CINCINNATI—Beauty is pain: We’ve heard women say that—joking or not—for decades.
This mantra helps you get through those agonizing last few miles on the treadmill or jazzes you up when going to the salon for an eyebrow wax or tweeze.
But some of the pain associated with society’s image of beauty could truly be harmful for health, says one UC Health primary care physician, and it doesn’t have to be as extreme—or as expensive—as surgery or injections.
"There are all sorts of products on the market that are truly unnecessary, but we are told we need these things to fit into society,” says Shyamala Jagtap, MD, who sees patients in the UC Health Physicians Office in West Chester, citing teeth whitener as an example and a new deodorant that is supposed to stop underarm hair growth in women. "These are not harmful, but they are not vital to our health. In some cases, what makes us fit in could not only mean pain now, but also health problems down the road.”
Specifically, Jagtap relates this to a fashion staple in most women’s closets: High heels.
A recent poll by the Society of Chiropodists and Podiatrists found that 25 percent of women who wear high heels are more likely to get arthritis.
"When you stand, the forces of gravity supporting your body go along your spine, then split into two along your pelvic bones to your hipbones, downward into your thigh bones, then down your leg bones to your heel, and then along the outer margin of your feet. The forces then spread throughout the rest of the foot, to your toes and finally to your big toe,” Jagtap explains. "If you change that alignment, causing weight to be borne on your toes instead of your heels, throwing your whole weight bearing system off and changing the line of gravity, it can affect your joints negatively, eventually leading to arthritis in your knees, ankles and back.”
She adds that more immediate problems could arise before the aches and pains of arthritis begin.
"Feet, like one’s ears and nose, keep growing throughout a lifetime,” Jagtap says. "In most women’s shoes, high heels in particular, the front of the shoe comes to a point at the center, causing the bigger toe—our longest toe—to get pushed towards the middle of the shoe, causing bunions.”
Jagtap adds that cramming your feet into the small and narrow shoe box of high heels can lead to hammer toe, in which the end of the toe is bent downward. High heels can also lead to Achilles’ tendonitis and additional back problems.
In addition to purchasing shoes with a large enough shoe box to allow toes to align side-by-side, Jagtap suggests:
Buy shoes at the end of the day. Feet swell throughout the day, and to avoid shoes that pinch, its best to buy when your feet are at their largest.
Measure the right and left feet separately and buy shoes to fit the larger one, providing padding for the smaller one.
Leave a little room in the shoe box, enough to slip an extra finger.
Buyshoes with good arch and heel support.
If you do buy heels, make sure they are no higher than an inch to an inch and a half.
Walk around in new shoes to make sure they fit correctly; shoes should have a slight give when you lift the foot, and the back of the foot should not feel tight.
"If you really want to wear the most fashion-forward stilettos, you can carry something more comfortable and foot-friendly to change into,” says Jagtap. "The older you get, the more you should think about comfort shoes, and you should always think about getting shoes that fit well. It’s OK to be fashionable, but we must keep our health in mind and try to decide which is more important or determine a way to be both trendy and healthful.”
08/09/2011
Showing posts with label mobility and foot pain. Show all posts
Showing posts with label mobility and foot pain. Show all posts
Tuesday, September 13, 2011
Saturday, August 20, 2011
New papers revisit, rekindle flexible flatfoot controversy
“Other considerations” spark debate
Two recent literature reviews have reignited the debate over treatment options for pediatric flexible flatfoot.
In January 2010, when LER first covered the controversy, Australian podiatrist and researcher Angela Evans, PhD, had recently published a paper in the Journal of the American Podiatric Medical Association suggesting that children whose feet were flatter than expected, but asymptomatic, should be monitored rather than automatically treated with orthoses.1 This provoked the ire of some American pediatric foot specialists, who thought the approach downplayed important pathologies. Not everyone agreed, however; for example, Edwin Harris, DPM, the lead author of guidelines from the American College of Foot and Ankle Surgeons, concurred with the basic premise of Evans’s approach, and said it provided a practical direction for further investigation.2
More recently, Evans and a colleague, Keith Rome, DPM, professor of podiatry at Auckland University of Technology in New Zealand, published two literature reviews revisiting the topic—and rekindling the debate. In the first, comprising three trials involving 305 children, they concluded that the evidence was too limited to draw definitive conclusions about use of nonsurgical interventions for pediatric pes planus.3 The more recent review broadened the inclusion criteria for studies, reviewing 15 and proposing an algorithm for managing flexible flat feet.4
Part of the goal, Evans told LER, was to further develop the “yellow zone” in the original JAPMA paper—the asymptomatic children who, as mentioned, should simply be monitored.
“That seems to have been interpreted in an absolute sense of monitoring only,” she said. “But monitoring is a dynamic process; within that yellow zone, if a clinician sees a foot that’s not painful, but that also isn’t functioning well, that should direct some form of treatment. That may mean changing their shoes or using an inexpensive foot orthotic. Our criticism has been of the excessive use of expensive customized orthoses. But it also came out of the review that in children with arthritis and foot pain, customized orthoses are indicated because they improve both pain and function.”
Alan Ng, DPM, who practices with Advanced Orthopedics and Sports Medicine Specialists in Denver and is on the board of directors for the American Board of Podiatric Surgery, concurs with the monitoring approach in asymptomatic children.
“I think a lot of pediatric flatfoot can be treated conservatively, as long as there’s no coalition,” he said. “The initial evaluation should include weight-bearing, x-rays, gait analysis, resting calcaneal stance position, and mobility. Most of the time, initial treatment is physical therapy, muscle strengthening, functional orthotics, or good, supportive shoes, and eighty or ninety percent of the time they do fine. But if a kid is asymptomatic and can do full activity with no issues, I don’t touch them; putting them into an orthotic just because they have flat feet is inappropriate.”
Russell Volpe, DPM, who teaches at the New York College of Podiatric Medicine, said that the evaluation and treatment parameters in Evans and Rome’s most recent paper don’t go far enough.
“It’s an exemplary review and analysis of what’s been published, but it doesn’t cover the complicated topic of what makes asymptomatic flat feet a potential issue,” he said.
What Evans and Rome refer to passingly in the paper as “other considerations” are, to Volpe, a big issue and a significant part of his practice. They include superstructural and pedal influences on all three body planes.
“They miss the point about the huge role of lower extremity residual torsions, equinus, genu or tibial varum, calcaneal varus, and the like,” he said. “There’s a lot that goes into identifying the foot that is at risk to become dysfunctional and symptomatic over time, and the big tool for evaluating it is the biomechanical integrity of that lower extremity. In their paper I see one sentence about it in twenty pages. That’s the problem.”
Such influences, Volpe said, are better corrected with custom orthoses, and he took particular umbrage at the paper’s suggestion that custom approaches “desist.”
“I will not desist; in fact I will insist!” he said. “For the cohort with biomechanical comorbidities, I need to incorporate postings and modifications that allow me to manage both the primary structural comorbidity and the compensation in the foot, and for that I need to use a custom orthosis.”
By Cary Groner
Two recent literature reviews have reignited the debate over treatment options for pediatric flexible flatfoot.
In January 2010, when LER first covered the controversy, Australian podiatrist and researcher Angela Evans, PhD, had recently published a paper in the Journal of the American Podiatric Medical Association suggesting that children whose feet were flatter than expected, but asymptomatic, should be monitored rather than automatically treated with orthoses.1 This provoked the ire of some American pediatric foot specialists, who thought the approach downplayed important pathologies. Not everyone agreed, however; for example, Edwin Harris, DPM, the lead author of guidelines from the American College of Foot and Ankle Surgeons, concurred with the basic premise of Evans’s approach, and said it provided a practical direction for further investigation.2
More recently, Evans and a colleague, Keith Rome, DPM, professor of podiatry at Auckland University of Technology in New Zealand, published two literature reviews revisiting the topic—and rekindling the debate. In the first, comprising three trials involving 305 children, they concluded that the evidence was too limited to draw definitive conclusions about use of nonsurgical interventions for pediatric pes planus.3 The more recent review broadened the inclusion criteria for studies, reviewing 15 and proposing an algorithm for managing flexible flat feet.4
Part of the goal, Evans told LER, was to further develop the “yellow zone” in the original JAPMA paper—the asymptomatic children who, as mentioned, should simply be monitored.
“That seems to have been interpreted in an absolute sense of monitoring only,” she said. “But monitoring is a dynamic process; within that yellow zone, if a clinician sees a foot that’s not painful, but that also isn’t functioning well, that should direct some form of treatment. That may mean changing their shoes or using an inexpensive foot orthotic. Our criticism has been of the excessive use of expensive customized orthoses. But it also came out of the review that in children with arthritis and foot pain, customized orthoses are indicated because they improve both pain and function.”
Alan Ng, DPM, who practices with Advanced Orthopedics and Sports Medicine Specialists in Denver and is on the board of directors for the American Board of Podiatric Surgery, concurs with the monitoring approach in asymptomatic children.
“I think a lot of pediatric flatfoot can be treated conservatively, as long as there’s no coalition,” he said. “The initial evaluation should include weight-bearing, x-rays, gait analysis, resting calcaneal stance position, and mobility. Most of the time, initial treatment is physical therapy, muscle strengthening, functional orthotics, or good, supportive shoes, and eighty or ninety percent of the time they do fine. But if a kid is asymptomatic and can do full activity with no issues, I don’t touch them; putting them into an orthotic just because they have flat feet is inappropriate.”
Russell Volpe, DPM, who teaches at the New York College of Podiatric Medicine, said that the evaluation and treatment parameters in Evans and Rome’s most recent paper don’t go far enough.
“It’s an exemplary review and analysis of what’s been published, but it doesn’t cover the complicated topic of what makes asymptomatic flat feet a potential issue,” he said.
What Evans and Rome refer to passingly in the paper as “other considerations” are, to Volpe, a big issue and a significant part of his practice. They include superstructural and pedal influences on all three body planes.
“They miss the point about the huge role of lower extremity residual torsions, equinus, genu or tibial varum, calcaneal varus, and the like,” he said. “There’s a lot that goes into identifying the foot that is at risk to become dysfunctional and symptomatic over time, and the big tool for evaluating it is the biomechanical integrity of that lower extremity. In their paper I see one sentence about it in twenty pages. That’s the problem.”
Such influences, Volpe said, are better corrected with custom orthoses, and he took particular umbrage at the paper’s suggestion that custom approaches “desist.”
“I will not desist; in fact I will insist!” he said. “For the cohort with biomechanical comorbidities, I need to incorporate postings and modifications that allow me to manage both the primary structural comorbidity and the compensation in the foot, and for that I need to use a custom orthosis.”
By Cary Groner
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