Foot Health Information

Polio is an extremely contagious virus that swept through the US during the earlier half of the twentieth century and now has largely been eradicated by the polio vaccine, created by Jonas Salk in the 1950s. It is transmitted between people usually through fecal-oral contact, and the virus is most prevalent during summer months. Ninety-five percent of the time polio produces no symptoms (known as asymptomatic polio). When it does produce symptoms, the disease comes in three degrees:

1. Abortive polio: The infected person suffers from flu-like symptoms of sore throat, fever, diarrhea and general malaise. Symptoms usually clear within a two week period and the survivor proceeds with life as normal.

2. Non-paralytic polio: More serious than abortive polio, people with non-paralytic polio show neurological symptoms of stiffness in the neck and sensitivity to light.

3. Paralytic polio: A form of the disease that leads to muscular paralysis. Paralytic polio can sometimes end in death. The virus attacks the nervous system governing the muscles. While some people make a full recovery, others suffer from paralysis and deformity that will last for their entire lives.

Foot and leg deformities are widely associated with paralytic polio. Conditions such as scoliosis, improper posture, uneven leg length, stunted growth of the pelvis, pain in the neck, back hip, knee or foot due to uneven growth, flat feet, flaccid feet, high arch (cavus foot), over pronation (the foot’s tendency to roll in towards the body when we walk), mismatched feet, calluses, bunions, corns, hammertoe and claw toe are all long term symptoms of paralytic polio that persist for polio survivors today despite the miraculous vaccine.

These conditions, of course, greatly affect and often reduce a polio survivor’s mobility and thereby, their ability to independently navigate the world.

In order to deal with these foot deformities and problems, special supports and shoes are necessary. Shoe raises can be made to alleviate uneven limb length, which leads to complications in the muscles, joints and tendons of the back and legs. Orthopedic inserts (orthotics) can be used to provide the proper support for flat or flaccid feet, or for feet with stiff and high arches. Other polio survivors need high heels in order to retain the body’s proper balance. Knee, back and lower leg braces can protect the body while increasing mobility. Mismatched shoes may be necessary in order to provide each foot with customized support and proper alignment.

The symptoms of a Morton’s neuroma tend to develop gradually over time. At first, you may only notice pain when you wear narrow shoes or put unusual stress on your foot. Pain may quickly dissipate if you massage the affected area or take your shoes off. As the neuroma worsens, pain may occur anytime you put weight on your feet (but will go away once you rest your feet). In the later stages of the condition, pain may last several days or even weeks.

People with Morton’s neuromas generally report a shooting pain. The pain is localized at the base of the third and fourth toes. The pain is caused by compression of the nerve that runs between the metatarsal bones of these two toes. This compression can lead to irritation and eventually inflammation of the nervous tissue. Sometimes people report feeling a hard, round object that seems to be lodged in the ball of the foot. In addition to a shooting pain, the symptoms are sometimes described as a feeling of burning, tingling or numbness.

Doctors and patients alike often misdiagnose Morton’s neuroma when confronted with symptoms that involve forefoot pain. Your chances of having a Morton’s neuroma increase if you suffer from other foot deformities such as bunions, hammertoe, claw toe or flat feet. If you’re experiencing forefoot pain but do not have a foot or toe deformity, and have no sign of inflammation or reduction in movement in the third or fourth toes, chances are that something other than a Morton’s neuroma is causing your pain. Other possible diagnoses include capsulitis (the inflammation of the ligaments surrounding the metatarsal bones) and intermetatarsal bursitis. These conditions are caused by inflammation of ligaments, tissue and joints not inflammation of the nervous tissue.

In order to correctly diagnose a Morton’s neuroma, a podiatrist will first have you complete a full medical history and will examine your foot externally. He may squeeze or pinch your toes. If the pain is caused by a neuroma, a clicking sound may be heard. This “click” is the noise the neuroma makes when it pops through the two metatarsal bones, and it is often referred to as Mulder’s Click. The podiatrist will also test your toes for their range of motion. X-rays may be necessary, and a MRI scan of your foot will enable the podiatrist to see problems in your soft tissue.

There are several precautions you can take to prevent runner’s knee, a painful wearing away of the cartilage surrounding the kneecap.  This condition (known as patellofemoral pain syndrome, or PFPS) is more likely to affect women than men and is particularly common among beginning runners who start out too intensely.  

The first way to prevent runner’s knee is to stretch and strengthen your leg muscles.  The condition is often the result of an imbalance in the muscles of the thighs (quadriceps, hamstrings and hip abductors).  An unbalanced body (if your quadriceps are much stronger than your hamstrings, for example) puts stress on your joints.  The most common imbalance that leads to runner’s knee occurs when the hamstrings and calves are too tight, and the quadriceps are too weak.  It is important to develop a combination of stretching and strengthening exercises to correct this imbalance before it leads to injury.  

In addition to maintaining your body, it is important to be smart about the environment you run in as well.  Avoid hard surfaces like concrete.  Instead, seek out asphalt or, even better, dirt paths.  Running downhill also puts added stress on your knees.  If you start to experience inflammation or pain in the area surrounding your kneecap, then you should modify your route for a few days so that your knees won’t be subjected to steep declines.  

It is also important to be smart with your exercise plans.  You should never increase your mileage more than 10 percent per week.  Too much of a work out can cripple you before you even get started.   It is important to pay attention to what your body is telling you.  Pain means that something is not right.  You shouldn’t feel like you need to push through the pain.  (Especially when it comes to your knees!)  Instead, you should feel free to cut back your workouts for a few days to allow your body to recuperate.  Taking a little bit a time off to stop runner’s knee in its early stages will ultimately mean less of break then if you wait for the condition to digress into a much more debilitating stage.  

Finally, invest in a quality pair of running shoes.  Look for shoes that advertise high quality shock absorption.  If you have flat feet or tend to over pronate, you may want a pair of running shoes with motion control.  Over pronation puts a lot of extra stress on your knees.  Remember: your running shoes should be replaced every 300 to 500 miles.  A really expensive pair of high-tech shoes won’t do your body much good if you wear them until they are flat.

New Balance has long been popular among runners and avid walkers for their comfortable athletic shoes.  Their line of custom orthopedic shoes promises the same level of quality that their customers have come to expect.

Each New Balance Orthopedic Shoe is constructed over a wooden structure known as a “last”.  There are 13 different lasts that New Balance works from.  Each one is uniquely engineered to address specific pressure points or problem areas for men, women and children.  Some of the lasts are better for certain activities.  For example, the Straight Last (SL) produces an orthopedic shoe designed for running and walking.  The Athletic Last, on the other hand, is designed to support feet during fitness activities such as aerobics, jump rope and working out in the gym.  By building the shoe on the last, New Balance is able to take into account a “360 degree custom fit”.  

The goal of New Balance Orthopedic Shoes is to provide, what the company calls, “individualized solutions”.  The available features are varied.  Anatomical Arch Support, for example, is available for people who suffer from arch pain, plantar fasciitis, high arch (cavus foot) or flat feet.  These features will reduce stress and improve balance.  The size of the arch support will largely depend on the customer’s particular foot type and the source of the pain.  Deep Contoured Heel Cups are available for those customers who suffer from plantar fasciits (heel pain caused by inflammation of the connective tissue that runs along the bottom of the feet) or problems with their Achilles tendon. Add-On Gel Pads are available to target particularly vulnerable sore spots on the feet such as bunions, corns, hammertoe, claw toe or calluses.  Cushioning Foam is a more generalized support system that relieves pressure points along the sole of the foot.

If you are considering purchasing a pair of orthopedic shoes from New Balance, the best thing to do is to get on the phone with someone from the company so that you can discuss your specific needs and identify which type of shoe is best for you.  In addition to orthopedic shoes, New Balance provides shoes that come in extra wide widths or with extra depth as well as shoes suited to particular types of physical activity.  When investing in a pair of orthopedic shoes, it is always a good idea to shop around.  Check out other major footwear companies such as Nike and Reebok to see what sort of orthopedic options they offer.  You should also look into companies like Brooks, Orthofeet and PW Minor who specialize in orthopedic shoes.

When deciding which running shoe to buy, perhaps the most important feature of the shoe is its midsole.  You can’t see the midsole (it is sandwiched between the outsole and the insole), but it is largely responsible for the cushioning your feet, knees, hips and entire body receive each time your feet hit the ground.  It can also help promote foot stability and prevent conditions such as over pronation (when your foot rolls too far inward) or under pronation (when your foot does not roll inward enough), which are associated with flat feet and high arches. 

Midsoles are generally made from two basic materials: EVA and PU. 

EVA stands for ethylene vinyl acetate.  It is not plastic or rubber but foam.  Each midsole is made up of thousands of foam bubbles that act like cells.  Each one of these foam bubbles is filled with gas.  The result is a material that is lightweight and flexible.  Each time you land on an EVA midsole, your shoe breathes a little.  The gas is pushed out and then let back in once your foot leaves the ground. 

PU is also a type of foam.  It stands for polyurethane.  The material is heavier than EVA and is generally less preferred by runners because of its density.  That said, PU tends to hold up better than EVA.  Over time, the bubbles that make EVA midsoles so light and bouncy to begin with permanently lose some of their air.  PU gives less bounce in the beginning, but its bounce lasts longer.

Some midsoles are made with a combination of the two midsoles.  The classic design is to put PU on the outside (where the shoe receives the most stress) and then maintain an EVA core. 

In addition to the midsole, you will want to carefully examine the shoes’ other features as well.  With regards to the outsole, it is normally most important to examine the quality of traction it provides.  Features to look for with insoles include arch support and contoured foot beds. 

A word to the wise: often Shoe companies will use special terms or “company lingo” when it comes time to advertise these straightforward terms.  For example, Asic’s Speva™ is in fact a fancy way of saying EVA (i.e., spEVA).  Most high quality running shoes favor EVA over PU, or some combination of the two.  You probably will not find too many PU-only midsoles, unless you are shopping in the vintage section.

Good foot health is especially important for senior citizens.  The longer your feet stay healthy, the longer you can maintain an active lifestyle.  Simply follow these 5 guidelines put forth by the International Council on Active Aging (ICAA) and the Institute for Preventative Foot Health (IPFH):

Principle One: Proper Foot Hygiene.  Simple daily routines can go a long way when it comes to promoting foot health among senior citizens.  Feet should be washed daily, taking special care to wash between the toes.  Just as important as daily washing is making sure that the feet are dried thoroughly.  Damp feet in shoes can lead to infections such as fungal toenails and Athlete’s foot.  Footwear should also be kept clean and dry.  Rotate footwear regularly, and purchase shoes with removable insoles – a feature that makes it easier to thoroughly dry shoes overnight.  

Principle Two: Regular Foot Inspections.  If left untreated, small cuts and sore spots on the feet can lead to more serious infections.  Foot ulcers (open wounds on the feet) are common among senior citizens who fail to notice minor foot injuries early on.  Reduced nervous sensation and circulation in the feet mean that the feet will need to be inspected visually.  A family member or friend may need to help out if there are problems with eyesight or flexibility.  

Principle Three: Proper Nail Care.  Failure to trim nails properly can lead to ingrown toenails and various infections.  Toenails should be cut straight across to prevent the corners of the nail from growing into the skin.  File away any sharp edges.  If a toenail does become ingrown or infected, see a doctor who can care for it properly.  This is especially true from senior citizens with diabetes or anyone who is particularly vulnerable to infections on their feet.  Discolored or abnormally thick toenails may be a sign of a fungal infection.  If the discoloration or tenderness persists, speak to your doctor.

Principle Four: Foot Care for Diabetics.  Senior citizens with diabetes must be particularly vigilant when it comes to the care of their feet.  Daily foot inspections are crucial, and your doctor should also inspect your feet on a regular basis.  Invest in a pair of orthopedic shoes.  Avoid going barefoot or soaking your feet in hot water.  

Principle Five: Proper Footwear.  Supportive footwear is especially important when it comes to preserving good foot health.  Look for shoes that protect and support your feet.  Orthopedic walking shoes often provide a good combination of comfort and support.  Avoid shoes with narrow toes or little arch support.  Make sure your shoes fit you properly and can accommodate the socks you usually wear.

Hush Puppies is an internationally successful brand of casual footwear based in Rockford, Michigan.  The first Hush Puppies were created in 1958 when the Chairman of Wolverine Worldwide (the parent company of Hush Puppies) was investigating the process of tanning pigskin for the US military.  What resulted was “the classic American brushed-suede shoes with the lightweight crepe sole”.  Hush Puppies were extremely popular in 1950s and 1960s America.  They dwindled in the 70s and 80s before experiencing a resurgence in popularity during the 1990s when young people in Manhattan decided they were “hip” again.  Hush Puppies sales went from 30,000 in 1994 to 430,000 in 1995 and were picked up by major designers. 

The Hush Puppies were named after the fried cornballs popular in the South.  When Hush Puppies sales manager asked why the food was given that name, he was told that they were thrown under the table to quiet barking dogs.  At the time, “barking dogs” was an idiom for sore feet.  Hush Puppies (the shoes!) it seems were meant to quiet “barking dogs” (i.e., sore feet!). 

While Hush Puppies are a stylish shoe, they are in fact incredibly comfortable and are often recommended by podiatrists for people who suffer from sore arches, plantar fasciitis, heel pain or flat feet.  Let’s take a look at a specific example.  The Hush Puppies “Power Walker II” is made with a full-grain leather upper with a padded tongue and collar.  Shoes made of leather provide good air circulation and can help control foot perspiration.  The padded tongue and collar is a nice feature because it prevents irritation of the sensitive skin on the top of the feet.  The inner material is something called Dri-Lex® and it is designed to wick away moisture.  Combined with the leather upper, this high-tech inner lining will keep your feet cool, dry and also odor free.  The insole is removable, which makes it easier for to thoroughly dry the shoes after an exercise session and also means that the shoe can accommodate custom orthotics if necessary.  The midsole is lightweight and the entire shoe clocks in at a very wearable 12 ounces.  The shoe closes with a hook-and-loop instep strap, which provides a secure fit and also allows the shoe size to be easily adjusted to accommodate foot swelling, etc.  All in all, this is a great shoe by orthopedic standards.

Q: What is the difference between flat feet and fallen arches?

A: Though some people use flat feet and fallen arches interchangeably, they can and should be distinguished.  Medically speaking, a person with flat feet has no arches at all.  The soles of their feet rest solidly on the ground. Only 5 percent of the population fit into this category.  Many people who think they have flat feet actually have fallen arches.  This condition is much more common (roughly seventy percent of the population) and rarely has a negative impact on a person’s mobility, athletic ability or susceptibility to common foot and leg injuries.

If you have fallen arches, your foot will appear normal especially when sitting or laying down.  You should be able to make out the curve of the arch just by looking at your foot.  Your arch collapses, however, when you stand and your foot is made to bear the weight of your body.  People with low arches experience a phenomenon known as overpronation.  Each time you take a step, your foot naturally pronates.  That is, it rolls slightly inward as you move through your gait from your heel to your toes.  People with fallen arches tend to overpronate.  Their ankles roll inward to an abnormal extent.  This can lead to increased incidences of knee and soft medial injuries (shin splints) especially among runners.  Athletic shoes that promote stability and motion control can help prevent these injuries among athletes with fallen arches.

People with flat feet are also susceptible to the above injuries.  In fact, having flat feet was one of the easiest ways to be dismissed from military service during World War II (although future studies have proven that the link between flat feet and foot and leg injuries was highly exaggerated).  A large percentage of children are born with flat feet (some studies suggest upwards of twenty percent) but most outgrow the condition in early childhood.  Simple exercises such as walking barefoot outside can help encourage the muscles in the foot to develop and a healthy arch to form.  Sometimes adults contract flat feet.  This is usually the result of injury, long periods of stress to the feet or illness. Unlike children, adults who contract flat feet are rarely able to regain their arches.  Once the muscles and tissues in the feet have stopped growing, no amount of exercise or physical therapy will trigger the arch to reform.    

If you are still not sure whether you have flat feet or fallen arches, perform a simple wet-footprint test.  Dunk your foot in water and then leave a footprint behind on a surface where it will be visible, such as cement.  A flat-footed person will have a solid footprint.  A person with fallen arches will have a slight curve on the inside of the foot – smaller than a foot with normal arches, but present nonetheless.

The quick and crucial answer to the question, “What’s the difference between flat and flaccid feet?” is that flat feet, though they have fallen arches, retain mobility whereas flaccid feet have lost the ability to move at all.  Both conditions are long term consequences of the polio virus, which in its most severe form can lead to paralysis and deformity.  Ninety-five percent of the time, the virus never makes it out of the intestinal tract, and so the infected person is spared the more serious symptoms and instead suffers from what feels like symptoms of a common flu or cold.

When the virus does make it outside of the intestinal tract and into the bloodstream, it attacks nerves, which can lead to muscular paralysis.  The actual duration of the illness may only last two weeks, but the damage to the nerves and the muscles they support can be permanent.  Foot and leg deformities, including different sized limbs, high arches, hammertoe, claw toe, flat foot and flaccid foot, are often associated with the virus.  

Flat feet (pes planus or fallen arches) occurs when the posterior tibial muscle (part of the system of muscles that makes up the calf) is paralyzed.  This paralysis causes the arches of the foot to sag or fall, and the foot becomes flat across the bottom so that the entire sole of the foot makes contact with the ground when standing upright.  Some people are born with flat feet while others lose their arches due to injury or an illness such as polio.

When there is no pain, someone with flat feet can largely go untreated.  Pain in the foot, knees or lower back is an indication that treatment may be necessary.  Orthotics may be required and worn for life.  If the condition is less severe, arch supports can be purchased at a local drugstore.  Some doctors also recommend various foot exercises.  In children, these exercises (sometimes as simple as going barefoot on a rocky beach) can strengthen the muscle and help to form or reform the arch so that overtime the feet become normal.  This reformation of the arch is much more difficult to accomplish with adults who have fallen arches.

Flaccid feet occur when there is complete paralysis of the foot muscles.  Sometimes surgery is able to restore the foot to its fully functioning state.  Occasionally non-surgical treatment is recommended by a doctor that includes orthopedic inserts and foot exercises designed to regain foot mobility.

1.    When purchasing athletic shoes, you will probably need to go 1/2 size bigger than your regular size.  Feet tend to swell when you run.  Be warned.  Not all brands of athletic shoes are sized the same.

2.    If you use orthotics or orthopedic insoles, purchase athletic shoes with these inserts in mind!  You may need a bigger shoe to accommodate the orthotic device.  The same goes for athlete’s who wear particularly thick socks.  

3.    Purchase shoes that cater to your foot type.  People with flat feet should look for athletic shoes that promote stability.  Often these shoes will have packaging that mentions “motion control”.  People with high arches, on the other hand, should look for shoes that advertise added cushioning or support, and shock absorption.  

4.    If you run every day, consider purchasing two pairs of shoes and alternating between them.  Using two pairs ensures that your shoes dry thoroughly between runs, which prevents unsightly foot problems such as athlete’s foot and fungal toenail infections.  If you’re unable to purchase two pairs of shoes at one time, remove your insoles after physical activity to help your shoes dry faster.

5.    Test your running shoes for a week after you buy them.  If blisters form or the shoes cause hot spot on your feet, don’t put up with the foot pain!  You may need a different pair of shoes.

6.    Replace running shoes every 300 – 400 miles.  This will ensure that your foot is getting the orthopedic support it needs.

7.    Buy athletic shoes specific to your sport.  Follow these guidelines:

o    Racing shoes: Racing shoes are extremely lightweight and provide little cushioning or added features.  When it comes to racing shoes, less is more.

o    Cross-country running shoes (or trail shoes):  These heavy-duty shoes are meant for uneven surfaces.  Look for shoes with toe bumpers and solid stitching.  You don’t want them to break down.  

o    Walking shoes: Walking shoes should have an upturned toe that helps you to roll through your gait (like your foot does normally when you walk barefoot).  They may have less cushioning than running shoes and should be fairly lightweight.  

o    Aerobic Shoes:  These athletic shoes should be lightweight and should provide added support beneath the ball of the foot.  

o    Cycling Shoes: Cycling shoes be lightweight and have stiff soles.  They should fit tightly to your feet and provide traction on the sole of the shoe so that you can maintain a firm grip on the pedals.