The feet don’t receive enough attention compared to other body parts of the that we generally put out on display. Sometimes I am tempted to inquire from patients whether their feet receive one tenth of attention compared to their faces or hair? Hence it is no wonder that most feet I see are in ‘bad shape’.  

The entire body weight is borne by the ankles and the structure up to the tiny bones of the feet. This is the structure which helps us whenever we stand, walk or run. The feet perform this amazing task of weight bearing. Throughout our lifespan there is a lot of wear and tear taking place in our feet. The foot has two curvatures. One from the front of the foot to the rear. And the other is from middle part of the foot to the outer aspect. Every body structure serves a purpose. The foot curvatures are like shock absorbers of a vehicle. This curvature becomes flat when force is placed on the foot and re-coils on its own when the feet are off the ground.   

The ankle joint is smaller, but bears more weight compared to the knees. It’s firmly kept in place thanks to the several strong muscles and many band like structures called ligaments. These ligaments also hold the bones of the feet together. Scientifically we divide the foot in to three parts. They are the hind, middle and the forefoot. The hind foot is the area which is closest to the ankle. It has two large bones named talus and calcaneus. These two bones directly bear our weight when we stand. The mid foot has smaller bones that transmit the weight of the body to the corner most part of the foot called the fore foot. The toes and their bases constitute the forefoot, which is the terminal part of the foot.  

When we walk, the heel hits the ground first. The next stage is when the entire foot hugs the ground and becomes flat. At this moment, our entire body weight is borne by just one foot as the other is off the ground. Then comes the heel off stage where we use the tip of the foot and toes to push the body forward; the propulsion phase. Finally, the big toe gives that very important final push before becoming airborne. We call this the toe off the ground phase.  

Not all parts of the bottom of the foot bear weight. If you take a stroll along the beach and observe footprints, the outer side of the mid foot has made more indentation on the sand than the inner. This changes with regard to those who are flatfooted. This condition causes the body weight to be equally distributed over the entire bottom portion of the foot. The undesired areas which bear weight could cause pain in the foot. The exact opposite of flat feet is high arched feet. This is when the front to back curvatures of the foot are in excess. High arched feet could cause pressure related pain symptoms.  

Take out your regular shoes or sandals, and observe the worn out heel. A lot can be learned from the wear and tear that has taken place at the bottom of the shoe. If the inner aspect of the rubber heel is eroded, that person pronated the foot when walking. This means that the feet are slightly twisted outward. If the foot is twisted in, then the rubber heel shows wear and tear on the outer aspect. This is called supination. Even though one might consider these as unimportant, joint specialists can use this information to treat foot pain.  

So what’s proper footwear? A shoe or a sandal that snugs comfortably to your feet, has proper padded areas for the heels and the base of the toes are features of proper footwear. A proper running/walking shoe should first of all have a good “out sole”; this means a good bottom part for the shoe to hug against the floors, whatever the slippery surface might be. Two types of rubber are used for this. They are carbon rubber as seen in tires and blown rubber which is lighter in weight. The “mid sole” is the area of our foot that rests inside a shoe. This is comprises foamy material which is very comfortable. The upper part of the shoe covers all other aspects of the foot and has breathable material which allows air in.  

In Sri Lanka, the issue that needs to be resolved among patients is the decisions taken regarding proper footwear. Many patients have no clue about what is best to wear and then end up with undesired foot problems. I have noted that certain types of ladies’ slippers and sandals have no supportive structures for the areas of the foot that bear weight. Without proper heel, arch and toe support they could cause problems on the long run. The out sole of any shoe should act as a shock absorber, with a cushion like heel. Most ‘office shoes’ worn by gents have rock hard heels. The practice of wearing casual/sports shoes even during office hours is seen in the west. Even knee problems could be averted by switching to better shoes.   

High heels worn for several hours a day could lead to many joint problems. High heels prevent the weight of the body from getting equally distributed along the foot; instead the ball of the heel bears more weight. The unsteady posture adopted with high heels can lead to backache as well.   

If a patient is suffering from long term foot pain, there are ways of customising the footwear to minimise symptoms. Devices like a heel cushion, a medial arch support or even an insole fitted in to a shoe can help. Certain conditions like bunions or callosities need specialised care. Patients with diabetes should be extra vigilant on protecting their feet as they cant sense injuries easily. A shoe that covers the entire foot is ideal.