The painful effects from a lifetime of wearing bad shoes
By Mitchell Kahn, M.D.

Age may bring wisdom, but it just as frequently brings sore feet. If you’re over 50, more likely than not, you suffer from aching feet. That stands to reason since you don’t see many cars with tires that are 50 years old. In most cases, the culprit for foot pain is a lifetime of wearing shoes that, while perhaps fashionable, don’t fit properly. In my view, that’s too high a price for vanity.

Bunions
A bunion is a deformity that usually occurs at the base of the big toes at the head of the bone that connects the big toe to the arch of the foot (also called the first metatarsal bone.) Afflicting one-third of older adults — 90% of them women — bunions are most often caused by the prolonged wearing of ill-fitting shoes with a narrow, pointed toe box that squeezes the toes into an unnatural position. Even ordinary shoes can sometimes push the toes inward away from its natural position.

A study by the American Orthopedic Foot and Ankle Society found that 88% of women in the U.S. wear shoes that are too small and 55% have bunions. As the big toe angles inward toward the center of the foot, the head of the first metatarsal bone moves outward and rubs against the inside of the shoe. Wearing high heels only makes things worse. The friction in turn causes a painful inflammation of the underlying tissue. That’s followed by the formation of bony growths that can make walking very painful. A bunion at the base of the little toe on the outside of the foot is called a tailor’s bunion or bunionette.

Bunions often become painful if they are allowed to progress, but not all bunions do. Some can be managed without surgery by using splints, orthotics, anti-inflammatory drugs and cortisone injections. Obviously the simplest solution is prevention — i.e. wearing properly fitted shoes.

Some patients feel the urge to have their bunions surgically corrected just so they can wear fashionable shoes again. But that would be a mistake, since bunion surgery is not always effective. Of patients who get bunion operations, 83% are better afterwards, but 17% are not. This is why orthopedic surgeons do not recommend surgery for bunions that cause little or no pain. With proper preventive care, these types of bunions may never become a problem. Laser surgery is often touted for bunions, though the results are roughly the same as conventional surgery. Recovery time might be shorter, however, because lasers cause fewer traumas to the tissue.

Plantar Fasciitis
Another common foot malady, plantar fasciitis, is characterized by painful first steps when you first get out of bed in the morning or after sitting for a long time. The plantar fascia is a thick band of tissue that runs down the bottom of your foot from the heel to the ball of the foot. It acts as the spring that keeps the arch of your foot from collapsing. If you usually wear shoes that do not provide arch support, the plantar fascia gets tugged on with every step. Eventually it can grow inflamed and cause pain. Sometimes this happens when people gain weight, since each step stretches and stresses the plantar fascia more than usual. Some patients with this condition compare the sensation to walking on glass.

As with bunions, the best treatment is prevention. Wear comfortable shoes with good arch supports. If you’re already a victim, plantar fasciitis can usually be alleviated by anti-inflammatory drugs, physical therapy, orthotics and, in some cases, a cortisone injection. Surgery is rarely performed for this condition, and should only be considered if less intrusive measures have failed.

Heel Spurs
If you suffer from plantar fascia and still continue to wear shoes that don’t adequately support the arch of your foot, the constant tugging associated with this condition can eventually pull out a tiny spicule of bone from your heel, resulting in a heel spur. Many of the same treatments for a plantar fasciitis are also effective for a heel spur. But more often, this condition requires a cortisone injection or surgery.

Shoes, shoes, shoes
The simple truth is that a good pair of shoes can do more to safeguard you from foot pain than a team of high-priced surgeons. Even after you develop a bunion or other condition, the best treatment is often switching to a pair of sensible, well-fitting shoes with solid arch supports. It’s a lot cheaper than surgery.

Mitchell Kahn, M.D., is Assistant Clinical Professor of Medicine at Columbia Medical School and is Director of the
Miller Health Care Institute at New York’s St. Luke’s Roosevelt Hospital.