Help for Aching Feet at Yuletide : Proper Footwear Is a Boon to the Harried Shopper
‘Tis the season to go rushing to the mail box, trudging through the stores and standing in seemingly endless lines. After a full day of shopping, it can feel like Santa has dropped his whole bag of toys on your aching arches or that Rudolph’s reindeers have just trampled across your tootsies.
Wearing the proper shoes can alleviate some of the everyday aches and pains, according to orthopedist Dr. Phillip Kwong, director of the new Foot Treatment Center at Orthopaedic Hospital in Los Angeles.
The 28 small bones in the feet, and the surrounding network of ligaments, tendons and muscles, do an amazing job, Kwong said, considering that these complex structures absorb up to five times the weight of the body they carry. And if the feet do not support all this weight evenly, the body automatically realigns itself to share the load, he added.
About half of the population has some sort of foot problem serious enough to require professional help, said Kwong, who helped launch the clinic in October. A foot bath, foot massage, or just putting your feet up for a few hours are good palliative measures for general foot discomfort, but chronic pain in the ball of the foot, the instep or the ankle could mean the foot is assuming more strain then it can handle.
Fairly Thick Sole
The best kind of shoe for shopping--or for any activity that keeps you on your toes--has a fairly thick sole that does not bend too much. A sole that bends too much puts a lot of weight on your toes and the ball of the foot and does not have enough cushion to act as an effective shock absorber, Kwong said.
The bottom front of the shoe should be tapered upwards so that as you walk, you roll off the toe, rather than bend it. A low heel distributes weight more evenly, he said; wooden clogs and wedge heels are usually good choices in footwear.
“Soft Italian loafers may feel good on your feet and look good to your friends, but they are not that good when walking on hard surfaces,” Kwong said.
Athletic-type tennis shoes are generally good bets for shopping because they are geared toward high-activity wear, have good energy absorption and are wide enough to fit the natural contour of the foot, as opposed to dress shoes that are not designed for comfort.
Kwong said a shoe should fit snugly at the heel and mid-foot, but have enough room for the toes to wiggle. The heel of the foot should rest fully on the shoe’s heel. It is always a good idea, he added, to alternate shoes daily.
“Shoes get beaten down very quickly and need to dry out and freshen up,” he said, noting that women routinely change shoes to match their clothing, while men tend to stay with the same basic shoe.
Give Feet a Break
Even though Kwong wears comfortable, thick-soled shoes every day to work, at night he gives his feet a break (and his toes a workout) by slipping into clogs.
Changing shoes or adding insoles or orthotic devices such as plastic arches may help ease some pains, but, he cautioned, not all foot problems are caused by ill-fitting espadrilles.
“We are all born with a certain mechanical linkage that changes throughout our lives,” he explained. “The foot is a weight-bearing and energy-absorbing system. Bones are like the Tower of Pisa--they need to be stacked up properly so as not to strain the architectural system. If they are not stacked up right, then the ligaments become strained because the bones do not take the weight effectively.”
To treat foot problems, Kwong said, orthopedists and podiatrists “have to look at the foot not as an entity by itself, but in connection with the other bones in the skeleton.” Some people are prone to certain foot ailments, such as calluses or corns, because of the way their body is aligned. Bunions, for example, can be aggravated but not necessarily caused by wearing ill-fitting shoes or being overweight.
“If shoes caused bunions, every woman who wore high heels should have bunions, but they don’t,” he explained. “And women who never wear high heels still get bunions.”
Too often, Kwong said, doctors merely cut the bunion off, treating the effect but not the cause.
“You have to determine what is causing this bone to drift out and fix that. The bone has shifted out for a reason. It’s like tires--if they are wearing unevenly, merely changing the tires won’t cure the problem. You have to find out what causes the tires to wear that way and fix the alignment.”
Foot problems affect the ankles, knees and sometimes the hips more so than they do the back, he said, because the foot is on a longitudinal system. The back, he said, is a vertical system and can be affected if one leg is shorter than the other or by wearing high-heeled shoes. High heels, he said, throw the body out of whack, forcing the wearer to walk more on the balls of the feet and shifting the center of gravity. To compensate for the gravity shift the back arches. Women who wear high heels constantly also face the problem of a tightening heel cord and may find it painful to shift to a low-heeled shoe later, Kwong said.
On the other hand, constant wearing of negative-heeled shoes (the heel is lower than the toes) creates the opposite problem--the tendon stretches and may cause pains in the calf, as may happen after running barefooted on the beach.
Check Shoe Wear
The best way to discover a foot problem, especially in children, Kwong said, is to see how the shoe wears.
“The foot leaves an imprint in the shoe, telling what your feet are doing. Looking at a worn shoe tells you if there is a problem.”
The shoes of someone with flat feet, for example, will roll inwards and look worn on the inner side.
In its most serious form, flat feet can lead to degenerative arthritis and a lot of discomfort, he said. The bones don’t stack up properly, which strains the ligaments in the foot. This can cause leg cramps, painful calluses or pain in the joints.
Kwong said most children are born with flat feet and do not develop an arch until age 4 or 5, when their feet must change to bear more weight.
An easy way to check for flat feet among children, he said, is to look at the foot from the side, while the child is standing. Children with flexible flat feet will show an arch when on tiptoe; those with rigid flat feet will not show an arch at all.
If the problem stems from the front part of the foot, it can be corrected fairly easily by using special shoes with bars attached, or even by using casts, Kwong said. If there is a problem in the alignment of the shin bones or hip bones, there is little doctors can do, he added.
The most radical procedures for fixing flat feet require fusing parts of the arch bones, which Kwong is reluctant to do until the child is at least 14 or 15 and his bones have stopped growing. Kwong, who is a clinical professor of orthopedics at the USC School of Medicine, said he has developed a procedure to surgically shift the heel “to get a more effective base of support.”
He said response to the clinic, which has two full-time orthopedists and two physical therapists, has been better than expected, with more than 100 patients seeking help in the first month. He said new patients undergo a complete gait analysis as well as other diagnostic tests, with an initial consultation costing $150 to $175.
