Solutions to Four Common Foot Problems

One surprise of aging: Your tootsies can feel the worse for wear. Here's how to deal with bunions, heel inflammation, hardening skin and nail fungus

by Emily Listfield
feet image
Photograph: Illustrated by Thomas Fuchs

Deland recommends doing the following two stretches for five minutes in the morning and at night: “Put your affected foot on your opposite knee and gently pull the toes toward the shin and also let the ankle bend. Hold for 15 seconds, relax and then repeat.” Then do a classic runner’s stretch: Press your hands against a wall, standing two to three feet away so you’re leaning into the wall. Let your elbows bend so that your body goes forward. Adjust your distance from the wall to maximize the stretch in the back of your calves. You can also buy boots that stretch your plantar fascia while you sleep (one source: Amazon.com).

If you are overweight, you have one more reason to drop the pounds. “Walking is the equivalent of putting three times your body weight on your foot with each step. If you take some weight off, you lessen the strain,” says Youner.

Cortisone shots can help with the pain, though they won’t remedy the underlying cause of your problem, according to Baravarian.

What a doctor can do: “Ninety percent of people with PF get better with traditional treatments, but there are 10 percent of patients, mostly over 40, for whom the condition doesn’t improve,” says Raymond Rocco Monto, MD, an orthopedic surgeon on Martha’s Vineyard and Nantucket, Massachusetts. One problem: “Microtears to the connective tissue accumulate over the years.”
A number of therapies are available for these stubborn cases. Among the newest is platelet-rich plasma (PRP) therapy, recently in vogue among elite athletes to treat injuries such as tendinitis and tennis elbow. In this procedure, a patient’s blood is drawn, then spun in a centrifuge to concentrate the platelets, which release growth factors. The plasma is then injected into the affected area. In a study involving patients with severe plantar fasciitis, “we found the group treated with PRP did much better right away than those who received traditional nonoperative treatments,” says Monto. “The PRP people also maintained those good results over the year of follow-up.” Insurance coverage for platelet-rich plasma varies, and many doctors still have a wait-and-see attitude about the procedure, but it is becoming more accepted.
One treatment that is not gaining widespread support is the use of Botox to treat PF. While some doctors have touted the nerve paralyzer as a way to lessen heel pain, most in the medical community are dubious. “Your muscles can atrophy so that you might have trouble even walking,” Baravarian says.

Condition 3: Neuroma
What it is: An inflammation and thickening of nerve tissue in the ball of the foot, usually between the third and fourth toes.

Symptoms: The feeling that there is a pebble in your shoe; pain that is lessened when a shoe is removed.

Causes: If your feet tend to roll inward when you walk, that motion over time
can irritate the nerve tissue between the third and fourth toes, producing a neuroma. Another possible contributor: wearing tight shoes that put pressure on nerves in the ball of your foot. Because a variety of factors can cause a similar pain, a neuroma can be difficult to diagnose. Many doctors use a sonogram to see if nerve tissue is inflamed; others press the ball of the foot to listen for a clicking sound that indicates thickened nerves. To be absolutely certain, some inject the nerve tissue with Novocain. If the pain is alleviated, it is a good bet that a neuroma was the cause.

What you can do at home: “If you have a neuroma, deal with it early because it’s much easier to make an improvement then,” Baravarian says. Make sure your shoes are wide enough to avoid squeezing; orthotics and an over-the-counter insole pad to cushion the ball of the foot can also help. “You are better off in rigid-soled shoes that give more support. If you’re going to wear high heels, choose a platform or a wedge—or try to wear a bulkier heel so you don’t teeter on it,” says Baravarian.

First published in the September 2012 issue

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