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"Exercise, exercise, exercise" has become the battle cry of many
older Americans. If they are not hearing it from their doctors, they are
imposing an exercise regime on themselves. Exercise is a good thing, but for
many older people their spirit is willing but their feet are weak. An estimated
10 million Americans suffer from osteoporosis and another 18 million more have
low bone mass putting them at risk for stress fracture, particularly when they
begin exercise.
According to the U.S. National Center for Health Statistics, impairment of
the lower extremities is a leading cause of activity limitation in older people.
Foot problems can also lead to knee, hip and lower back pain that undermine
mobility just as effectively.
Older people are much more active than they've been in the past, as a result,
they place a higher demand on their feet and lower extremities, and if they
haven't been taking care of them, their feet are subject to overuse problems.
Many of the foot problems facing older people stem from the cumulative effect of
years of neglect and abuse. The good news is that many of these foot problems
experienced by older people can be treated successfully.
One condition limiting the lifestyles of many older people is arthritis.
Arthritis, which is estimated to affect one in seven people, is often the most
frequent source of debilitating pain and joint destruction. Although there are
many forms of arthritis, osteoarthritis, traumatic arthritis and rheumatoid
arthritis can cause the most damage to joints, including the ankle joint.
Traditional treatment of an arthritic ankle includes anti-inflammatories, pain
medication, shoe inserts, called orthoses, that help with foot mobility, and
physical therapy and exercise. When these measures of treatment fail to provide
relief, surgery, such as ankle arthroscopy and ankle arthroplasty, is
considered.
Regardless of how one stays active, foot care should be a part of everyone's
routine. Healthy feet mean limitless exercise, within a doctor's recommended
guidelines, which can lead to a longer, more healthy life.
The following are tips for overall foot and ankle health.
- Wear proper fitting shoes. For more strenuous walking and running, an
athletic shoe with gel soles, rubber bottoms, arch supports and a size
larger are recommended. If mall walking or street walking is preferred, a
supportive walking or running shoe will suffice. Wear thicker socks for more
cushion.
- Stretch daily and remain active. As a body ages, circulation suffers,
daily stretching will help warm up muscles to begin exercise and help cool
down tired muscles after activity.
- Always contact a family physician before starting an exercise program.
Stress fractures
Stress fractures have become "the great masquerader" to the
sports enthusiast and physician. The stress fracture appears to be most often
associated with maltraining. A stress fracture is most likely caused by
recurrent microtrauma resulting in cortical bone fatigue, which is often
imperceptible on plain radiographs until 6 to 8 weeks after the onset of pain.
The stress fracture is most often seen in the tibia, fibula or metatarsal,
but any persistent, activity-related pain of the foot or ankle should arouse
suspicion. Stress fractures involve the bones ranging from the tarsal navicular
to the metatarsals. Anatomic malalignments and muscle-tendon imbalance, as well
as maltraining may be contributing factors.
Often the diagnosis of stress fracture can be made clinically. Technitium-99m
bonescans are useful when there is some diagnostic uncertainty, for example, a
runner with lower leg pain in which a compartment syndrome is suspected, a
stress fracture must be ruled out. Individualized treatment of the stress
fracture is the rule. Often, minor technique changes or decreasing the frequency
of an activity will allow healing. There are, however, some stress fractures
that require immobilization. Even while immobilized, the athlete is encouraged
to exercise within the limitations of no pain. Weight-bearing is allowed in all
but the most unusual situations. Encouraging activity prevents disuse atrophy
and bone demineralization. Stretching, strengthening, and analyzing techniques
are mandatory to prevent recurrence of stress fracture.
Foot health: Selecting the right athletic shoe
Summer offers us a variety of sports and activities. From running to
aerobics, the feet bear much of the burden for carrying out these summertime
activities, and selecting the right footwear is critical to foot health and
performance.
Feet are made to bear tremendous pressure, an average day of walking brings a
force equal to several hundred tons to bear on the feet. Weight bearing sports
like running and aerobics put even more pressure on the feet and ankles.
Selecting the right athletic footgear is important to the overall health of
the feet. Depending on your sport of choice there is a shoe to meet your foot
care needs.
Use the correct shoe for each sport. For example, a running shoe is built to
accommodate the impact that concentrates on the forefoot, while a tennis shoe is
made to give relatively more support to the ankles, and permit sudden stops and
turns.
The following identifies the proper style of footwear for a particular sport:
Tennis
Proper tennis shoes "give" enough to allow for side-to-side
sliding. In addition, tennis shoes need to have padded toe boxes to prevent
injuries.
Cycling
Select a cycling-specific shoe that is right for you among models designed
for racing and mountain biking. The casual rider without known foot problems can
use cross training shoes (i.e. combination cycling-hiking shoes), which provide
the necessary support across the arch and instep in a shoe as well as the heel
lift that cycling shoes give.
Golf
No longer driven by fashion, today's golf shoes are constructed using basic
principles of athletic footwear. Advanced technological innovations keep golf
shoes light and add strength.
Running
A good pair of running shoes is the most important piece of equipment for a
runner. Shoe choice should be determined by weight, foot structure, and running
regimen. Keep in mind that all shoes have a different shape, and sizes are not
uniform from shoe to shoe. It's a good idea for a beginning runner to see a foot
care specialist before starting a running regimen.
Children's athletic shoes
It's not the brand name or price tag of an athletic shoe that makes the
difference in a child's foot health. Foot care specialists agree it's often
better to buy a child two pairs of less expensive shoes than a single expensive
pair. The reason that two pairs are better than one is so the shoes can be
rotated to avoid rapid wear deterioration. Excessive wearing of the out-sole,
loss of shoe counter support, or wearing out in the mid-sole indicate it's time
to replace the shoes. Proper fit is the key.
If you have a preexisting foot condition, your foot care specialist can make
recommendations for appropriate shoes.
Comfort, fit and support are the key drivers in selecting shoes. The
following are general shoe buying tips:
- Have your feet measured while you're standing
- Always try on both shoes, and walk in the shoes before buying them
- Buy for the larger foot; feet are rarely the same size
- Shoes should feel comfortable immediately, not needing a break-in period
- Shop for shoes later in the day; feet swell during the day
- Be sure that the widest part of your foot corresponds to the widest part
of the shoe
- Try on shoes while you're wearing the same type of sock you'll be wearing
with the shoe
- Because children's feet are constantly growing, allow at least one fingers
width from the end of the longest toe when buying shoes
Shin splints
Definition
Inflammation of the tendons on the inside of the front of the lower leg
(Sports-medicine specialists don't like to use the the term "shinsplints"
because it commonly refers to several lower leg injuries. We'll use it anyway
but focus on the specific problem that is the most common: tendinitis of the
lower leg.).
Symptoms
An aching, throbbing or tenderness along the inside of the shin (though it
can radiate to the outside also) about halfway down or all along the shin from
the ankle to the knee. Also, pain when you press on the inflamed area. Pain is
most severe at the start of a run, but can go away during a run once the muscles
are loosened up (unlike a stress fracture of the shinbone, which hurts all the
time). With tendinitis pain resumes after the run.
Causes
Tired or inflexible calf muscles put too much stress on tendons which become
strained and torn. Overpronation aggravates this problem, as does running or
hard surfaces such as concrete sidewalks.
Beginning runners are the most susceptible to shinsplints for a variety of
reasons, but the most common is that they're using leg muscles that haven't been
stressed in the same way before. Another common cause of shinsplints among
beginners is poor choice of running shoes, or running in something other than
running shoes. Runners who have started running after a long layoff are also
susceptible to shinsplints because they often increase their mileage too
quickly.
Self-treatment
Many runners experience mild shin soreness which usually can be tolerated.
"If shinsplints hits you at the beginning of a season, a certain amount of
running through it will help the body adapt," says David O'Brian, DPM, a
podiatrist in Roselle, Illinois. "But, if it's a persistent problem, you
shouldn't run through it.
If it does persist, ice the inflamed area for l5 minutes three times a day
and take aspirin or ibuprofen. Ice immediately after running. To hasten
recovery, cut down on running or stop altogether. Recovery time: two to four
weeks.
Medical treatment
If the injury
doesn't respond to self-treatment and rest in 2 to 4 weeks, see a podiatrist,
who may prescribe custom made orthotics to control overpronation. Ultrasound and
anti-inflammatories may also be prescribed. Surgery is rarely required.
Alternative exercises
Nonimpact
exercises, such as swimming, pool running, walking, and cycling in low gear.
Preventive measures
To stretch and
strengthen the tendons and muscles in the front of the leg, sit on a table or
chair and loop an ankle weight around your foot. Without bending your knee, move
your foot up and down from the ankle. Or have a partner grasp the foot to
provide resistance. You can also strengthen the lower leg with band exercises.
Anchor one end of an exercise band to a heavy object, such as the leg of a sofa.
Stretch the band then loop it around the end of the foot. Move foot up and down
and side to side against the band's resistance to exercise different muscle
groups. The band can be ordered from a doctor or bought at some sporting goods
stores. Ask for "tension tubing."
Finally, make sure to wear motion control shoes and orthotics if your doctor
says you need them. Don't run in worn-out shoes. Warm up well and run on soft
surfaces. Avoid overstriding, which puts more stress on shins.
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