Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

29 Av 5766 - August 23, 2006 | Mordecai Plaut, director Published Weekly










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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

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.


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