The foot provides durability in a complex structure but versatile design. The organization of 26 major bones with numerous muscle tendon groups provides tremendous strength and tolerance to enormous weight bearing forces, while providing elegant flexibility of movement. It provides a foundation for virtually all movements, which carry weight-bearing forces that can be many times the weight of our own body. The speed of walking jogging or jumping, in addition to supporting weight of additional objects, can require the feet in particular to tolerate a load of twenty times our own body weight. With such hard work taking its toll on this unassuming and often overlooked tool, the foot is vulnerable to both acute traumatic injury and prolonged overuse. The nature of the injury can be obvious or very obscure.
Acute trauma to foot and lower extremity leads to common more easily detected injuries. Sprains, strains and fractures are common with acute trauma. If severe enough most fractures are easily detected with routine x-rays. A thorough exam by a knowledgeable medical provider can usually identify or rule out these conditions. A detailed understanding of the circumstances at the moment of injury provides clues to the nature and location of injury. However, some of these injuries can result in obscure subclinical damage that may be difficult to localize. A stress fracture is by definition a crack to the bone that initially does not appear on an x-ray. It is not apparent until 2-3 weeks later when new bone formation becomes visible on an x-ray signifying repair to the bone. Even that may not be detectable without a special bone scan or MRI in order to identify the reason for lack of improvement or continuing pain in excess of expectation.
The numerous components of the foot are also subject to overuse injury through repetitive motion. Some of these may seem excessive or extraordinary activities while others may be regular daily tasks that simply go beyond the capacity of the foot to tolerate the demands. Blisters, tendonitis, plantar fasciitis, Morton's neuroma, bursitis are all examples of repetitive overuse injury to the foot. The natural shape of an individual's foot, strenuous activity, or footwear improperly fitted or unsuitable for the activity contributes to overuse injury.
Treatment for foot injuries relies on the fundamentals of rest, ice, elevation, and typically an anti-inflammatory medication. Immobilization of an unstable fracture or bracing of a weakened ligament or tendon is often necessary. Having said that, immobilization is assigned for as short a period as possible. Mere inactivity contributes to stiffness and muscle atrophy. Basic mobility is dependent on walking even if it means crutches to enable partial weight bearing. There simply is no substitute for providing adequate time for the weakened component to heal. This can be a slow and frustrating process. Some weight bearing is preferred, if tolerated, while restricting activities. Careful planning for transitional activities, use of cold packs, an anti-inflammatory, and physical therapy all add to the repair process. Consultation and coaching by a physical therapist can facilitate re-strengthening, enhance range of motion, and accelerate the healing process by eliminating the intrinsic complications of inactivity. A plan for home exercises is part of rehabilitation program as well. Frequent course corrections are made by continued collaboration with the physical therapist to enhance the most efficient outcome. Designing exercises specific to a job or sport for the individual are very helpful and part of the physical therapy contribution to recovery.
Management of any of these injuries includes careful planning for transitional activities. When to resume full duty of unrestricted play or work should be decided by careful planning with the health care team. Attention to both physical and mental aspects of the injury is important. Equally important are confidence in the recovery, good body mechanics when resuming activities, proper training and warm up to maintain your good health while preventing further injury.
Blisters and fungal infections of the foot (Athlete's foot) are common relatively minor problems that cause a great deal of disability and time loss. Both are very preventable with consistent management. Dry feet are important to both situations. Wet feet are more likely to form friction blisters and wet feet are more prone to breed a fungal infection. Both conditions ignored can be temporarily disabling and very uncomfortable. Preventing blisters depends on properly fit shoes that are suited for the activity. Suitable socks that pad the high friction areas of the foot. If necessary adding self- adhesive moleskin or plain zinc oxide tape over the potential problem areas before beginning the activity can be a great benefit for prevention. If a blister does develop, these same products are useful as a "second skin" for temporary protection. Popping the blister should be avoided unless it is an uncomfortable weight bearing area. Even then proper cleaning of the area with disinfectant and use of clean instrument are important to prevent infection. Leaving as much of the blister dome in place temporarily may help provide some protection in conjunction with "second skin" products. Ongoing wound care and possible removal of the devitalized skin may be necessary to prevent infection. Fungal infections develop slowly and easily ignored until they advance enough to cause bothersome symptoms. Cleaning the feet, changing socks and even shoes, daily may be necessary. A few fungi typically on the skin cultivate in worn clothing and accumulate in footwear, especially if they are chronically damp from moisture or sweat. This breeding ground infects the skin causing itching, redness, peeling and even pain from the breakdown of the skin. Dryness helps. However over the counter treatment with a broad-spectrum anti-fungal cream such as terbinafine (available as a generic or brand Lamisil) applied twice daily will adequately treat most cases in 2-3 weeks. If these simple measures do not prevent or manage your symptoms consult your health care provider for further evaluation.
You must take good care of your feet if you expect to go very far!
