Director, Emergency Services, Bikur Cholim Hospital
It is easy to forget this part of your body which is almost
always covered up, takes a beating, costs a lot to cover up
but is never adorned or talked about in public. This
neglected area is your feet.
Feet get the short end of things medically. In Israel they
are the "property" of orthopedists. You can find an expert in
shoulders or knees, but an orthopedist who specializes in
feet is uncommon. In the USA, they are dealt with by
podiatrists who go to podiatry school — an education
separate from medical school.
The foot shares a lot of similarities with the hand. Toes are
built like fingers, and they have similar bones. But the hand
is for fine-touching, grasping, and is sensitive enough to be
called a sense whereas feet are just for weight bearing.
Therefore, for example, we operate on torn tendons in the
hand since fine-tuned motion is important. But in the foot we
often leave them alone.
The foot needs a lot of care because it is indeed unique. The
bottoms of your feet are well padded to deal with the extra
pressure. This tougher skin takes much longer to heal if
lacerated due to its poor blood supply being so far from the
heart. Lacerations can come easily from walking barefoot, a
common malady among little children.
The nail through the shoe is a setup for bad infections
because the foot has major disadvantages when it comes to
infections. The bottom of the foot has the greatest
concentration of sweat glands. This wetness attracts
bacteria. The feet are often covered up and not by the most
absorbent of materials. Synthetics keep in the wetness, and
lack of air and darkness encourage bacteria. With this in
mind, funguses also thrive in the area. Athlete's foot is
famous for acting up between the toes, and diabetics get
infections rather easily in the feet.
Solutions? Keep the feet dry with powder. Change socks or
hose often. If they get wet — especially in the winter
or if someone has diabetes — change them. Diabetics
should check their feet and between their toes often. Small
infections can turn big fast. Cotton socks absorb and are
good for people with infections. Treat athlete's foot. Mikvas
are wet places and can breed fungi in the slippers they
provide and in showers. The solution is to bring your own
slippers and to dry your feet off well after using the
showers.
A second problem not known by our forefathers is the plague
of ill-fitting shoes. Fashionable shoes are often killers on
the feet. First, all shoes need to be broken in. Waiting for
Shabbos and walking a long distance to shul in those
new shoes will lead to blisters. Break them in during the
week, and then wear them for short periods until they are
comfortable. Corns and bunions also come from pressure on
parts of the feet, and shoes are often the culprit. Loose
fitting shoes are always preferred.
Ingrown toenails are infections due to nails growing into the
skin fold. Poor nail cutting technique (cutting too close to
the skin fold) and tight shoes will lead to this.
High heels or pumps are not generally worn in our community,
but if you have friends who wear these, note that the weight
distribution of the body is now concentrated on the ball of
the foot which is at a very unnatural angle. Pointy-toed
shoes are also a problem for our toes.
On the men's side, dress shoes should be tested for comfort,
and replaced when they become uncomfortable.
Plantar Fascitis is a pain in the heel area. This padded area
can get painful if there is a spur (called a durban in
Hebrew) and it is tough to treat. The solution to this
problem can be inserts, but often with less-than-optimal
results. Often this is a malady of the overweight, so it pays
to lose weight.
What about fractures? Toes are never cast. Midfoot fractures
can do well with a walking cast but fractures in the heel
area need a lot of pressure to occur (like falling from a
height) and heal poorly. Surgery may be needed.
This has been just an introduction to feet. Diabetics have
special issues and they need to be in close touch with a foot
doctor. Sometimes only the doctor is capable of cutting their
nails. The best course is prevention of problems.
Write me in care of the Yated.
