Common Disorders
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Did you know the foot has 28 bones, 37 joints, 107 ligaments, 19 muscles, and numerous tendons? These parts all work together to allow the foot to move in a variety of ways while balancing your weight and propelling you forward or backward on even or uneven surfaces. It is no wonder that most Americans will experience a foot problem that will require the care of a specialist at one point or another in their lifetime.

As recently as thirty-five years ago, athletic shoes consisted of just a few shoes that were used for a wide variety of athletic events. There were a few tennis and basketball shoes. There were no shoes marketed specifically as walking shoes. Aerobics or fitness shoes were nonexistent. Running shoes only amounted to a few in number.

However, in today's athletic shoe stores, the number of brands and styles of shoes for all types of sports is staggering. There are shoes made specifically for wrestling, rock climbing and windsurfing in addition to the more common sports such as running, basketball, tennis, racquetball, aerobic dance and walking. In the running shoe market alone, there are nine major shoe manufacturers with each manufacturer having about five to ten running shoe models within their line. Even though the increased selection of shoes increases the possibility of finding just the right shoe for each set of feet, the large selection of models creates a large degree of confusion among the consumer.

It is actually this diversity and complexity within athletic shoes that is their most interesting aspect. Shoes that have different shapes, are made of different materials, and which are put together by different construction methods all will function on the foot differently. The purpose of this article is to explain the major structural differences between the three broadest categories of athletic shoes (i.e. running shoes, court shoes and fitness shoes) so that their functional differences may be better appreciated.

As all runners know, running begins with a good foundation. And where do we find that foundation? At the ground level where the rubber meets the road.

In other words, your shoes, the pieces of leather and rubber that separate your feet from the hard concrete of the road.

Let's look at the anatomy of a running shoe, and the four sections of the shoe that make it complete.

The uppers of the shoe may be made of leather or, for the lighter shoes, a synthetic which is lighter, washable and breathable (to reduce heat from the foot). Another component of the upper is the tongue of the shoe, which should be padded in order to cushion the top of the foot against lace pressure. At the back of the shoe, the ankle collar should also be padded to prevent rubbing and irritation of the Achilles tendon.

The outersole of the shoe is the treaded layer which is glued to the bottom of the midsole. It resists wear, provides traction, and absorbs shock. This is probably the most important layer for the "street fighter" or road runner. The outer sole usually consists of blown rubber, hard carbon rubber, or a combination. The blown rubber is the lightest, but is not durable as pure carbon. The stud or waffle outersoles are excellent for running on soft surfaces such as grass or dirt as they improve traction and stability. On the flip side, the ripple sole is better designed for running on asphalt or concrete surfaces.

For many people, finding a shoe that fits properly can be a frustrating and time-consuming process. Because many people have subtle abnormalities of their feet, the process of finding a proper fitting shoe can be difficult. There are few simple guidelines that if followed can make the process a bit more tolerable. There are several good shoes on the market some of them may even be styles that you may like. With the availability of Internet shopping, the process of finding shoes for the hard-to-fit indiuidual may be made a bit easier.

When purchasing shoes, it is always a good idea to have the salesperson measure your feet. It is also a good idea to have both feet measured, because in many instances there may be a difference in the size of your feet. If you have two feet that are not the same size, it is recommended that you buy shoes to fit the bigger foot. Our feet change just like our eyes do as we get older. A person's feet tend to become a bit longer and wider. Women, during pregnancy have a tendency for their shoe size to change. This is because during pregnancy a woman's body produces a hormone called elastin. This hormone softens the ligaments about the pelvis to assist during delivery. Unfortunately, the hormone also affects other ligaments in the body. The ligaments in the foot are particularly affected. This coupled with an increase in weight and a change in the center of gravity causes many women to experience a change in their shoe size. Our feet also have a tendency to change size during the course of the day. Shoes that may feel comfortable in the morning may feel tight and uncomfortable later in the day. This occurs because of a variable amount of swelling in the feet that occurs as the day goes on. Therefore it is a good idea to buy your shoes later in the day.

Athletes will often encounter a problem with their toenails turning dark. This may be due to the toes hitting the end or the top of the shoe toe area. Quite often the toenail may become loose and fall off. This can also occur in people who have worn a tight shoe for a prolonged period of time. The dark color is a result of bruising under the toenail. Generally it is not painful. The damage caused to the toenail may allow the establishment of a fungal infection in the nail. In people who have diabetes, any change in the color of the toenail should be evaluated by a doctor. The pressure, which caused the bruising of the nail, can cause a small sore under the toenail, which can become infected.

Psoriasis is a common, chronic, and recurrent inflammatory disease of the skin. It is characterized by round, reddish, dry scaling patches covered by grayish white or silvery white scales. The lesions have a predilection for the nails, scalp, elbows, shins and feet. On the feet, it can be difficult to distinguish it from athlete's foot, and the nail appearance may be confused with fungal infections of the toenails. The nail appearance does have a unique characteristic; it may have a pitting appearance. A characteristic feature of the condition is pinpoint bleeding when the scaled areas are brushed off. A variant of psoriasis is called pustular psoriasis. This form of the disease is characterized by small pustules or blisters filled with clear or cloudy fluid. This can mimic acute athlete's foot. It characteristically does not itch or burn. It is distinguished from athlete's foot by negative fungal cultures. The picture can become confusing because a secondary fungal infection is possible. In this instance both conditions are present at the same time.

Ingrown toenails are due to the penetration of the edges of the nail plate into the soft tissue of the toe. It begins with a painful irritation that often becomes infected. With bacterial invasion, the nail margin becomes red and swollen often demonstrating drainage or pus. In people who have diabetes or poor circulation, this relatively minor problem can be become quite severe. In this instance, a simple ingrown toenail can result in gangrene of the toe. Patients with joint replacements or pace makers are at risk of bacterial spread through the blood stream resulting in the spread of infection to these sites. These patients should seek medical attention at the earliest sign of an ingrown toenail. There are several causes of ingrown toenails: a hereditary tendency to form ingrown toenails, improperly cutting the toenails either too short or cutting into the side of the nail, and ill-fitting shoes can cause them. Children will often develop ingrown toenails as a result of pealing or tearing their toenails off instead of trimming them with a nail clipper. Once an ingrown toenail starts, they will often reoccur. Many people perform "bathroom" surgery to cut the nail margin out only to have it reoccur months later as the nail grows out.

Gout is caused by abnormal metabolism of substances called purines that result in the accumulation of uric acid in the blood stream. Purines are a by-product of cell break down. When the excretion of the uric acid is hampered the accumulated uric acid in the blood stream causes crystalline deposits to form in joints or in the soft tissues. When this happens, there is a sudden onset of extreme pain with associated swelling, redness, and increased warmth to the skin or joint. Classic gout occurs in the big toe joint. It also commonly occurs in the knee joint. Rarely is it seen in more than one joint at a time. Uric acid accumulation in other joints and areas of soft tissue is less common. When gout presents in these areas it, may not be recognized as gout by the treating doctor.

Gout can also mimic an infection. Your doctor will evaluate you for the possability of infection and may treat you for infection as well as gout.

The common wart is known as verruca vulgaris. They are caused by a viral infection of the skin. This occurs as a result of direct contact with the virus. They do not spread through the blood stream. They occur more commonly in children than adults. When they occur on the bottom of the foot, they are called plantar warts. This name is derived from the location of the foot on which they are found; the bottom of the foot is called the plantar aspect of the foot. A common misconception is that plantar warts have seeds or roots that grow through the skin and can attach to the bone. The wart may appear to have a root or seeds, but these are in fact small clusters of the wart just beneath the top layer of the skin. The wart cannot live in any tissue except the skin. Moist, sweaty feet can predispose to infection by the wart virus. They can be picked up in showers and around swimming pools. They are not highly contagious, but being exposed in just the right situation will lead to the development of the wart. Avoiding contact in the general environment is nearly impossible. If a member of the family has the infection, care should be taken to keep shower and tile floor clean. Children who have plantar warts should not share their shoes with other people. Young girls often share shoes with their friends and this should be discouraged.