Daily Steps for Healthy Feet
Drying out your shoes is the first step. It takes at least 24 hours for shoes to dry out from normal wear, so shoe/boot dryers are helpful if you don't have a pair to rotate. The best protocol is to use a boot dryer for 90-120 minutes after a day's use and have two pairs that you can rotate.
Wearing wicking socks is also important, or even changing your socks during the day. Socks made with synthetic materials will wick away moisture better than cotton or wool. If you get sweaty feet and don't want an anti-perspirant, consider toe socks to avoid skin-to-skin contact.
Nightly foot hygiene - remove the dirt, sweat, and loose/dead skin cells from the day. With a soft bristled toothbrush and soap and water: brush the nails, nail grooves, fronts of nails, between the toes, and under the toes. If you can't get a toothbrush between your toes, use a soft wash cloth or old tee-shirt. Gently use a damp wash cloth on the rest of your foot with attention to areas with dead skin and calluses/corns. Rinse and dry thoroughly.
Use a mildly acidic lotion (e.g. Aveeno, Eucerin, Cetaphil, Cerave), which will hydrate the skin and make dead skin easier to exfoliate tomorrow. Water hydrates the skin, while oils fill in the spaces between the skin cells and coat the top of the skin to keep water in. This is why applying lotion after a shower will help hydrate your skin the best. There are water containing lotions if you don't have pre-hydrated skin.
If you have a lot of dry, dead skin build up, consider using a file before washing (e.g. diamond grit file, emery board, or 220 grit sand paper). Skin is a lot like wood: you want to only sand the dry areas. If you sand wet areas, it comes off in chucks and takes good skin with it. You also want to be careful of dust and avoid breathing it in.
Do not put moisturizers (i.e. lotions (emollients) or ointments (humectants)) on wet/white/waterlogged skin (i.e. macerated skin). Those areas need to dry out. Place a dry cotton ball between your affected toes at night to improve air circulation (commonly between the last two little toes (4th and 5th) there's a deep pocket that holds onto moisture - seen with men mostly); or between the 1st and 2nd toes for those with hallux valgus bone deformities (commonly referred to as bunions and mostly seen with women). When skin is waterlogged, it loses its natural protective barrier and bacteria and fungus can invade and cause infection. Skin to skin contact is bad; it leads to maceration. Consider toe socks to provide a layer of protection. Almost every recommendation is to avoid putting lotion between the toes, but those spaces can also get dry and the skin can crack if you separate the toes. If you proceed with caution, you can moisturize between the toes, but you must wipe off all excess lotion and strongly consider the use of toe socks (lightweight Injinji brand toe socks are excellent and what I wear).
DO NOT SOAK YOUR FEET.
1. Cracks (i.e. fissures). Soaking and removing natural oils can further dry out the thick, hardened skin. Your skin may crack and bleed, which has the potential of getting infected.
2. Waterlogged skin (i.e. maceration). You don't want to cause waterlogged skin, which inhibits your natural skin barrier and leads to infection. If you have macerated skin, it must be dried out and protected from friction. Avoid keeping macerated skin in a warm, moist environment with lots of friction (e.g. going on a long walk in your usual walking shoes). Dry the area out first and let the skin heal.
3. Soaking in stagnant water introduces bacteria and fungus to cracked and waterlogged skin. Normal showering with constantly running, clean water is best for cleansing.
Calluses and Corns
Calluses and corns are caused by pressure and friction - those elements need to be resolved to stop the calluses and corns from forming.
1. Avoid walking barefoot on floors or in shoes. Not only does this cause pressure and friction, but it can also cause a sharp injury if you step on something while walking barefoot inside or outside. Find a comfortable "house shoe" that isn't dependent on fashion. I like classic Crocs with the heel strap behind the heel. There's enough room to spread out your toes and move your feet; they are convenient slip-ons; and, the holes provide nice ventilation. Pair with Injinji toe socks for optimal foot movement and protection.
2. Wear well fitting socks (not loose socks or tight socks).
Loose socks create seed corns (i.e. small intractable plantar keratosis (IPK)) usually found on the ball of your foot, more specifically around prominent metatarsal heads). IPKs can be sanded down and will exfoliate on their own if you remove the source of friction. Sometimes they can be bigger or there can be many of them, and they become their own source of friction. IPKs may additionally cause calluses, both of which need to be sanded down.
Tight socks can contribute to soft corns between your toes, which are more likely to lead to an ulcer, because of the skin to skin contact that contributes to excess moisture and friction.
3. Wear pressure relief inserts in your shoes and change ever 4-6 months.
Calluses can be prevented with pressure relief from inserts. Inserts have a lifespan depending on how much friction and pressure that your feet produce (i.e. how much you walk and how much your foot presses down on the insert). When inserts "bottom-out" they no longer provide cushion: they no longer provide protection. It is time to purchase new inserts even if it's before 4 months.
Plantar fat pads protect your toes, balls on your feet (metatarsal heads), and heels. Over time, pressure on those fat pads will restrict blood flow to the fat cells and they may shrink (atrophy) and die, leaving you with what feels like bone to skin contact. The excess friction can lead to corns and calluses, which is an added hard-layer of pain. The additional pressure can lead to ulcers, infection, and amputation. Please change your inserts when they lose their cushion. Still unsure of when to get new inserts? Take out your insert and find the deepest impression (e.g. toe, ball of foot, heel...). If you squeeze it and it doesn't compress, there's not enough cushion to protect your weight bearing foot.
4. Wear properly fitted shoes:
Take the insert out of your shoe for inspection:
a. Do your toe imprints all fit on the shoe? If not, your need either a wider toe box or longer shoes.
b. To support the findings on "a", place the insert on the floor and step on it while standing. Does your foot spill over in other places? A professional shoe fitter at a specialty store for running/walking or orthotic shoes can help you find the right fit. Please accept the opinion if it is to size up more than what you're used to. It may also be helpful to go from a wide-width-shorter-shoe to a normal-width-longer-shoe for more toe room. Wide shoes accommodate the midfoot more than the forefoot. Square shaped feet need a square, wide toe box, or a very long tapered toe box.
For regular shoe wear, find a style that will allow you to spread, lift, and flex your toes. Sometimes with the numbness from peripheral neuropathy, people may choose shoes that they can feel, but this means that the shoes are too tight. Shop with the assistance of a professional shoe fitter if you cannot feel your toes or feet.
There are times when certain people will need a stabilizing shoe that doesn't let their foot move. Restricting foot movement is dependent on your DPM recommendations, as it will decondition your foot over time. Muscles will weaken, tendons and ligaments will tighten, nerves may be pressed on, and circulation may be affected. Only restrict your foot movement if it is medically necessary.
Fallen arches or flexible flat feet contribute to overpronation, bone deformity (hallux valgus), bunions (hallux valgus with bursitis), ankle pain, and gait instability that can lead to falls. Solutions are possible for flexible flat feet.
There are three arches on the foot and corresponding three main points of weight bearing pressure.
1) Medial Longitudinal Arch
2) Lateral Longitudinal Arch
3) Transverse/Metatarsal Arch
A) 1st Metatarsal Head
B) 5th Metatarsal Head
C) Heel (Calcaneus bone)
Each arch height contributes to what type of foot you have: high arch, flat foot, or normal arch. Every arch type will have the same pressure points labelled as A, B, and C, however, the anatomical arches will differ in contact with surfaces. Flexible flat feet are normal aches that have weakened, which can lead to overpronation of the foot, causing:
-Hallux Valgus bone deformity
-Bunions (hallux valgus with bursitis)
-Over-stretching (pulling) of the plantar fascia leading to chronic plantar fasciitis and heel spurs
-Ankle instability and pain
-Gait imbalance and falls
Most commonly, weak medial longitudinal arches are supported with orthotic inserts. The arch support in inserts can prevent your foot from rolling in (medially) too far, but they should not be used as a permanent support for your arch - they are a safety net to prevent rolling of the ankle.
Arch support that pushes up on soft tissue can cause pressure injuries; it can cut off the blood supply to the skin and soft tissue and cause an ulcer. This is why custom-made orthotic inserts must be made my a DPM or with an order from a DPM, so they are not constructed too high. It is also why over-the-counter orthotic inserts typically don't provide a hard or high arch support, because it can be misused on the wrong feet. So, arch supports are okay as long as they sit at or below your weight bearing arch. It is anatomically necessary for the arch to drop when bearing weight. The foot acts to absorb shock upon impact, and acts as a lever while stepping forward (transition and toe off), in which your arch will lower and lift itself naturally. It cannot be held in one position during these movements.
Orthotic inserts will not correct your arch. You must strengthen the muscles that can help recondition your natural arch. The most studied exercise that is found to cause statistically significant improvement is the short foot exercise. The goal of this exercise is to pull the ball of your foot (metatarsal heads) towards your heel, which lifts your arch and shortens your foot. Keep your toes flat the entire time. The short foot exercise will increase the height of a non-weight bearing arch, and more importantly, will decrease the amount that your arch falls during weight bearing. This will support your ankle from rolling in, which will decrease pain, gait instability, and risk for falls. It will also limit the amount that your plantar fascia is stretched, preventing/resolving chronic plantar fasciitis. And for those with existing hallux valgus bone deformities and bunions, it may prevent them from getting worse.
For improvement in just two weeks (it will be in small increments):
-Hold for 10 seconds
-Rest for 1-2 seconds
-Repeat 5 times
-Perform every day, several times a day
For additional information and exercises, see my slide presentation:
There are many medical reasons why arches fall, but addressing the lifestyle associated reasons will help recondition your arch, such as performing the short foot exercise, reducing excess weight, and increasing walking activities. Please see your PCP if you are experiencing pain or discomfort that is keeping you from walking.