Tuesday, May 8, Noon ET

Best Foot Forward

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Dr. Arnold Ravick
Podiatric Physician
Tuesday, May 8, 2007; 12:00 PM

Dr. Arnold Ravick was online Tuesday, May 8 at noon ET to offer advice about summer foot care and footwear.

A transcript follows.

Dr. Ravick is a podiatric physician and surgeon with more than 25 years of foot care experience in the Washington, D.C., area. he specializes in sports medicine and foot surgery and often addresses foot problems related to improper footwear, such as bunions, neuromas and plantar fasciitis. He currently serves on the staff of Sibley Memorial Hospital and The Center for Ambulatory Surgery in Washington, D.C.

Read more: On Your Feet.

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Dr. Arnold Ravick: Hi! This is Dr. Ravick. I'll try to answer as many of your questions as possible. We'll try to help you put your best foot forward!!

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Washington, D.C.: I am curious about foot odor. How can I reduce my foot odor. My schedule and lifestyle does not allow much time for sandals or open shoes.

Dr. Arnold Ravick: Foot odor can be a real headache during the summer months. It can be caused by closed shoes, that causes your feet to sweat and that creates bacteria. It's bacteria that makes your feet smell. Some simple solutions are you can change shoes regularly, wear shoes and socks that wick away moisture and wash feet regularly. Make sure you alternate shoes daily too. Cornstarch and anti-perspirant will help your feet control sweating. Also, spraying Lysol in the shoes is a good way to control bacteria.

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Bethesda, Md.: I wanted to see if you can offer some advice, that has nothing to do with today's article: I usually spend the summer (when I'm not at work) barefoot, or at the most, I wear flip-flops. What are the pros and cons of living a barefoot lifestyle?

Dr. Arnold Ravick: Good question. The main problem is the possibility of stepping on something and injuring your foot. The other issue is the lack of support. For support and protection, we recommend whenever outdoors you wear a shoe. You might try some of the open athletic shoe types.

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Washington, D.C.: Lower heels are better but what kind of heel and heel position are better than others?

I've seen shoes with a low (1 inch or shorter) heel but that have that heel positioned in the middle of back part of the shoe... looks unhealthy to me.

Dr. Arnold Ravick: Many people feel the same way. The best type of heel is a stacked heel or thicker heel. Try to keep the angle of the heel decreased and a less flexible shoe.

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Washington, D.C.: Is osteoarthritis of the knee or foot able to be corrected medically (without surgery)?

Does calcium and/or vitamin D help to strengthen the affected area?

Dr. Arnold Ravick: Osteoarthritis is wear and tear of a joint. It is possible to correct many of the joints in the foot, but your goal is to lessen the stress. Better shoes and the use of a prescription orthotic device should accomplish this.

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Washington, D.C.: I am 33 years old and have severe bunions. I saw a podiatrist when I was 24, and he said that I could have surgery completely paid for by my insurance company because of the severity. My concern is that if I have the surgery now, I will have to have surgery again in the future because the bunions will come back. In your experience, is this true?

Dr. Arnold Ravick: Good question! The reoccurrence rate after bunion surgery is approximately 20 percent. This is due to the cause of bunions, which is the way a person walks. If post operatively one wears prescribed orthotics, you increase your success rate.

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Washington, D.C.: Isn't it best to go 1/2 a size smaller since most shoes tend to stretch?

Dr. Arnold Ravick: Shoes should fit from the first wearing! Generally people wear shoes that are too small. For more information about how to select the shoe that is right for your foot, go to www.apma.org .

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Vienna, Va.: My son and I both suffer from plantar fasciitis, I presume because we share a skeletal structure that causes us to overpronate. He has been suffering a lot in P.E. class where they are required to do a lot of running. His sneakers are supportive and he wears inserts in them also, but do you have any suggestions that might help him? As an adult I can easily avoid activities that make my feet hurt, but an 11-year-old can't avoid having to run that mile in P.E., and he is hobbling for days after that.

Dr. Arnold Ravick: First, we need to establish if this is indeed plantar fasciitis. Many conditions in the heel area seem similar to plantar fasciitis. I would recommend a consultation with a podiatric physician to establish the correct diagnosis. That being said, the hallmarks of treating plantar fasciitis are stretching and support.

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Plantar Fasciitis: Hello Dr. Ravick,

I was a runner (18 miles a week) and developed plantar fasciitis. I tried everything (stretching, Advil, night splints, ensuring my shoes were properly fit, ice, etc.) Nothing has worked and I stopped running last August (after nearly 18 months of heel pain). In January I went to a podiatrist and luckily no spurs; just mild case of plantar. Didn't even get injected.

My question is do you think I will ever be able to run again? I have been mainly pain free for 3 months so stopping the running was the big fix. But I would like to run again.

Thanks and for anyone not having plantar, count your blessings.

Dr. Arnold Ravick: Generally, plantar fasciitis (PF) is a recurrent problem. But I would recommend you start running very gradually and do not increase speed or mileage by more than 20 percent per month. Make sure your shoes are built for motion control and possibly use a custom prescribed orthotic.

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Berkeley, Calif.: During the summer, for everyday errands, I often live in Teva sandals -- the kind with a thick rubber sole, velcro straps, etc. Are those okay? If I do any serious walking, I find I need to switch to athletic shoes, or my soles start to burn.

Dr. Arnold Ravick: Tevas are a good choice for sandals, but for increased activity, an athletic shoe is much better. With increased motion, the foot needs more support.

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Ashburn, Va.: What should you look for in a running shoe? Are these unique designs like the Nike Shox beneficial or more of a gimmick?

Dr. Arnold Ravick: Excellent question! First, one needs to be aware of their foot type, and which shoe is best for your foot. Generally, a good running shoe is rigid at the heel and slightly flexible at the ball. The gimmicks are generally not advisable for most foot types. For recommended running shoes, check out apma.org and click on 'Recognized Products'.

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Washington, D.C.: Bunion follow-up question -- I always thought that I was born with bunions. If its based on how I walk, can I learn to walk different and they won't get worse?

Dr. Arnold Ravick: Two factors create bunions. The first is your inherited foot type. The second is the environment in which you walk. We utilized prescription orthotic devices to alter the supporting surface, which will correct the way you walk.

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Arlington, Va.: What kind of flat shoes provide support for a woman's foot? What should I look for when shopping for a casual flat shoe? Thanks.

Dr. Arnold Ravick: The easiest answer is the stiffer the better when it comes to flats. A sole that doesn't twist excessively is the best. Use a shoe that is appropriate for the activity. A dress shoe is for looks and should be worn over shorter periods of time. For more information about how shoes affect your feet, visit apma.org.

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Frederick, Md.: How good are shockwave treatments, do they really work better then heal surgery

Dr. Arnold Ravick: Shockwave is still considered experimental by many experts, and I would explore conservative treatments before any surgical intervention is undertaken.

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Alexandria, Va.: Hi,

Gross question. I have been plagued over the past 5 years or so by plantar warts. They sometimes come and go without rhyme or reason (seemingly on their own), but sometimes I have as many as 40-50 at one time. They are stubbornly resistant to treatment. My podiatrist and I have tried freezing, cutting, even high dose vitamin a, formaldehyde and duct tape.

They often hurt, but mostly are just gross. I would give my left arm to be able to get a pedicure like normal women!! Is there anything else I can do to get rid of these and prevent them from returning?

Thanks so much!

Dr. Arnold Ravick: First, warts are a virus. As we all know, our bodies don't do well with getting rid of viruses (common cold). You've been utilizing similar methods of irritating the tissues to try and stimulate your immune system to fight off the virus. The other main method is surgical excision. With large skin surfaces, this can be complicated. The one saving grace is that generally, they self-limit at a certain age. They're more rare between the ages of 30 and 60.

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Washington, D.C.: Hello Dr. Ravick and thanks for the chat. I'm a life long soccer player and have had my toes crushed into cleats and otherwise poorly cared for for years. I'm now finally wearing a pair of cleats that are comfortable. But, between the occasional bouts of fungus and dryness, my toenails are in awful shape. What should I do? Does it matter that my feet seem to be very dry and that they don't generally itch?

Dr. Arnold Ravick: Fungal infections are treatable with oral medications that should solve the majority of your problems. The fit of soccer cleats is a tough problem. You seem to have found a good solution. I would recommend a visit to a podiatric physician.

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Morton's neuroma: Thank you for taking my question. I have had surgery twice on both feet for Morton's neuroma - more than 18 years ago. At age 50, I am beginning to experience the same pain that I had before the surgeries. Is this common? Are there any new treatments for Morton's neuroma?

Dr. Arnold Ravick: Reoccurrence of Morton's neuromas is sometimes seen. Two newer advances are ultrasound for diagnosis and sclorosing injections for treatment.

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Manassas, Va.: I've heard conflicting reports as to whether or not it's okay to let toddlers go barefoot. Is it okay for kids to go barefoot in the summer? Or are shoes recommended? I think it's best to be as natural, yet safe, as possible.

Dr. Arnold Ravick: As soon as children start to walk, shoes are recommended. For toddlers, frequent shoe replacement due to foot growth is necessary. Barefoot outside other than on the beach is not recommended. A good, supportive sandal or aqua sock would fit the bill. For a list of recommended shoes for kids, check out apma.org and click on 'Recognized Products.'

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Washington, D.C.: Hi -

I am 32, in great health, not overweight, but my feet are always in terrible shape. Tons of dry skin, cracked peeling, dirty. I try wearing moisturizer w/socks at night, it doesn't seem to help. Someone suggested it might be a fungus.

Dr. Arnold Ravick: Good question. Fungus is commonly misdiagnosed as purely dry skin. It doesn't have to itch, crack or be between the toes to be fungus. I would suggest spraying your shoes weekly with Lysol and try an over-the-counter topical anti-fungal. It generally takes three months for fungus to go away. If this is not successful, a consult with a podiatric physician would be in order.

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Washington, D.C.: Hello. When running or doing yoga I often get severe cramps in my toes. Do you have any idea of what might be causing this and how to prevent it?

Thanks.

Dr. Arnold Ravick: Possible causes are nerve compression or early hammertoe formation. The easiest solution would be stretching exercises for the foot. See today's Health Section under Be Kind to Your Feet. Apma.org also has a list of stretches you can use.

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Washington, D.C.: Can you walk too much? Should you be able to walk as much or as far as you desire?

Dr. Arnold Ravick: There's a limit to any physical activity. The best exercise is to cross train. Mix walking with some other activity, such as biking, swimming and weight training. Walk every other day and mix in your other activity. Always be sure to wear a supportive shoe and stretch.

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Washington, D.C.: I have a painful callus that develops on the bottom of my foot, under my middle toe. It runs the length of the bone, and has a hard spot in the widest part. It's hard to walk on it. I've been removing it by using nail clippers and a pumice stone. Is that bad? What else should I do?

Dr. Arnold Ravick: The cause is generally the way you walk. The best solution is to ease the pressure from this particular spot on your foot with an arch support or a prescribed orthotic device. I do not recommend using any cutting tool on your feet. A pumice stone is helpful. A podiatric physician would be able to eliminate the callus and try to prevent its return.

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Germantown, Md.: After my first pregnancy I noticed my feet spread. I know this is permanent now, however when I wear certain shoes, like flats after several hours I will have tingling and numbness in by foot by my little toe. Sometimes it is so severe I have to take my shoes off and massage my foot. What could this be caused from and is there cause for concern. Considering I'm pregnant again and have problems with my sciatica.

Dr. Arnold Ravick: Many possible causes exist. With pregnancy, one does experience an increase in shoe size. With multiple pregnancies, this increases and can become permanent. The problem may be a nerve compression in your foot or may be coming from your back. You should explore both options to avoid any further damage.

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Too small?? : Dr. Ravick--I find it hard to believe most people wear their shoes too small. Most women I see have shoes that are too big (for comfort) and they look sloppy and poorly dressed. In fact, I buy mine a bit too small so that the fit is right on today AND ten years from now.

I will say though that these women killing themselves wearing super high designer heels are nuts. My husband doesn't even look at shoes -- I don't think most men care. They just want to see a pretty, complete package and not "designer shoes."

Dr. Arnold Ravick: The reality is, most studies, as seen in the Post, show women buy their shoes too small. But as I tell my patients, shoes should fit correctly, not too small or too big. Remember, sizes can vary by shoe manufacturer and the fit, not the number is what matters.

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Alexandria, Va.: My feet always hurt because of bunions. I have started wearing Crocs everywhere I can. They are the most comfortable shoe I have ever found. Are they good for my feet?

Dr. Arnold Ravick: In the world of flip-flops, Crocs are an improvement. That being said, there are more supportive choices for longer walks. A good resource is the Recognized Products tab at apma.org.

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Washington, D.C.: Never thought about "foot types" before until it was mentioned here. How many foot types are there? Should you know your foot type and are there things you should or should not do depending on your foot type?

Dr. Arnold Ravick: Good, I'm glad you've found the chat helpful! There are three general foot types - High arched, Medium and Low or Flat foot. You should pick a shoe that matches your foot type. Flat feet require a more sturdy and motion control shoe. A podiatric physician can help assess your foot type.

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Olney, Md.: I am a senior in high school and am fascinated with the importance of foot care and the human body.

Along with today's Washington Post article on the subject, I recently read some interesting statistics about feet including that women have about four times as many foot problems as men, attributed to high heels, as today's Health section article illustrates.

Also it amazes me that an active person takes between 8,000 and 10,000 steps a day, which adds up to about 115,000 miles over a lifetime. That's a lot.

So are people better off having a high arch versus flat feet? And what can we do to encourage foot hygiene, especially during these hot muggy summer days ahead?

Dr. Arnold Ravick: The majority of people have a flatter foot. But each type has it's problems. High arch feet are more prone to arthritis and flatter feet to bunions. The most important part of summer foot care is to keep your feet dry. Never wear the same shoes two days in a row so they can dry out.

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Washington, D.C.: I have a really hard time finding shoes that are comfortable even for a few hours. I cringe when I walk by a shoe store because there are so many cute shoes that I can't even try-on without pain. I know I should probably see a doctor but it feels vain to walk into a doctor's office and say "I can't wear cute shoes." Are there tell-tale signs I can watch for that my foot pain is an actual medical problem and not just a sign that I wasn't meant to wear those shoes?

Dr. Arnold Ravick: Foot pain is not normal. It is generally a sign of a foot deformity. Don't be scared. A visit to a podiatric physician could be very helpful and liberate you from your shoe limitations.

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Fort Myers, Fla.: I was recently diagnosed with Achilles tendinitis and metarasalitis attributable to wearing high heels. Orthotics have been recommended. Any other suggestions -- other than to STOP wearing my favorite high heeled pumps??

Dr. Arnold Ravick: It is advisable to vary your heel height. Stretching exercises are very helpful for tendinitis. Dress orthotics could help with your metatarsal pain. But you need to have a game plan.

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Clinton, Md.: Dr. Ravick,

I have severe stinging, mostly in the arch of my foot when I am exercising. To the point it's hard to continue. I've tried several style shoes that support the arch but it has not helped. I am a bit over weight and not sure if that contributes but I have no idea what this can be. It is not a "constant" pain, only when I exercise (aerobics). Can you shed some light?

Dr. Arnold Ravick: Excessive weight can add to a foot problem. You need to have your problem correctly diagnosed in order to develop a solution. It is possible that supporting your foot with a prescription orthotic device as you exercise and strive to lose weight will be helpful.

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Dr. Arnold Ravick: I've enjoyed answering all of your questions. I hope this has been helpful!

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