Foot Health for Women
Women are more vulnerable to certain foot problems than men, mainly from years of walking in narrow-fitting shoes that squeeze the toes and from high-heels that cramp the forefoot and pose risks for arch and ankle problems. Some common foot problems for women are:
A neuroma is a thickening of nerve tissue. In the foot, it most commonly occurs at the base of the third and fourth toes. This condition is called Morton’s neuroma or intermetatarsal neuroma. Neuromas may also occur in other locations in the foot and are caused by compression and irritation of the nerve, producing swelling and possible permanent nerve damage.
A major risk factor is wearing shoes with a tight toe box, or high-heeled shoes that force the foot into the toe box. Women who run, play racquet sports or participate in physical activities that exert repetitive stress on the forefoot are prone to develop neuromas. The combination of repetitive stress activities and wearing tight fitting shoes increases the risk for women.
Neuromas enlarge as the condition progresses, causing tingling, burning pain and numbness of the toes. Patients often complain it feels as if something is stuck inside the ball of the foot. The symptoms may go away temporarily by massaging the foot, wearing wider shoes with low heels, and avoiding activities that exert stress on the forefoot. Symptoms become more intense as the nerve enlarges and the temporary damage becomes permanent. Therefore, it’s best to seek treatment if discomfort persists for more than a few days. A neuroma isn’t detectable by x-ray, so the diagnosis is based on symptoms and a physical examination during which a physician attempts to reproduce the symptoms by manipulating the foot.
Treatment options depend on severity. At early stages, padding lessens pressure on the nerve, icing reduces swelling, nonsteroidal anti-inflammatory drugs, such as ibuprofen, decrease pain and inflammation, and custom orthotic devices provide support to reduce compression. Also, physical activity modifications might be recommended as well as avoiding narrow, tight fitting shoes and high heels.
In severe cases, surgery might be the best option to provide relief. A foot and ankle surgeon can release or remove the affected nerve in an outpatient procedure. Surgery for neuromas has a very high success rate. It relieves the pain, although there might be a loss of sensation in the area where the nerve provides feeling to the toe.
Heel Pain (Plantar Fasciitis)
Heel pain is most often caused by plantar fasciitis, a condition that sometimes is also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a tumor. Because there are several potential causes, it is important to have heel pain properly diagnosed to consider all the possibilities and determine the underlying source of heel pain.
About 15 percent of all adult foot complaints involve plantar fasciitis resulting from chronic inflammation of the connective tissue extending from the heel to the toes.
Although faulty foot structure is the most common cause of plantar fasciitis, being overweight and wearing non-supportive shoes are common contributing factors. Heel pain is most noticeable after getting out of bed in the morning, but it tends to decrease after a few minutes and returns during the day after sitting for long periods of time.
Self-treatment of heel pain, such as taking nonsteroidal anti-inflammatory drugs and doing stretching exercises, often is tried before seeking medical advice. To help diagnose its origin, physicians will ask about the time of day the heel pain occurs, types of shoes worn regularly, normal physical activities, and if recent trauma has occurred. X-rays, MRIs or bone scans can help differentiate various types of heel pain.
Treatment options for plantar fasciitis include nonsteroidal anti-inflammatory drugs and custom orthotic devices. Patients also are advised to stretch their calf muscles regularly, avoid wearing flat shoes and walking barefoot, and limit the frequency of extended physical activities.
Most patients with plantar fasciitis respond to non-surgical treatment within six weeks. If improvement occurs, therapy is continued until the heel pain is resolved. If there is no improvement after six months, surgery might be recommended.
Bunions are often described as a bump on the side of the big toe. But a bunion is more than that. The visible bump actually reflects changes in the bony framework of the front part of the foot. With a bunion, the big toe leans toward the second toe, rather than pointing straight ahead. This throws the bones out of alignment—producing the bunion's "bump."
Bunions are a progressive disorder. They begin with a leaning of the big toe, gradually changing the angle of the bones, slowly producing the characteristic bump, which becomes increasingly prominent. Usually the symptoms of bunions appear at later stages, although some people never have symptoms.
Contrary to popular belief, bunions are aggravated, not caused, by shoes. The late anthropologist Margaret Meade observed many members of a South Sea island tribe had bunions, yet they had never worn shoes! A bunion is usually a result of inherited faulty foot mechanics that put abnormal stress at the base of the big toe.
The majority of bunion surgeries are performed on women. They outnumber men among bunion patients mainly because society puts women in “stylishly” tight, pointed, confining or high-heeled shoes, which often move the big toe toward the smaller toes. The crowding inside the narrow toe box aggravates and accentuates a pre-existing weakness, pressuring the joint, pushing it outward, and a bunion begins.
For a moderate-sized bunion, padding, wearing comfortable shoes, and avoiding high-heels can relieve pressure and slow the progression of the deformity. Nonsteroidal anti-inflammatory drugs may be prescribed to relieve pain and swelling.
When the pain and deformity of a bunion interferes with daily activities, surgery may be considered. Several types of procedures are used to treat bunions. They are designed to remove the "bump" of bone, correct the changes in the bony structure of the foot, as well as correct soft-tissue changes that may have occurred. The goal of these corrections is the elimination of pain. In selecting the procedure or combination of procedures for a particular case, a foot and ankle surgeon will take into consideration the extent of the deformity based on the x-ray findings, the patient’s age and activity level and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed.
Many foot and ankle surgeons consider ankle sprains to be the most neglected injury in the U.S. Sprains occur when one or more ligaments in the ankle are stretched, partially torn or completely torn, mostly on the outside of the ankle joint.
The ankle joint is made up of three bones: the tibia, fibula, and talus. They form a socket in which the ankle joint moves. All three are connected to each other by ligaments that hold the bones together so the joint remains stable and functions properly. When a sprain occurs, the area often is tender, swollen, discolored and sometimes painful to touch. A sprained ankle often feels unstable, especially if ligaments are torn.
A sprained ankle can happen simply by stepping off a curb, walking or running on uneven ground, playing basketball and other court sports, or wearing high heels, shoes with platform soles or other improper footwear. Anyone born with weak ankles and those with a history of ankle injuries are at higher risk for sprains.
Left untreated, sprains can lead to chronic ankle instability and leg weakness. Also, a sprain could mask a more severe injury, such as coexisting mid-foot trauma or a possible fracture.
The "RICE" method (rest, ice, compression and elevation) is the best immediate treatment and usually eases pain and reduces swelling. However, if pain, swelling or difficulty walking persist more than 48 hours, a foot and ankle surgeon should be consulted to evaluate the severity of the injury. In some cases, x-rays or MRI or CT scans might be ordered to further examine the injured area.
Rehabilitation of a sprained ankle may include:
- Continuation of icing
- Pain medications
- Nonsteroidal anti-inflammatory drugs
- Immobilization: bracing, crutches, casting or a walking boot
- Compression wraps
- Physical therapy
For some patients with severe sprains, surgery might be necessary to repair damaged ligaments. Foot and ankle surgeons frequently use minimally invasive arthroscopic procedures to visualize the joint and repair the damage. Proper rehabilitation is critical for successful outcomes. Ankle strengthening exercises following the injury may help prevent recurrence. As a preventative measure to protect against reinjury, ankle braces or taping around the ankle joint are helpful, especially for those participating in sports.
Cosmetic Foot Surgery
In February 2004, the American College of Foot and Ankle Surgeons issued this position statement.
“The American College of Foot and Ankle Surgeons promotes the highest standards and ethics of foot and ankle surgery. Members of the College have extensive training and experience in surgical procedures performed for relief of pain, restoration of function, and reconstruction of deformities of the foot and ankle.
All surgery carries risks, and these risks are of increased importance when they have the potential to affect the individual’s ability to lead an active life, as they do with surgery of the foot and ankle. Patients considering surgery of the foot or ankle and their surgeons must thoroughly discuss and weigh the risks and benefits of the procedure.
Surgery performed solely for the purpose of improving the appearance or size of the foot or ankle carries risks without medical benefit, and therefore should not be undertaken.”