Top Five Foot Problems to Avoid

January 05, 2005
Howard E. Friedman, DPM
Trail Walker


Top Five Foot Problems to Avoid



A 59-year-old man complained to his podiatrist about pain in his right heel that began during a recent camping trip. The patient had been hiking, camping, and fishing for several days. He was also portaging a canoe with his buddy. The combination of poor arch support in his wading boot and carrying a heavy canoe contributed to an acute foot condition. Now, this hiker is sidelined until the pain and inflammation of his foot subside.
His condition-as well as many other hiking-related foot injuries-could have been avoided had preventive steps been taken. Moreover, once such injuries occur, further damage can be avoided if treatment is sought promptly.

Five Preventable Foot Conditions

One foot condition that can be often be prevented is a stress fracture-an incomplete break of a bone that occurs in response to a repetitive action, such as running, jumping, or even walking. Symptoms include pain and some swelling in the affected area. The metatarsals, the bones that connect directly to the toes, are common locations of stress fractures. Other areas that may be subject to a stress fractures are the tibia or fibula in the lower leg. To prevent this injury, one should be sure to include adequate supplies of calcium and vitamin D in one's diet. One early sign of this condition is a stubborn ache or pain in the affected bone, although accurate diagnosis sometimes requires an MRI. Prompt treatment will prevent further injury.

A foot problem more visible than a stress fracture is a painfully infected ingrown toenail. Pain in the corner of the nail, along with redness and swelling, are the early warning signs. Home treatment can include soaking the toe in warm salt water and applying a topical antibiotic. Usually, however, the ingrown nail needs to be removed under local anesthesia. If the condition recurs, the border of the ingrown nail can be permanently removed. Trimming toenails straight across and avoiding tight shoes or boots can prevent this condition from occurring; prompt treatment can avoid complications.

No other part of the body is routinely and completely "double-wrapped" in clothing as is the foot. The warm, damp environment inside the shoe or boot can lead to a fungus infection or a red, itchy inflammation of the skin known as dermatitis. In some cases, these conditions can be an allergic reaction to wool socks, or the result of contact with poisonous plants or insects. Treatment requires the application of a steroid cream. A chronic skin fungus, commonly known as athletes' foot, requires the daily application of an anti-fungal cream, often for a period of up to six weeks. Maintaining dry feet and changing into dry socks can help prevent these conditions. Removing boots at the end of a hike and changing into sandals or moccasins is also helpful.

Tendonitis-the inflammation of a tendon, such as the Achilles tendon-is the fourth preventable condition. Stretching the Achilles tendon prior to beginning a long hike can help prevent this serious injury which, in many cases, can last for months. One suggested method is as follows: Lean against a wall or tree, with feet flat on the ground, one foot in front of the other, and switch between leaning forward and standing straight. In addition, rising up on the toes for five-to-ten seconds, several times in a row, can help strengthen and condition tendons and muscles in the calf and foot. For best results, perform this exercise with the other foot raised off the ground. Prompt treatment will keep a mild injury to a tendon from becoming more severe

One of the most frequent causes of foot pain is plantar fasciitis-the inflammation of the tough, fibrous band of tissue (fascia) connecting the heel bone (calcaneus) to the base of the toes. This condition is often associated with a heel spur, or growth of bone on the undersurface of the heel bone, but may occur even in the absence of a heel spur. An early symptom of this sometimes debilitating condition is a pain or dull ache in the bottom of the heel bone, usually with the first step when getting up from a bed or chair. The pain sometimes diminishes as the day progresses. If left untreated, patients may resort to limping, and they can be sidelined for months from hiking, running, or even walking a treadmill. Carrying a heavy backpack on a long hike may cause this condition.

To prevent plantar fasciitis, one should wear well-fitted shoes with a supportive footbed (arch support). The stretching exercises described above for the Achilles tendon are also helpful in preventing this condition. Remedies include resting the heel on an ice pack for five-to-ten minutes a few times a day, and the use of an anti-inflammatory medication, such as ibuprofen. In some cases, prescription medication may be required. Other treatments include a stretching splint, custom-made arch supports (orthotics), and cortisone injections.

With some common sense, a person's feet should hold up well during years of hiking, walking, and staying physically active. Taking appropriate preventive steps, and early diagnosis and treatment of foot injuries, are very important in keeping patients on their feet.

Howard E. Friedman, DPM, is a podiatrist and board-certified foot surgeon treating hikers and non-hikers in Suffern, New York.