Important Information about Common Foot Problems from America’s Podiatrist Dr. Michael Nirenberg
Thanks to guest author America’s PodiatristSM, Dr. Michael Nirenberg for these great insights into some common foot pain problems. I hope that you have healthy and happy feet, but if any of the foot problems below are an issue for you – please listen to your feet and seek medical attention if necessary. Treatment and prevention is a whole lot better than living with pain!
I hope you enjoy reading this helpful foot-care info!
Common Foot Problems to Watch for in Your Feet
By Michael Nirenberg, DPM
Eighty percent of people, at some point in their lives, have a foot problem that requires medical care. However, many people let their problems persist and worsen untreated. Here is a list of the most common foot problems I see in my practice that you can watch for to ensure the health of your feet.
Heel Pain
Heels get a bad rap. The dictionary defines a heel as a dishonorable person, and the term “Achilles’ heel” refers to a fatal weakness. The reality is our heels are quite strong, though no other part of our foot malfunctions more. Heel pain is the number one reason people come see me.
Heel pain can be very complicated and may have a variety of causes, including a stress fracture, pinched nerve, bone cyst, or tumor. Most patients with heel pain believe they have a heel spur. This may be part of the problem, but the most common cause of heel pain-whether or not a heel spur is also present-is inflammation of the largest ligament in our foot, the plantar fascia. In doctor-speak this problem is called plantar fasciitis.
Treatments for plantar fasciitis range from custom-made arch supports (called orthotics), to simple stretching exercises, to the revolutionary, high-tech shockwave treatment.
Nerve Problems
Burning, numbness, tingling, or shooting pain in our feet or ankles often means something is wrong with a nerve. Nerve problems are common in our feet, so if you have one don’t get nervous. Most of the time, the treatment is relatively simple.
The main nerve problems I see are:
• Morton’s Neuroma
Not to be confused with Morton’s Steakhouse-which may cause a full stomach-Morton’s neuroma causes cramping, tingling (a feeling of pins and needles), burning, or shooting pain in the toes or ball of your foot. A neuroma is a painful growth on a nerve that forms when the nerve becomes irritated. Treatment for neuromas consists of using a special arch support, called an orthotic, and sometimes injections are needed. Surgery is rarely necessary.
• Tarsal Tunnel Syndrome
Almost everyone has heard of carpal tunnel syndrome in our hands, but few people realize the same problem occurs in our feet. Tarsal tunnel syndrome may cause burning, tingling, shooting pain, or a cramping sensation in our foot. The good news is that there is a light at the end of this tunnel. Tarsal tunnel syndrome is often easily treated with orthotics, injections or a short, outpatient procedure.
• Neuropathy
Neuropathy literally means a “disease of the nerves,” and it affects millions of people each year. Persons with neuropathy often experience loss of sensation, burning, tingling, or shooting pain. The number one body part affected by neuropathy is the feet. Persons with diabetes are those most afflicted with neuropathy, but it also occurs in people with thyroid problems, vitamin deficiencies, alcoholism, and some types of arthritis. Neuropathy has many treatment options and some people might opt for a new, somewhat controversial, procedure that involves surgically freeing up the nerves to restore normal sensation to their feet.
Arthritis of the Foot and Ankle
Degenerative joint disease, osteoarthritis, or just plain old “Arthur” is a deterioration of the joints between our bones. When Arthur visits people’s feet or ankles, many believe they just have to live with it. This is far from the truth. The reality is podiatrists have many techniques to alleviate arthritis, including a high-tech, tiny arthroscopic camera that can remove arthritis from sore ankles.
Nail Problems
I am not talking about rusty nails on your garage floor, but ingrown toenails and fungal toenails. Ingrown toenails occur when the edge of the nail grows deep into the flesh of the toe. These are painful and can become infected. Fortunately, a brief, in-office technique can alleviate ingrown toenails, often permanently.
Fungal toenails are another story, and usually require a long course of medication.
Bunions
These are protrusions of bone or bumps that form on the inside of the foot at the joint at the base of the big toe. If you wear ill-fitting shoes, don’t blame them for bunions. Blame your parents.
Bunions are inherited. However, poor footwear can contribute the formation of a bunion.
Numerous conservative treatments, such as trying wider shoes or foot soaks, can alleviate painful bunions, though getting rid of them requires a short, outpatient surgical procedure.
Other Big Toe Problems
• Hallux Rigidus
With hallux rigidus the big toe may look normal; however the inside of the joint at the base of the big toe is deteriorated and painful. Sometimes the big toe won’t bend. Like bunions, simple treatments can lessen the pain, but in on some cases surgery is necessary.
• Gout
Known as the “rich man’s disease,” gout doesn’t just affect the rich. Gout is a type of arthritis that most often occurs in the joint at the base of the great toe, causing redness, swelling, and pain. Some patients say the pain was so severe they couldn’t stand the bed sheet resting on their toe. Other patients describe less intense symptoms.
Gout occurs when too much uric acid is present in our body. Uric acid is a natural chemical that our bodies manufacture, and we ingest in certain foods, like pork, beer, or liver. Treatment consists of altering the patient’s diet to limit the amount of uric acid they ingest, and if that isn’t enough, medication is prescribed.
• Corns and Callouses
Corns have nothing to do with plants that grow ears. Painful corns (and callouses) are a build-up of hard, dead skin that often occurs due to an abnormal bony prominence or a bone out of position.
Corns occur on toes and callouses are found on the bottom of the foot. Contracted toes (hammertoes) cause corns to form, and callouses form when a bone or bones are out of position. Treatment of a corn or callous depends on what is wrong with the bone underneath them.
Final Thoughts on Common Foot Problems
These are the top foot and ankle offenders, but the list of problems I see in my practice is endless. If you have foot or ankle pain or another problem, the best thing you can do is have it checked by a podiatrist.
To learn about our amazing feet and ankles, visit Dr. Nirenberg’s blog America’s Podiatrist.
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Dr. Michael Nirenberg – America’s PodiatristSM — is passionate about helping America’s 600 million feet. He has treated over 10,000 feet, been featured on the radio, magazines, newspapers and on TV (including the History Channel and Fox News). He is a podiatric physician, surgeon, and forensic podiatrist. His practice Friendly Foot Care is located in Crown Point, Indiana. To get more great insights on foot care and all things feet, visit Dr. Nirenberg’s blog.
Osteoporosis and Exercise – Activities, Guidelines, Research, and Insights from Physical Therapist and Polestar Pilates Educator Sherri Betz
Many thanks to guest author Sherri Betz of TheraPilates® Physical Therapy Clinic in Santa Cruz, CA for letting me share this great information for Osteoporosis and exercise on my Centerworks.com/blog. Sherri recently published this article in her newsletter, and then added extra insights once the questions started flooding in!
I encourage you to keep reading below and pass this very important information along to your fellow Pilates teachers and friends to better understand what types of exercise are most beneficial for increasing bone density and avoiding the risk and health challenges of osteoporosis.
Osteoporosis and Osteopenia do not have to be debilitating, and can be reversed! But it takes the right types of exercise and activities to facilitate bone growth. Thanks Sherri for sharing your expertise!
Osteoporosis and Exercise
In response to the plethora of questions from the Osteoporosis Update, let’s put bone building into perspective…. Okay, so the question is: To jump or not to jump?
Jumping and Osteoporosis
Jumping stimulates bone the best in the femoral neck. This means loading the long bones of the femur dynamically with 4-8x body weight. Apparently, jumping rope or jumping on a mini-trampoline is not enough to really stimulate bone significantly to increase density. Dynamic sports such as gymnastics, volleyball, soccer, rugby, football seem to do well in the bone category with athletes.
DO NOT JUMP if you have less than a -3.0 T-score in the spine or hip!
You may do faux jumps or “stomping” (I think of Flamenco Dancing….I was just in Spain and am going to investigate this further!) I also wonder about the popular exercise “Zumba” which might be a great bone stimulus. Bring back the 80’s Step Aerobics Classes…great for balance, lower body strength, coordination and bone!
Bareither ML, et al. Habitual Site-Specific Upper Extremity Loading is Associated with Increased Bone Mineral of the Ultradistal Radius in Young Women. J of Women’s Health, Vol. 17, No. 10, 2008.
Swimming and Osteoporosis
Swimming appears to have a negative effect on bone. It appears that the gravity-eliminated environment of the water, EVEN in competitive swimmers and water polo players depletes bone. Kavouras did a study in 2006 on water polo players where they measured BMD in the legs and arms at the beginning of the season and by the end of the season the players showed a DECREASE in BMD of the legs and an increase in the arms. So exercise in the water (even vigorous water exercise) does not build bone and may be having a detrimental effect on the bones of older adults who love their aqua exercise classes! Talk about taking candy away from a baby!
G.Bravo, et al. A weight-bearing, water-based exercise program for osteopenic women: Its impact on bone, functional fitness, and well-being. Archives of Physical Medicine and Rehabilitation, Vol. 78, Issue 12, Pages 1375-1380, 1997.
Kavouras SA, et al. Water Polo is Associated with an Apparent Redistribution of Bone Mass and Density from the Lower to the Upper Limbs. Eur J Appl Physiol (2006) 97:316-321.
Magkos F, et al. The Bone Response to Non-Weight-Bearing Exercise is Sport, Site and Sex-Specific Clin J Sport Med (2007) 17; (2)123-128.
Running, Biking and Osteoporosis
Cycling is next on the list….competitive cyclists have significantly lower BMD than Runners and Weightlifters as shown in studies by Sowers, Drinkwater and several others.
What about Running? Running may initially have a stimulating effect on bone but to continue running for several years would obey the bone law of diminishing returns. This is possibly demonstrated in one study showed that runners who ran more than 20 miles per week showed a decrease in BMD. Novel stimulus or “surprising the bones” is really good for getting bone turnover but the same exercise after a while is not going to have a significant bone response. We really have to vary our activities.
Pilates Exercise and Osteoporosis
A trend I am seeing while following clients for several years at my Pilates Studio is that the first year they might see an increase and the second year they seem to plateau with consistent Pilates Mat and or Apparatus training.
Everyone has asked, what about jumping on the Pilates Reformer?? Well, the jumping that stimulates bone is 4-8x body weight. The Reformer jumping is actually LESS than body weight and is not against gravity (2 strikes against it for building bone) However, it is a fantastic tool to safely introduce someone to jumping with correct form and alignment so that they can eventually jump or “faux jump” against gravity. Jumping on the Reformer might also help to increase leg strength to help clients tolerate the impact on their hip, knee and ankle joints.
Power Marching or Stomping and Osteoporosis
Someone asked about “power-marching” in place…does this build bone? Actually the folks from Oregon State University are just about to publish a study on “stomping” with good results in increased BMD! Now, the folks who can’t or should not jump can SAFELY stimulate bone! I think this will take the Bone world by storm!
The Best Exercises, Activities, and Sports to Improve Bone Density and Reduce Risk of Osteoporosis
Overall, the best exercises to effect bones appear to be: high-impact aerobic exercise (in small doses), gymnastics, squash, volleyball, rugby, soccer, and weight training.
Todd JA and Robinson RJ. Osteoporosis and Exercise (Review) Postgraduate Medical Journal (2003)320-330.
Points to remember:
• If you have below a -3.0 T-Score in the hip or spine DO NOT Jump!!
• A sedentary individual who begins ANY (safe) exercise program will likely see results.
• Doing the same exercise program or type for years and years will likely not produce good results.
• Swimming and cycling should not be considered bone building exercise.
• Start where you are…if you are in poor condition, DO NOT begin a jumping program, progress slowly, building your lower body and core strength, preparing your joints for higher impact activities.
• Pilates Reformer work is a good preparation for vertical jumping.
• Pilates Wunda Chair work, Trapeze Table Standing Arm Work and Assisted Squats as well Ped-o-Pul exercises are excellent alignment, weight-bearing and control exercises to prepare for progression to more dynamic exercise.
An article just came out in the NY Times on “The Best Exercises for Healthy Bones”. It was interesting to say the least. The writer suggested that hopping was the best exercise to build bone but gave no context or guidelines to incorporate hopping or jumping safely into an exercise program! I decided to pull together the best information from the top researchers in the field of bone and exercise. I like to look at the groups who have been doing this kind of research for a long time. I was at a bone symposium last week and was able to ask Beth Lambright, the Oregon State University exercise teacher of all the main studies during the past 15 years if jumping rope or mini-trampolines build bone. The answer was “No, you need 4-8x body weight impact to stimulate bone. For children this means jumping off a 24″ box and for adults this means jumping off an 8″ step. They progress from 4″ to 6″ to 8″ very slowly and prepare the knees and hips with step-ups, heel raises, squats, lunges and faux jumps before jumping off the steps. So what else will give us healthy bones?
1. Walking does not build bone and should not be considered an osteoporosis exercise. (However, walking is great for your heart if you keep up a good pace.)
Palombaro KM. “Effects of walking-only interventions on bone mineral density at various skeletal sites: a metaanalysis.” J Geriatr Phys Ther. 2005;28(3):102-7.
2. Weighted vests with lunges, squats, step ups, side lunges and small jumps 3 x per week builds bone in the hip according to Christine Snow’s bone research lab at Oregon State University.
(Long-term Exercise Using Weighted Vests Prevents Hip Bone Loss in Postmenopausal Women by Christine M. Snow, Janet M. Shaw, Kerri M. Winters, and Kara A. Witzke Journal of Gerontology: 2000, Vol. 55A, No. 9, M489-M491) They are continuing their long-term studies and the latest one should be published next month!
3. Sinaki has the best long-term research on exercise for building bone and fracture prevention in the spine (vertebral bodies).
(Sinaki, M., et al. 1986.”Relationship between bone mineral density of spine and strength of back extensors in healthy postmenopausal women.” Mayo Clinic Proceedings, 61 (2), 116-22.)
(Sinaki, M., et al. 1996. “Can strong back extensors prevent vertebral fractures in women with osteoporosis?” Mayo Clinic Proceedings, 71 (10), 951-56.)
(Sinaki, M, et al. 2002. “Stronger back muscles reduce the incidence of vertebral fractures: A prospective 10 year follow-up of postmenopausal women.” Bone, 30 (6), 836-41.)
(Sinaki, M,“The role of physical activity in bone health: a new hypothesis to reduce risk of vertebral fracture.” Phys Med Rehabil Clin N Am. 2007 Aug;18(3):593- 608)
4. Loren Fishman has some ongoing research on Yoga for osteoporosis and is getting some increases in BMD with his program.
(Yoga for Osteoporosis: A Pilot Study by Loren M. Fishman, MD. Topics in Geriatric Rehabilitation. Vol. 25, No. 3, pp. 244-250: 2009)
Main Points for Exercising Your Bones:
Hip Bone Building
Jumping is best. (If your T- score is below a -3.0 do not jump!) Prepare for jumping by doing forward and side lunges, squats, step ups, heel raises and standing balance exercises.
Consider using a weighted vest up to 10% of your body weight. Mini-trampolines are a good warm-up or for cardiovascular work but they do not build bone.
Spine Bone Building
Prone (face down) Back Extension Exercises are best.
Walking briskly on uneven terrain up and down hills is great for your heart but should not be considered a bone building exercise.
Yoga and Pilates in general are not considered bone building exercises YET! They may be effective programs to increase variety and pleasure with exercise and are a good body awareness fracture prevention and preparation for the bone loading exercises necessary to stimulate bone formation!
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Guest Author Bio:
Sherri Betz, PT has been a licensed Physical Therapist since 1991, international presenter, Polestar Principal Educator/Examiner, Gyrotonic®/GyrokinesisTM Instructor, nominated for APTA Geriatric Clinical Specialist Award 2004, author of The Osteoporosis Exercise Book, 2nd Edition, creator of modified Pilates videos for special populations & is pioneering development in Pilates for Osteoporosis and Geriatrics. Sherri is dedicated to increasing awareness about bone health and serves on the Professional Education Committee of the Foundation for Osteoporosis Research and Education (FORE). Sherri owns TheraPilates® Physical Therapy Clinic, in Santa Cruz, CA. She has served as the Vice-President of the Pilates Method Alliance Board of Directors since 2003. Visit Sherri at: http://therapilates.com/
