YOUR PODIATRIC PHYSICIAN TALKS ABOUT WOMEN'S FEET

Active Women's Feet

As women move into the US work force in greater numbers, a lot of them are finding that their professional and white-collar employment brings job satisfaction, but that it's tempered by other realities. One is that the new responsibilities probably haven't replaced those of the woman's once-traditional role as homemaker and mother.

Those roles remain, and many women find themselves not only holding down a full-time salaried position, but still doing the marketing, the child-rearing, the laundry. Women probably were on their feet a lot more than men before work outside the home beckoned, and their new situations certainly haven't alleviated that. Their feet are taking even more punishment, and the footwear that some feel obliged to wear in the work place may be playing a role.

All this adds up to a need for women to pay more attention to foot care, to avoid subjecting themselves to unnecessary foot problems, particularly those that might be caused by improper footwear and hosiery.

High Heels: Use and Abuse

The wearing of high-heeled shoes is a prime example of women inviting foot problems. Doctors of podiatric medicine see no value in high heels (generally defined as pumps with heels of more than two inches). They believe them to be biomechanically and orthopedically unsound, citing medical, postural, and safety faults of such heels.

They know, for example, that high heels may contribute to knee and back problems, disabling injuries in falls, shortened calf muscles, and an awkward, unnatural gait. In time, high heels may cause enough changes in the feet to impair their proper function. Most women admit high heels make their feet hurt, but they tolerate the discomfort in order to look taller, stylish, and more professional. In a Gallup Poll, 37 percent of the women surveyed said they would continue to wear high heels, even though they did not think them comfortable.

Toward Greater Comfort

If women persist in wearing high heels, there are ways to relieve some of the abusive effects; they can limit the time they wear them, for example, alternating with good-quality oxford-type shoes or flats for part of the day. High heels that are too tight compound the abuse; it's good advice to buy shoes in the afternoon, since feet tend to increase in size later in the day.

Women have other heel-size choices, fortunately. They don't have to endure pain at the expense of their foot health. The key is wearing the right shoe for the right activity -- and that means varying heel height, determining what heel is most suitable.

For example, there are comfortable and attractive "walking" pumps (also called "comfort" or "performance" pumps) for women for work and social activities. The shoe manufacturers who have introduced them seek a marriage of fashion considerations and comfort, offering fashionable pumps with athletic shoe-derived construction, with reinforced heels and wider toe room. They are using space-age materials, like long-lasting memory cushioning that acts as a shock absorber. And the soles are more pliable.

Several companies have also designed footwear for certain athletic activities, including aerobics, specifically for women.

Perhaps the best shoe for women, from an orthopedic point of view, is a walking shoe with ties (not a slip-on), a Vibram type composition sole, and a relatively wider heel, no more than a half or three-quarters of an inch in height -- even though such a shoe may not be widely acceptable in the work place.

What About Stockings?

Women who always wear nylon pantyhose are also inviting foot problems. Nylon is occlusive -- it doesn't breathe -- and the heat that it generates and traps causes excessive perspiration. A warm, damp area is an ideal place for the encouragement of fungal infections such as athlete's foot. (Pantyhose aren't the only apparel that cause excessive perspiration; the dress boots and shoe boots many women don in cold weather shouldn't be worn all day in an office.) Nylon, which tends to be abrasive, is even more so when it's damp; in a tight shoe that's already irritating, it offers little protection against blisters. Support hose, because they're so much tighter, can be the worst culprits of all.

Inexpensive nylon pantyhose can also cause forefoot problems, because the stretch mechanism constricts normal expansion of the foot when walking, and may pull the toes backward when the pantyhose ride up. The cramping and pressure of the hose can contribute to ingrown toenails and hammertoes. A better quality nylon will provide a better fit, and the better the fit, the less likely it is that cramping will occur. Women's feet have grown larger because of improved health care and nutrition. The one-size-fits-all stocking no longer is the universal answer, if it ever was. Attention to proper fit is essential.

Pregnancy

Pregnant women need to observe good foot health to prevent pain and discomfort. Since the body undergoes changes and acquires a new weight-bearing stance, women should wear shoes with broad-based heels that provide support and absorb shock. Additional body weight also calls for more support, to prevent foot "breakdown."

The expectant mother often experiences more than ordinary swelling of her feet and ankles, which can aggravate existing foot conditions and promote inflammation or irritation. Pregnancy also triggers the release of hormones which enhance laxity in ligaments, which can contribute to foot strain. If problems develop, she should see a podiatric physician.

Women Over 65

Older women have more trouble with their feet than younger ones, for the simple reason that fat pads on the bottom of the feet tend to deteriorate in the aging process. They can alleviate some foot problems by wearing properly fitted, well-constructed shoes -- shoes which provide cushioning and have a soft, flexible upper that will conform to the shape of their feet. They also need leather shoes which "breathe" and can reduce the possibility of skin irritation. Soles should be lightweight, with enough flexibility and shock-absorbing quality to provide solid footing and not be slippery. Low-heeled shoes provide greater stability, more protection for the feet, and greater comfort. Because older women often have circulatory problems, they have a special need to keep their feet warm in cold weather, to prevent frostbite or chilblains.

Women's Foot Afflictions

Whether the sources are congenital problems, foot abuse, high heels, poorly fitting shoes, or other maltreatment of the feet, women are subject to a number of afflictions involving the feet (most of which can also occur to men):

Achilles tendinitis: inflammation of the Achilles tendon, the link between the calf muscle and heel bone. Those who wear high heels regularly can expect to acquire shortened tendons; switching to low heels for strenuous physical activity without appropriate warm-up exercises creates an ideal scenario for Achilles tendinitis.

Bunions: misaligned big toe joints which become swollen and tender. Bunions tend to be familial, but the tendency can be aggravated by shoes that are too narrow in the forefoot and toe.

Hammertoe: a condition in which the toe is contracted in a claw-like position. Although the condition usually stems from muscle imbalance, it is often aggravated by ill-fitting shoes, socks, or hosiery that cramp the toes.

Metatarsalgia: general pain in the ball of the foot; often caused by wearing high heels.

Neuromas: enlarged, benign growths of nerves, most commonly between the third and fourth toes. They may stem, in part, from ill-fitting shoes, resulting in pain, burning, tingling or numbness between the toes and in the ball of the foot. Treatment includes orthotic devices and/or steroid injections, and sometimes surgery.

Plantar fasciitis: inflammation of the long band of connective tissue running from the heel to the ball of the foot, a main cause of rear-foot pain. This condition is sometimes caused by shoes that cramp the feet, especially in the arch area.

Pump bump (Haglund's deformity): a bone enlargement at the back of the heel bone, in the area where the Achilles tendon attaches to the bone. The deformity generally is the result of faulty biomechanics causing increased motion of the heel bone against the shoe counter.