Leg Health Questions

Leg Health Questions
1. What can I do at home to get better blood flow to my legs? Exercise and walking are good basics to help. The role of exercise in preventing the development of arterial disease is better documented and less controversial than that of diet. During vigorous exercise, the body releases high-density lipoproteins (HDLs). These HDLs act like detergents to chemically "clean and scrub" the inside of your vessels. HDLs cannot be bought at your local health food store -- exercising is the only way to produce them.

While most senior citizens can't be expected to train for marathons (although some do), it is important to begin regular "workouts" -- whether it is a daily swim, a round of golf, some bicycling, or perhaps the most popular and easiest exercise of all, walking.

Evidence shows that brisk walking -- from a hike in the wilderness to competitive race walking -- is nearly as good a fitness builder as running. President Harry Truman was an advocate of brisk early morning walks, convinced that they would help him live longer. Truman lived to age 88. Whatever route you choose, check with your physician first and then make it a part of your daily regimen. Ideally, you should start your program slowly and aim for from three to five half-hour workouts each week. Proper exercise will make you feel younger and healthier and may in the end be more important to your circulation than any medicine or dietary change.



2. I have painful varicose veins. What causes them? Your veins have the difficult job of returning your blood, against gravity, to your heart. The body has many ways to assist in this action. When your calf muscles contract during walking, for instance, they help squeeze blood upward. "One-way" valves in you veins also prevent blood from flowing down. As we get older, however, these valves may become less efficient. The result may be venous insufficiency manifested in varicose veins or swollen ankles. Although varicose veins are thought of mostly for their cosmetic unattractiveness, they present a serious risk to seniors. A varicose vein which is accidentally cut will bleed profusely. What would you do to stop the bleeding? If you only apply a pressure dressing, the bleeding may not stop. The correct treatment is to first elevate the leg, then, while it is elevated, apply pressure with a bandage.

Varicose veins can also result in painful ulceration of the leg and ankle. These ulcerations are generally the end product of a progressive disease process which first causes the skin of the lower leg to become thickened and discolored. This "bark-like" skin is often itchy. Ulcers usually develop on the lower inside aspect of the leg, at the point where the venous pressure is the greatest.

Standing still for long periods of time tends to aggravate venous conditions so:

Whenever possible, try to raise your feet onto a footrest or chair. Elevate the base of your bed by placing an encyclopedia or large telephone book under the end of your mattress. Elastic stockings are useful in both the prevention and treatment of venous disorders. Do not use heating pads or whirlpools as this may damage the fragile tissues of your feet and toes.

3. My nails are quite thick and hurt when I wear some shoes. What causes that? Your nails will generally thicken with age. This could be due to fungal infection, decreased circulation, or accumulated trauma to the nails. Thickened nails are unattractive and may cause a shoe-fitting problem. Pain may result when the thickened nail presses against the top of the shoes.

Thickened nails require the care of a podiatrist, since using a standard clipper is nearly impossible. A podiatrist will use a high-speed drill to grind the nail. Periodic visits to your foot doctor will keep your nails looking as normal as possible. Oral anti-fungals such as Sporonox® and Lamisil® can also be useful.



4. My doctor says I have arthritis in my feet. What does that mean? Perhaps the most common malady affecting the aging foot is osteoarthritis, a type of arthritis resulting from the chronic wear of bones and joints. The bones and joints of the foot support more weight than any other part of the body. Unfortunately, the hundreds of thousands of miles of walking we have logged by the time we become senior citizens make osteoarthritis an almost inevitable prospect for our later years. Heavy individuals are especially prone to this form of arthritis.

The symptoms of osteoarthritis follow a classic pattern. Early in the morning your affected joints are stiff and painful. After some walking, the stiffness gradually diminishes, only to return later in the day and become progressively worse by evening. The foot joints most subject to osteoarthritis are the metatarsal joints (at the ball of your feet). These joints assume the most force during walking. A bunion is a dramatic form of osteoarthritis, which occurs at the first metatarsal-phalangeal joint.

The toes are also affected by osteoarthritis. A hammertoe results from the "buckling up" of the small joints of the toes. A thickening of these joints often results at the knuckles (proximal interphalanageal joints). The raised position of a hammertoe predisposes the formation of corns. The top of the toe rubs against the top of the shoe, irritating it and stimulating the growth of a corn.



5. How should I manage my arthritis? If you suffer from arthritis, your immediate goals are elimination of pain and maintaining the range of motion of your joints. These usually go hand-in-hand. The pain/motion cycle develops as follows: pain in the joints causes a limitation of motion of the joints which in turn leads to more pain and so on. Breaking the pain cycle leads to more motion, which in turn leads to less pain and so on.

Analgesic and anti-inflammatory drugs are useful in decreasing pain. The most cost-effective of these are the non-steroidal salicylates. Ordinary aspirin is still one of the safest, most effective medicines available for the treatment of arthritis. Each year another new "miracle" drug is introduced. Motrin®, Indocin®, Feldene® , and Clinoril® among others, have all at one time held the limelight. Be careful, however, if you are prone to stomach ulcers since these drugs can negatively affect the stomach lining. Your podiatrist or rheumatologist will prescribe his favorite anti-arthritic drug. You may have to try a few of these drugs until you find the one that is the most effective and has the fewest side effects.

If a joint in you foot is acutely painful, it may require an injection of a steroid mixed with a local anesthetic. The local anesthetic immediately numbs the joint and allows you to walk normally. This breaks up adhesions and allows the joint to regain its normal range of motion. The steroid acts as an anti-inflammatory agent to help maintain the joint in a non-irritated state.

Physical therapy is a highly recommended adjunct to any arthritic treatment program. After you have soaked for about fifteen minutes, begin to manipulate your toes. Start by gently pulling out on the toes. This opens up the joint spaces. Next, while maintaining some outward pulling force on the joint, begin to move the toe up and down through its available range of motion. Move the toe only as far as it will comfortably go. Do not force it!



6. What are shin splints? This is a catchall expression for many conditions, which cause pain in the lower front part of the leg. Shin splints are an overuse syndrome of one or more muscles, which originate on the leg and insert into the foot. The two basic conditions often found are anterior and posterior shin splints.

The anterior muscles are located on the outside front part of the leg. They act to slow down and prevent the foot from slapping the ground. These muscles can become irritated when an athlete begins to train on hills or changes from a flatfooted to a toe-running style. Anterior shin splints are often predisposed by a relative weakness of the front leg muscles. Activities such as running tend to build up the calf muscles more than the anterior leg muscles.

Studies have shown that when the calf muscles become more than four-and-a-half times stronger than the anterior leg muscles, the development of shin splints is likely. Prevention of anterior shin splints is accomplished by exercising these muscles. If you religiously exercise them, you will gradually build them up and avoid the muscle fatigue and inflammation of anterior shin splints.

The exercise that is most effective in building up these muscles is dorsi-flexion of the foot In a sitting position, stretch the front part of your foot up toward your leg, as if trying to touch your shin with your toes. This exercise should be done in three sets of ten repetitions each day. After the first week, you may begin to add a one-pound weight per week for the next five weeks. You needn't use standard weights. A few books in a pail can be hung over your foot.



7. Why do I frequently sprain my ankle? This condition borders on being both a training and a structural injury. Ankle sprains are certainly among the most commonly suffered injuries of athletes. They are more common in individuals with a large range of ankle motion. If you can easily invert your feet (turn the soles toward each other) your chance of a sprain are increased.

Sprains are not easy to prevent. Most occur when your foot plants in an incorrect position. If you have a tendency to sprain your ankles often, stable low-heeled shoes, strapping, and elastic ankle supports can be helpful.

The treatment for an ankle sprain depends on the severity of the injury. A minor ligament pull requires little treatment. If after a few minutes, you can hop on the injured foot without pain, it's safe for you to return to your activity.

If you can't bear weight without pain, you will need R.I.C.E. (rest, ice, compression, elevation) and a further work-up. In a moderate ankle sprain, a tear often occurs in the lateral talo-fibular ligament. Tears of this nature should not be taken lightly. Because of the poor blood supply to this area, ligament injuries may take even longer to heal than bone fractures.

In severe ankle sprains, the calcaneal-fibular ligament may be severed. Treatment of this type of sprain ranges from casting to surgery (to re-sew the torn ligaments).



8. What are "Bunions"? The best-known biomechanically caused foot deformity is the bunion. Technically known as hallux abducto valgus, this is another painful condition involving the big toe joint. A bunion begins as a small enlargement at the head of the fist metatarsal which slowly and progressively grows.

The underlying cause of a bunion is abnormal pronation of the foot This collapsing force gradually causes a rotational dislocation of the big toe joint. As the first metatarsal drifts toward the mid-line of the body, the toe itself moves in the opposite direction, often moving above or below the second toe.

Faulty foot structure leads to bunion formation. Abnormal pronation causes the foot to collapse and be unstable at a time when it should supinate and be rigid. Bunion formation is a gradual process which develops over many years. This condition may be hereditary and is not caused by wearing improper shoes. Wearing pointed shoes, will, however, aggravate and accelerate bunion formation.

Bunions cannot be corrected without surgery. Over the years many contraptions such as splints have been tried to correct them. People have also resorted to everything from exercise and manipulations to vitamin regimens in vain. The forces that cause bunions are simply too great to be mechanically corrected.

There is some evidence, however, to back up the claim that bunions can be prevented by biomechanically controlling the abnormal pronatory forces affecting the foot. Wearing orthotics can best control these forces.



9. My doctor says I need Orthotics. What are they and why do I need them? Orthotics -- custom-made inserts that fit into your shoes -- can be thought of as "eyeglasses" for the feet. Superficially they look like arch supports and in fact they do help support the arch, but that is only a small part of what they do. Orthotics actually change the way you walk. They prevent excess pronation of the foot and allow the foot to supinate at the proper time in the walking cycle.

In the treatment of certain metatarsal conditions such as certain types of calluses, orthotics can be modified to form depressions that will accommodate one or more "dropped" metatarsal bones. This way a plantarflexed metatarsal which would normally hit the ground with more force than the adjacent metatarsals can now land innocently into a small depression in the orthotic. The net result is better weight distribution of the metatarsals.

Orthotics are universally acknowledged as being useful in the treatment and prevention of many structural conditions including abnormal pronation, bunions, heel spurs, plantar fasciitis, shin splints and metatarsalgia. They are not, however, a panacea for all foot problems. Why?

While they provide for better foot function, orthotics do not correct faulty foot structure. Remember our analogy to eyeglasses. Just as eyeglasses do not correct vision, orthotics do not correct foot structure. However, if you thought your vision wasn't up to par, you would have your vision checked. If you develop persistent foot or leg pain or notice an uneven or abnormal wear pattern on you shoes, you should visit your podiatrist.



10. How can I keep my skin healthy? Your skin is lubricated by sebaceous (oil-containing) glands. As you get older, these glands become less active and your skin is likely to become dryer. Excessive washing of the skin will also cause dryness. Caustic soaps and detergents in particular deplete the skin of its natural oils.

Dry skin gives you the appearance of being older than you are. This accounts for the tremendous sales success of moisturizing creams and lotions. Of course if your skin does not respond to any of the over-the-counter moisturizers, you should consider a prescription product such as Lachydrin® 12%, available from your podiatrist or dermatologist.

There is a proper way to use the various products available. Alpha-keri Creme®, Nivea®, Vaseline Intensive Care Lotion®, and Jergens Hand Creme® are all good. The only part of the feet that should be thoroughly dried is between the toes (this area is naturally moist). Next apply a liberal amount of you moisturizing creme or lotion.



11. How does diabetes affect the feet? A systemic disease with a special predilection for the feet is diabetes mellitus, a metabolic disorder in which the body is not able to transport sugar from the blood to the tissues. Diabetes causes a thickening of the small vessels in the body, some of which supply the nerve fibers. When these vessels close, the underlying area becomes insensitive to pain and temperature.

The foot is of particular concern to diabetics because it is so vulnerable to trauma and its vessels are so small. Diabetics are very prone to both foot infections and ulcers and should therefore be seen regularly by both a physician and a podiatrist.

If you are a diabetic or suffer from any disease which results in decreased pain and temperature sensation, you should;

Monitor water temperature. Be sure to use a thermometer to measure the temperature of water when bathing. If you step into a hot tub, you may unknowingly burn your feet The recommended temperature for bathing is ninety to ninety-five degrees Fahrenheit. Inspect your feed daily; look for signs of redness and swelling. These are signs of inflammation or infection. Cuts, abrasions, or cracks in the skin must be treated promptly with an antiseptic solution such as Betadine® and covered with dry sterile gauze. Use only paper tape to secure gauze. Never use conventional adhesive tape. Removal of such tape can be dangerous because of the possibility of also removing the top layer of skin. Keep the skin of your feet and your entire body moist and supple. Regular application of a moisturizing skin cream helps prevent your skin from drying out and cracking. Buy the softest and best fitting shoes possible. Properly fitting shoes are essential in the prevention of pressure sores and ulcers. Any new pair of shoes must be "broken in" slowly. Wear a new pair a half hour the first day and add an additional half hour each subsequent day. Inspect your feet after each wearing. Look for signs of redness or irritation. If such friction marks are found, immediately note their presence and bring the shoes to your shoe repairer for modification. Custom molded shoes are recommended for those who have difficulty in finding shoes to properly fit their feet.