Foot Conditions and Disorders

Foot problems in women: Can your shoes impact your health?

– [Alyne] Hey ladies, do your feet hurt? Even if they don't, you may be hurting them with the shoes so many of us love to wear. Here to tell us more is
Dr. Benjamin Jackson, an orthopedic foot and ankle
surgeon with Prisma Health. (upbeat music) This is "Flourish," a podcast brought to you by Prisma Health. I'm Alyne Ellis. Welcome Dr. Jackson. – [Benjamin] Hey, how are you today? – [Alyne] Oh, doing great. Thank you so much for your time today. – [Benjamin] Oh, happy to help. – [Alyne] So I assume that you see a lot of
women who may have damaged their feet over a period of time because of the shoes that they wear.

– [Benjamin] Absolutely, that's definitely a group
of patients that I see. – [Alyne] And let's begin
with the kinds of things that perhaps do the most damage. Can high heels or pointed shoes do a lot of damage to your feet? – [Benjamin] Well, I think
damage is a relative thing. And so I think there are
definitely certain conditions that are exacerbated by high heels. Some people have pain in
the ball of their foot. The fancy doctor word for
that is called metatarsalgia. Yes, I had to go to medical school just to learn how to pronounce that. But that's a condition where you have pain in the ball of your foot. And obviously when you're wearing a thing, like a high heel, that
can cause more of that. And so that's something
that can definitely be exacerbated with high heel wear. – [Alyne] And what about pointed toes? – [Benjamin] Those can definitely exacerbate conditions like a bunion, which is the curvature of the big toe.

We have a curvature of the small toe that's called a bunionette. And so both those can help
contribute to those conditions and kind of exacerbate them some. – [Alyne] So if you
wanted to take a different shoe approach and say, wear a platform shoe, are those a better
option for a lot of women than high heels? – [Benjamin] For certain
conditions? Yes, absolutely. So I think the there's certain conditions, particularly things like stress fractures, even though a platform
high heel is better for it, what they're really better for is actually Achilles tendon problems. So the Achilles tendon,
as you probably know well, is the main kind of tendon,
the largest tendon in your body and connects the calf
muscle into the heel.

Often folks have Achilles tendon problems. Believe it or not wearing
a platform high heel actually helps make that better. Believe it or not, because
it elevates that heel and takes some of the stress
off the Achilles tendon. So this can be helpful,
particularly for that condition. – [Alyne] So what about if I just tone down the amount of
time I wore high heels would that make a big difference? How much time could I wear
'em without doing damage? – [Benjamin] Again, I think it depends on the condition that you have. So a lot of that is kind of, what we call, activity as tolerated. So as long as it's not hurting you, generally, it's not kind of doing damage. When folks have, again, that
condition called metatarsalgia or if you have a stress
fracture in your foot, high heels can definitely exacerbate that. If you have something
like a stress fracture, then typically recommend
wearing a stiffer soled shoe, more like a tennis shoe or athletic shoe, and then not wearing
something like a high heel for six to eight weeks.

So that's definitely a
condition that can make worse. You need to take some time
off from wearing those. – [Alyne] So something
like that would mean I shouldn't even be wearing
'em for a special occasion, for example. – [Benjamin] You could,
but as I tell folks, you're kind of going to pay for it. So it depends how
special that occasion is. So if there's some special occasion, you may do it for a
limited period of time, but it's definitely
going to make that worse, at least for the next few days.

– [Alyne] Now, what about flats? Are those better for your feet than what we've already discussed? – [Benjamin] They can be
definitely, in several ways. One as you mentioned. So what we described
kind of the pointed toe, in kind of a doctor and shoe speak is what we call the toe box. So the toe box is how wide
the front of your foot is. The wider the front of the foot is, it helps make some conditions have less pain associated with them. A few of those conditions
will be like a bunion, or a bunionette. Another condition is fairly common, it's called a Morton's Neuroma, and that's where you have
some inflammation of a nerve in the front of the foot.

That's exacerbated by the
foot being squeezed tightly. So often folks that wear
narrower toe box shoes that makes that condition worse. When they wear a flat
or a wider toe box shoe, or even go barefoot, it helps
make that condition better. – [Alyne] And what about flip flops? – [Benjamin] Flip flops,
you know, in general, I don't have a problem with those shoes. They are not great for
stress fractures though. So if you have a stress fracture, you really want something with
more of a rigid soul to it. And so I think that that's
one particular condition that can be made worse. Now, the other thing, just not regarding the foot, but the ankle obviously there's less
support in the ankle with a flip flop or a shoe like that. And so that's something that
you want to consider when choosing that shoe, but in
general, a flip flop is okay, there's some support to it, but not much support at the ankle, but it does have a wider to box area.

– [Alyne] And how about going barefoot? I know, for example, people
who have planter fasciitis going barefoot is not a
particularly good idea. – [Benjamin] Yeah, so, I think kind of depends
on the timing of it. So the reason why people
kind of perceive that plantar fasciitis is difficult is because with that particular condition, typically what folks
come and they tell me, as far as the normal history of that, is that pain with the
first step in the morning. And so that pain is very exquisite. Many folks describe it as a hot poker, sticking them on the bottom of their heel, which just sounds uncomfortable. And so often that condition is worse with the first step of the morning when people are typically barefoot.

Often they kind of walk
it off, as they say, and typically after 10 or 15 steps, it starts to get better and better. And as long as you stay up
on your feet, you're okay. So that's why people kind of perceive that as being more of a barefoot condition, although it is not necessarily exacerbated by having a barefoot,
it's just when, generally, most people experience most of that pain. And so that's why they
kind of associate it with going barefoot. – [Alyne] And can going
barefoot cause problems? – [Benjamin] It can. And so I think that
there's certain conditions that it can definitely make worse. So again, we talk about
stress fractures of the foot. There is more stress across the foot when you're going barefoot, you know, for a while, maybe a decade or so, there's that kind of
craze; barefoot running.

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We saw a really a significant
increase in stress fractures of the front of the foot
with the barefoot running because there's definitely more
stress associated with that. The shoe takes a lot of
the stress off of the foot, provides cushion, and support to it. And so particularly for
something like a stress fracture going barefoot can't exacerbate
that particular problem. – [Alyne] Well, that certainly
leads me into a question that is really worth pursuing when you're going to be
exercising and running.

How should you pick the
right athletic shoe? – [Benjamin] That's a great question, and something I get very commonly. So I think a few rules of thumb. It's one; you want to
find a good fitting shoe. I think that is one of
the most important things. So because shoes that are too small from a length standpoint, can cause issues with your toenails, can even cause bruising
over your toenails, or even extreme situations
'cause you to lose your toenails. So you don't want that. You want the appropriate
width of a shoe too. And that's something that
people often overlook. So I would say that from
a high fashion standpoint, the pointed toe shoes are
much more high fashion, but are obviously
significantly less functional.

If somebody ever wants to
prove that to themselves, they can take a sheet of paper, and they can stand on that sheet of paper, and outline their foot just
like you did in kindergarten where you outlined your
hand to make a turkey. You can outline your foot,
and you can see that outline without any shoe kind of pushing in on it. And then you can put
your shoe on top of it and you'll see how much
wider your foot is, particularly than a high fashion shoe, like a high heel shoe
or something like that. Your foot is much wider than that shoe. So that's putting a lot of pressure on it. So when you're looking
for an athletic shoe, you want to make sure you have a good fit from a length and width standpoint, and then you want to make sure
you have the appropriate shoe for that particular activity. So if you're going a ballet dancing, you probably don't want
a running shoe for that, and vice versa. So I think you want to find
a sport appropriate shoe. And then there are obviously brands that they're out there for certain shoes.

They've got hiking brands
and running brands. And so I think generally
going to a reputable store, they can help you with those. I think many of the national
brands for the most part, don't make too many bad shoes. And also think with shoes,
like many things in life, you kind of get what you pay for. I typically don't recommend people buy the least expensive shoe. And so at least getting somewhere in that kind of middle
ground, I think is helpful. So getting a good fit, from a
length and width standpoint, getting a sport specific shoe, and getting something at least kind of in that medium price range, and broad brush strokes will get you a pretty good fitting shoe that'll do the task you're
looking for it to do. – [Alyne] Now you mentioned
outlining your foot, but the size of your foot can change. Particularly as you get older, or you gain weight, or
maybe you're pregnant. Maybe you could fill us in a little bit on how much your foot can change. – [Benjamin] Absolutely. So
that is a great question. Believe it or not, it's actually something
we're doing a clinical study on right here at Prisma Health.

So we're actually doing
the study currently, we bought a pressure mat, people can step on that pressure mat. And currently we've enrolled
actually a thousand patients into that study trial and help understand what is, quote, normal? So what is a normal arch?
What is a high arch? And what is more of a
flat foot type person? It's interesting a study like that has not really been done before. So we're leading in the front
on that at Prisma Health, actively doing that research right now. So we hope to be able to get to you, and maybe get back with
you more about that soon. So that's one thing we're
trying to understand more about. But you mentioned pregnancy. That's a very common thing that I hear. Believe it or not, that's actually
going to be a separate study that we plan on doing once
we're done with this first study and the pressure mat. It's trying to do a longitudinal study, looking at women and
how their foot changes during the pregnancy period. We do know that certain hormones,
particularly progesterone, can help to lengthen tendons and relax em, which is important for
the birthing process.

We do believe that the foot
size and shape changes, particularly with pregnancy. So that is something that we're
going to be doing a study on, 'cause I hear women tell me frequently their foot change a half size to sometimes even a whole size and often times their arch drops some, compared to their pre partum state. So we look to investigate that more. And again, we hope to
get back with you once we have the results of that. You mentioned just in general,
as people do get older, sometimes folks foot does get flatter. So that's something we're trying to learn more about as well. When we look at the
condition of what we call a symptomatic flat foot or
what folks are now calling a progressive collapsing foot deformity is the latest lingo for that.

What we find is the age group, at least that has the
most surgery for this seems to be women,
typically Caucasian women that are in their 40s or 50s seem to have the most, at
least, surgery for that. So we believe that's a group that has the most painful flat foot. We're not sure why that
demographic has it more, it's a bit unclear, but we're
doing some studies to try and investigate that further as well.

So there are changes with arch height, but as you grow, it's kind
of interesting in children, their foot actually, their arch height, it gets higher as they grow, probably until about age eight or nine. And then it kind of is what it is until maybe you get some
changes later in life, or with pregnancy. This is really a moving target
as far as your foot shape and position in life, which is
why oftentimes maybe wearing the shoe that you wore
five or 10 years ago may not be the right
size and fit for you now. – [Alyne] And moving on with this, how does the type of shoe that you wear affect the rest of your body? – [Benjamin] So I think
in several different ways, typically, the we'll just take
running shoes, for example. The reason why running
shoes are very helpful, 'cause they're shock absorbing. The foot is your body's first
line of shock absorption. The shoe can help with that as well. That's why, again, I mentioned
that barefoot running craze, they were wearing the minimalist shoes, or even truly running barefoot.

There was really more
of a minimalist shoe. We saw more stress fractures because there was less cushion to the foot and there was less cushion,
there was more shock. It was sent to the foot and the knee and the hip and the
lower back area as well. That's one area where the shoe can really affect your whole body. – [Alyne] So when should you
see a doctor about foot pain? – [Benjamin] Foot pain is something that is incredibly common. Many times, like many
orthopedic conditions, will kind of resolve on its own. Everybody kind of gets
a sprain or strain here, an acre or a pain there. The kind of red flags
for me are a few things.


One I would say pain is
progressively increasing. So you start to have some pain, and then a few days
later the pain is worse, and a few days later it
continues to get worse. That's definitely very
concerning from my standpoint. And also pain that doesn't get better. So if you're starting, let's say a new exercise
or running program, you start to get some pain in your foot. You say, hey, I'll take a week or so off, you try running again
and it's still hurting, I'll take another week off. And then even after that second week off, you're still having pain. I think that's a time to come see an orthopedic foot and ankle
surgeon for that problem. That's one reason. Then the
other reason is for deformity.

Things like a bunion, or
a bunionette, hammer toes, or a progressively collapsing foot, or more of a deformity type problem that started as a deformity, frequently before they
even become painful. So those are reasons that you want to see an orthopedic foot and ankle surgeon, because some of those
deformities can be either slowed down or prevented
from getting worse. So that's one of those things, a kind of a stitch in time saves nine that's something may want to come see an orthopedic foot and ankle surgeon for. – [Alyne] And what do
you finally recommend that we do to take care
of our feet in general? Pedicures, for example,
or other things like that? – [Benjamin] Pedicures are
great for several reasons, as long as you're going to a place that uses sterile equipment for
the work that they're doing, and doesn't trim the nails too far back. I think those can be very helpful in preventing things
like ingrown toenails, kind of keeping corns
and callouses trimmed, I think is very helpful.

And then I think lotioning
the foot is helpful. Particularly some folks
just seem to have drier skin or sweatier skin, and both extremes of
those can cause trouble. So the skin is very dry and it's cracking, the skin is the best bearer to infection. So if you get deep callouses
or dry and cracking skin, that can be an entrance
wound for infection, and those can actually be
pretty serious infections that can develop. That's something where
lotioning can be very helpful. Again, you mentioned like a pedicure often they that do that there. One area on the dry cracking skin, make sure that you keep that lotion. Keep healing callouses and corn softs, they're not getting hard and cracking. One because that's painful. And two, because that can
be a source of infection. Then you kind of get the other end, particularly in South Carolina, and the Prisma Health area of the world, a lot of foot sweat.

And so if the foot stays sweaty, that can actually cause a problem as well. Typically from fungal
infections in the feet, something like an athlete's foot. Typically what that looks like
for of patients is it's the most commonly is infection
between the toes. So what you'll see is, it's
just like I tell folks, if you were to be in a pool, or an ocean or a bathtub for a long time, like your hands or body gets wrinkly, and the same thing when
your food gets wrinkled. When it gets wrinkled like that, the skin becomes very soft and can crack. And you can also be a source of infection because again, that cracking,
that barrier of the skin into infection and that
cracking can lead to infection. Where that most commonly starts is kind of in between the toes.

So making sure you keep the
area in between your toes dry, particularly for folks
that that are sweaters. As I like to say, folks that sweat a lot, not something you wear in the
winter, but a sweater person. Typically drying in between
the toes is helpful. Changing your socks. One to two times day can be helpful, particularly if you're working outside, like in landscaping or
something like that. Or drying off in between
the toes after you shower, that can be really helpful. I particularly counsel my
diabetic patients on that, 'cause they're a little bit higher risk for getting these fungal
infections in between the toes. So literally taking the towel and drying off in between your toes, almost flossing in between the
toes is particularly helpful for preventing that type of infection.

If you're more of a
sweating type of a person. – [Alyne] Is there anything
else you'd like to add? – [Benjamin] The area that
we haven't really touched on too much is a concept
of an ingrown toenail. So toenails can cause problems. So I think the single biggest thing that I would mention about toenails is not cutting them too short. Particularly around the
corners of the toenails. So an ingrown toenail is when, literally the edge of the nail, typically your big toe,
truly grows into the skin. And when it goes into the skin, as we mentioned with
several other conditions, it causes cracking in the skin and that can lead to infection getting in. So that's what an ingrown toenail is. It's an infection because the toenail is literally growing into the skin, hence the kind of common sense name there.

The best way people can prevent that is not cutting the nail short enough that it can grow into the skin. So as long as you leave your
nail longer than that area, where you look at your nail
and there's color to it. And then at the end of
your, it turns white. As long as you leave
some of that white area where it's gone beyond
where the skin attaches, you will never get an ingrown toenail. And so I think that's one of
the easy things that folks can do to help prevent in grown toenails. Is not cutting those, particularly edges, of the big toe too short. That doesn't allow it to grow in and really helps prevent a
lot of problems down the road. – [Alyne] Well, thank you so much for all the us really great information. I know that we rely on our feet and sometimes we take 'em for granted.

So I really appreciate you talking to me. – [Benjamin] Oh, well, happy to help. – [Alyne] Dr. Benjamin Jackson is an orthopedic foot and ankle
surgeon with Prisma Health. For more information and
other podcasts like this one, head on over to This has been "Flourish," a podcast brought to you by Prisma Health. I'm Alyne Ellis, stay well. (bright music).