YOUR HEALTH - MEDICINE 101

FEET

Ever hear the medical expression, "Boy, my dogs are barking tonight?" It's a common phrase used during internship, after you've been on your feet all day. Its hard to have a really good day, to take delight in life, if your feet are sore - and let's face it, many of us, though we have hearts of gold, have feet of clay.

The foot is really quite a neat little bit of mechanics. It's the spot where all of us meet the ground, and a spot in which we've got to get some traction to get ahead in life. The foot is a complex collection of bones. The vertical talsus or ankle bone and two groups of horizontal bones - the calcaneus or heel bone going back at an angle here and the metatarsal or toe bones going forward here. This arrangement - the long toe bones going forward and the shorter thicker heel bone going backward lets the foot act as a sort of shock absorber, a spring. Another part of the spring mechanism involves arches. We know from architecture that an arch is used to distribute force equally. In the foot there are two arches. A longitudinal one and a transverse one. The arches are maintained by ligaments that hold the bones together, but also by muscles. For example, on the inside of the foot one of the tendons from the shin comes underneath the bones of the foot to attach on the far side, acting as a sling to keep the foot up. The foot is elegantly designed to distribute the forces involved in walking and running over this network of structures.

So why do our dogs bark so often? One of the commonest reasons for foot pain has to do with the arches. Flatfootedness can happen from injury or age, but most often they're simply present from birth - the architecture of the foot is different. If you're flatfooted, the distribution of forces in the foot is not the same and pain results. Not only can you loose the longitudinal arch here, but it's quite common as we age to lose the transverse arch here, with splaying and widening of the forefoot. This abnormal wear commonly produces thickening on the skin of the sole of the foot, producing a callous -- a localized, hard area of thickened skin. A bunion is a prominence of the end of the first metatarsal commonly seen in flatfootedness. As the foot becomes flatter, walking, and particularly pushing off with the toes pushes the big toe to the side.

Because architecture and the distribution of force in the foot is so important, the commonest medical approach to foot pain is to try to correct the abnormal alignment by adjusting the footwear with an insert called an orthotic (ortho is from the Greek word meaning straight or correct). A plaster cast is used to measure the exact defect, and then a plastic insert is made to fit in the shoe, forcing the foot into its correct alignment.

One last thing. The best shoes on the market are running shoes such as these, because runners have demanded good support and shock absorbing designs and materials. You may not be an Olympic athlete, but you can benefit from this technology. Feel embarrassed with the idea of walking around in a pair of running shoes - get over it. It will give you the support to put your best foot forward. Besides it'll stop them dogs barking.