Meet the Feet

They’ll never get top billing in the body, but the pedal extremities are magnificent machines— and a key reflection of your health

June 10, 2012

David Levine,

Consider the foot. Low on glamour but anatomically complex, it’s what the American Podiatric Medical Association (APMA) calls “a biological masterpiece.” Sure, that group may be biased, but the foot is indeed remarkable. Inside this lowly appendage, 26 bones (together, the two feet contain 25 percent of all our bones), 33 separate joints and more than 100 tendons, muscles and ligaments must work together to keep us upright and power us on our way, all the while withstanding forces that, during an average walking day, amount to the equivalent of several hundred tons. Indeed, if walking upright helps to define us as a species, our feet are one of the keys to our humanity.

It’s no surprise, then, that foot problems are among the most common health issues we face. From fungal infections to torn Achilles tendons, sprained ankles to bunions and hammertoes, medical conditions in the feet keep podiatrists very busy. And many of them are caused by the shoes we wear.

“Shoe gear has huge effect on feet,” says Jordan S. Steinberg, D.P.M., of the Foot Health Center in West Orange. The biggest culprit: women’s high heels. A recent study in the Journal of Applied Physiology found that high-heel wearers engage their muscles and tendons differently than the rest of us, and in ways that increase the risk of injury. “High heels triple or quadruple the body-weight pressure on the foot,” Dr. Steinberg says. The shoes are OK on occasion, he says, but should not be worn on a consistent basis.

Now that summer’s here, many of us will be tempted to live in our flip-flops. But that’s not a great idea, says Marc Cohen, D.P.M., of Marlboro Podiatry Center in Manalapan. “Nonsupportive shoes such as flip-flops lead to heel spurs [extra growths on the bone] and plantar fasciitis [painful inflammation of the arch],” he says. “If you are doing any extensive walking, you need good support.” The only place he recommends flip-flops is around the pool, to help avoid infections, including warts. “Go barefoot as little as possible,” he recommends.

As we age, our soft tissues—ligaments, tendons and muscles—tend to become drier and more brittle and thus susceptible to tearing, explains Paul Kovatis, M.D., of the Orthopedic Spine & Sports Medicine Center in Paramus. Take the Achilles tendon, which he says is “responsible for the spring in our step.” It’s especially vulnerable to injury in so-called “weekend warriors” over age 35. “It is generally the size of two thumbs, about 2 to 2½ inches wide, where the typical tendon is onefourth to one-half inch wide,” explains Dr. Kovatis. “And it crosses over three joints, the hind foot, ankle and knee, where most tendons cross just one.” Its size makes repairs trickier and recovery longer than for most tendon-related injuries. Older athletes should make it a point to stretch their Achilles before physical activity to help prevent tears.

You can’t fault feet for requiring frequent, thorough hygiene to minimize odor—after all, they bear the body’s weight and have more than 250,000 sweat glands. But these keys to your mobility are also, in a sense, health watchdogs for the body, because problems in the feet can signal systemic illness. That’s one reason it’s important to consult a podiatrist if you have persistent foot pain or other problems in the feet. A podiatrist is a physician and surgeon who has training in “all of the intricately related systems and structures of the foot and lower leg,” says the APMA, “including neurological, circulatory, skin and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles and nerves.”