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This month we answer your questions about foot miseries. We want to help you stand on your own two happy, healthy feet.
Q: My heel pain was diagnosed as plantar fasciitis. What caused this? My doctor prescribed exercises; should I keep doing them after my foot heals?
A: The plantar fascia is a thick bundle of tissues that runs from the toes to the heel on the bottom of your foot. Overworking that tissue tears the fascia, causing inflammation, intense pain (it feels like severe bruising on the bottom of the heel) and a lovely limp, to boot. The blood supply to the area is limited, so plantar fasciitis can be very slow to heal.
The injury typically results from overpronation, or rolling the front of the foot too far to the inside. You’re more susceptible if you’re a runner, although this injury also affects those who don’t gallop. You’re also more likely to suffer this injury if you have a tight Achilles tendon or a high arch, or if you wear shoes with high heels, poor arch support or worn soles. Being very overweight can take a toll on your sole, too.
We agree with your doctor’s recommendations but with more emphasis: Do your stretching (detailed in 1. below) every day, no excuses… for the rest of your life. Stretches reduce the pain, which peaks in the morning when you first put weight on the injured foot. Recovery can take eight weeks—longer if you use your feet a lot. Here are the best treatments:
1. Morning stretch: Sit up and cross your legs, setting the ankle of the affected foot on the knee of the other leg. Grasp the sore foot’s toes and pull them toward you. Hold for five minutes.
2. Stretching during the day: Put the ball of the sore foot on the edge of a step, hold the railing, and let your heel hang down; try to hold for one minute. Or repeat the toe stretch from 1.
3. Ice massages: Roll your foot back and forth over a can of frozen juice for 10 to 15 minutes twice a day to increase blood flow and break down adhesions from the inflammation.
4. Nonsteroidal anti-inflammatory drug: Take an NSAID such as ibuprofen to get ahead of the pain—don’t wait until it sets in.
5. Heel pads: Put cushy inserts, sold at drugstores, inside the shoes for both feet.
For prevention: Save the stilettos for weddings and parties, get correct-fitting shoes (or if needed for alignment, get orthotics) and again, do stretches every day.
Q: I have an icky yellow toenail fungus. The doctor’s brush-on medicine didn’t work, and I’ve heard the anti-fungal pills can damage your liver. How can I cure this?
A: First, toss the shoes you’re wearing because the fungus can live there. Keep your toenails dry with absorbent socks and wear open-toed shoes when you can. Don’t go barefoot. Fungi hide in crevices on floors, especially the shower floor. Kill them with chlorine bleach or other disinfectant before they find your feet.
Keep your toenails short, dry and clean. Trim the nails straight across to help prevent bacteria from collecting under the nail. Use a small emery board or nail file on sharp edges. After bathing, dry your feet (even between your toes), because fungi like moisture. Don’t pick or trim the skin or cuticles around your nails, which gives germs access.
You probably tried a topical antifungal medication such as Lamisil to kill the fungus. Topical creams or ointments are only about 10 percent effective. Penlac, a prescription nail lacquer, has been more effective for some patients but is not a sure cure.
The most potent medical treatments are potentially toxic anti-fungal drugs taken by mouth, such as Ketoconazole, Lamisil (again), Sporanox and Diflucan. These cause serious liver complications in about one in 10,000 people, so you should avoid them for a superficial problem.
We recommend home treatments instead. Apply tea tree oil and let it air-dry before putting on your socks. Or soak your feet in a solution of two parts water to one part apple cider vinegar for 15 to 20 minutes each day. Or try 5 grams of Chinese golden larch bark with 2 ounces of vinegar; apply to nails and let the solution air-dry. (The tree products are available where herbal remedies are sold.) Another treatment option is soaking the area in a mixture of a whole clove of garlic and 8 ounces of vinegar for five minutes, twice a day. Last, you might try rubbing the affected nails daily with Vicks VapoRub.
(By the way, the laundry processes used for most health-club towels don’t kill the fungi, bacteria and viruses from a previous user, so you might want to tote your own.)
Q: My big toes get ingrown nails that I cut away to ease the pain. What causes them? What treatments are available?
A: An ingrown toenail—in which a nail’s corner curves downward into the skin—results from improper nail trimming, tight shoes or poor posture. To avoid infection, see your doctor, who will numb the toe and safely trim the ingrown nail. Your doctor can prevent a recurrence by applying an 80 percent phenol solution to destroy the nail-growing cells in the affected area. (Laser removal is equally effective but costs more.) As you heal, protect your toenails from germs by wearing absorbent socks and open-toe shoes when you can.
Q: I have a large bunion that isn’t too painful, although it’s hard to find shoes that fit right. My doctor recommends surgery, but a friend has never walked comfortably since her bunionectomy. What should I do?
A: Unless you have very narrow feet, the frequent wearing of pointy high-heeled shoes will push your big toe out of alignment, causing a partial dislocation of the toe. This creates a bony prominence, or bunion, below the big toe. If you continue to wear tight, pointy shoes, the bunion will worsen.
You have two choices: Modify your shoes or allow a surgeon to modify your foot by correcting the toe’s alignment. Look for shoes with a toe box that is wide and high; this will stop the irritation over the bump and slow the progression of the deformity.
Bunionectomy is an option if you can’t find proper shoes and your pain worsens. The best time for surgery is when your pain symptoms are moderate or you’ve had a significant decrease in shoe comfort. After surgery, you will be unable to wear normal shoes for several months. (Your friend might not have recovered adequately after surgery.)
If you opt for a bunionectomy, choose a highly experienced surgeon. A podiatrist should have completed a surgical residency, and an orthopedist should have had a foot and ankle fellowship.
Afterward, avoid tight, pointy shoes at all costs.