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My Aching Feet by Ihor Magun, M.D., F.A.C.P. Earlier this year, I wrote a column, which pointed out several common knee problems: how they were caused, what could be done about them, and how much healthy knees contribute to quality of life and general health. (See "My Aching Knee," February 2005). This month's column explores many of the same issues. Like knees, feet are composed of ligaments, muscles, and tendons, all wonderful parts of skeletal and muscular systems that help us walk, run, dance, jump, and move about in hundreds of ways. We tend to take both knees and feet for granted if they are functioning as they are supposed to. It is only when they ache or cause discomfort that we pay much attention to them. The foot is composed of twenty-six bones, muscles, ligaments and tendons and is subject to enormous amounts of pressure. Just consider how much weight your feet hold while you are standing. Then think about how much work they need to do while you are walking or running or using them to kick something or push something heavy out of the way. When you think about how many times a day you do any of these things and for how long, it is pretty amazing that your feet can withstand this daily workout. Sometimes, unfortunately, they don't. One of the most common foot injuries is an ankle sprain. You can cause an ankle sprain by step ping down "funny" or slipping on an uneven surface or a number of other ways. The result is pain, swell ing, and redness. Basic treatment recommendations include immediate icing, ace leg bandages, and pro gressive walking as tolerated. An x-ray is indicated only if the foot won't bear weight immediately after the injury or if there is tenderness at the midfoot area. Achilles tendonitis is commonly seen in runners and affects the back of the heel. The pain is confined to the tendon. It becomes worse with activ ity and is associated with swelling and tenderness to touch. Treatment includes stretching the tendon, rest, and anti-inflammatory agents like ibuprofen. The most common cause of heel pain is plantar fasciitis. The pain is unilateral and is worse after a period of rest. There is no nocturnal pain; the pain, however, is most pronounced with the first steps taken after getting up in the morning. This condition, more common to women than men, is caused by prolonged or constant standing or im proper footwear. Using an arch support that distrib utes the weight-bearing load of the foot is recom mended. Proper footwear can go a long way to pre vent or reduce painful episodes. Pain in the front part of the foot, localized most commonly between the third and fourth base of the toes, is called a Morton's neuroma. It is five times more common in women than in men, and is especially common in women who frequently wear high heels. People with flat feet are also sus ceptible to this problem. For patients with flat feet, an arch support is helpful. Women who wear high heels may consider switching to more comfortable shoes. Padding and taping of the forefoot is also recommended. Occasionally steroid injections may be helpful. A sudden onset of severe pain, which can occur over several hours and is associated with warmth, redness, and stiffness, can indicate a condi tion referred to as gout. Gout is caused by a deposit of uric acid crystals in the joint space. Typically, it affects the large toe, but any joint can be involved. Any minor touch, even from something as light as a bed sheet, can produce severe pain. The recom mended treatment is a potent anti-inflammatory agent or a medication called colchicine. The most common fracture of the foot oc curs with the big toe. It is usually caused by direct trauma, either from walking barefoot into something or dropping something on the toe. X-rays will show whether bones have shifted and whether a cast shoe would be helpful. If no bone has shifted, the big toe is taped to the adjoining toe to keep it stable. One foot problem that is typical during the winter months is lack of hydration. It is a good idea to keep feet well moisturized, focusing on dry and scaling areas that can become a source of infection. People with diabetes should be especially careful about this, but moisturizing the feet is a good for everyone. Infections from lack of hydration can sometimes lead to hospitalization. I recommend AmLactin 12% lotion. It is available over the counter and can be used on all body parts. “НАШ Е Ж ИТТЯ”, ЛИСТОПАД 2005 19
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