Athlete's Foot Care and Symptoms

Dermatophytosis, tinea, fungus infection

Athlete's foot is the common term applied to a number of different fungal infections of the foot.  The medical term for this condition is tinea pedis; tinea referring to the causative organism and pedis referring to the location of the infection.  The two fungal organism we see most often are tinea rubrum and tinea mentagrophytes. Fungus, or the plural, fungi, are non-flowering plants that lack chlorophyll.  Since they lack chlorophyll they can't synthesize their own food and therefore have to live off other materials.  In the case of athlete's foot, the tinea organism is actually living off of the dead skin cells of our foot.  Fungi differ from bacteria in that they are plants.

There are three conditions that are necessary for us to acquire an athlete's foot infection.  First, fungus will only grow in an environment that will support it.  Think of how we contribute to the growth of athlete's foot with our lifestyles.  We jump out of the shower, put on our socks and shoes and go for the next 18 hours.  In a sense, we can contribute a lot to the success of a fungal infection by creating an environment in our shoes that is dark, warm and damp.  

Secondly, many people are more susceptible to athlete's foot infections because they lack the immune response necessary to fight it off.  This lack of immunity is common in the elderly or in immune compromised conditions.  It seems that most athlete's foot infections are acquired by individuals that  lack that one brick in the wall of their immunity system.  Be it genetic or otherwise, some patients seem to be predisposed to athlete's foot infections.

And lastly, patients need to come in contact with the fungal organism.  What strikes me about most cases of athlete's foot is that patients seem to focus on this issue and rack their minds about whether they acquired their infection at a hotel, the gym, their sister-in-law's house and so on.  In virtually all case they end up chasing their tails to get an answer.  I believe the more important issue is what we discussed earlier in that we create an environment conducive to the growth of fungus.

Achilles Tendonitis:

Achilles Tendonitis causes inflammation and degeneration of the achilles tendon.  The achilles tendon is the large tendon located in the back of the leg that inserts into the heel.  The pain caused by achilles tendonitis can develop gradually without a history of trauma.  The pain can be a shooting pain, burning pain, or even an extremely piercing pain.  Achilles tendonitis should not be left untreated due to the danger that the tendon can become weak and ruptured.

Achilles Tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation.  In some cases even prolonged periods of standing can cause symptoms.  It is a common problem often experienced by athletes, particularly distance runners.  Achilles Tendonitis is a difficult injury to treat in athletes due to their high level of activity and reluctance to stop or slow down their training. Individuals who suffer from achilles tendonitis often complain that their first steps out of bed in the morning are extremely painful.  Another common complaint is pain after steps are taken after long periods of sitting.  This pain often lessens with activity.

There are several factors that can cause achilles tendonitis.  The most common cause is over-pronation.  Over-pronation occurs in the walking process, when the arch collapses upon weight bearing, adding stress on the achilles tendon. Other factors that lead to achilles tendonitis are improper shoe selection, inadequate stretching prior to engaging in athletics, a short achilles tendon, direct trauma (injury) to the tendon, and heel bone deformity.   

Athletes, particularly runners, should incorporate a thorough stretching program to properly warm-up the muscles.  They should decrease the distance of their walk or run, apply ice after the activity and avoid any up hill climbs.  Athletes should use an orthotic device, heel cup, or heel cradle for extra support. 
A heel cup or heel cradle elevates the heel to reduce stress and pressure on the achilles tendon.  The device should be made with light-weight, shock absorbing materials.  An orthotic device can be used to control over-pronation, support the longitudinal arch, and reduce stress on the achilles tendon.   
If the problem persists, consult your foot doctor.

Arch pain: Arch pain (often referred to as arch strain) refers to an inflammation and/or burning sensation at the arch of the foot.

There are many different factors that can cause arch pain.  A structural imbalance or an injury to the foot can often be the direct cause.  However, most frequently the cause is a common condition called plantar fasciitis. The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot, that runs from the heel to the forefoot.  Plantarfasciitis is caused by excessive stretching of the plantar fascia, usually due to over-pronation (flat feet).
The inflammation caused by the plantar fascia being stretched away from the heel, often leads to pain in the heel and arch areas.  The pain is often extreme in the morning when an individual first gets out of bed or after a prolonged period of rest.  If this condition is left untreated and strain on the longitudinal arch continues, a bony protrusion may develop, known as a heel spur.   It is important to treat the condition promptly before it worsens.

This is a common foot condition that can be easily treated.  If you suffer from arch pain avoid high-heeled shoes whenever possible.  Try to choose footwear with a reasonable heel, soft leather uppers, shock absorbing soles and removable foot insoles.  When the arch pain is pronation related (flat feet), an orthotic designed with a medial heel post and proper arch support is recommended for treating the pain.  This type of orthotic will control over-pronation, support the arch and provide the necessary relief.

Arthritis: Arthritis is a disease characterized by the inflammation of the cartilage and lining of the body’s joints.  Inflammation causes redness, warmth, pain and swelling.  There are about 40 million Americans who suffer from arthritis. According to The National Institute of Arthritis and Musculoskeletal and Skin Diseases, it is estimated that by the year 2020, about 60 million Americans will have arthritis. The primary targets for arthritis are people over the age of 50.  Arthritis is a major cause of foot pain.  This is because each foot has 33 joints which can become affected by the disease.

Osteoarthritis: There are many different types of arthritis.  The most common type is called osteoarthritis.  Osteoarthritis causes excessive strain and the wearing away of cartilage in the joints of the foot.  Movement becomes very difficult and painful.  The pain and swelling worsens while standing or walking, and stiffness usually occurs after periods of rest.

Gout: Gout is another form of arthritis that also leads to foot complications. Excess uric acid crystals collect in and around the joints of the big toe.  The big toe joint is commonly the focal point due to the stress and pressure it experiences during walking and other weight bearing activities.  This often leads to severe pain in the big toe.  Men are more likely to develop gouty arthritis than women.

Rheumatoid Arthritis: Another type of arthritis is rheumatoid arthritis.  It can develop at any age and there is no known cause for this condition.  Rheumatoid arthritis is the most crippling form of the disease that can effect people of all ages.  It can cause severe deformities of the joints with associated fatigue of the entire body.  People who suffer from rheumatoid arthritis often develop severe forefoot problems such as bunions, hammer toes, claw toes, and others.

There are many causes of arthritis.  Heredity plays a major role.  However, arthritic symptoms can develop due to many other factors.  Some of these include bacterial and viral infections, prescription and illegal drugs, traumatic injuries, and bowel disorders such as ileitis and colitis.
Forefoot problems such as hammer toes, claw toes, mallet toes, and bunions often develop as a result of arthritis, particularly Rheumatoid arthritis.  Problems can also develop in the heel and ankle area due to the erosion of the involved joints.

Conservative treatment (non-surgical treatment) of the arthritic foot includes proper footwear, orthotics, and/or forefoot supports.  Arthritic footwear should provide the following benefits:

• High, wide toe box (high and wide space in the toe area)

• Removable insoles for fitting flexibility and the option to insert  orthotics if necessary.
• Rocker Soles - These soles are designed to facilitate ambulating (walking) and to reduce stress and pain at the ball-of-the-foot.

Arthritic footwear should also accommodate swelling of the foot.  Orthotics designed to provide comfort, support and extra cushioning are also recommended.  Orthotics made with a material called Plastazote are often recommended because they mold to your feet to provide customized comfort.  The proper footwear and orthotics will reduce pressure to provide a comfortable and healthy environment for the foot.
Forefoot supports such as gel toe caps, gel toe shields, gel toe straighteners and others can often provide relief.
If the problem persists, consult your foot doctor.

Bunions: Bunions, referred to in the medical community as Hallux Valgus, are one of the most common forefoot problems.  A bunion is a prominent bump on the inside of the foot around the big toe joint.  This bump is actually a bone protruding towards the inside of the foot.  With the continued movement of the big toe towards the smaller toes, it is common to find the big toe resting under or over the second toe.  This causes a common forefoot condition called overlapping toes.  Some of the symptoms of bunions include inflammation, swelling, and soreness on the side surface of the big toe.  The discomfort commonly causes a patient to walk improperly. Another type of bunion which some individuals experience is called a Tailor’s Bunion, also known as a Bunionette.  This forms on the outside of the foot towards the joint at the little toe.  It is a smaller bump that forms due to the little toe moving inwards, towards the big toe.

Bunions are a common problem experienced mostly by women.  The deformity can develop from an abnormality in foot function, or arthritis, but is more commonly caused by wearing improper fitting footwear.  Tight, narrow dress shoes with a constrictive toe box (toe area) can cause the foot to begin to take the shape of the shoe, leading to the formation of a bunion.  Women who have bunions normally wear dress shoes that are too small for their feet.  Their toes are squeezed together in their shoes causing the first metatarsal bone to protrude on the side of the foot. It is important for men and women to realize that wearing dress shoes and boots, which are tapered in the toe area, can cause the bunion to worsen to the point where surgery is necessary.

In the early stages of the formation of a bunion, soaking feet in warm water can provide temporary relief.  The best way to alleviate the pain associated with bunions is to wear properly fitting shoes.  Shoes designed with a high, wide toe box (toe area) are recommended for people suffering from forefoot disorders, such as bunions.  Shoes with rocker soles will unload pressure to the bunion area.  Orthotics are also recommended for this condition to provide extra comfort, support, and protection.
Other conservative treatments include using forefoot products designed to accommodate and relieve bunions such as bunion shields, bunion night splints, and bunion bandages.  These conservative treatments can limit the progression of the bunion formation, relieve pain and provide a healthy environment for the foot. If the problem persists, consult your foot doctor.

Diabetes: Diabetes is a serious disease that can develop from the lack of insulin production in the body or due to the inability of the body’s insulin to perform its normal everyday functions.  Insulin is a substance produced from the pancreas gland that helps process the food we eat and turn it into energy.
Diabetes affects approximately 16 million Americans and is classified into 2 different types: Type 1 and Type 2.  Type 1 is usually associated with juvenile diabetes and is often linked through heredity.  Type 2, commonly referred to as adult onset diabetes, is  characterized by elevated blood sugars, often by people who are overweight or have not attended to their diet properly.
There are often many complications associated with diabetes.  Diabetes disrupts the vascular system, affecting many areas of the body such as the eyes, kidneys, legs, and feet.   People with diabetes should pay special attention to their feet.

Neuropathy: Of the sixteen million Americans with diabetes, 25% will develop foot problems related to the disease.  Diabetic foot conditions develop from a combination of causes including poor circulation and neuropathy.  Diabetic Neuropathy can cause insensitivity or a loss of ability to feel pain, heat, and cold.  Diabetics suffering from neuropathy can develop minor cuts, scrapes, blisters, or pressure sores that they may not be aware of due to the insensitivity.  If these minor injuries are left untreated, complications may result and lead to ulceration and possibly even amputation.  Neuropathy can also cause deformities such as Bunions, Hammer Toes, and Charcot Feet.
It is very important for diabetics to take the necessary precautions to prevent all foot related injuries.  Due to the consequences of neuropathy, daily observation of the feet is critical.  When a diabetic patient takes the necessary preventative footcare measures, it reduces the risks of serious foot conditions.

Poor Circulation:
Diabetes often leads to peripheral vascular disease which inhibits a person’s blood circulation.  With this condition, there is a narrowing of the arteries that frequently leads to significantly decreased circulation in the lower part of the legs and the feet.  Poor circulation contributes to diabetic foot problems by reducing the amount of oxygen and nutrition supplied to the skinand other tissue, therefore causing injuries to heal poorly.  Poor circulation can also lead to swelling and dryness of the foot.  Preventing foot complications is more critical for the diabetic patient since poor circulation impairs the healing process, and can lead to ulcers, infection, and other serious foot conditions.

1.  Take Care of Your Diabetes
Make healthy life style choices to keep your blood sugar close to normal. Work with your health care team to create a diabetes plan that fits your life style characteristics.
 
2. Check Your Feet Every Day
You may have foot problems that you may not be aware of.  Check your feet for cuts, sores, red spots, swelling, or infected toenails.  Checking your feet should become part of your daily routine. If you have trouble bending over to see your feet, use a plastic mirror to help.  You can also ask a family member to help you.
Important Reminder - Be sure to call your doctor immediately if a cut, sore, blister, or bruise on your foot does not heal after one day.
 
3. Wash Your Feet Every Day
Wash your feet in warm, NOT HOT, water.  Do not soak your feet because your skin will get dry. Before bathing or showering, test the water to make sure it is not too hot.  You should use a thermometer or your elbow. Dry your feet well.  Be sure to dry between your toes. Use talcum powder to keep the skin dry between the toes.
 
4. Keep the Skin Soft and Smooth
Rub a thin coat of skin lotion or crème on the tops and bottoms of the feet. Do not put lotion between your toes, because this might cause infection.
 
5. Trim your Toenails Each Week or When Needed
Trim your toenails with clippers after you wash and dry your feet.  Trim the toenails straight across and smooth them with an emery board or nail file. DO NOT cut into the corners of the nail or rip off hangnails. If your nails are thick or yellowed, DO NOT cut your own nails, have a foot doctor trim them.
 
6. Wear Shoes and Socks At All Times
Wear shoes and socks at all times.  Do not walk barefoot, not even indoors. It is extremely easy to step on something and hurt your feet. Always wear seamless socks, stockings, and nylons with your shoes to help avoid the possibility of blisters and sores developing. Be sure to choose seamless socks that are made of materials that wick moisture away from your feet and absorb shock and shear.  Socks made of these materials help keep your feet dry. Always check the insides of your shoes before putting them on.  Make sure the lining is smooth and there are no foreign objects in the shoe, such as pebbles. Wear shoes that fit well and protect your feet.
 
7. Protect Your Feet From Hot and Cold
Always wear shoes at the beach or on hot pavement. Put sunscreen on the tops of your feet for protection from the sun. Keep your feet away from radiators or open fires. DO NOT use hot water bottle or heating pads on your feet. If your feet are cold, wear seamless socks at night.  Lined boots are good to keep your feet warm in the winter.  Choose socks carefully.  DO NOT wear socks with seams or bumpy areas.  Choose padded socks to protect your feet and make walking  more comfortable. In cold weather, check your feet often to keep your feet warm avoid frostbite.
 
8. Keep the Blood Flowing to Your Feet
Put your feet up when you are sitting. Wiggle your toes for 5 minutes, 2 or 3 times a day.  Move your ankles up and down and in and out to improve blood flow in your feet and legs.
• DO NOT cross your legs for long periods of time.
• DO NOT wear tight socks, elastic, or rubber bands, or garters around your legs.
• DO NOT wear restrictive footwear or foot products.  Foot products that can cut off circulation to the feet, such as products with elastic, should not be worn by diabetics.
• DO NOT smoke.  Smoking reduces blood flow to your feet.

If you have high blood pressure or high cholesterol, work with your health care team to lower it.

9. Be More Active
Ask your doctor to plan an exercise program that is right for you. Walking, dancing, swimming, and bicycling are good forms of exercise that are easy on the feet. Avoid all activities that are hard on the feet, such as running and jumping.
Always include a short warm-up or cool-down period. Wear protective walking or athletic shoes that fit well and offer good support.
 
10. Communicate With Your Doctor
Ask your doctor to check the sense of feeling and pulses in your feet at least once a year. Ask your doctor to tell you immediately if you have serious foot problems. Ask your doctor for proper footcare tips. Ask your doctor for the name of your local podiatrist.

Heel pain: Heel pain is a common condition in which weight bearing on the heel causes extreme discomfort.

There are two different categories of heel pain.  The first is caused by an over-use repetitive stress.  Over-use repetitive stress refers to a soreness resulting from too much impact on a specific area of the foot.  This condition, often referred to as “heel pain syndrome”, can be caused from shoes with heels that are too low, a thinned out fat pad in the heel area, or from a sudden increase in activity.
Plantar fasciitis, a very common diagnosis of heel pain, is usually caused from a biomechancial problem, such as over-pronation (flat feet).  The plantar fascia is a broad band of fibrous tissue that runs along the bottom surface of the foot, from the heel through the midfoot and into the forefoot.  Over-pronation can cause the plantar fascia to be excessively stretched and inflamed, resulting in pain in the heel and arch areas of the foot.  Often the pain will be most intense first thing in the morning or after a prolonged period of rest.  The pain will gradually subside as the day progresses.

To properly treat heel pain, you must absorb shock, provide cushioning andelevate the heel to transfer pressure.  This can be accomplished with a heel cup, visco heel cradle, or an orthotic designed with materials that will absorb shock and shear forces. When the condition is pronation related (usually plantar fasciitis), an orthotic with medial posting and good arch support will control the pronation, and prevent the inflammation of the plantar fascia.
Footwear selection is also an important criteria when treating heel pain.  Shoes with a firm heel counter, good arch support, and appropriate heel height will be the ideal choice. If the problem persists, consult your foot doctor.