Footnotes
Summer Foot Tips
After what has seemed like the longest winter ever, we have finally been greeted with what is shaping up to be a truly stellar summer!
Like many Alaskans, I am looking forward to summertime activities including hiking, camping, rafting, cycling and outdoor concerts. Also like many Alaskans, I spent the winter either holed-up inside or engaged in activities that were lower impact and required less joint motion (particularly smaller joints in the front of the foot and toes) than many of the typical summer activities (i.e. skiing/snowboarding versus hiking, running, or rock climbing).
Through Summer
many of us make the transition to activities which can be higher impact.
Through summer, many of us make the transition to activities which can be higher impact and may include more strenuous exercises that can place more stress on our foot and ankle joints. Often, foot and ankle pains associated with these activities may have been developing over previous years but were not severe enough to cause the patient to seek care or were forgotten about over the winter.
One thing I have seen frequently in the past (and have already seen this season), is that some of us may not be engaging in certain activities in the correct type of shoes. (Visualize the Flattop climber ascending/descending in flip-flops or Crocs!)
This brings me to my first summertime foot care tip: Don’t hike in flip flops! This goes for sport sandals like Tevas or Chacos or similar! Not only do these types of footwear provide no protection from jagged surfaces, sticks, or creepy-crawlies, but flip flops are a fantastic way to sprain an ankle. This is because they have no straps to hold the back of the foot in place, allowing it to slip off of the footbed and the ankle to roll.
Additionally, many of these types of shoes really do not have any grip on them so sliding down the trail is also a real possibility. (Yes, this can happen with any shoe, but why increase the odds by wearing a flip flop?)
If you are going to hike, wear proper hiking shoes or boots. Hiking boots that come up past the ankle are preferred as they offer more mechanical stability, as well as improving proprioception (your brain’s awareness of your body parts in space) which improves functional stability. Save the Tevas and Chacos for strolling around town, walking on the beach, or engaging in water activities.
Another fun fact about flip flops and sandals: they dry out your skin terribly (especially the heels). Does that mean that you should never wear them? Of course not! We have such a short window of time to air out our feet that I would be remiss to suggest anyone keep them closeted during this glorious season.
Which brings me to foot care tip number two: It is important to maintain excellent hydration and to apply lotion to the feet twice a day to keep the skin supple, maintain elasticity and prevent dry cracked heels.
As the weather improves and people become more active, I notice an increase in the number of
ingrown toenails
that I treat.
As the weather improves and people become more active, I notice an increase in the number of ingrown toenails that I treat. In just the past few weeks, I have heard more than one patient with an ingrown toenail confess that their toenail had been ingrown, inflamed and painful for several months.
Ingrown toenails are generally easy to treat - with a quick (5-10 minutes) procedure in the clinic, the ingrown portion of the nail can be removed. By treating the nail root with an acid - usually trichloroacetic acid or phenol – we can prevent it from ever coming back. The aftercare is simple, and patients can usually get right back to full, unrestricted activities within a couple days.
Foot care tip number three: Anyone with an ingrown toenail (especially one that looks like it might be infected) needs to have it looked at and treated. With the toenail’s proximity to bone, an untreated infection due to an ingrown toenail can theoretically cause an infection of the bone - a much more serious problem. Once the ingrown nail has been removed and the toe is healed, it will look and feel much better.
There are many ways to treat toenail fungus
including oral and topical medications, laser care…
Summer is also a time when many patients choose to address their toenail fungus. In the winter months toenails can be “out of sight, out of mind” (unless there is a trip to Hawaii coming up!). There are many ways to treat toenail fungus including oral and topical medications, laser care, or, in extreme cases, toenail removal. Because toenail fungus is very contagious, it can spread to the skin resulting in athlete’s foot. And it can live in carpet for a long time too, potentially infecting others.
In the beginning of summer, I tend to see an increase in patients coming in with forefoot and toe joint pain and stiffness associated with bunions, tailor’s bunions and hammertoe complaints. Bunions are those large bony bumps at the base of the big toe, while tailor’s bunions are large bony pumps at the base of the little toe. Hammertoes are where the smaller toes start to contract and bend at the joints. All of these are progressive, structural deformities, meaning that while we can manage them conservatively (think shoe gear modifications, pads, orthotic inserts, anti-inflammatories), they can only be corrected through surgery.
In the summer we engage in activities that require the feet and toe
joints to have to bend and flex more.
The reason for this uptick is simple: In the summer we engage in activities that require the feet and toe joints to have to bend and flex more (hiking, camping, running, rock climbing, etc.). Going back to the summer sandal wearing, our feet are out there, exposed for all to see, and we are more acutely aware of these various deformities, lumps, bumps, etc.
Much of the time, patients will opt to try and wait until after summer to have foot or ankle surgery, so they don’t miss out on the precious few warm, sunny days during this time of year. So, they use the beginning of summer to get an assessment of their condition, learn about surgical corrective options, and start planning for possible surgery later in the year.
Foot care tip number four: If you have a bunion, tailor’s bunion, hammertoes, or any significant foot deformity that hurts or restricts shoes or activities, then consider having it surgically corrected. But if it is not painful, skip the surgery! And do not have surgery just for the sake of improving the cosmetic appearance of the foot.
Finally, I do encounter more injuries, particularly turf toe, tendon injuries, metatarsal fractures and ankle sprains in the summer versus the winter. No surprise there, especially when patients are not wearing the proper shoes for the activity in which they were engaging at the time of the injury. Refer back to foot care tip number one.
My fifth and final foot care tip: It is important to take care of your feet all year long and to avoid putting off seeing a podiatrist until a simple problem or minor pain becomes something more serious. You only get one set of feet. Take care of them and they will take care of you.
Now get out there and have fun!!
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