Foot Anatomy: Your Amazing Feet

Despite delicate foot anatomy, your feet are able to take a pounding every day. Help them go the distance by identifying and correcting common foot problems, from corns and calluses to Athlete's foot and hammertoes.

The human foot has 42 muscles, 26 bones, 33 joints, and at least 50 ligaments and tendons made of strong fibrous tissues to keep all the moving parts together … plus 250,000 sweat glands. The foot is an evolutionary marvel, capable of handling hundreds of tons of force — your weight in motion — every day. The foot’s myriad parts, including the toes, heel, and ball, work in harmony to get you from one place to another. But the stress of carrying you around puts your feet at high risk of injury, more so than other parts of your body.

Many foot problems, including hammertoes, blisters, bunions, corns and calluses, heel spurs, claw and mallet toes, ingrown toenails, toenail fungus, and athlete’s foot, can develop due to neglect, ill-fitting shoes, and simple wear and tear. Your feet also can indicate if your body is under threat from a serious disease. Gout, for instance, will attack the foot joints first.

Foot Problems: Athlete's Foot
Caused by a fungus that likes warm, dark, and moist environments like the areas between the toes or on the bottoms of the feet, athlete’s foot can inflame the skin and cause a white, scaly rash with a red base. The athlete’s foot fungus also causes itching, burning, peeling, and sometimes a slight odor; the infection can also migrate to other body parts. You can avoid athlete’s foot (also called tinea pedis) by keeping your feet and toes clean and dry and by changing your shoes and socks regularly. Over-the-counter antifungal creams or sprays can be used to treat athlete’s foot. If these remedies do not work, however, you may need to see a podiatrist and ask about prescription-strength medication.

Foot Problems: Hammertoes
If your second, third, or fourth toe is crossed, bent in the middle of the toe joint, or just pointing at an odd angle, you may have what’s called a hammertoe. Hammertoes are often caused by ill-fitting shoes. Early on, wearing inserts or foot pads can help reposition your toe, but later it becomes fixed in the bent position. Pain then sets in and you may need surgery. Because hammertoes are bent, corns and calluses often form on them.

Foot Problems: Blisters
It’s this simple: If your shoes fit well, you won't have blisters. Soft pockets of raised skin filled with clear fluid, blisters are often painful and can make walking difficult. It’s important not to pick at them. Clean the area thoroughly, then sterilize a sewing needle and use it to open the part of the blister located nearest to the foot’s underside. Drain the blister, slather with antibiotic ointment, and cover with a bandage. Follow these same care steps if a blister breaks on its own.

Foot Problems: Bunions
A bunion is a crooked big-toe joint that sticks out at the base of the toe, forcing the big toe to turn in. Bunions have various causes, including congenital deformities, arthritis, trauma, and heredity. A bunion can be painful when confined in a shoe, and for many people, shoes that are too narrow in the toe may be to blame for the formation of bunions. Surgery is often recommended to treat bunions, after conservative treatment methods like over-the-counter pain relievers and footwear changes fail.

Foot Problems: Corns and Calluses
Corns and calluses form after repeated rubbing against a bony area of the foot or against a shoe. Corns appear on the tops and sides of your toes as well as between your toes. Calluses form on the bottom of the foot, especially under the heels or balls, and on the sides of toes. These compressed patches of dead skin cells can be hard and painful. To relieve the pain, you may want to try placing moleskin or padding around corns and calluses. Don’t try to cut or remove corns and calluses yourself — see a podiatrist for care.

Foot Problems: Plantar Fasciitis and Heel Spurs
It’s common for doctors to confuse heel spurs and plantar fasciitis when a patient comes to them with heel pain. Heel spurs are found in 70 percent of patients with plantar fasciitis, but these are two different conditions. Plantar fasciitis is a painful disorder in which the tissue that connects the ball of the foot to the heel – the fascia – becomes inflamed. Heel spurs are pieces of bone that grow at the heel bone base and often develop after you’ve had plantar fasciitis. The heel spurs themselves are not painful; it’s the inflammation and irritation caused by plantar fasciitis that can hurt. Heel spurs are often seen on X-rays of patients who do not have heel pain or plantar fasciitis.

Foot Problems: Claw Toes and Mallet Toes
Claw toe causes all toes except the big toe to curl downward at the middle of the joints and curl up at the joints where the toes and the foot meet. Calluses and corns may often form when someone has claw toes. While tight shoes can be blamed for claw toes, so can nerve damage to the feet (from diabetes or other conditions), which weakens foot muscles.

With mallet toes, the last joint of the toe bulges, and a painful corn will grow near the toenail. Generally the second toe is affected because it’s the longest. Injuries and arthritis are among the causes of mallet toe.

Foot Problems: Gout
Gout is a type of arthritis caused by a build-up of uric acid in joint tissues and joint fluid, which happens when the body is unable to keep uric acid levels in check. One of the first places for this build-up to occur is in the big toe joint — temperature-wise, the toes are the body’s coolest parts, and uric acid crystallizes with temperature changes. You’ll know a gout attack when it happens: The toe will get warm, red, and swollen and will be painful to even the slightest touch. The best way to prevent a gout attack is to learn to identify triggers, including high-purine foods, red meat, seafood, and alcohol. Applying ice, keeping hydrated, and staying bed may help, too.

Foot Problems: Ingrown Toenails
The right way to clip toenails — straight across — is key to foot health. If you don’t cut them properly, the corners or sides of the nail can dig into skin and become ingrown. Other causes of ingrown toenails include shoe pressure, a fungus infection, and even poor foot structure. When you cut your toenails, use larger toenail clippers and avoid cutting nails to short, as this can also cause ingrown toenails or infection.

Foot Problems: Toenail Fungus
Toenail fungus can give nails an unattractive, deformed appearance. It can alter the nail’s color and spread to other nails, even fingernails. Avoiding toenail fungus is difficult, especially if you walk through wet areas where people tend to go barefoot, such as locker rooms and swimming pools. People with chronic conditions, such as diabetes or immune deficiency diseases like HIV, are especially vulnerable and may want to keep their shoes on.

Preventing Gout

Q: What dietary restrictions should I follow to prevent another attack of gout?

Earl, Kansas
A:
Gout is the result of an excess of monosodium urate crystals in the body. When the crystals accumulate in the spaces between joints, they can cause excruciating pain, most commonly felt in the big toe. Indulging in meat, seafood, and alcohol can play a role. Studies have shown that individuals who are prone to developing gout should reduce their intake of meats and seafood because these foods promote uric acid formation. Low-fat diet products, on the other hand, appear to decrease the risk of gout. Protein consumption has no effect, while alcohol raises uric acid levels, which may provoke an episode of gout. It is recommended that people at risk for gout drink 10 to 12 eight-ounce glasses of nonalcoholic liquids every day to reduce the risk of developing kidney stones. Drinking plenty of fluid helps to flush the body of uric acid crystals, which characteristically accumulate in people with this disease. It is also suggested that gout sufferers maintain a stable weight, work to avoid obesity, and avoid using diuretics or water pills.

Is Gout Prevention Possible?

Is Gout Prevention Possible?
You can't always control whether you get gout, but you can make diet and lifestyle changes to lessen your risk. Start taking gout prevention steps today. What can you do for gout prevention? "There are a number of risk factors for gout, some of them modifiable, some of them less modifiable," says Daniel Solomon, MD, MPH, associate professor of medicine at Harvard Medical School and physician in the rheumatology, immunology, and allergy department at Brigham and Women's Hospital in Boston.

Gout develops in people who have high levels of uric acid, produced when the body breaks down substances called purines, which are found in many foods, particularly meat and seafood. Excess uric acid can form sharp, needle-like crystals in the joints, leading to pain and swelling.

While some people will develop gout no matter what they do, there are some lifestyle and diet factors that can cause high uric acid levels. Researchers have identified a number of gout prevention strategies to help reduce your risk of developing gout or, if you already have gout, lower your chances of having a severe gout attack in the future.

Gout Prevention: Know Your Risk Factors

When it comes to gout prevention, scientists still don't know how much control people have over their risk of developing gout. "Gout is related to genes, environmental [influences], and gender," says Dr. Solomon. There seems to be a genetic component since gout sometimes runs in families. Also, men are at higher risk of developing gout than women. And the risk of gout increases with age.

But researchers have identified a number of gout risk factors that you can work to control:

Purine-rich diet
Excess weight
Excessive alcohol consumption
High cholesterol
Diabetes
High blood pressure
Certain medications, including some diuretics, niacin (a B vitamin), low-dose aspirin, cyclosporine, and several cancer drugs
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Gout Prevention Strategies

If you are looking for ways to reduce your risk of developing gout, try the following:

Limit purines in your diet. Hyon Choi, MD, DrPH, clinical associate professor of medicine in the rheumatology section at Boston University School of Medicine, says reducing the amount of purine-rich foods in your diet can lower your chances of developing gout. Eat less salmon, herring, sardines, organ meats, mushrooms, and asparagus.Reduce the red meat and seafood in your diet. In his research on gout risk factors, Dr. Choi and his colleagues found that people who had more red meat and seafood in their diet were at higher risk of developing gout.Eat more dairy. Choi also looked into how dairy products affected patients’ gout risk. "Dairy products — particularly low-fat dairy products like skim milk or yogurt — reduced the risk of gout," says Choi. For gout prevention, your daily diet should include the equivalent of two or more cups of milk.Watch what you drink. "Coffee, including decaffeinated coffee, was associated with a lower risk of gout," Choi says. On the other hand, people who drink more alcoholic beverages, especially beer, are more likely to develop gout. Choi says that drinks sweetened with high-fructose corn syrup are also associated with an increased risk of gout.Take your vitamin C. "Vitamin C tablets — 500 milligrams per day — decrease the risk of gout," Choi says. That extra vitamin C will cause you to excrete uric acid through your urine.Maintain a healthy weight. Being overweight is a risk factor for the development of gout, so aim to maintain a healthy weight.Control medical problems. Since high cholesterol, high blood pressure, and other health problems are associated with an increased risk of gout, follow your doctor's instructions to keep these conditions under control.Consider switching medications. If you are taking a medication associated with increased gout risk, ask your doctor if switching to another drug is an option for you. If you are concerned about your gout risk, talk with your doctor. The earlier you start treatment, the sooner your pain will be under control.

By Krisha McCoy, MS
Medically reviewed by Lindsey Marcellin, MD, MPH