Walking and Your Feet

Ingrown Nails Got You Hanging?

If you have an ingrown toenail, you can relate when I say the pain and discomfort is beyond aggravating. Trying to find comfortable shoes is sometimes impossible. But what do you do about an ingrown toenail? Do you try to cut it out with a toenail clipper? Will it be there forever? Some people are scared to seek medical attention because they think they will have to get their nail removed. Though sometimes this is necessary, it is rare that one will have to lose their entire nail.

An ingrown toenail is a nail that digs into the skin and causes pain, swelling, redness, and sometimes infection. It can be caused by genetics, trauma, or improper trimming. Stubbing your toe or dropping an object on your toe may result in an ingrown toenail. Many people cut their nails too short. This encourages the skin to surround the nail and the nail can then pinch the close confiding skin.

A podiatric physician can do a simple in office procedure to remove the offending nail border. The nail will continue to ingrow unless the matrix or the root of the nail is destroyed. When only the outside border is causing problems, the doctor can remove that portion of the nail and only kill the root of that area of the nail. Thus you will still have a nail but a small portion will be removed and will not grow back. Those concerned with cosmetics will be happy to know that the removal of the border of a nail often goes unnoticed by others when the condition is minor. If there is a serious infection present, the root of the nail will not be killed due to the reaction of the chemicals used with the infectious tissue. The nail border is removed and the injury is allowed to heal until the tissue is healthy to undergo chemical cauterization.

Though some need to undergo more invasive surgeries to remove the matrix, most have their problems solved by a simple 15 minute visit to the doctor. The most important thing to do is to keep your hands off your toenails. Do not try to pick at it or cut it because a small problem can become a big problem if you do not remove it correctly.

Heel Pain

The most common cause of heel pain is a condition called plantar fasciitis. The plantar fascia is a ligament on the bottom of the foot that goes from the heel to the ball of the foot. The definition of-ITIS is disease or inflammation. So plantar fasciitis is inflammation or disease of the plantar fascia.

The plantar fascia ligament consists of 3 bands-the medial band in the arch of the foot, the middle band and the outside band. If you suffer from plantar fasciitis, you have inflammation and tightness usually of the inside or medial band in the arch of the foot.

If you have plantar fasciitis, you have a very tight ligament that acts like a rubberband. When you sit or sleep, the ligament tightens up and gets stiff. As soon as you get up and stand from sleeping or prolonged sitting, the arch in your foot drops, your foot lengthens and ultimately pulls that tight plantar fascia. This causes severe pain especially with the first steps in the morning after getting out of bed. That initial first step pain may ease up a little as you walk it out as the ligament stretches or loosens with less pain. The more pulling you get, the more inflammation develops and inflammation causes the pain.

There are numerous reasons why you can develop plantar fasciitis but a common source is due to overuse. The most common causes of heel pain from plantar fasciitis are unfavorable work conditions, exercise-induced or improper use of shoe gear. You are at-risk for heel pain, if you have an occupation involving a lot of walking and/or prolonged standing on hard floors. Nurses, dancers, athletes, runners, teachers, farm workers, construction works, just to name a few are prone to heel pain. Also if you are involved in a traumatic injury such as a car accident or fall at work, you are susceptible to having heel pain. If you recently started a new exercise or workout routine or change in your activity level, you may develop this heel pain condition. Even if you are a world-class athlete, you can 'overdo it' and develop plantar fasciitis. Finally, if you suffer from chronic low back pain, you can be prone to heel pain. Your back condition should be treated and monitored by a back specialist at the same time as seeing a podiatrist for the heel pain.

The symtoms of plantar fasciitis include pain in your arch, your heel or the entire bottom of your foot. If left untreated, your acute heel pain can develop into painful, long-term chronic heel pain.

If you have experienced these symtoms, it is crucial to see a foot and ankle specialist as soon as possible to prevent further pain and suffering. Diagnosis by a podiatric foot and ankle specialist will involve clinical evaluation and x-rays to further evaluate the heel bone and foot structure contributing to the pain. MRI is sometimes needed if a rupture of the ligament or other condition is suspected.

Good News! If you suffer from plantar fasciitis, it can be successfully treated without having surgery most of the time! Initially, the inflammation needs to be addressed and reduced first before the other treatments can work. Stretching and orthotics are very important but they can make your heel pain worse if there is a lot of inflammation and pain.

There are many ways to reduce the pain and inflammation such as Resting by reducing physical activities and 'babying' your foot, Icing your foot 20 minutes 2-3 times a day, Compression with a snug wrap or brace and Elevation of your foot. This can be summarized by the R.I.C.E. mnemonic. Also there are oral steroid and non-steroidal anti-inflammatory medications that can be prescribed by your podiatrist for pain relief. The most effective way to reduce the inflammation and pain by far is a cortisone steroid injection performed in the office of a podiatrist.

Comfortable, supportive shoe gear is important for heel pain relief in addition to wearing high-quality prefabricated or custom orthotics, which can be obtained by your podiatrist. A strapping or taping of the foot can also be performed by your podiatrist or therapist to support your arch. You should not walk barefoot not even around the house (not just socks) to aid in increased shock absorption and heel pain relief. Flip-flops and non-supportive shoes can make your heel pain worse.

Stretching the tight plantar fascia is imperative in the reduction of heel pain from plantar fasciitis. Stretching can be accomplished by using a combination of three different modalities: 1) home stretching exercises, 2) devices to stretch the ligaments and tendons called a night splint and day splint and 3) a formal program of physical therapy done 2-3 times a week by a trained professional.

If all else fails, there are a variety of other types of treatment for chronic, long-standing cases of plantar fasciitis.There is a new, non-invasive treatment of heel pain called the MLS laser. This laser therapy works by interacting with the tissues on a cellular level, speeding up metabolic activity to improve the nutrients crossing cell walls, promoting quick and healthy healing. This is done in the Willow Street Office of Henderson Podiatry with a series of 6 pain-free, quick 8-minute visits.

The last resort for heel pain relief is surgery to release the ligament. This minimally invasive procedure performed in a sterile operating room is called an Endoscopic Plantar Fasciotomy (EPF). It releases the tight medial band only of the plantar fascia.

Once the pain goes away, it can always return no matter what treatment you have had-even surgery. Maintenance to prevent the pain from coming back involves wearing a good, supportive pair of custom orthotics in your shoes, not walking barefoot and stretching the ligaments twice a day.

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.