FOCUSING ON THE "FOOTAMENTALS"

By James J. Porter, DPM, FACFAS

Owner & Physician at Spokane Foot Clinic

 

As a 15-year old young man, I dreamed of someday starting on our high school varsity basketball team, (which still holds the state record for the most state basketball championships). To give myself the very best chance, I decided that I would work hard, save my pennies, and earn the money needed to attend the prestigious John Wooden Basketball Camp in Los Angeles that summer in preparation for trying out for the team in the fall. Thankfully, my parents split the cost with me. Under Coach Wooden, who was known as, “The Wizard of Westwood,” UCLA had won 10 NCAA Basketball Championships in a 12-year period between the years of 1964 through 1975! (Wow, that really dates me). So many of my childhood memories of the NCAA Basketball Tournament included those of the UCLA team cutting down the nets. So, you can image how thrilled I was to work toward that dream of being coached by the famous John Wooden. “Perhaps he would teach me how to do a better behind-the-back pass, dribble between my legs, or hey, maybe even spin the ball longer on my finger,” I thought. The anticipation built up and the day finally arrived. As we gathered together as a large group of aspiring players, Coach Wooden came into the gym to give us his opening camp address. There I sat, sporting my short shorts, knee-high socks, (I think those are coming back in style, by the way) with a glazed look; I was in awe. Here was this legend, and I was going to benefit from all of his experience and knowledge. But... to my surprise, there was NO mention of any tricks, fancy plays, or “look at me” showmanship. Rather, he explained that the success of their program was built upon learning the fundamentals and then doing them better than anyone else. “It’s all about the basics”--everything that I had already heard from my own coach back home a hundred times. And yet his message rang loud in my mind. “There is no short cut, trickery, nor gimmick to compensate for my failure to focus on the fundamentals. It’s all about the basics,” I kept repeating during that long flight home. And to this day, I still look back on that simple yet powerful message as great words of wisdom.

What applied to basketball also applied to general foot care. You have likely heard of these “basics” a hundred times, but the fundamentals are what keep your feet the healthiest and you the most active. There are rarely any gimmicks or tricks which can override the need for basic foot care. If we slack on the basics, our risk of foot problems increases. Over the 24 years that I have been a podiatrist, I can now back up many of these guidelines with a tragic story of one who ignored them. And so, we’ll now focus on 5 foot care fundamentals which I’ll refer to as, “footamentals.” (Okay, that’s corny, but easy to remember) as well as “Top 25 Tips” for foot care.

Footamental #1: Understand YOUR feet. Why Feet?

I get asked almost weekly, why I chose podiatry as a career. As a college student I felt invincible to health problems. So, I neglected the principles learned years before and my own foot condition only got worse. I didn’t understand how important the feet are until it affected me personally. Or, as one of my patient’s jokes, “It’s a different experience when YOU are the one experiencing the “agony of [de feet].”

If we don’t understand the feet, we won’t understand the need to care for the feet. Out of sight; out of mind. Here are some “fun foot facts” that may spark your interest in the importance of foot care.

A. The foot contains 26 bones, 33 joints, 107 ligaments and 19 muscles and 1/4 of all the bones in the human body are down in your feet. When these bones are out of alignment, so is the rest of the body.

B. During an average day of walking, the total forces on your feet can total hundreds of tons, equivalent to an average of a fully loaded cement truck.

C. The average person will walk around 115,000 miles in a life time; that's more than four times around the earth!

D. The pressure on the feet when running can be as much as four times the runner’s body weight.

E. Women have about four times as many foot problems as men.

• 9 out of 10 women wear shoes that are too small for them.
• High heels are partly to blame.
• Note: Men erroneously encourage woman to wear high heels. (Ok, so I included the last bullet point to confess my guilt to my wife). Do you see the trend?

F. About 75% of Americans will experience foot problems at one time or another in their lives. (Ok, not a “FUN” fact, but true nonetheless).

G. During the first year of a child’s life their feet grow rapidly, reaching almost half their adult size. By 12, a child’s foot is about 90 per cent of its adult length.

Top Tips:

1. Learn what foot type you have (low vs. high arch, pronated vs. supinated, flexible vs. rigid) and buy shoes at a reputable shoe store that can find the appropriate type of shoe for your feet.

2. It is very common for new mothers to have foot pain during the end of their pregnancy or after giving birth. The sudden release of hormones to relax soft tissue to allow the baby to be born also affect the feet. Orthotics and proper shoegear can help limit pain associated with a change in foot structure.

3. You might get away with “bathroom surgeries” when you are younger, but when one’s circulation and healing ability is less than optimum, it becomes a very dangerous practice. Seek medical help!

Footamental #2: Listen, Inspect, and Respect!

Listen to your feet: I had a patient once who told me that he had lost his hearing aid and could not find it. When he took off his shoes that night, he found his hearing aid had been in his shoes all day long. “That explained why I had been hearing footsteps all day long,” he joked. In all seriousness, if our feet are screaming at us in pain, it’s time to investigate why. If your feet tell you that a certain pair of shoes or activity hurts, stop wearing or doing what hurts your feet. Sounds like a basic, but we hear patients’ stories frequently about how they ignored this basic footamental. The adage “no pain, no gain” has never made sense to me as it relates to foot care. Pain is our body’s way of telling us that something is wrong.

Inspect your feet daily: The greatest prevention of serious foot problems is AWARENESS. Foot ailments can become your first sign of more serious medical problems. Your feet can mirror your general health, so conditions like diabetes, arthritis, circulatory and nerve disorders can sometimes show their initial symptoms in your feet. When you inspect your feet, look for redness, drainage, swelling, bruising, lesions, and changes in the shape of your toes, feet, and ankles. They can tell you a story, if you listen.

Respect your feet: Listening to your feet but not doing anything about them is DISRESPECT. (I can hear a Diana Ross and the Supremes / Temptations song coming on). We hear so commonly, “I’ve had the foot problem for 6-7 months, but just kept thinking it would go away.” And with loving words that almost sneak out of my mouth, I’m thinking, “And how has that being working out for you?”

Top Tips:

4. Remember a 30 second daily foot inspection may save your foot literally. Look for the following:

• Sores, cuts, cracks
• Signs of potential infection: redness, swelling, drainage, streaking up the foot, unusual odor
• Small cracks (fissures) between the toes, or excessive wetness
• Discoloration of toes, bruising
• Excessive dryness, calluses
• New skin lesions, masses
• Change of foot / toe structure
• Areas of numbness
• Objects stuck in your foot

5. If you’re choosing between an activity which you enjoy but which causes foot pain, your feet get the final vote.

6. Choose comfort over fashion every time (ok, except for those really rare dates).

7. Don’t forget your children! Pay attention to children who:

• Can’t keep up with their peers
• Voluntarily withdraw from activities they usually enjoy
• Trip and fall more often than usual and
• Complain of foot pain. (They are not always trying to get out of doing chores).

8. With the higher level of competitive sports among more youth, I have been treating more overuse injuries. Be cautious of children playing multiple sports concomitantly.

9. Whenever the level of competition intensifies, the frequency of injuries multiplies.

Footamental #3: Don’t Forget Your Supporting Cast

“It’s not all about you,” is a phrase a narcissist may hear. But, sometimes our patient’s still ignore that concept. “I think I have this foot problem because that’s just the way my feet are,” can be a true statement on occasion, but when I look down and see the “shoes” that they’re wearing (or not wearing), I sometimes teach otherwise. Give your supporting cast a little more attention and they’ll make you perform and feel better. Flip flops change foot biomechanics. High heels shift your center of gravity. Worn out shoes can tilt the feet into an abnormal position and place added stress and strain on the tendons and ligaments of the feet. And so generally, one is only going to be as healthy, successful, and ultimately active as the supporting cast around them. Investigate and invest in a good supporting cast by considering more stable shoes, good arch supports, or sometimes even custom-made orthoses to keep your body in better alignment.

Top Tips:

10. Simply put, wear comfortable shoes. The best way to protect feet and toes from injury is to wear shoes.

11. Buy shoes later in the day to size for slightly swollen feet.

12. Shoes with soft leather uppers can mold to the shape of your feet better.

13. Use flip-flops and sandals more sparingly (in place of walking barefoot, in locker rooms, and around pools).

14. Choose appropriate footwear according to the activities of the day. (Just as you don’t wear hiking boots to play basketball; don’t wear basketball shoes for hiking). Buy the right shoes for the right sports/activities.

15. Don’t forget the importance of appropriate socks, especially when wearing new shoes.

16. Don’t forget to check your children’s shoes for excessive wear, fit, and comfort. Remember, they can grow 2 shoe sizes within 6 months or so.

Footamental #4: Forgotten Flexibility: Remember both Strengthening AND Stretching Exercises

When I was in Junior High, I had one coach that would watch some of us “stretching” during the designated stretching period and see our less than enthusiastic efforts. He would comment with the same declaration, “You’re only hurting yourself. Some day, some day . . . ,” he would sigh in prophetic tones. When we’re younger, perhaps we can get away with not stretching as much as we should, but the older I become (and I am getting older as you can see from some of my previous statements) the more I am realizing just how much inflexibility can affect performance. Tight muscles and tendons definitely have a negative effect on joints and foot/ankle function. Many patients also confuse strengthening with stretching. Both are needed, but most of us put more effort into the former than the later. There are many exercises you can find on-line, but one simple test to determine how your arches are performing in their important functions is the Foot Push-Up Test listed below:

Foot Push-Up Test for Strengthening:

• In bare feet, stand facing a kitchen counter.
• Place your palms on the counter with slight pressure.
• Stand with your back straight and lift one foot off the floor.
• Slowly lift the heel of other foot, placing all of your weight onto the ball of your foot.
• Slowly lower your heel back to the floor.
• Do 10 foot push-ups.
• Repeat steps 1 – 6 with the other foot.

Calf stretching (with the knee both extended and flexed) is one of the most important stretches one can do to improve foot/ankle flexibility.

Top Tips:

17. Each time you walk up or down stairs, pause for 20 seconds to allow your calves to stretch by slowly hanging your heels off of the edge of the step.

18. When you’re standing for more than 15-20 minutes, try to walk around to flex your calf muscles and improve the circulation.

Footamental #5: Remember Protection: Don’t let your Achilles heel be YOUR point of weakness.

Many may be familiar with the great Greek mythology hero, Achilles. Although Achilles was a mighty warrior during the Trojan War, it was believed that he was invulnerable in all areas of his body except for his heels, and sources concur that he was killed near the end of the Trojan War by Paris, who shot him in the heel with an arrow (perhaps the only area unprotected by armor). Because of his death from a small wound in the heel, the term, “Achilles heel,” has come to mean a person's point of weakness. Know the weaknesses of your feet. And remember, protection is usually prevention!

Top Tips:

19. If you are prone to sunburn, apply sun screen to your feet before going out.

20. Be very cautious of hot pavement or sand.

21. If you have unstable ankles, then wear high top tennis shoes, comfortable boots, and/or ankle stabilization braces.

22. Avoid buying shoes with open toes or heels. Remember Achilles!

23. Not all sandals are alike. If you feel the need to wear sandals, look for a sturdy, cushioned, supportive sole with padded straps.

24. Avoid getting your feet too hot or too cold. If you’re prone to getting cold feet, wear wool socks and/or insulated boots.

25. When in doubt, come and check us out! The sooner one seeks medical care for a foot condition, the quicker recovery is, generally.

Conclusion: Each of us, some time in our lives, has wanted to skip past the basics, believing that “they just don’t apply to me.” But, it might just behoove us to remember that profound principle taught by a wise coach to a group of high school want-a-bee basketball players: “The success of our program has been built upon learning the fundamentals and doing them better than anyone else.”

I didn’t ever start for our Varsity Boys Basketball Team, but I did make the team that year as a sophomore and our team went 25-0 to win another State Basketball Championship. And . . . I can at least say that I learned one more lesson: Sitting on the opposite end of the bench away from the coach isn’t as much fun as starting, but even that seat is a front row seat in a large gymnasium!