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.