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Children's Footcare

You worry about your children's teeth, eyes, and other parts of the body. You
teach washing, brushing, and grooming. But what do you do
about your child's developing feet which have to carry the entire
weight of the body through a lifetime?
Many adult foot ailments, like other bodily ills, have their origins in childhood and are present at birth. Periodic professional attention and regular foot care can minimize these problems in later life.
Neglecting foot health invites problems in other parts of the body, such as the legs and back.

Your Baby's Feet

The human foot (one of the most complicated parts of the body) has 26 bones, and is laced with ligaments, muscles, blood vessels, and nerves. Because the feet of young children are soft and pliable, abnormal pressure can easily
cause deformities.

Foot care for Kids

A child's feet grow rapidly during the first year, reaching almost half their adult foot size. This is why foot specialists consider the first year to be the most important in the development of the feet.
Here are some suggestions to help you assure that this development proceeds normally:

- Look carefully at your baby's feet. If you notice something that does not look normal to you, seek professional care immediately. Deformities will not be outgrown by themselves.

-Cover baby's feet loosely. Tight covers restrict movement and can impede normal development.

-Provide an opportunity for exercising the feet. Lying uncovered enables the baby to kick and perform other related motions which prepare the feet for weight bearing.

-Change the baby's position several times a day. Lying too long in one spot, especially on the stomach, can put excessive strain on the feet and legs.

Starting to Walk

It is unwise to force a child to walk. When physically and emotionally ready, the child will walk. Comparisons with other children are misleading, since the age for independent walking ranges from 10 to 18 months.

When the child first begins to walk, shoes are not necessary indoors. Allowing the youngster to go barefoot or to wear just socks helps the foot to grow normally and to develop its musculature and strength. Of course, when walking outside or on rough surfaces, babies' feet should be protected in lightweight, flexible footwear made of natural materials.

Growing Up
As a child's feet continue to develop, it may be necessary to change shoe and sock size every few months to allow room for the feet to grow. Although foot problems result mainly from injury, deformity, illness, or hereditary factors, improper footwear can aggravate preexisting conditions. Shoes or other footwear should never be handed down.

The feet of young children are often unstable because of muscle problems which make walking difficult or uncomfortable. A thorough examination by a chiropodist may detect an underlying defect or condition which may require immediate treatment or consultation with another specialist.

Chiropodists have long known of the high incidence of foot defects among the young, and recommends foot health examinations for school children on a regular basis.

Sports Activities

Millions of children participate in team and individual sports, many of them outside the school system, where advice on conditioning and equipment is not always available. Parents should be concerned about children's involvement in sports that require a substantial amount of turning and turning, or involve contact.

Protective taping of the ankles is often necessary to prevent sprains or fractures. Parents should consider discussing these matters with a chiropodist if they have children participating in active sports. Sports-related foot and ankle injuries are on the rise as more children actively participate in sports.

Advice for Parents

Problems noticed at birth will not disappear by themselves. You should not wait until the child begins walking to take care of a problem you've noticed earlier.

Remember that lack of complaint by a youngster is not a reliable sign. The bones of growing feet are so flexible that they can be twisted and distorted without the child being aware of it.

Walking is the best of all foot exercises, according to chiropodists. They also recommend that walking patterns be carefully observed. Does the child toe in or out, have knock knees, or other gait abnormalities? These problems can be corrected if they are detected early.

Going barefoot is a healthy activity for children under the right conditions. However, walking barefoot on dirty pavements exposes children's feet to the dangers of infection through accidental cuts and to severe contusions, sprains or fractures.

Another potential problem is plantar warts, a condition caused by a virus which invades the sole of the foot through cuts and breaks in the skin. They require professional treatment and can keep children from school and other
activities.

Be careful about applying home remedies to children's feet. Preparations strong enough to kill certain types of fungus can harm the skin.

Whenever you have questions about your child's foot health, contact your chiropodist.

Proper Footwear Can Reduce Foot Problems

From ancient Egypt, medieval times and down through the centuries, footwear has been designed to meet mankind's real and perceived needs such as protection, support, comfort, sturdiness and style.

Today, there are almost as many different kinds of footwear as there are pieces in a jigsaw puzzle. An almost endless variety of shoe styles and materials make buying a pair of shoes a major dilemma. This dilemma can be minimized if you concentrate on the health of your feet. A well made, proper fitting shoe will help a great deal in the reduction of foot problems.

Our daily routine causes a great deal of pressure on our feet. An average day of walking brings a force equal to several hundred tons to bear on your feet. Your feet are more susceptible to more injury than any other part of your body. This is why we need to protect them with proper footwear.

Everyone including men, women, children, athletes, police officers, fire fighters, postal workers and construction workers have different shoe requirements, and such requirements will vary considerably across a wide range of activities.

Women's Shoes

Fashion footwear inflicts a great deal of punishment on women's feet. Chiropodists believe heels of more than two inches are orthopaedically unsound. Such footwear contributes to medical, postural and safety problems.

Women can lessen these negative effects by wearing good quality sneakers or flats for part or all of the day. They can also vary heel height. There are comfortable and attractive "walking" pumps (also called "comfort" or "performance" pumps) for work and social activities. These shoes blend fashion considerations and comfort with athletic shoe-derived construction, reinforced heels, and wider toe room.

Activity has a bearing on the considerations. Wearing the right shoe for a particular activity is very important.

Perhaps the best shoe for women, from an orthopaedic viewpoint, is a walking shoe with laces (not a slip-on) with Vibram-type composition sole. The shoe should have a wide heel with a rigid and padded heel counter. The heel should be no more than a half or three quarters of an inch in height.

Men's Shoes

The best shoes for men are good quality oxfords, loafers and low dress boots.

Men (and women), should buy shoes for work, leisure, and special activities -match the shoe to the activity, in other words.

Male (and female) office workers should have cushioned-sole shoes which give good support.

There is no question about the need for foot protection for those who work in heavy industry. Safety shoes and boots that are waterproof or water-resistant, with insulated steel toes and soles, help prevent and/or reduce the severity of foot injury.

Children's Shoes

When a child begins to walk, shoes generally are not necessary. Allowing an infant to maneuver indoors without shoes helps the foot grow normally. It also develops muscle, and strength and dexterity in the toes.

As children grow more active, and their feet develop, the need for shoes becomes apparent. It becomes necessary to change shoe sizes at a pace which frequently surprises parents. Proper fitting shoes allow room for growth. Though fit is the most important consideration, function is also pertinent. For youngsters who have reached the stage of walking unassisted, footwear with crepe or rubber soles is best. Dressier thin soled shoes do little to cushion the impact of growing feet.

Shoes for Athletics

Different sports activities call for specific footwear to protect feet and ankles. Sports-specific athletic shoes are a wise investment for serious athletes, though perhaps a less critical consideration for the weekend or occasional athlete. Nevertheless, it's a good idea to use the correct shoe for each sport.

Athletic footwear should be fitted to hold the foot in the position that's most natural to the movement involved.

For example, a running shoe is built to accommodate the impact on the forefoot, while a tennis shoe is made to give relatively more support to the ankles, and permit sudden stops and turns. Because of the many intricate maneuvers involved in such events and the added strain they put on the feet, athletic shoes ought to be fitted for comfort and support.

It is widely accepted that a regular regimen of walking is physically rewarding. Here again, footwear with proper support is most important. Choose a good quality, lightweight walking shoe with breathable upper materials, such as leather or nylon mesh. The heel counter should be firm and the heel positioned close to the ground for walking stability. The front or forefoot area should have flexibility, and plenty of room for the toes to move around.

Consideration should be given to cushioned soles for resilience on hard surfaces and tread for traction on slippery surfaces.

Buying Tips

Have your feet measured while you're standing.
Always buy for the larger foot; feet are seldom precisely the same size.
Don't buy shoes that need a break-in period. Shoes should be comfortable immediately.
Don't rely on the size of your last pair of shoes. Your feet do get larger, and lasts (shoemakers' sizing molds) also vary.
Shop for shoes later in the day; feet tend to swell during the day, and it's best to be fitted when they are at their largest.
Be sure that shoes fit well- front, back, and sides to distribute weight. Be sure the widest part of your foot corresponds to the widest part of the shoe.
Select a shoe with a leather upper, stiff heel counter, appropriate cushioning, and flexibility at the ball of the foot.
Buy shoes that don't pinch your toes, either at the tips, or across the toe box.
Try on shoes while you're wearing the same type of socks or stocking.

The Fungus Nail Report

An Underreported Health Problem

Fungal infection of toenails is a common foot health problem. A majority of victims don't seek treatment, maybe don't even recognize the existence of a problem. Studies estimate that it afflicts three to five percent of the population. However, chiropodists think that because so many cases go unreported, the incidence is much higher than that.

Probably one reason that so many people ignore the infection is that it can be present for years without ever causing pain. Its prevalence rises sharply among older adults (20 to 30 percent, the studies say, though chiropodists think it's much higher). Because the older adults may be experiencing much more serious medical problems, it is understandable that fungal nails can be passed over as very minor, though it is anything but that.

Whatever the case, the disease, characterized by a change in a toenail's colour, is often considered nothing more than a mere blemish -ugly and embarrassing. It is assumed that since white markings or a darkening of the nail are minor occurrences, the change represents something minor as well, even when the blemish spreads. It may be that cosmetologists see this condition as often as doctors. Nail polish is an easy solution for many women, rendering the problem "out of sight, out of mind".

In many cases, however, that change in colour is the start of an aggravating disease that ultimately could take months to control. Fungal infection of the nails is known to chiropodists as onychomycosis. It is an infection underneath the surface of the nail, which can also penetrate the nail. If it is ignored, its spread could impair one's ability to work or even walk. That happens because it is frequently accompanied by thickening of the nails, which then cannot easily be trimmed and may cause pain while wearing shoes. This disease can frequently be accompanied by a secondary bacterial and/or yeast infection in or about the nail plate.

What is a Fungal Nail?

Onychomycosis is an infection of the bed and plate underlying the surface of the nail, and is caused by various types of fungi, which are commonly found throughout the environment. Fungi are simple parasitic plant organisms, such as molds and mildew, that lack chlorophyll and therefore do not require sunlight for growth. A group of fungi called dermophytes easily attack the nail, thriving off keratin, the nail's protein substance.

When the tiny organisms take hold, the nail may become thicker, yellowish-brown or darker in colour, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of
spreading to other toenails, the skin, or even the fingernails.

Because it is difficult to avoid contact with microscopic organisms like fungi, the toenails are especially vulnerable around damp areas where people are likely to be walking barefoot -- swimming pools, locker rooms, and showers, for example. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems,
or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of athlete's foot and excessive perspiration.

Prevention

Because fungi are everywhere, including the skin, they can be present months before they find opportunities to strike, and before signs of infection appear. By following precautions, including proper hygiene and regular inspection of the feet and toes, chances of the problem occurring can be sharply reduced, or even put to a halt.
• Clean, dry feet resist disease. Wash the feet with soap and water, remembering to dry thoroughly.
• Shower shoes should be worn when possible, in public areas.
•Shoes, socks, or hosiery should be changed daily.
• Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
• Use a quality foot powder with talcum, not cornstarch.
• Wear shoes that fit well and are made of materials that breathe.
• A void wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fibre tend to "wick" away moisture faster than cotton or wool socks, especially for those with more active life styles.

Artificial Nails and Polish

Moisture collecting underneath the surface of the toenail would ordinarily evaporate, passing through the porous structure of the nail. The presence of an artificial nail or a polish impedes that, and the water trapped below can become stagnant and unhealthy, ideal for fungi and similar organisms to thrive.

Always use preventive measures when applying polishes. Disinfect home pedicure tools and don't apply polish to nails suspected of infection. (i.e. toes that are red, discoloured, or swollen.)

Treatment

Depending on the nature of the infection and the severity of each case, treatment may vary. A daily routine of cleansing, over a period of many months, may temporarily suppress mild infections. White markings that appear on the surface of the nail can be filed off, followed by the application of an over-the-counter liquid anti-fungal agent.

However, even the best-over-the-counter treatments may not prevent a fungal infection from coming back. A fungus may work its way through the entire nail, penetrating both the nail plate and the nail bed. If an infection is not overcome, or continues to reappear, further medical attention is strongly recommended.

Chiropodial Care

A chiropodist can detect a fungal infection early, culture the nail, determine the cause, and form a suitable treatment plan, which may include prescribing topical or oral
medication, and debridement (removal of diseased nail matter and debris) of an infected nail. Indeed, debridement is one of the most common foot care procedures performed by chiropodists.

Newer oral anti-fungals approved by the Food and Drug Administration may be the most effective treatment. They offer a shorter treatment outlook (three to four months) and improved effectiveness, though chiropodists advise that lengthier treatments, up to 12 months, may still be required for some infections. Current studies show that, for a small percentage of the population, there are some unwanted side effects with any oral anti-fungal.

In some cases, surgical treatment may be required. Temporary removal of the infected nail can be performed to permit direct application of a topical anti-fungal. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail.

Trying to solve the infection without the qualified help of a chiropodist can lead to more problems. With new technological advances in combination with simple preventive measures, the treatment of this lightly regarded health problem can often be successful.

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David Simard

David-Simard

David Simard has been practicing chiropody for the past 20 years.  He currently practices in Sault Ste. Marie, ON and his services extend to the Greater Algoma District.

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