Foot Health John Shapiro, DPM Instructor Department of Orthopaedics University of Maryland School of Medicine 9/15/2010

Keeping Feet Healthy Examining feet Medical conditions affecting the foot Shoe-wear Diseases of the foot Orthopaedic conditions Surgical intervention

Examining Feet Doctor’s evaluation

Examining Feet Self examination

Examining Feet What to look for: Too wet, too dry Bruising Blisters Toe nails

Medical Conditions Affecting Feet Diabetes 16 million diabetics in the United States Over 25% develop foot problems Diabetic neuropathy Diminished circulation Bunion and hammer toe Deformities Heel pain (plantar fasciitis)

Foot Anatomy

Nerves of the Foot

Muscles of the Foot

Intrinsic Muscles of the Foot

Ligaments of the Foot

Shoes Who benefits from correct shoe wear? Diabetics Rheumatoid Arthritis Connective Tissue Disease PVD

Shoes Foot precipitating factor to cause of trauma, leading to lower extremity ulceration and amputation in people with diabetic neuropathy. Benefits of proper shoe wear to rheumatoid patients: reduction in pain and increased mobility. Elderly population - badly worn shoes or slippers cause falls and increase risk of fracture = loss of mobility. Medicare diabetic shoe therapy program

Footwear Construction Lasts – molds on which shoes are made. Measurements of the last are related to volume, width and length and is not an exact impression of a foot. This is to ensure good fit and takes in to account the change in dimensions of the foot during movement.

Footwear Construction Vamp – covers tops of toes and forefoot. Quarters – the sides and the back of the shoe. Throat – formed by the seam, joining the vamp and the quarter. Lower throat line is more useful in patients that require ease of access to a shoe.

Footwear Construction Shank – reinforced middle of the shoe from underneath to prevent collapsing or distorting.

Footwear Options Rocker Soles – helpful in reduction of forefoot pressure in a diabetic foot and pain and pressure in a rheumatoid foot. Custom Footwear – major deformities such as charcot or advanced rheumatoid arthritis.

Examination of Footwear Check if shoe-wear is correct size. Investigate the heel to ball measurement and the depth of the footwear

Footwear It is important to convey to the patient the necessity of proper shoe wear in that doing so will give the patient comfort, protection, and lessen the risk of lesions which could ultimately cause infection and lead to amputation in compromised patients.

Spenco Plastazote Pelite

Orthotics Pressure relieving devices: Felt pads Inserts can be fabricated for custom fit for the foot, and a specific area of depression or support can be added.

Treatment Heel cups Stretching Ice Anti-inflammatory Cortisone Injections Night splints (5 degrees dorsiflexion) Heel wedge

Diseases of the Foot Athletes foot Rheumatoid arthritis Osteoarthritis Warts Onychomycosis Gout

Orthopaedic Conditions Bunion deformities (hallux abducto valgus) Hammer toe deformities Fifth toe corns Hallux limitus, rigidus Flat foot condition Pes cavus condition (high arch) Plantar fasciitis

Surgical Intervention Should only be attempted after conservative therapies have failed Most common elective foot surgeries: Bunionectomies Hammer toe corrections Tailor’s bunionette defomities

Summary Any kind of foot pain is not normal and should be evaluated. This is more true with patients with poor circulation, particularly diabetics. A non-healing wound should be evaluated by a foot and ankle specialist as soon as possible. Proper shoes can reduce the risk of blistering and infection. Daily examination of feet has been shown to greatly reduce the risk of long term medical intervention or amputation.