Outrageous footwear!

High heels – of course they damage your feet. But women still buy them. Just take a look at an outrageous South African blog: Google- Shoegirl South Africa and see what you get!

Apparently a new fashion trend is to wear socks with your high heels. Socks with high heels? Almost as bad as socks with sandals for men.

Even better is the website for FitFlops, yes you read correctly. I saw them with my wife at a Johannesburg shoe store last Saturday. What about footwear advertised as: The flip flop with the gym built in! Cushioned heel absorbs 36% more shock than regular footwear. Micro wobble-board midsection slows eversion rate by requiring 15% more energy to walk. Firm toe area promotes faster toe-off.

And the result? Firmer buttocks and leg muscles. One wearer says she does feel like she has just done a workout after wearing them.

They are available through one string of outlets – I’m not advertising them! Check the website. www.fitflop.com

I’m dying to know more about them.

Here’s another idea, from Bignews page 14 January 2008.(This is a local business newspaper.)Transparent shoeboxes.(Very politically correct in SA today!). Boitunelo Mofokeng has obtained the rights to exclusively distribute Shoebby, a transparent shoe box manufactured in the United States.

So no more searching for ‘that’ pair of shoes, because all your pairs are visible in these neat transparent boxes. For the guys it could mean the end of sifting through that disorderly pile of assorted shoes in the bottom of the wardrobe! Contact Mofokeng at 082 453 8692.

Goodnight!

Can High Heels Heal?

‘Walking on sunshine.’ ‘Sexual heeling.’ ‘Toeing the line.’ All headlines for articles recently printed in the South African press taken from The Telegraph, The Sunday Times and The Times respectively, all from London. Toeing the line is all about the Chinese tradition of foot binding and I’ll pick up on that later this week.

The other articles are all about the benefits and effects of wearing high heels! Both suggest that wearing high heels is sexy and in ‘sexual heeling’ the research of a University of Verona urologist, Dr Maria Cerruto, is reported where she tackled “bizarre” theories about the effects of wearing high heeled shoes. The idea of sexual heeling refers to the Dr Cerruto’s assertion that pelvic floor activity is affected.

Traditionally we have blamed high heels for a variety of ailments, such as bunions, stress fractures, knee pain, lower back pain and increased risk of arthritis. South African research by Drs. Zipfel and Berger of The University of the Witwatersrand in Johannesburg showed scientific proof that wearing shoes had bad effects on the wearers when compared to unshod people. (I know this was on old bones but they have the proof). Dr. Cerruto’s evidence is due to be published in the journal European Urology. Since I am concerned with your foot health, I’ll leave that train of thought for you to follow.

However, in the article there is a comment from a UK fitness instructor who runs classes in London for women with high heels called Sweat and Stilletos. These sessions are designed to help women wear stilletos more comfortably. Whilst she agrees with the effects of muscle toning in the buttock region, she says that there must be compensation somewhere else and therefore her classes help with postural alignment.

Now as podiatrists we spend a lot of time dealing with and correcting the effects of postural malalignment. A personal trainer to some celebrities was quoted as saying that” the knees and metatarsals are put under strain, the hips are out of position. It can lead to long-term health risks.”

For me the evidence is there that the movement of the body’s centre of gravity forward causes increased loading and pressure. There is an increase in callus formation and the calf muscles shorten over time. This will lead to deformities of the toes. I agree however that exercises specifically to strengthen the intrinsic muscles of the foot will resist these deformations.

In “Walking on sunshine” they report on a New York sports therapist who holds classes for women to strengthen their foot muscles to cope with wearing high heels. Yamuna Zake also gives some good advice on foot care. She has been working with dancers for 25 years and those of you who struggled to get your (or your child’s) feet into the basic ballet positions without them falling flat will appreciate this. The essence of ballet is to be able to get your foot extended down from the ankle as far as possible and have almost 90 degrees of flexibility at the big toe joint.

So what’s the bottom line? Let me quote from the articles. ‘It’s a way to appeal to the male species. I have men who say heels have saved their marriage.’ Yamuna Zake says, ‘my husband is a freak about high heels. He thinks they’re very sexy.’ During my recent tutorials with Wits University medical students I was demonstrating the possible effect of rheumatoid arthritis on the way a person walks. I asked on of the girls to walk across the room in her high heels and then again barefoot to show the difference in patterns of healthy person. Guess what she said before walking barefoot? ‘Oh please I’ll walk like a boy!’

I wonder if walking in high heels will become an Olympic sport?

Read the articles:

Walking on sunshine. Melissa Whitworth. The Telegraph, London. In The Sunday Times (Johannesburg)Lifestyle section. [not sure when, towards the end of 2007].

Sexual heeling. Roger Dobson & Steven Swinford. The Sunday Times, London. In The Sunday Times (Johannesburg) Lifestyle. February 24 2008. Page 17.

Eschewing shoes may save your soles. Gill Gifford. The Star, Johannesburg. Friday October 26 2007.Page 6.

Is Your Backache Caused by Your Leg Length?-2

Having legs of different length is recognised as a common cause of low back pain; but as I said the other day usually the body compensates for the difference. These compensations or adaptations place increased stress on various joints throughout the body and hence the pains.

Not surprisingly this condition affects growing children and they can show some funny signs when you examine them. For example one of the basic observations that we do is to look at the relative heights of the knees with the child lying flat on his/her back; a higher knee means a longer leg in the thigh(femur bone) segment.

Usually the bone on the inside of the ankle is also lower on the longer leg when you have the legs stretched out. Easy! there is a subjective dianosis based on clinical examination and suspicion. That’s fine until you see that it’s the other leg that is actually longer at the ankle!!! So what’s the message here? Be very careful about jumping to conclusions with any patient but especially with children.

This simple example shows why the definitive test is the X-ray called the scanogram, because the radiologist views and measures the lower limbs (yes both) from hips to toes. The first place to look is in the hip joints to assess the alignment of the hip joint which is made up of the head of the femur and a cavity in the side of each hip called the acetabulum.

As podiatrists we are able to prescribe the local treatment based on biomechanical and gait analysis. This is only part of the team approach I referred to though. In younger people regular re-asssessment is needed to see if any correction has occured and then the local foot therapy will change. In older people the foot therapy is usually permanent. This is the situation in many people who have had hip replacement surgery. Which reminds me of a story.

I have a patient who has been a very successful ballroom dancer for more than 50 years. When she required hip replacement surgery she did her research and was distressed to find out that she might end up with a shorter leg, like some of her friends. As a result she threatened her surgeon – who happens to be “the hip expert of Johannesburg” – that she wanted a guarantee that her legs would still be equal after the operation. Believe me when I tell you that she is still dancing!

Take care of your pair – see a podiatrist

Is Your Backache Caused by Your Leg Length?

Well it could be. Are your legs the same length? Do you have a Limb Length Discrepancy? When you stand, is one foot flattening or collapsing whilst the other one stands up straight? Do you suffer from chronic back pain?

During the past few weeks, we have been people of all age groups with significant differences in the length of their legs. Limb Length Discrepancy or LLD as we call it. This condition causes all sorts of problems and pains. people complain of pain in the lower back, between the shoulder blades, in the knees, in the soles of the feet, at the heels and at the ball of the foot.

Usually the longer limb gives the most trouble and the typical view the podiatrist gets is of a person who rolls from side to side as they walk with one shoulder higher. In technical terms the condition is referred to as being Functional or Measurable.

The LLD can be very subtle and is often difficult to spot, especially if the person is an athlete or physically fit. This is because well-toned muscles enable the body to compensate for the oddity in structure. We usually diagnose it visually during a biomechanical examination and gait analysis.

There are signs such as spinal curvature – scoliosis – dropped shoulders on the side opposite to the short limb plus some changes in arm swing. The diagnosis of a Functional LLD is confirmed by something called a Scanogram, which is carried out by a radiologist.

The management requires teamwork involving podiatrist, physiotherapist and biokineticist, because it is easy to jump in with heel raises or to buy ready-made devices from the pharmacy without fully analysing the components of the condition.

More on this tomorrow

Podiatry Students Unethical?

Not at all! As I said last week, the 4th year Podiatry Students at the University of Johannesburg(UJ), had their first taste of me starting the lectures on Practice Management and Ethics. There are many concepts to take on board including grasping the difference between ethical values & standards – represented by core values which are aspirational or value-oriented – such as Respect for persons, Human rights, Truthfulness,  etc., and ethical guidelines -represented by specific rules or duties associated with professional practice. We started to examine the challenges faced in daily practice and led into how we apply ethical reasoning to move from the understanding of guidelines to using them to influence our practical decision making and choices.

I’m usually never short of a word or two on most subjects! But beginning this course has made me think very hard again at the way in which I reach and make my day to day decisions. So just for fun!!! Let’s look at the 4 steps of ethical reasoning:

The problem: formulate  the problem and ask is there a better way of understanding it?    

Information: gather all the relevant data, clinical, personal, social etc.

Options: under the circumstances, consider all reasonable options, choices or actions.

Moral assessment: weigh the ethical content of each option by asking –

•     what are the likely consequences of each option
•     what are the most important values, duties and rights? which is strongest?
•     what are the weaknesses of your view?
•     how would you want to be treated in the circumstances of the case? i.e. apply the Golden Rule

(I acknowledge the Health Professions Council of South Africa (HPCSA) as the source of the above).

Easy isn’t it? Hopefully someone at the HPCSA will be able to tell me this week what the Golden Rule is, I think I know but I’d better get the official opinion on it!

Naturally we are all making choices every moment of our lives, some better some worse, but getting into deep philosophical discussions can be quite daunting – especially when all most of us want to do is practise our profession.(Oh, and make lots of money!)

Perhaps as you read this you should start to apply some ethical reasoning to why you should or should not book an appointment with your podiatrist. Are you a person with diabetes who hasn’t had a diabetic foot assessment recently or ever? Have you any idea what a podiatrist can do to help your feet if you suffer from some form of arthritis? Are your children normal or do they have some biomechanical anomaly (odd alignment) that is undiagnosed but could be treated by a podiatrist? Do you care if your Gran can’t cut her toenails? Do you really have to but another pair of running shoes to get relief from foot and leg pain or should see a podiatrist? Is it possible that a podiatry consult could shed some light on the cause of by chronic back pain?

This morning I saw the effects of good podiatry care in a 5 year old who has good foot alignment although she has rheumatoid arthritis. She has been wearing foot orthotics for one year and has not developed any deformity in this time. As part of the team at Chris Hani Baragwanath Hospital I hope that the future choices we make will produce such pleasing results. It comes as a surprise to most people that children can suffer with arthritis, so I’m going to write about this during the next few weeks.

In the mean time spare a thought for my students who must be faced with ethical decisions about whether they should do the assigned reading for this week or go to the movies in the hope that  I’ve got it all sorted!

Podiatry Students Under Threat?

University of Johannesburg 4th year podiatry students are in for a new experience on Tuesday 5th February! For the first time in 12 years I am returning to lecturing. I will be lecturing Private Practice Management, which is part of the course on Health Systems Management.  I’m looking forward to re-joining the academic team, despite a dislike of marking. It seems to me that full-time academic life in 2008 is like a road full of potholes called "admin,"  so I hope I can avoid these potholes as a part-timer! Being burdened with too much "admin" was one my reasons for leaving in 1995!.

Podiatry education in South Africa started in 1977 at the Witwatersrand College for Advanced Technical Education (WCATE), as a 3-year Diploma plus a year of in-service training. Then it became a National Higher Diploma after 4-years of study after WCATE became Technikon Witwatersrand(TWR). It evolved into a 4-year Bachelor’s Degree at TWR and when TWR and the Rand Afrikaans University merged to form the University of Johannesburg(UJ), this became the latest home for the degree. The degree isn’t offered by any other University in South Africa,  which is disappointing and leads to all sorts of difficulties in enrolling students from around the country. However graduates from UJ are distributed all over the world and many have gone on to become leaders in the profession in their new countries. In fact this week another young podiatrist is leaving Johannesburg for Australia, another went to Canada last Christmas and another two also left for Australia in 2007 whilst yet another relocated to Saudi Arabia (Hopefully this is only a temporary posting).

Fortunately there are some of us left in South Africa, mostly in private practice, but there are more posts being created in the State Health Services, including the Military, with students having to work back their bursary committments. As yet there is no requirement for podiatrists to do Community Service, mainly it seems due to the lack of available supervisors and posts. If and when Community Service becomes a requirement, podiatrists are well qualified to perform an important role in the management of foot problems associated with chronic disease and more importantly I think those affecting children.

Fitting Children’s Shoes – Again!

Fitting children with shoes can be really difficult and is often unpleasant for all involved. That includes brothers, sisters and fathers hanging around nearby! This means that the responsibility for getting the correct usually lies with Mum. The trauma increases due to the fact that in South Africa, there are virtually no shops who know how to measure children’s feet and fit the correct size of shoe.

Some stores have had measuring boards available in the shoe section for some years, but using it was left to the customer. At the same time there was no guarantee that the size system on the board matched the size system of the shoes. Anyone who has bought sports shoes/trainers recently will know that they have three or four different size numbers on the tongue of the shoe. This is because the shoes are made in Asia for sale all over the world where the basic unit of measurement differs – including different centimetre units.

In an attempt to bring some order and science into the art of shoe fitting, the South African Podiatry Association (SAPA) has been working with various manufacturers and retailers to establish standards for footwear in this country. There is a committee of experts headed by a podiatrist who has done ground-breaking original research into the feet of South African women. This committee assesses lasts(the plastic shape around which a shoe is built) and footwear design, against a checklist based on this scientific research.

One retailer is Woolworths and if you buy your child’s shoes there – although you will have to fit them yourself – you will see certain styles have the SAPA approval logo on the green tag. Look out for other large retailers getting involved in 2008.

Do Your Children’s Shoes Fit?

Children’s feet need special care and attention and nothing is more important than selecting and fitting children’s shoes.

Oh yes, Happy New Year! The year is racing along already with Christmas holidays a fading memory. At present summer in Johannesburg also feels like a fading memory thanks to all the rain. With January came the start of a new school year and being too distracted with moving the practice I missed a great opportunity for ‘back to school tips’, but it’s never too late to review some of the basics. Especially as children grow so quickly and usually don’t tell you about short shoes because they get used to squeezed toes, or they hate the look of their prescribed school shoes. (Remember how long they stay as soft cartilage).Look at the page on Children’s Feet.

Did you have your children with you when you bought their shoes? Many parents buy based on size and take the shoes home to fit. [There are valid socio-economic reasons in South Africa, but it’s still a bad idea]. Also getting children into school shoes can be difficult if they are first-timers or have just spent six weeks barefoot or in sandals. (Or possibly Crocs!!)

Did you buy the shoes with your children wearing the socks they normally use for school?

Are the shoes stable and protective for those soft  vulnerable feet?  Is the sole firm with a flexible leather upper?How much synthetic material is there which is going to make the feet sweat? How do they fasten? Velcro is ‘cool’ but not often found on a school shoe. Doing up laces is currently ‘uncool’.

I doubt very much that you were able to check the fit of the shoes by having your child’s feet measured! A simple method of checking fit is to pour some powder into the shoes, put them on and have the child walk round the kitchen. Carefully take off the shoes and look inside for a centimetre of powder beyond the end of the toes. If you don’t see it then the shoes are probably too small.On the other hand never buy shoes too big so that they "can grow into them" or in the hope that the shoes will last a school year.

Children can outgrow shoes as quickly as new cars lose their value, so at the end of every school holiday check the fit of your children’s school shoes.

It could be that your "little Einsteins" are suffering irrepairable damage to their feet and you haven’t checked.

You And Your Feet

I’ve just come across an article I wrote a while ago for the South African Journal of Natural Medicine and thought it might be useful as a reminder as we embark on another year.

We need to take care of our lives, our relationships and our bodies as we renew our efforts in the New Year – and that includes our feet. 

Take a look now at You and Your Feet

Are Bunions The Bane of Your Life?

Bunions are among the most common and frequently most painful of conditions affecting the foot.

Remembering that your feet carry ALL of your weight ALL of the time that you are standing or walking then it is not surprising that the complex structure of your feet sometimes suffers re-alignment as they strive to accommodate our lives and activities.  Sometimes we do not help matters by forcing our feet into unsuitable or badly fitting shoes.

Go to the Foot Health Articles section for some useful advice on bunions.