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What About My Feet?

By Sharon Puszko, PhD, LMT

During a recent session with a regular client of mine, we ended up having a conversation about feet. I cannot remember how the topic came up - maybe he was having particularly bad pain in his feet that day - but we ended up discussing what kind of shoes we wear the majority of the time.

The conversation made me realize that for as much time as I spend working peoples' feet, I have not yet written exclusively about feet and massage, or self-care of feet for practitioners.

Massage therapists are one of the groups of professionals who spend most of their time working on their feet; in addition to pulling, pushing, bending, leaning and lifting. We have a rather "physical" job, and after giving five to eight massages in one day, I know my feet have frequently felt the effects of this.

I can also admit I rarely do anything more than stretch my feet out and give myself a mini-pedicure before I go to bed. The following morning, my feet seem to recover, and I go about my day as usual. However, after the aforementioned conversation, I started discussing footwear and lower body pain with colleagues, and I decided this topic would be extremely useful to write about.

According to the American Podiatric Medical Association (APMA), almost 75 percent of people experience foot pain at some point in their lives, and only one out of every six sufferers seeks help from a podiatrist. Research from the APMA also demonstrates that those who spend four or more hours a day working on their feet suffer from chronic foot pain more than any other group of people. Even more important is the fact that nearly 78 percent of Americans suffer from foot pain because they are wearing ill-fitting shoes. So now I'm wondering, have I recently been properly fitted for shoes? In fact, have I ever been properly fitted for shoes? Since we fall into the category of people who stand for more than four hours a day while we work, it is crucial that we pay attention to our feet, and what we are putting on them. Here are some tips from the APMA on how to purchase shoes that will both fit you well and serve you well:

• Have your feet measured while you're standing.
• Always buy for the larger foot. (Feet are seldom precisely the same size.)
• Don't buy shoes that need a "break-in" period. Shoes should be comfortable immediately.
• Don't rely on the size of your last pair of shoes. Your feet do get larger, and shoemakers' sizing molds also vary.
• Shop for shoes later in the day. Feet tend to swell during the day, and it's best to be fitted while they are in that state.
• Be sure that shoes fit well--front, back, and sides--to distribute weight. It sounds elementary, but be sure the widest part of your foot corresponds to the widest part of the shoe.
• Select a shoe with a leather upper, stiff heel counter, appropriate cushioning, and flexibility at the ball of the foot.
• Try on shoes while you're wearing the same type of socks or stockings you expect to wear with the shoes.
• If you wear prescription orthotics--biomechanical inserts prescribed by a podiatric physician--you should take them along to shoe fittings.

There is one category of shoes that is so controversial I feel like we need to address it all on its own: flip flops. Just mentioning them in front of physical therapists and orthopedic doctors elicits snarls and frowns. At first, I was amused by the reactionary tendencies these summer shoes evoked in the health care community. But after reading up on them, it is clear that frequent use of flip flops can cause long-term foot problems for people, such as tendonitis, blisters, plantar fasciitis and sprained ankles. The more immediate consequences of wearing flip flops in place of other shoes include cuts, bruises and injuries because they do not offer your feet good protection or support. Visit the APMA Web site for their recommendations on finding a good pair of flip flops for the summer. I stress this, because all current research says they should not be worn for work, and should not be worn on a daily basis.

Strength & Flexibility Exercises

Now that we've discussed footwear, I would like to share some stretches with you that I came across on Runner'sWorld.com. They focus on your foot, ankle, and lower leg, and if done daily, will increase your strength and flexibility, which can help prevent injury in the future.

The Monopoly Game: Put 10 small objects on the floor (i.e. marbles or Monopoly pieces) and place a small cup nearby. Using your toes, pick up the pieces one at a time and put them in the cup. Do two sets of 10 with each foot. Compete with your spouse or kids to see who can do 10 in the fastest time.

The Drunk Flamingo: Standing on stable ground, balance on one foot with your eyes open. Once you can do that for one minute, try it with your eyes closed. Master that and then move to an unstable surface such as: a mini-trampoline, foam block, wobble board or Bosu trainer.

Toe Tug: Loop one end of an exercise band around a sturdy table leg or bedpost. Sit with your legs straight in front of you, and loop the other end around the top part of one foot. The band should be anchored straight in front of you, and it should be taut when your foot is pointed away from you. Pull your toes toward you, keeping your leg straight. Go as far as your ankle will let you. Release slowly, returning to the starting position. Do two sets of 20 on each leg.

Bent-Knee Wall Stretch: Runners often forget to stretch the soleus - a muscle deep in the calf that attaches to the Achilles. "Doing a calf stretch with a straight leg hits the gastrocnemius, but that's only half the battle," Schneider says. Here's how to target the soleus: Stand with your palms against a wall, one leg forward, one leg back. Lower into a "seated" position with legs bent. Lean into the wall until you feel it in your back calf. Hold 30 to 45 seconds then switch legs.

Negative Calf Raises: Stand on a step with your toes on the edge and your heels hanging off. Push up with both feet into a calf raise. Lift one leg off the step, and lower your other leg so that your heel drops below the step. Take at least 10 seconds to lower it all the way down - that's the eccentric part of the move and has been shown to help prevent Achilles tendinitis.

Plantar Stretch: Sit down barefoot and cross your right leg so that your ankle rests on your left thigh. Hold your toes and bend them back toward your shin, stretching the plantar fascia. A study showed that people suffering from plantar fasciitis had a 77 percent chance of returning to full activity within three to six months after performing this stretch. Researchers suggest that you do the stretch 10 times at least three times a day (once or twice a day doesn't produce as strong of an effect).

I've always been selective when it comes to buying shoes, and after researching for this article, I am certainly happy for that trait. I am also looking forward to staying up on current research regarding footwear and foot health; I will continue to be careful before I stand on my own two feet!

Resources

1. "Foot Care & Footwear: Steps To Take For Healthy Feet" USAToday, June 2010.
2. "Footwear" Tip Sheet, APMA.org
3. Spiker T. "Build Stronger Feet and Ankles: Key exercises to get(and stay) pain-free". Runner's World, May 10, 2007.

Sharon Puszko is the owner/director/educator for Day-Break Geriatric Massage Institute. She may be contacted at or through her Web site: www.daybreak-massage.com.