Happy feet

The bad news is you have to ditch those high heels!

Janet Ng (not her real name) loves high heels, and wore them through­out her teach­ing career. Stand­ing in uncom­fort­able heels hour after hour took a toll on her feet, and by the time she retired, she had devel­oped severe bunions. These bumps, which form on the joint at the base of the big toe, pre­vented her from stand­ing or walk­ing com­fort­ably, a con­di­tion that experts say is common.

Man­fred Mak Yao­quan, a podi­a­trist in the Depart­ment of Podi­a­try, Sin­ga­pore Gen­eral Hos­pi­tal (SGH), said: “Many of our patients with foot prob­lems are women who have either been wear­ing high heels for pro­longed peri­ods or have been forc­ing their feet into ill-​fitting shoes. Often, van­ity is the main cause.”

Accord­ing to Mak, who sees about 50 women every month for high-​heel-​related prob­lems, an increas­ing num­ber of younger women, some in their late 20s, are get­ting treat­ment for prob­lems like bunions, heel spurs and hard skin on their feet. “High heels are not good for feet. If you have to wear them, the max­i­mum heel height should be one to two inches,” he said.

Squeez­ing broad feet into shoes that are too nar­row is also not advis­able. Many women believe that blis­ters are a nat­ural con­se­quence of the “breaking-​in” process for new shoes, but Mak said these should not con­tinue to form after the sec­ond or third wear.

If the shoe fits

“Just because your foot can fit into a shoe doesn’t mean it’s a good fit. There are many soft tis­sues in the foot which shouldn’t be com­pressed,” said Mak. One way of ensur­ing a proper fit is to remove the shoe’s insole, put it on a flat sur­face, and then place the foot over it. If the foot is too large for the insole, the shoe is too small.

Apart from fit­ting well, a good pair of shoes should also hold the feet down prop­erly with fea­tures such as laces, buck­les or straps. Elas­tic bands are not ideal, as they often don’t offer enough sup­port. Often over­looked too is the heel counter, or the back of the shoe, meant for hold­ing the foot in place and pro­vid­ing sup­port while walk­ing. Footwear with a solid back sup­port or firm back strap is rec­om­mended – mean­ing san­dals should be cho­sen over flip-​flops for walk­ing. Flip-​flops such as Japanese-​styled slip­pers are not rec­om­mended for those with dia­betes because fric­tion from the toe-​grip can injure the area between the toes.

Men have prob­lems too

While many women are guilty of mak­ing poor footwear choices, men fall short when it comes to foot hygiene. “Men usu­ally develop fun­gal infec­tions between their toes because they tend to sweat more and don’t dry their feet prop­erly. They also often neglect to change their socks daily,” said Mak. He also had a word of cau­tion for women who visit nail salons. “If, for instance, instru­ments used in nail salons are not cleaned prop­erly, fun­gus spores and bac­te­ria can spread eas­ily from one cus­tomer to the next,” he said.

Ulti­mately, per­sonal foot hygiene and good foot health are one’s own respon­si­bil­ity. For a start, change socks daily, mois­turise dry spots and choose footwear that fits well. While it may be coun­ter­in­tu­itive for many women, “com­mon sense and not van­ity should pre­vail to ensure good foot health,” said Mak.

Com­mon foot conditions

• Athlete’s Foot – The fun­gus that causes Athlete’s Foot can cause skin to become itchy and sore, then start to crack and peel. Wors­ened by poor foot hygiene, Athlete’s Foot can be picked up from floors where peo­ple are likely to walk around bare­foot, such as in locker rooms, swim­ming pools and nail salons. SOLU­TION: There are over-​the-​counter Athlete’s Foot treat­ments. You can con­sult the phar­ma­cist on the right one for you, or see your doc­tor or podi­a­trist for advice.

• Cal­luses – Cal­luses are areas of thick­ened skin caused by repeated fric­tion and pres­sure, and com­monly affect the heel and sides of toes. Peo­ple with flat feet are prone to cal­luses, espe­cially on the balls of their feet and the insides of their heels, as their abnor­mally low foot arches cause exces­sive pres­sure on these areas. Going bare­foot often or wear­ing poorly fit­ting shoes can also be con­tribut­ing fac­tors. Left untreated, cal­luses can develop a mass of dead cells in their cen­tre, lead­ing to corns. SOLU­TION: Again there are over-​the-​counter treat­ments for cal­luses. You might want to use a pumice stone and foot file to reduce the thick­ened skin.

• Heel spur – An abnor­mal growth of the heel bone (bony pro­tru­sion) largely due to cal­cium deposits, heel spurs can cause great pain when stand­ing or walk­ing. Those with flat feet, unusu­ally high foot arches or women who reg­u­larly wear high heels are prone to this con­di­tion. SOLU­TION: Short-​term rest, inflam­ma­tion con­trol and wear­ing an appro­pri­ate footwear or insoles.

• Bunion – An abnor­mal enlarge­ment of the joint at the base of the big toe, a bunion often causes the joint to stick out and the big toe to lean towards the sec­ond toe, result­ing in pain and sore­ness. Wear­ing high heels, shoes that crowd the toes and spend­ing long peri­ods on one’s feet can aggra­vate the sit­u­a­tion. SOLU­TION: Treat­ment can include change of shoes, orthotics, rest, ice and med­ica­tions to surgery to address the deformity.

(Infor­ma­tion has been pro­vided by Man­fred Mak Yao­quan, SGH)

Choos­ing the right pair of shoes

1. Shoes have to be firm, for instance, the shoe should only be flex­i­ble (and bend) at the ball of the feet (at the big toe joint). Shoes that are able to bend in the mid­dle por­tion often do not offer suf­fi­cient sup­port for the foot.

2. For closed-​in shoes, there should be suf­fi­cient space (length, width and depth, in the front of the shoes (toe box)). Toes should not be squashed; the wearer should be able to wrig­gle his toes and there should be one thumb space in the front, from the longest toe to allow the foot to extend dur­ing walking/​run­ning. Ask some­one to mea­sure this for you while you are stand­ing obtain an accu­rate measurement.

3. A raised and curved arch with ade­quate depth in the shoe (foot is not ‘falling’ out of shoe).

4. Purpose/​function of shoes – what is the shoe being used for? For exam­ple, for sports, shoes with suf­fi­cient cush­ion­ing and sup­port are rec­om­mended due to an increase in impact forces on the foot. For exam­ple, high-​heeled shoes are not designed for extended peri­ods of walk­ing and should not be used if you plan to walk a con­sid­er­able distance.

5. Dif­fer­ent makes of shoes come in dif­fer­ent lengths and widths. For exam­ple: A size 8 Nike is dif­fer­ent in length, etc as com­pared to a size 8 Adi­das. Vari­a­tions can also occur within the brand itself. There­fore, it would be advis­able to have your feet mea­sured (whilst stand­ing, not sit­ting) each time you pur­chase shoes. As far as pos­si­ble, avoid ask­ing some­one else to buy shoes on your behalf with­out per­son­ally try­ing out the shoe first. Feet are sel­dom pre­cisely the same size. The left foot might be slightly larger than the right foot, vice versa. Hence, buy shoes that fit the big­ger foot, not the smaller one.

6. Never pur­chase tight footwear think­ing that it will ‘wear in’ and expand after use. Blis­ters, etc will have already occurred by then.

7. Shop for shoes in the after­noon as feet tend to swell up in the later part of the day.

8. Try walk­ing with both shoes in the shop before pur­chas­ing them. Try them on using the sim­i­lar pairs of socks you intend to wear with them. Shoes should feel com­fort­able and do not need to be stretched or broken-​in to.

(Infor­ma­tion has been pro­vided by Man­fred Mak Yao­quan, SGH)

1. Calf stretches – This exer­cise will help prevent/​relief/​relax the calf mus­cles, which would then put less stress on the plan­tar fas­cia, thus reduc­ing the com­mon ‘heel pain’ (see below).Exer­cises that help improve con­di­tion of feet

2. Towel stretch – Sim­i­lar effect to calf stretches, can be per­formed sit­ting down. Place towel across ball of one foot and grab the towel at the two ends with your hands. Keep your back straight and pull the towel towards you. Ensure that leg is fully straight­ened through­out the exercise.

3. Foot rolls – This will be help­ful to mas­sage the arch area and the bot­tom of the foot to relieve aches/​pain. For a foot roll, con­sider using a water bot­tle that con­tains ice to reduce inflam­ma­tion or give a sooth­ing effect at the same time.

4. Mar­ble grab­bing – Pick­ing up small, rounded objects (no sharp objects) with your toes can help to strengthen and work the intrin­sic mus­cles of the foot.

5. Ankle cir­cles – Pri­mar­ily works the lower leg mus­cles and helps to stretch or strengthen them as well as pre­vent deep vein throm­bo­sis if seated for long peri­ods of time. You can do this seated, or lying down. Keep leg com­pletely still and cir­cle the foot slowly and as widely as it will go. Do this 3 to 5 times, then cir­cle in the oppo­site direc­tion. Repeat on the oppo­site leg.

(Infor­ma­tion has been pro­vided by Man­fred Mak Yao­quan, SGH)

** Por­tions of this story was first pub­lished in Sin­ga­pore Health, May/​June 2010 (a SingHealth and SGH pub­li­ca­tion) and has been reprinted with per­mis­sion from SingHealth and SGH. Spe­cial thanks to Man­fred Mak Yao­quan and Serene Ng.

(PHOTO CREDITS: Heel pic­ture: ELE­GANT STILETTO SHOE © Gabriel Blaj | Dream​stime​.com; Stand­ing calf stretch pic­ture: Man­fred Mak Yao­quan, SGH)