My feet are killing me!

This is a common cry. At least half and probably as many as nine out of 10 adults have some problems with their feet, ranging from relatively minor disorders, such as ingrowing toe nails, to severe feet deformities.

The foot has 26 bones which bear the weight of the body, and all the forces involved in standing and walking - not to mention the stresses involved in sport and other strenuous activity. The 26 bones fit together in a complex arrangement and are linked by a large number of joints, held together by ligaments and tendons.

The foot is an often neglected part of the body, despite the fact that foot ailments can dramatically impact upon work, recreational and leisure activities.

Individuals who have arthritic problems are more prone to disabling foot pain and are often unaware there is a wide variety of treatment modalities available to them. All tissues and structures of the foot can be affected by arthritis, including osteoarthritis, rheumatoid, psoriatic, juvenile chronic arthritis, and gout.

Care of the foot is a multi-disciplinary effort; podiatrists, general practitioners, physiotherapists, orthotists and surgeons may work together to provide a solution to an individual's particular problems.

Common problems

Common problems associated with arthritis in the feet are swelling and pain, loss of flexibility and movement, joint deformity, thinning of the skin and loss of protective skin layers.

The circulation and sensation to the foot may be decreased, and sometimes there is an increased risk of infection and pressure sores.

In some forms of arthritis, there is a tendency to bunion formation. This problem, a swelling and enlargement of the 'great toe joint', often causes footwear problems. Claw or 'hammertoes' may develop, causing corns and calluses to form, and the ball of the foot may become sensitive as a result of the loss of the fatty protective pad normally present. Calluses may form across the ball of the foot, and the joints there may become very prominent and painful while walking. It is also quite common for the arch height to change.

Solutions: the ABCs of foot care

• accommodate prominent areas of the bottom of the foot using custom insoles
  footwear in general is poorly suited to the arthritic foot. Even with careful attention to fit, shoes can play a big part in the feet becoming sore. Use prescription or alternative footwear such as sport shoes where possible to reduce the likelihood of pressure sores. In this way, bunions, hammertoes and prominent joints on the bottom of the foot are protected and are unlikely to become painful. The use of cushioned materials in the shoe will relieve the pain caused by the foot having lost its natural protection
• balance the foot using custom supports provided by your podiatrist or orthotist
  these devices, known as orthoses, may be made of soft material or of more rigid material where the aim is to maximise the support of the foot. The most successful form of orthoses are those made from a plaster impression of the foot, ensuring a proper fit. These devices will work to prevent fatigue and muscle strain, and may prevent the joints of the foot from degenerating due to the combination of stress and arthritis. Aligning the foot properly may take strain off the ankle and knee joints as well
• correct the causes of these problems where possible
  Your doctor can advise you about the use of medicines which may aid in the control of pain and inflammation. Surgical treatments for bunions and hammertoes may be advisable, and may be carried out after consultation with your doctor or surgeon. The non-surgical treatment for problem corns, calluses, or ingrowing toenails is also important, and can be done on a regular basis to prevent more serious problems from developing.

Foot pain need not be a part of a person's daily life. By following the recommendations here, and by maintaining a healthy lifestyle; eating right and getting a moderate amount of exercise, arthritis will not keep you off your feet.

Care of the feet

• keep the skin clean and dry. Use of a foot powder after drying can be helpful
• nails should be kept clean and short, and trimmed regularly. Cut toe nails straight across the top. Never cut down the corner. This will cause pressure from the shoes to push the margin of the toe up into the edge of the growing nail and damage the skin
• removal of corns and layers of hard skin is best done by a podiatrist. Consult him/her for further advice on treatment and prevention. It is inadvisable to treat corns with medicated corn cure pads
• posture is important.

Your rheumatologist may refer you to an orthotic department of the hospital where an orthotist may make an insole or surgical shoe to suit your requirements. These are many special devices or alterations that can be made to shoes which help keep the foot in the best position.

Your podiatrist will also be able to provide insoles and other devices to make your feet more comfortable.

Exercising the feet

Remember, walking is the best exercise for feet. Foot exercises will help feet to stay healthy and prevent pain. Those with arthritic feet or swollen joints should contact their doctor, podiatrist or Arthritis New Zealand field officer about suitable exercises.

Footwear

Wearing the correct fitting footwear is very important in preventing foot problems. Time should be spent finding shoes which suit your feet, are the right size and comfortable. Feet can change in size and shape, and different brands of shoes vary in size. Insist on having shoes fitted every time a new pair is purchased.

Choosing the right shoes

Choosing the right size is a basic necessity. The size printed on the shoe is less important than the way it feels.

Here is a quick and easy way to check that shoes are the right length:

• place your foot on flexible card 1cm wide
• mark where heel and longest toe come
• cut strip on the measurement and place inside shoes with one end flush to the heel. You should be able to slide it forward at least 1cm for adults. When buying children's shoes, remember to allow for growth. Shoes for them should be 18mm (3/4') longer than the foot
• always check that the heel fits firmly in the back of the shoe.

To check width:

The shoes should be broad enough to wriggle the toes. If you wish to check width measurement, draw around the whole foot on flexible card. The cut out should fit into the shoe without creasing or folding.

Dos and don'ts for selecting footwear

• select footwear which is the proper type for the job it has to do
• insist on having shoes fitted on both feet
• choose good quality leathers. Man-made plastic leathers are good imitations but not as comfortable if you have foot problems because they do not stretch. Make sure the sole is flexible enough to move with the foot
• do try to avoid shoes that have seams across the toes or over the toe joints
• don't buy shoes that feel tight or uncomfortable. You shouldn't have to 'break' them in

Selecting footware for children

• always have the child present and insist on having the shoes fitted on both feet
• avoid high-heels and sling-back shoes
• avoid plastic and synthetic shoes. They do not allow moisture from the foot to evaporate
• don't let children wear gumboots, sandshoes and basketball boots for long periods of time. They should be worn for the purpose for which they are intended
• don't let children wear socks that are too small. Cotton or woollen socks are most suitable, stretch nylon socks tend to compress the foot.

If you have arthritis

• High quality running shoes are light, absorb load very effectively and accommodate a wide fitting. Buy high quality running shoes which have a removable washable insole. Insoles can be replaced by specially made orthoses to suit special needs.
• Do consult your podiatrist. They are able to make a whole range of orthoses which will benefit your feet and help maintain good function.
• Look for roomy, wide, soft top shoes. Keep formal dress shoes for formal occasions.
• Choose shoes which have adjustable fastenings such as lace or Velcro fastening - buckle and strap, which can allow for expansion to accommodate any swelling that may occur.
• Select shoes that have flat heels and are raised no more than 2.5cm (one inch). Remember, the higher the heel the more weight is thrown into the toe joints. Width of heel is important too. Narrow heels cannot cushion the heel of the foot or provide adequate balance.
• If your fingers cannot cope with normal laces, try elastic laces which can be purchased from the occupational therapy department of your local hospital or ask your Arthritis New Zealand field officer where you can obtain them.
• Many shoe shops will allow you to purchase shoes on approval which will enable you to take them to your doctor or podiatrist who will check their suitability. Make arrangements with the shop to change them for a more suitable style if they prove to be unsatisfactory.

Original material supplied by Arthritis New Zealand. Reviewed by everybody, July 2005.