on a pebble or a marble are common complaints. Compressive forces on the forefoot (e.g., from wearing shoes with pointed toes or engaging in certain athletic activities) exacerbate these symptoms. A positive Mulder sign (clicking as the neuroma rubs on the adjacent metatarsal heads) can occur on dorsal-to-plantar or side-to-side compression of the forefoot. The diagnosis is best made based on clinical examination or with a diagnostic injection of local anesthetic in the interspace between the metatarsal heads.

Neuromas can also be diagnosed with magnetic resonance imaging (MRI), ultrasound or nerve conduction studies. Other pathologies that can cause similar symptoms are capsulitis, metatarsalgia, avascular necrosis or stress fractures of the metatarsals, soft-tissue tumors, tarsal tunnel syndrome, and plantar plate ruptures. After diagnosis of the neuroma, the patient should be referred to a podiatrist or other foot specialist for evaluation and treatment. Conservative treatments include padding and strapping, orthotic devices and steriod injections. A less-widely used but successful conservative regimen involves weekly injections of a sclerosing alcohol mixture (a combination of local anesthetic and dehydrated ethyl alcohol). In a 1999 study, 82% of patients who were given weekly sclerosing alcohol injections for 3 to 7 weeks experienced complete relief. If conservative therapies are not sucessful, the neuroma can be excised surgically; however, this will lead to a decrease in sensation in the corresponding digital interspace.

Stress Fractures
Metatarsal fractures commonly affect women during and after the menopausal transition; however, athletes and military recruits also can suffer from the condition. The lesser metatarsals are a common location for stress fractures. Patients complain of persistent pain and swelling in the forefoot and might report recent periods of weight-bearing activity (often involving a particular repetitive motion). Initially, the injury is limited to cortical bone - but, if left untreated, the fracture can extend through the entire bone and even become displaced. Although conventional radiographs might be negative for the first 21 days after injury, bone scans or MRIs can reveal the fracture earlier. One study that included 37 female athletes (primarily runners) showed that 47% of stress fractures were identifiable with initial radiographs, whereas 96% were detectable with bone scans. Successful conservative treatment consists of compressive bandaging and immobilization (surgical shoe, cam walker boot, or cast). To prevent fracture recurrence, modification of physical activities and shoe gear should be addressed; in addition, treatment for bone density loss, if present, is warranted.

Plantar Fasciitis
This inflammatory condition of the plantar fascial band (which courses along the plantar aspect of the foot) is one of the most common foot ailments, accounting for 15% of all adult foot complaints. Pain often is localized to the medial plantar region of the heel. Patients report pain when they stand after periods of rest (poststatic dyskinesia). Typically, a brief period of walking offers some relief.

Common causes of plantar fasciitis include foot structure, obesity, changes in physical activity, and lack of supportive shoe gear. Plantar fasciitis is best diagnosed clinically, but ultrasound and MRI often are helpful for visualizing changes in the thickness or continuity of the plantar fascial band. Radiographs can reveal the plantar calcaneal spur that often accompanies this condition. Several other conditions that can cause heel pain (i.e., nerve entrapments, bone cysts, calcaneal stress fractures, systemic arthritic conditions, and lumbar spine disorders) should be considered if the patient has an atypical presentation or is not responding to conservative measures.

Conservative therapy renders successful outcomes in most patients and usually should be employed for a minimum of 6 months. The best conservative therapy employs a combination of icing, stretching, nonsteriodial anti-inflammatory drug therapy, padding, strapping, custom molded orthotics, night splints, physical therapy, steroid injections, short-term oral steroid therapy, or immobilization with a cast or cam walker boot. When warranted, surgical treatments for this condition include open or endoscopic plantar fasciotomies. Newer therapies that show promise but are not yet widely used include extracorporeal shockwave therapy, cryotherapy, and Topaz coblation (radiofrequency technology).

Conclusion
Several podiatric conditions have higher incidence in women than in men. Early diagnosis of these pathologies can lead to more-focused, successful treatment.

About 67 million adults in this country have discovered that walking is one of the most fun, natural, and inexpensive ways of keeping your health—and your feet—in top shape. Walking can be enjoyed almost anywhere, any time, and year around. It's also a good way to get exercise, particularly for people who are out-of-shape.

According to the American Podiatric Medical Association, exercise offers a host of benefits. Walking helps control weight, blood sugar, and cholesterol levels. A brisk walk can burn up to 100 calories per mile or 300 calories per hour. Walking also improves cardiovascular fitness. As an aerobic exercise, walking gets the heart beating faster to transport oxygen-rich blood from the lungs to the muscles. The heart and lungs grow more efficient with a regular walking regimen, reducing blood pressure and the resting heart rate. Walking is also a central element of medical rehabilitation for a wide array of health problems. For example, recovery from a heart attack can be facilitated by a regular walking regimen. Additionally, walking creates an overall feeling of well-being, and can relieve depression, anxiety, and stress by producing endorphins, the body's natural tranquilizer. A brisk walk will relax you and also stimulate your thinking.

To gain the most health benefit from walking, it is important to pay attention to your feet. Shoes that don't fit properly or provide adequate support, lack of stretching, and improper gait can lead to foot injuries or pain. The most common foot problems are blisters, corns, calluses, and plantar fasciitis.

Walking Shoes

The only equipment you need to enjoy walking for fitness is a good pair of shoes. But before you can shop for the best shoe for your foot, you need to identify the natural inclination of your foot and gait. There are three basic foot types:

Pronators are people with relatively flat feet, caused by low arches, which generally leads to overpronation, or a gait in which the ankle rolls inward excessively. People with this foot type need motion control shoes that offer support for mid-foot. Motion-control shoes are more rigid and built on a straight last. These are generally board-lasted shoes, which have a piece of cardboard running the length of the shoe for greater stability. Look for sturdy uppers for added stability and avoid shoes with a lot of cushioning or highly curved toes. Also look for a reinforced heel counter to maintain foot support and stability.
Supinators are people with high arches, which can lead to underpronation that places too much weight on the outsides of the feet. People with this foot type need stability shoes designed for extra shock absorption and often having a curved or semi-curved last. A slip-lasted shoe is also recommended, because the sewn seam runs the length of the shoe giving it greater flexibility. Also look for shoes that are reinforced around the ankle and heel to stabilize the foot and extra cushioning under the ball of the foot.
People with normal feet can wear any type of walking shoe, although a curved last is generally preferred.

When you walk, the natural motion of your foot rolls gradually from the heel to the toe, with your foot bending at the ball on each step. That's why it is important for walking shoes to have enough flexibility in just the right places. A good walking shoe should give a little when you twist it and bend at the ball of the foot. When you put the shoe on a flat surface and push on the toe the heel should come up off the surface. If it does, the shoe has the curvature you need to conform to your movement during walking. Make sure the heel is low and not too wide. A slight undercut in the heel will help your foot begin its roll from the heel through the step.

Here are some other important tips for buying a good pair of walking shoes:

Shop at the end of the day when your feet are slightly swollen to get a good fit.
Try on shoes with the socks you will wear when walking. If you use an orthotic, bring that to the store when you try on shoes as well.
Have your feet measured standing up and fit your shoes to the larger of your two feet.
Be sure there is enough room in the toe box for your toes to wiggle and about a half inch between your toes and the end of the shoe.
Take time when shopping to try on different brands and walk around the store in each pair. Be sure to walk on a hard surface, not just on carpeting. Let your foot be the guide to the fit, not the shoe size or style.
Look for lightweight, breathable materials for greater comfort.
Run your hand all over and inside the shoes to feel for any seams or catches that might irritate your foot.
Choose shoes that lace for better foot stability and control.
Make sure your heel fits snugly and does not tend toward slipping out of the shoe.
Wear your walking shoes only for walking to extend their life. Consider buying two pairs and rotating your wear to give each pair time to breath between walks.
Replace walking shoes after every 300 to 600 miles, depending on how hard you are on your shoes.