This interview was conducted by Gary Pozsik, host of Health, Wealth, And Happiness, WGCV, Columbia, SC on February 24, 2012 at 12 o’clock.
Gary Pozsik : Good afternoon everyone, welcome to Health, Wealth, and Happiness. My first guest joins us via the phone. He is Dr. Brett Fink, author of the Whole Foot Book: A Complete Guide To Taking Care of Your Feet. And today we’re going to talk about how to take better care of your feet.
Welcome, making his first appearance on Health, Wealth, and Happiness, Dr. Brett Fink. Good to have you here.
Dr. Fink: Thank you Gary. It’s a pleasure being with you.
Gary Pozsik : There’s no doubt about it, one thing that makes your business the business that it is, is footwear, especially women’s footwear. It ain’t good for the foot.
Dr. Fink: Well, certainly some of it isn’t good for the foot. The high-heeled shoes that women wear can certainly make the women’s foot painful. And sometimes the flexibility of the shoe that is common in women’s high heels can overload the front of the foot and can keep you from being comfortable.
Gary Pozsik : And I would guess with the numbers of young people that wear flip-flops on a continuing basis, 30 years from now you’re going to see a heck of a spike in people coming to see podiatrists saying, “my God, something is the matter with my feet.”
Dr. Fink: Well, I’m not sure that I agree with that completely. The feet adapt to the conditions that they’re in. To be honest with you, I feel that people see would be much more healthy if they were kept in the foot wear that our bodies have evolved into, and that is nothing at all. Until the last hundred years, people really didn’t wear shoe wear. I think that a lot of the problems that we have now occur because the foot is not allowed to develop normally, seeing the stresses that naturally help it develop. Flip-flop shoes in people that are not used to them can be difficult, but they don’t really cause problems in my mind. Because the shoes are not well attached to the foot, they can become unstable. So for something like soccer, they might be inappropriate, but flip-flop shoes in healthy feet are actually okay.
Gary Pozsik : Boy, when you talk about footwear designed for the foot, there’s no doubt about the fact that in the last 25 years, shoe manufacturers when they come to the area of foot had designed every kind of footwear known to man. For your favorite sport, there is a shoe that is made for you.
Dr. Fink: That’s certainly true.
Gary Pozsik : Is that a sham or is that really necessary.
Dr. Fink: Again, I mentioned before that for the last hundred years, we didn’t wear shoes for much of the time. But now our feet are accustomed to shoe wear. They have developed softer footpads, the muscles are less strong. So, a lot of times the shoes are necessary to protect our deconditioned feet.
Besides, the stresses during the sports that we subject our feet to, are not really natural stresses. So, having a shoe with a cleat, or making the shoe more rigid or more flexible for the sport that you are practicing is entirely appropriate. I’m just saying, there’s not anything wrong with minimalizing the amount of support within the shoe, and I believe it makes the foot stronger over the long run.
Gary Pozsik : Obviously, you and your co-author wrote a book because you thought it was necessary that people have information on how to take better care their feet.
Dr. Fink: Yes, the book that I wrote is geared toward people who already have a foot problem and are looking for ways to make it better. The reason that I wrote the book is because people who go to a primary care physician, even a specialist, do not get a complete picture or enough information to really make it easy for them to manage the foot. And, really, while the doctor is able to make suggestions, if the person having the foot problem does not understand the suggestions, then it is difficult for them to be enthusiastic or effective at implementing them well.
Gary Pozsik : Well, Brett, do you think that part of the problem is that when you go to any pharmacy, pick the one you want whether it is a big-box pharmacy or a compounding pharmacy, you see Dr. Scholl’s and a blue million products for the foot, so you can be your own Dr. Fix-it? How much do you want to spend? Step right up here and we will show you what product you should buy for your foot in some of these products are not $3.99 some of them are $80.
Dr. Fink: A custom orthotic generally runs $300 or $400. And the stores, the big-box stores, have convinced the public that orthotics and other devices are healthy and necessary for their foot. That their foot is a little bit more fragile than it really is. I agreed that it is more fragile than it should be, but if people used their feet in a more natural way, it would be less fragile and would have less problems. While arch supports are very helpful for certain problems, not everyone needs support and not every foot problem requires support.
Gary Pozsik : I keep waiting to go back to footwear, but is part of the problem vanity? Should a woman wear a size 8 when trying on a size 6. My God a size 8, all make it fit.
Dr. Fink: I think that there is something to be said for that. If you wear a shoe that does not conform to the shape of your foot, obviously it’s going to push on the foot in ways that could cause you to develop deformities. If you look at the Japanese or the Oriental society a hundred years ago, they would actually bind their foot in order to make it conform to a certain desired shape. So it is possible to mold the foot in ways that are not healthy for it. But a lot of the things that are blamed on the shoes are probably a part of natural aging and genetics, an aging process that has probably been made worse by overprotecting the foot in modern shoes.
Gary Pozsik : The reason why I ask it is in my next question is are corns and calluses in bunions natural phenomenon or are they something that are doing wrong?
Dr. Fink: That’s interesting. There are actually a couple of studies that have looked at populations of people who live close to one another that either wear or do not wear shoes. What they have found is that people who do not grow up wearing shoes have a much lower incidence of bunions and flat feet. And you may say that this is because the shoes mold the feet, but I believe that it is because the muscles have not been allowed to develop properly inside of the shoes.
Gary Pozsik : You see people that are 60+ years old that are literally hobbled many times because of their feet and the condition of the feet.
Dr. Fink: Oh yes, I see that frequently. Once a person has developed this problems, the horse is out of the barn. There is not much you can do to reverse it, to make an arthritic foot less arthritic or to make a foot with a ligament irritation such as heel spurs or plantar fasciitis less problematic. What you have to do is to protect the foot until those problems heal, once they had healed in a gradually reintroduce exercise stress to make the foot more resilient.
It’s a little like when you have a fracture. A cast is often used to treat this. But once the fracture has healed, it is no longer necessary to use the cast indefinitely. In fact, it can be unhealthy for the arm to be placed in a cast for long periods of time. The muscles begin to atrophy and waste and the joints become stiff.
The same is true for foot problem. If it is an issue that can be reversed like tendinitis, then what you wanted to do is to protect the foot until the tendinitis resolves. And then, after it is resolved, expose the foot more and more stress and tell it obtains the resiliency that you want. Tendinitis, a tendon is a simple structure and can heal back to its normal architecture and shape. However joint cartilage is more complex and once it has been damaged really can never return to its normal status, so that arthritis really never completely resolves once it has begun. But people with arthritis can be made better with an exercise and conditioning program that decreases the damaging loads that a poorly conditioned foot is exposed to and perhaps can avoid surgery or prolonged use of overly restrictive shoes.
Gary Pozsik : Speaking of pain, one of the reasons why people don’t seek podiatry is just that they are under the impression that if they going to have the corn removed, by God, that’s going to hurt. Well, let me use myself as an example, I had a corn and I thought a corn, how much can that hurt. The answer is a lot. And I suffered with it for about, I’m going to admit it, four months, and I had just about all the fun I could stand. I, like everybody else, tried several different Dr. Scholl’s products, but, I’ll have you know, finally I went to a podiatrist. And he looked at it and said that you have to get the core out. He did that it didn’t hurt, and so I was setting myself up and I wish I would’ve seen a professional sooner, but I was afraid that this was going to hurt like sin because, man, it hurt. I thought, me, I don’t want somebody cutting on me, this is really going to be painful, but it wasn’t. It wasn’t painful at all. So there you go.
Dr. Fink: Well, fortunately, corns are more or less a problem of the skin. They are callouses that develop under an area where the bone is pressing against the skin too hard and so if you remove the corn, it generally doesn’t involve any of the parts of the tissue that are that bleed or have sensory nerves. So, it should be fairly painless. It should not hurt a great deal to have a corn removed.
But getting back to my point, as far as corns are concerned, a corn does not generally developing young people. It is usually that affects us as we get in our 30s, 40s, and 50s. And what happens sometimes is that the skin on the bottom of your foot acts like the skin and the rest of our body, it becomes thinner. And if the skin on the bottom layer foot becomes thinner, the bones put much more pressure on a direct point in the skin. And just like it does on your hands, stress stimulates the skin to become thicker. The pressure from walking the callous pushes the callous into your skin. Essentially at that point, what you are doing is walking on a BB ofhard skin tissue. You have to remove that BB in order to relieve the pressure and the pain. So, the podiatrist, or in my case an orthopedic surgeon, shaves the BB down so that it is much less painful. The tissue gradually fills behind the callous until it becomes normal again. If you keep up the shaving or if the pressure is relieved, then the callous will no longer form and the corn will not redevelop.
Gary Pozsik : And that’s exactly what happened. It went away and hasn’t reoccurred. But, it’s like the old adage, there is no greater fear, then fear the unknown. And it was fear the unknown. If I ever have this recur, at the first sign, I will make a beeline for the podiatrist and get it taken care of. When we come back after the break, I’d like to get a reaction from you, of the people that have read your book, and I bet there are a lot what had they had to say about your book and if they had shared for with you why they have bought your book and if it is help them.
Gary Pozsik : We’re back, and my guest is Dr. Brett Fink, co-author of The Whole Foot Book: A Comprehensive Program for Taking Care of Your Feet. Coming to us from Indianapolis. I have a Masters degree from Indiana University so I’m somewhat familiar with where you are. We were talking before the break about different problems with regard to the foot and obviously you and Dr. Mizel wrote a book about the foot and it’s a complete program for taking care of your feet. How long has the book that out?
Dr. Fink: It came out in the very beginning of January.
Gary Pozsik : What kind of reaction have you had from the readers?
Dr. Fink: Well, so far it’s been very positive. My book is been out on Amazon and I recently got my first review on Amazon. And she was very happy with the book. The physicians and podiatrist that I had review it have also been very positive. Of coarse, I looked too many of them for suggestions about what to include in it even before it was published.
Gary Pozsik : Over the years in your practice, what is the biggest mistake that people make in regards to their foot care?
Dr. Fink: Well, I think that some of the biggest things that I see are the misconceptions that people have about foot care. One of the biggest is that there is any ideal shoe for a foot. A lot of times I have mothers and fathers come in with their children worried that they need to buy a certain very expensive shoe in order for the child’s foot to develop properly. As I stressed before, I really think that no shoe in all is probably the most healthy way to allow a child’s foot to develop properly. After that, it’s also the feeling that a particular orthotic is going to solve a problem. In general, I look at the whole foot, the posture, and the flexibility of all the joints in the legs and back that my lead and overload certain parts of their body. I think that that is the key to giving someone a long fasting result.
If you look again to a problem like heel spurs or plantar fasciitis, the surgical treatment for that disease treats the symptom and not the underlying problem. A person who has an operation for plantar fasciitis may develop relief from the plantar fasciitis only to develop another problem that is caused by the same mechanical overload that caused the plantar fasciitis. In my practice, I like to emphasize maintaining proper foot health as a way to keep it healthy over the long term and avoid unnecessary surgery.
Gary Pozsik : I’m sure that people do not realize the wear and tear that they put on their feet over the years and so they really have a problem. And you explain to them, it’s in little or no wonder. They don’t understand the importance of keeping healthy feet. They make their money on their feet.
Dr. Fink: Sure, we all make our living on our feet. No one could function properly without walking on the feet. I agree with you, when we are younger, in our teens and in our 20s, it’s very easy for our feet to adapt to our mechanical problems. As we got older, they become less and less resilient. Perhaps, they become less and less resilient because we protect them more and perhaps as a natural part of the process of aging.
Gary Pozsik : Are there any exercises to the feet that you recommend?
Dr. Fink: Absolutely, I think that most common foot problems result from overloading the front of the foot. I find commonly that the Achilles tendon and hamstring muscles are contracted and lack proper flexibility. This causes them to put too much pressure on the front of the foot and to leave that pressure on the front of the foot too long at the end of the step. That causes the foot to overload. So addressing that by having a consistent stretching program, it I think is very helpful. I also think it’s helpful for people to watch their posture. If you walked slumped over or have abdominal conditioning problems, such as the typical beer belly, it shifts all the weight forward and the only way that you can control that weight is by placing pressure on the front of the feet. So I recommend working on abdominal conditioning and lumbar conditioning, ensuring that the shoulders are centered over the pelvis. I think all of these are important and often overlooked problems they can really be key to the success of treating many chronic foot problems such as forefoot pain or metatarsalgia, or heel pain, known as plantar fasciitis.
Gary Pozsik : It’s interesting to hear you talk about the importance of stretching, because certainly you see before you professional athletes prior to football games, before basketball games, you see it in professional dancers, they all really go through a regimen of stretching, not only of their feet but their legs as well.
Dr. Fink: Right, I think it is also important that stretching me done other times than right before an athletic event. It should be a part of a daily routine, as a matter of fact, several times a day. What stretching does is stimulate the muscle fibers to become longer. If the muscle fibers are not stimulated on a regular basis, you really are not caught accomplishing much.
Gary Pozsik : I’m sure that people come to see you for things, I know that as a surgeon, that people have to go under the knife. But I’m sure they complain of, like leg cramps, my God, I can wake up in the middle of the night with a Charlie horse in my leg, and people have restless leg syndrome. These are things that are very common in the general population.
Dr. Fink: Sure, as far as leg cramps, usually leg cramps are caused by fatigue. The muscles have been asked to do more than they are accustomed to or conditioned for, or more than they are capable of, then they become very irritable and spasm frequently. And then there are the occasional people with leg cramp that have an electrolyte problem such as the calcium being too low or their potassium being too low, and those people should be worked up for metabolic problem by a physician. As far as of restless leg syndrome, that’s a degenerative neurological condition. Often, it is very treatable with medication, but of course those medications have any side effects.
Gary Pozsik : What kind of side effects?
Dr. Fink: I would have to say that that is kind of outside of my practice, but usually sleepiness, difficulty getting up in the morning, nausea, those kind of side effects.
Gary Pozsik : I got you. What is the normal thing that people come to see you with, that you see on a regular basis?
Dr. Fink: The foot has an infinite number of ways that it can break. Some of the most common things that I see are Achilles tendinitis, pain in the back of the heel, plantar fasciitis, pain on the bottom of the heel, I would say that those make up about 60% of what I see. And then, hammer toes and bunions, and foot arthritis of various joints. And then there are the more difficult cases where it takes a little bit more work to figure out what is going on. And in those patients, their diagnosis may be unique to them.
Gary Pozsik : And there again, I’m sure a lot of people put up with a great deal of pain and suffering before they ever come to see you, I’m just surmising, but I’m sure you’re thinking that, gee, it would’ve been great if you had come here six months ago?
Dr. Fink: Well, I would have to say that I try not to bash people over the head with that too much. Generally, there are an awful lot of pains that you just live with. People that run to a doctor immediately when they develop a pain may spend all of their time in a doctor’s office. There our problems that I think are okay to watch and often they will go away on their own. I, myself, have had several forms of tendinitis that seem to just come and go, but when they become persistent or when the foot changes in alignment, it probably is a good idea to see a physician to be diagnosed and at least to have the peace of mind that you are not doing any harm to your foot. So, while I’ve written a book to give people an idea of what kind of things they can do beyond the advice given to them by their doctor, or what their doctor may not have been able to go over with them during the course of a fairly short appointment in a medical clinic, which unfortunately is 15 or 20 min. at most. It is a good idea to see a doctor and be diagnosed and to at least be given some advice on what a good treatment plan is. So, while I hope my book is informative, it is not a substitute for proper medical care.
Gary Pozsik : Brett, for those people that are interested in getting a copy of your book, The Whole Foot Book, how can they do that?
Dr. Fink: Well, it’s available at Barnes & Noble online as well as on Amazon.com. I hope that it will soon be available in bookstores, you know local bookstores, but that will depend upon the initial sales.
Gary Pozsik : I thank you so much for sharing on Health, Wealth, and Happiness.
Dr. Fink: It’s been a pleasure, Gary.
This is an interview with Matt Nie of 89.1 WBSD, Community Focus in southwestern Wisconsin, February 16, 2012.
Good morning, welcome to Community Focus. A show dedicated to exploring the personalities, issues, and events of southeastern Wisconsin. I'm your host Matt Nie. Today we have Dr. Brett Fink, co-author of the book, The Whole Foot Book, A Complete Program for Caring for Your Feet. Dr. Fink, I know a lot of us don't put in the amount of time thinking about feet as you do, yet in paging through your book it is amazing that this is what holds us up every single day. Can you explain your fascination that led you to create The Whole Foot Book?
Thank you very much, Matt. Just like you, I've always been fascinated with mechanics of the foot. Of course, the foot contains many, many tendons, joints, ligaments, and bones and they all work together in such an intricate way that, I agree with you, it is quite amazing that it does what it does for us. This was my inspiration for becoming a specialist in foot and ankle problems and I’d like to share with my readers.
Now, though foot book is very comprehensive. And I just mentioned the co-author, Dr. Mizel, put a lot of work into outlining every potential aspect of the foot, problems as well as foot care. Some things are very specific. But, in general, what do you think are some of the basic foot maintenance things that we should do throughout the course of our lives?
The main premise of the book is that many of our problems are caused from overload of the forefoot and this happens for a lot of different reasons. Because, we live in a society where footwear is important, the foot does not develop quite the way should. The foot is protected from a lot of the forces that it naturally would encounter and because of this we develop problems in our ligaments. Unfortunately it's hard to tell a patient this after they've already developed foot problems. Once a foot problem has developed foot injuries, it is important to protected it for a time, but is important to regain the strength of the foot after the foot has begun to heal.
It is my feeling that a lot of foot problems, even foot problems with lots of different manifestations, with lots of different places that you may hurt, should be approached in the same fashion. Ensuring that all the ligaments of the entire leg are stretched out properly, ensuring that you use proper posture, and use proper shoes that address the needs of the foot at the time that I see it. Protecting the foot during the initial healing phase, and exposing it to greater and greater stresses during the recuperation.
I know that there is a trend, and I don't know whether it's here to stay, of the glove shoe or minimalist shoe, where does that fit in in terms of your thinking of the foot?
I agree with the concept of the minimalist shoe. In fact, I think it would be best, if you're on a safe surface, to wear no shoe at all. If your yard is quite safe and free of objects that might hurt the foot and the foot is properly conditioned, I think it is quite reasonable to go barefoot. Now, short of that, we live in a world where there are objects on the ground that might hurt the foot, especially as the skin on the foot has become protected and quite fragile because of the protection. Now, in a healthy foot, I see no reason that people cannot enjoy using minimalist running shoes. However, it is important to realize that the foot needs to be conditioned to that stress. If your foot is used to a standard running shoe or you have never run before, it is important that you approach the stresses incrementally, because otherwise you could overuse the foot and develop an injury that could take some time to recover from.
I am absolutely fascinated by the chapter on rehabilitation, the suggestions, a lot of the different stretches do not seem to even address the foot at all. I'm looking at chapter 10, the rehabilitation of the foot, and the first things that I see are neck twists, crossover shoulder stretches, shoulder rolls, how does this all factor into foot rehabilitation?
For the person that is not a high level athlete, who just does the normal everyday activities, it is absolutely critical that, if they have a foot problem, that they use good posture. And that involves ensuring that the head is centered over the shoulders, that the shoulders are centered over the pelvis, and that we are not leaning forward and shifting weight onto the front of our foot. And so these exercises are directed towards increasing back flexibility, hip flexibility, to ensure that we carry ourselves in the proper fashion, so that our forefoot is loaded as appropriately as possible. I believe that foot problems should be looked at as a total body posture problem rather than treating it in isolation.
If you're just joining us, we are talking to Dr. Brett Ryan Fink, the co-author of The Whole Foot Book, a Complete Program for Taking Care of Your Feet. Lots of mention of shoes, even orthotics, we see so many inserts on the market as well as substantial prescription based orthotics. What are your feelings on orthotics?
Shoe prescriptions and orthotics are just a method of approaching deficits that people have in their feet. They are not a cure-all. In fact, for normal healthy feet, I do not feel that they are helpful. Certainly, it is difficult to approach the subject scientifically because it's hard to take a group of people and use them essentially as lab rats to find out if they are going to respond favorably to posture changes. But it makes sense to me to put the foot in the most natural environment possible, but if you have certain problems, orthotics can be helpful. But for someone that does not have foot problems, I think that they are harmful. Anything that you put in your shoe to protect the foot is going to deconditioning the muscles, it's going to deconditioning the skin in your foot which is a very important natural protector of the bones and muscles and it helps to diffuse and redistribute the stresses with her foot.
If you can imagine, as a doctor, I often have the opportunity to shake people's hands, if I shake the hand of someone who is a manual laborer, I will feel the palm and it will be very thick. It won't move and it will not be very flexible. However, if I shake the hand of, I hate to pick on lawyers, an attorney, their hands will be much softer, I will feel the bones and tendons easily through their skin. The same thing happens in the foot. If the foot is overly protected when it's healthy, then it will be less resistant to injury. However, if it has already been injured, it is important to protected it until it is healed. Once it is healed, stresses can be incrementally reintroduced until it becomes resilient to the stresses that it sees every day
It's interesting. Many of us have had the experience of being at a wedding all day in those hard soled shoes and were very sore at the end of the day. How can we tell the difference between what is normal wear and tear and what is a sign of a problem?
I think that the larger problems and the smaller problems that you mentioned are part of a spectrum. If you have been at a wedding and had been on your feet for several hours, what your feet are telling you is that they are not use to those kinds of stresses. Therefore, parts of your foot are being overused and your muscles are becoming fatigued. When your muscles are becoming fatigued, then the ligaments take over as part of the non-fatiguable part of your foot, but they're going to become irritated. If you continue to expose your feet to stresses that are intermittent and strong, then it's quite possible for you to develop a chronic irritation of these structures. That's when you develop the common overuse problems such as plantar fasciitis or heel spurs, hammertoes, and midfoot irritation. All of that stuff comes with chronic overuse or chronic variable amounts of stress that we expose our foot structures to.
Let's take a condition like plantar fasciitis, what is some of the self-care, the small changes that we can do to prevent problems?
I think that plantar fasciitis is almost a prototypical injury. There is some scientific suggestion of this, but in terms of scientific fact, it is not yet proven. My belief is that people develop plantar fasciitis because they overload the plantar fascia, they expose the plantar fascia to more stress than it can repair by overloading the ball of the foot. If you overload the plantar fascia, and the plantar fascia is an important part of the way that the body redistribute stress through the midfoot, then you will get inflammation, small tears, and then it will become chronically painful or the pain will not go away for some time. Most people with plantar fasciitis will heal up eventually, but in some it will become very difficult to treat.
It seems logical to the layperson that I'm putting too much stress on the foot and therefore why don't I treat this stress with a cushion or wear an arch support.
And I would agree with that for the most part, but there is so much more that you should do. The rocker soled shoe, a shoe with a rounded stiff sole that helps to offload the front of the foot and reduce the stress on the ball of the foot, will make the foot feel better and is much in my opinion a good “healing” shoe. It protects the plantar fascia and perhaps will help it heal, but you need to improve your Achilles and hamstring flexibility. Once again, you have a healing phase, followed by phase where you gradually expose the foot to more stress. Perhaps, however, if we stayed away from overly protective shoes and kept the muscles in the skin of our foot from atrophying, we might see a lot less plantar fasciitis than we see nowadays.
It's very interesting, in terms of exercise, weight loss, you mentioned many things. Do you have a short list, not necessarily rehabilitation, of daily maintenance, things that we should all be aware of to keep our feet healthy?
Perhaps the most important thing is to use proper posture, to be aware of centering your shoulders over your pelvis, and leaning backwards slightly on your pelvis so that your hips open up slightly. Any weight that is forward of your sacrum, or tailbone, is going to have to be counterbalanced. And usually you counterbalanced this weight by placing more weight on the front of your foot. It is been shown that people with plantar fasciitis had a tendency to have less flexibility in their Achilles and less flexibility in their hamstrings, these are important things to correct. You need to work on weight loss, if that's a problem, but that doesn't come quickly. It is important to stress that a diet is not a weight-loss plan. True weight loss involves changes in dietary habits which do not come quickly and should be permanent.
Time for two more questions. Where can we go to find out more information about you and the whole foot book?
Well, I have a website, www.wholefoot.com, and I write a blog on that website to keep people informed on my own thoughts and ideas about foot pain. I have several worksheets that review the causes, the symptoms, and initial treatment of the most common foot problems. But I always encourage people that, if their foot problem is more than a mild problem, that they should see a physician for evaluation. A website or a book is not proper medical treatment and is not a proper way of treating a definite medical condition.
It's interesting when we watch little kids move and play, and they do it with such ease, and over time, I don't know if we forget how to move or if we just reinforce bad habits. How can we be aware of what we need to know about our foot as we age and is there some wisdom that can be gained from watching how children move?
I think that part of the reason that we age, in a lot of ways, is that we spend our life thinking of how to protect ourselves and our feet. As if our bodies are something that needs protection from the environment that it evolved in. Again, if you have any children, children hate shoes, and it is best for them to be and be in as natural a condition as possible. Let them spend time out of their shoes. If we did this throughout our lifetime, I feel that we would have a lot fewer foot problems.
All right. I really want to thank you for your time. We've been talking Dr. Fink, of The Whole Foot Book, a Complete Program For Taking Care of Your Feet. We really want to thank you for coming out today.
Thank you very much, Matt. I enjoyed it.
Mike Buchanan: Thank you very much. And good morning everyone. Well you know most people take a tremendous fuss in their overall health. That's why orthopedic surgeon, Brett Fink, has written a book about the importance of maintaining proper foot care. The foot is an amazing complex organ that provides a variety of activities during a person's lifetime. Dr. Fink will reveal the foot problems that are often misunderstood by the very physicians that we turn to for help. Furthermore, foot problems can affect every aspect of a person's life from work to parenting. These problems can be avoided and even reversed. Dr. Brett Fink is the author of the book, The Whole Foot Book: A Complete Program For Taking Care of Those Feet. And he joins us this morning. Good morning, Doctor, and thank you for joining us this morning!
Dr. Fink: Good morning, Mike, and thank you for allowing me to be on your show.
Mike Buchanan: Always nice to have you on the show. What are some ways to find the best foot care possible?
Dr. Fink: Well, I think that one of the ways to find the best foot care possible is to buy a reasonable pair shoes. I think that, despite what a lot of people think, orthotics are not necessary for a lot of things. For specific foot problems, they can be very important. And then to find a foot doctor who is knowledgeable and can help you with any problems that come up.
Mike Buchanan: For a person that has a foot problem is it best for that person to go to a podiatrist as opposed to a family doctor?
Dr. Fink: I suppose it depends upon what you're looking for. Certainly most people have exposure to a family practitioner on a regular basis, and for fairly minor problems I think that a family practitioner can help them with a lot of those problems. Certainly for a problem that is more persistent, is causing more problems, may be causing swelling, or foot deformity, then seen either a podiatrist or an orthopedist that is knowledgeable in foot problems could get them a little farther than it could with seeing a family practitioner.
Mike Buchanan: I was thinking, Dr., you go to a shoe store, and there are literally hundreds and hundreds of shoes to choose from. Do we sometimes make a mistake by purchasing the wrong shoes for a specific lifestyle or activity that we have?
Dr. Fink: Well, I think , Mike, that's an interesting question. First of all, I think we should take a step back, and look at the way the foot has developed. I mean, before hundred years ago, people didn't wear shoes very often and therefore the foot has evolved to do a fairly good job throughout our lifetime of performing without pain for our lifespan. So often shoes are not necessary or not therapeutic for most healthy feet. I think it is important to find shoes that fit properly and that, if you have foot problems, specific foot problems, then you should look for shoes that are designed, then mechanically counteract those problems.
Mike Buchanan: What are some of the most common foot problems that you find associated with the foot?
Dr. Fink: Well, the most significant problem I think is plantar fasciitis, or heel pain, also known as heel Spurs. That probably accounts for 30% of the people that I see in my office. Ten percent of people will have this sometime throughout their life. And usually it goes away without much problem. After that, various forms of tendinitis. All of these occur because of the way that we use our feet over a long period of time. Again, shoes are part of the problem, because in Western society we have begun to wear shoes that are fairly constrictive. A lot of times the muscles do not develop properly or become deconditioned and I think that this makes us prone to develop problems like plantar fasciitis, like Achilles tendinitis, like hammer toe deformities. That's what I go through in my book, I have developed a program to counteract those problems through exercise, therapeutic shoe wear when necessary, and overall good foot health.
Mike Buchanan: What are some other foot problems that, you know, you come across in your practice?
Dr. Fink: Well, again, hammer toe deformities are perhaps one of the biggest problems. And they often begin as simple swellings in the front of the foot and a lot of times people don't know what they are. You know, unfortunately, a lot of times if you go to a primary care doctor, who may not be quite as sophisticated about the number of diagnoses that he knows well, he may misdiagnose this as a Morton’s neuroma, a stress fracture, or something like that. And usually these problems begin as swellings that eventually become foot deformities. A lot of times the pain will go away but the deformity will persist. Other problems that you might run into are bunions, and various types of arthritis of the midfoot or forefoot. Arch pains, flattening of the arch, there are hundreds of potential diagnoses.
Mike Buchanan: I'm sure you've seen, like I have, these commercials on television and they're usually in like a Walmart store, where you stand on this, kind of like a pad or something, and this machine will tell you that you need this specific type of shoe. Are these machines pretty reliable, accurate, what you think?
Dr. Fink: Well, I don't think that a healthy foot requires an orthotic. The foot that is having problems may require an orthotic and surprisingly there's not much of a difference between orthotics. Studies have even looked at custom orthotics versus the type that you get over-the-counter at one of those kiosks and there is only very subtle differences between them. And foremost normal feet, feet that don't have significant deformities but are painful, just a simple over-the-counter orthotic can help many problems. But those machines, unfortunately, only look at a very small part of the foot, and therefore, I think it's difficult for machine to tell you what to do for any foot problem. And again orthotics are only a very small part of foot treatment.
Mike Buchanan: And you know these machines, Doctor, they are stepped on by hundreds of people don't they malfunction after a while?
Dr. Fink: Well, again, you have to look at the type of information that these machines are trying to get from your foot and it is, it's very limited. And they more or less determine how you distribute the weight on the foot while you are standing. And that isn't necessarily the same as when you're walking or you're doing any of the millions of things that we do during the course of the day. And so those machines, I think they only look at a very limited part of the foot and I think it's difficult for that machine to even judge whether orthotics are the proper way to go as they frequently aren't.
Mike Buchanan: Well, Doctor, let me ask you, we only have a couple minutes to go, are feet sometimes misunderstood?
Dr. Fink: Well, I think that, I still after 19 years of being a doctor, there are many things that I don't understand about the foot. I think that after years of considering some of these foot problems, you do eventually get some insight as to what is going on in them. But I think that, yes, the foot has many, many bones and joints and they all interact with the leg, so it's a very complex situation. But, in a lot of ways, the principles behind them are very simple to understand, but very difficult to convey to the patient during the course of a fairly short office visit.
Mike Buchanan: Doctor, how can someone obtain a copy of your book, The Whole Foot Book?
Dr. Fink: It's available through Barnes & Noble and Amazon and I think it's very reasonably priced. Really for the price that you can go to a physical therapist for one visit, it's much less than the copayment for physical therapist for one visit. And I think that people can learn a great deal if they just take the time to look into this stuff on their own rather than just expecting a doctor or physical therapist to teach them all of these things that I think are very important for them to learn during the course of their foot problem.
Mike Buchanan: As far as surgery goes, use surgery only as a last resort?
Dr. Fink: For most common problems, I think, surgery is almost always a last resort. It's very simple for a doctor to prescribe surgery for problem. They don't have to get a lot of help from the patient. It's time-consuming for doctors to go through with the patient, nonoperative treatment. And I think that it's overlooked and often not paid the attention that it should be. And I think that a lot of times people get in trouble because of that.
Mike Buchanan: Doctor, we have run completely out of time, Thank you very much for joining us this morning on Good Morning Magazine.
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