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Sole diaries

A sore foot can be a telltale sign of our health. Yet, most of us smile through the aches and pains and walk on. That's how the problem snowballs, experts tell Marisha Karwa

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Ever wondered why walking barefoot on grass is such a joyful experience?

Stripped of shoe paraphernalia such as the sole, the straps, the uppers, the inners and the laces, our feet are in as natural a state as possible to connect with nature. "Our feet are meant to walk on soft ground. The feet didn't evolve to walk on hard, uneven surfaces," says Chaitanya Shah.

As founder of the 15-year-old clinic Orthofit, dedicated to the care of the foot, ankle and lower limbs, Shah is a daily witness to the horrors inflicted upon the human feet: from the droves of runners on Marine Drive ("harming their feet due to wrong shoes or gait") to school kids ("half of them are in incorrectly-sized shoes") and the common man who walks into his clinic complaining of corns, calluses or heel pain. "Majority of people who have foot problems don't seek help unless they are in severe or unbearable pain. One of the biggest problems is lack of awareness," he says.

Dr Pradeep Moonot, among a handful of ankle and foot specialist surgeons in the country, concurs. "About 90 per cent of people will suffer from foot pain in their lifetime, but only a fraction of these will seek medical help," says Dr Moonot, who sees 10-15 new patients every day.

It's all in your gait

The 90 per cent statistic that Dr Moonot quotes may seem far-fetched, but consider this: The entire weight of our body rests on our feet. With every step we take, our weight impacts our feet; each time the heel lifts off the ground, half the body weight shifts on to the toes alone. "An average person takes between 5,000-10,000 steps each day," says Dr Moonot. "That is the equivalent of going around the earth five times during a lifetime. Imagine the stress that our feet go through."

The very act of walking, rather, how we walk, or the gait, is where trouble starts. Shah says that the ideal walking style should mimic a spring action, with the heel striking the ground first, then the mid-stance and then the toe-off. "If you have a flat foot, your body weight will tend to rest more on the inner side of the feet and on the first two toes. Over time, this excessive pronation stresses the calf muscles. On the other hand, those with a high arch, take more body weight on the outer edges and on the last two toes. This is called excessive supination and can lead to shin splints," explains Shah.

"Often times, people don't realise what their gait is, and so, inappropriate shoes alter the biomechanics. To make matters worse, people tend to compensate for pain in one foot, by shifting more weight onto the other foot. The weight transfers through the back and this is how lower back pain starts."

Not just back pain, inappropriate or ill-fitting footwear can also cause pain in the knees and the hips. And since seeking out podiatrists is a rarity in India, most people in pain end up relying on physiotherapy, which alleviates the symptoms without resolving the cause.

Heal those heels

Speaking from experience, Dr Moonot says that most women in India wear under-sized footwear. "Very often their sandals or slippers have no sole... they are very flat. The straps are too thin to offer any support," he says. "So instead of the footwear resting onto their feet, women tend to contract their foot muscles in order to hold on to their footwear. So naturally, over time, they develop hammertoe and claw toe deformities."

Shah says a similar pattern emerged in students after Orthofit conducted a small study in a Mumbai school. A majority of the students, he says, were clawing their toes because more than half were wearing wrong-sized shoes. "It's incredible that parents pay such little attention to their children's school shoes. The kids spend nearly six-seven hours in school shoes every day, yet most mothers will buy shoes that are a size bigger than required to avoid having to spend on another pair through the school year."

Other common complaints arising out of wearing inappropriate footwear are heel pain (plantar fascitis), pain in the forefoot (metatarsalgia), corns and bunions (a protruding bump at the base of the big toe). "Ankle sprains are also very common," adds Dr Moonot. "In the west, ankle sprains are common among athletes but here, almost every second person, walks in with an ankle sprain as a result of wearing the wrong kind of footwear." (See box: How to buy footwear)

Happy feet

Apart from good footwear, a diet rich in calcium, exposure to sunlight for vitamin D and a good exercise regimen are recommended for good foot health. Our feet aren't just meant to carry our weight but are also an indicator of our overall health. Sure shot indications for many diseases and conditions, including diabetes, thyroid, vascular diseases, anaemia and even cancer can be spotted on the feet. So make sure you keep those soles happy.

How to buy footwear

1) Don't buy footwear in the morning or evening when your feet tend to swell. The best time is in the afternoon, advises Dr Moonot.

2) Don't look for a shoe simply by length size. Your foot has three dimensions — length, breadth and height. If you have broad feet, ask for a wide shoe option. If you have a high instep, turn to shoes with laces and avoid slip-ons.

3) Based on your gait, try to find shoes with arch support

4) There must be about half a centimetre gap between your biggest toe and the edge of the footwear in the front, and a similar gap from your heel to the edge of the footwear at the back. In closed shoes, you should be able to wiggle your toes, so budget for about a finger of extra space in these.

5) Ensure the shoe has at least half an inch of sole. A good sole absorbs the impact when your foot lands on the ground, so don't be tempted to buy thin flats or 'flexible', folding shoes. If opting for heels, women would do best to try broad heels or kitten heels. Wedges are ideal if you find a pair that also supports the ankle to avoid sprains.

6) Shoe straps should be broad so they are able to offer support.

7) Wear new shoes on both feet, go for a walk and then decide if they are comfortable. Don't assume that a footwear will 'open up' after a few days of use. If they are not comfortable, do not buy them.

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