Our feet work so hard for us, but are often taken for granted.
Anyone who has spent time around babies between four and six months of age will know that they develop an absolute fascination with their feet at this point of their lives.
They wave them around, grab them and try stuffing them into their mouths.
However, once these young ones learn how to be mobile, i.e. crawl, stand and walk, this fascination wears away in favour of the more exciting world around, and feet become more of a means to an end.
As adults, the most we probably think about our feet is when we have been abusing them by standing too long or exercising them too much, or considering how they look in footwear.
This lack of attention, and sometimes abuse, notably for the sake of fashion, can result in our feet suffering unnecessarily.
International Medical University podiatrist Stella Chai shares some of common conditions our feet can be afflicted with.
Says Chai: “Diabetic wounds are the top foot problem in Malaysia.”
This is hardly surprising, considering that not only 15.2% or about 2.6 million Malaysian adults are estimated to have diabetes, but also that about half of them are unaware they even have the disease, according to the National Health and Morbidity Survey 2011.
In addition, the Diabcare Malaysia 2013 survey found that three-quarters of diagnosed diabetics do not have their blood sugar levels under control.
This means that they are more liable to develop complications, like loss of sensation in their feet (peripheral neuropathy).
This loss of sensation means that when they step on something sharp or have an irritant in their shoe rubbing against their skin, they actually do not realise that their foot has been injured.
And if they do not make the effort to regularly inspect their feet for such injuries, as is commonly advised by healthcare professionals, then the wound could progress as far as leaking pus and smelling foul before the patient picks up on it.
Diabetics who get injured, also do not heal as fast as healthy people, due to their disease.
Says Chai, who is part of the diabetes management team at the IMU Bukit Jalil, Selangor, clinic: “Normally, diabetic patients come in with Grade 4 (deep ulcer with abscess or osteomyelitis) or 5 (gangrene of the forefoot) wounds.”
They typically would have been to see several different medical specialists, who would probably have advised them to amputate their feet, or traditional medicine practitioners, or even tried their own home remedies, she adds.
However, Chai says that podiatrists can help patients prevent gangrene and amputation, even when the ulcers or wounds are severe, although she warns that this is a long process, requiring lots of effort and commitment from the patient themselves.
According to her, preventing such wounds from getting bad in the first place boils down to diabetics checking their feet diligently and thoroughly every day, as well as washing, cleaning and drying their feet daily.
“Malaysians like to wash their feet, but they don’t always dry them properly – you need to dry the feet as well,” she notes.
Skin and nail conditions
Such conditions commonly include calluses and corns, ingrown toenails, fungal infections and veruccas.
Chai explains that when shearing forces act on the feet from the action of walking in shoes, it can either result in a blister or a corn.
“When you have a shearing stress on a part of your foot, what happens is, your body, to protect that area from blistering, develops a layer of hard skin. This is actually a callus.
“When that callus builds up because the pressure keeps on coming and nothing is done about it, you’re going to develop a corn,” she says.
While most people can use corn plasters for treatment, Chai strictly advises diabetics against it as the plasters contain a chemical that can cause maceration and ulceration.
“What diabetics can do is actually file the corn down with a sandpaper file, apply moisturiser, and take away the pressure,” she says, adding that oftentimes the pressure is due to the shoe.
Ingrown toenails can be caused by poorly-cut nails or toenails that curl inward.
“Things you can do to prevent it is cut your nails straight across (and) make sure there are no sharp edges.
“And if your toenails are very involuted, what you can do is toe surgery,” she says.
Meanwhile, fungal infections are encouraged by sweaty feet, which in turn, are generally caused by our hot weather and preference for synthetic socks and shoes.
“Hygiene is very important – just drying our feet properly,” says Chai.
Common symptoms include itchiness, small blisters, and peeling and flaky skin.
Another common foot infection results in veruccas or plantar warts. These are caused by the human papillomavirus (HPV).
According to Chai, there is no 100% cure for veruccas, only the symptoms can be treated.
“Sometimes, symptoms can take weeks or months to cure. But what you can do is prevent the spread to other parts of the body or to other people, (so) keep it covered,” she says.
Treatment options include freezing and removing it, chemical treatment, and home remedies like applying banana skin and marigold flowers to the verucca.
Chai shares that flat feet are quite common among Asians, probably due to genetic predisposition.
One way to detect if you have flat feet is to wet them, then press them onto a piece of cloth; if the impression is squarish rather than a C-shape, then you have flat feet.
However, she adds: “All children have flat feet. They develop arches later on (around three to four years of age).”
For adults with flat feet that do not cause any problems, nothing needs to be done.
However, for those experiencing discomfort and knee, back or hip pain, Chai says, “You will find that they need to do a biomechanical assessment because flat feet affect the whole body.”
This assessment includes checking muscle strength, body alignment and leg length.
She notes that while the treatment requires patients to wear insoles every time they are on their feet, this rarely happens as patients tend to pick and choose when to use the insoles.
Therefore, they also need to attend physiotherapy to strengthen their muscles and arches to help prevent the pain caused by their flat feet.
In general, Chai advises everyone to check their feet and shoes regularly, moisturise their feet, cut their toenails regularly, and keep any wounds clean and dry.
According to her, most minor foot wounds should heal within three to four days, so if anyone has wounds that do not heal within a week, they should consult a doctor or podiatrist as soon as possible.