Written by John Ferrari
Our feet and ankles support us all day long—from the moment we step
out of bed throughout our day: standing, walking, maybe jogging or playing
a sport, perhaps even dancing. But how often do we think about them ...
until something happens? That’s when Torrance Memorial Medical Center’s
specialists can help us, well, get back on our feet.
People take thousands of steps a day, day after day, year after year, notes
Keri Zickuhr, MD. An orthopedic surgeon, she sees a gamut of foot ailments—from
sprains, tendonitis and fractures to arthritis and complications from
diabetes. “My goal is to get patients back to their activities,
back to the shoes they like to wear, without pain,” Dr. Zickuhr
explains. “I see a whole host of problems; every patient is unique.”
That said, foot and ankle injuries most often result from overexertion,
complications from diabetes or plain bad luck. Ankle sprains are probably
the most common athletic injury, Dr. Zickuhr says. Achilles’ tendonitis
and stress fractures, caused by overuse, are common too.
Treatment—including rest and, often, immobilization of the foot and
ankle in a cast or boot—doesn’t always sit well with individuals
accustomed to lots of activity. The good news: There are steps you can
take to avoid injuries from overuse.
Practicing good form and technique when exercising is important, but even
before lacing up your running shoes you can minimize your risk of injury
by choosing shoes that have good shock absorption and arch support. Dr.
Zickuhr notes that, generally, athletic shoes should be discarded after
300 to 500 miles of running or jogging or 300 hours of exercise classes.
Once your shoes are on, “make sure you do a light warm-up before
Stress injuries often begin with mild aches that worsen, Dr. Zickuhr adds.
“Listen to your body. If it’s giving you signs, don’t
The Importance of Physical Therapy
For people who do experience a foot or ankle condition—from tendonitis
to plantar fasciitis—physical therapy is as important as the initial
treatment, Dr. Zickuhr says. That’s where Richard Shen, DPT, comes
in. Shen, the lead physical therapist at Torrance Memorial’s South
Bay orthopedics clinic, sees a lot of patients who’ve simply overdone it.
“Typically,” he says, “it’s people doing more activity
than their body can handle—too much activity suddenly.” One
of the most common injuries—ankle sprain—can be caused by
something as simple and unavoidable as stepping off a curb the wrong way.
Initially, the best treatment for these and similar injuries is simple:
rest, ice and anti-inflammatories to reduce swelling and pain. After that,
physical therapy can help “retrain” the ligaments and muscles
to work together correctly.
The foot is part of a “kinetic chain,” Shen explains, linking
the foot, ankle, knee and hip. A foot or ankle injury can affect the entire
body—up into the core muscles and the spine—so orthopedic
physical therapy focuses not only on the foot and ankle but on the entire
kinetic chain, helping the patient improve flexibility, regain balance
and return to a normal gait.
Unlike sprains, tendonitis and similar complaints, some ankle injuries
can cause a problem long after they occur, such as arthritis. Using the
ankle joint—walking and jumping—can cause inflammation and
pain in the short term, joint stiffness and eventually bone spurs and
arthritis, Dr. Zickuhr says. Although some ankle arthritis is caused by
aging, most instances are the result of a previous trauma—like a
bad fracture—that damages the cartilage.
While ankle arthritis may be an intractable problem, there have been advances
in its treatment. “The gold standard used to be ankle fusion to
correct arthritis, resulting in no motion,” Dr. Zickuhr explains.
“Over the last 10 years the technology for ankle replacement has
really evolved. It’s now better than fusion for many patients, and
people can keep some of the motion they have.”
Another intractable problem, diabetes, is the other main cause of foot
injuries. “The majority of the patients I see have problems with
their feet as a result of diabetes,” says podiatrist Karen Shum,
DPM. Dr. Shum, medical director of Torrance Memorial’s Amputation
Prevention Center, says approximately half of people with diabetes develop
a loss of sensation (neuropathy) in their feet.
Even a blister or small cut, unnoticed and untreated, can lead to an open
ulcer—especially because diabetes also causes poor circulation,
which leads to slower healing times and an increased risk of infection.
“The problems compound with each added issue,” Dr. Shum notes.
Prevention is the best course, and the preventive measures are simple,
Dr. Shum says: careful foot inspections, including top, bottom and between
the toes. She also recommends closed-toe shoes for patients with diabetic
neuropathy; light-colored socks to reveal stains caused by any open sore;
and close blood glucose control.
The Holistic Approach
Whether they’re caused by overexertion, diabetes or bad luck, foot
and ankle injuries have one thing in common: pain. Integrative medicine—combining
Western approaches with complementary therapies including acupressure
and reflexology—can play an important role in reducing pain and
helping a patient regain strength, balance and flexibility.
Linda Chollar, MTI, who is certified in functional acupressure, is an expert
on integrative therapy and a committee member with Torrance Memorial’s
Graziadio Wellness Center. She specializes in pain management, integrating
a combination of manual therapies customized for each patient including
clinical reflexology and focus on soft tissue of the foot core system.
The National Institute of Health reports a clinical trial showing that
reflexology is effective at reducing chronic low back pain in nurses.
Chollar helps reduce patients’ pain levels and provides guidance
on correcting their gait and posture to restore overall body stability.
“My approach is based on both Eastern medicine and Western evidence-based
therapies,” she says. “The bottom line is cost savings to
the patient, fewer drugs and fewer side effects.”
Dr. Zickuhr agrees. A lot of pain is caused by inflammation, she says.
Drugs can reduce inflammation and pain, but so can acupressure, reflexology
and other hands-on therapies—even simple foot massage. Foot therapy
can stimulate the release of endorphins, increasing relaxation and reducing
anxiety, Chollar says, “Feet allow us great opportunity with therapeutic
touch, to communicate with the whole body.” •
Holistic footcare practitioner Linda Chollar is based in Manhattan Beach;
Tips to keep your toes in top shape
Stay light on your feet. Extra pounds add to the pressure and stress your
foot experiences with every step, exacerbating foot pain. Three times
the body’s weight is concentrated in the feet due to gravity.
Wear sensible shoes. Avoid styles that pinch your toes or concentrate all
of your weight on one part of your foot.
Keep it cushy. As a rough guide, replace athletic shoes every 300 to 500
miles of running or jogging or every 300 hours of exercise classes.
Shake it out. Always do a light warm-up before exercising and end your
workout with stretches.
Listen up. If you experience aches or pains in your feet, don’t ignore
them. Work with a trainer, coach, physical therapist, podiatrist, CAM
practitioner or medical professional to find the root cause and take care of it.
Pamper your tootsies. Foot massages and soaking can relax your feet and
your whole body, stimulating the release of endorphins and reducing anxiety.