And Other Things You Can Live With But Could Get Along Very Well Without - The vulnerable extremities

Aches and pains in the legs and feet occur for a wide variety of reasons, some trivial and easily corrected, others serious enough to require medical attention. Those that originate in such conditions as arthritis and rheumatism can often be alleviated by aspirin or some of the newer prescription medications.

Gout

Gout , which is usually a metabolic disorder, is a condition that especially affects the joint of the big toe, and sometimes the ankle joint, causing the area to become swollen, hot, and acutely painful. Although the specific cause of gout is not yet clearly understood, the symptoms can be alleviated by special medication prescribed by a physician. An attack of gout can be triggered by a wide variety of causes: wearing the wrong shoes, eating a diet too rich in fats, getting a bad chill, surgery in some other part of the body, or chronic emotional anxiety, as well as the use of certain medicines, such as diuretics (“water-pills”). See also “Gout” in Ch. 7, Diseases of the Skeletal System .

Fallen Arches

Fallen arches can cause considerable discomfort because the body's weight is carried on the ligaments of the inside of the foot rather than on the sole. When the abnormality is corrected by orthopedic shoes with built-in arches for proper support, the pressure on the ligaments is relieved. A physician rather than a shoe salesman should be consulted for a reliable diagnosis. In some cases, the physician may also recommend special exercises to strengthen the arch.

Flat Feet

Flat feet can usually be revealed by a simple test—making a footprint on level earth or hard-packed sand. If the print is solid rather than indented by a curve along the big-toe side of the foot, the foot is flat. Aching ligaments in the area of the instep are often a result, but can be relieved by proper arch supports inside the shoes. Corrective arch supports are particularly important for young children, for anyone who is overweight, and for anyone who has to stand a great deal of the time.

Blisters

Although blisters are sometimes a sign of allergy, fungus infection, or sunburn, they most commonly appear on the feet because of the friction of a shoe or of hosiery that does not fit properly. A water blister is a collection of lymph that forms inside the upper level of the skin; a blood blister goes down deeper and contains some blood released from broken capillaries. A normal amount of walking in shoes and hosiery that fit comfortably—neither too loose nor too tight—rarely results in blisters. When blisters do appear, it is best to protect them from further friction by the use of a sterile bandage strip.

Treatment

A blister that causes acute pain when one is walking can be treated as follows: after cleaning the area with soap and water, pat it dry and swab it with rubbing alcohol. Sterilize the tip of a needle in a flame, let it cool a little, and then puncture the edge of the blister, absorbing the liquid with a sterile gauze. The loose skin can be removed with manicure scissors that have been sterilized by boiling for ten minutes. The surface of raw skin should then be covered with an adhesive bandage. This procedure is best done before bedtime so that healing can begin before shoes are worn again.

If redness appears around the area of any blister and inflammation appears to be spreading, a physician should be consulted promptly.

Bunions

A bunion is a deformation in the part of the foot that is joined by the big toe. The swelling and pain at the joint is caused by inflammation of the bursa (a fluid-filled sac) that lubricates the joint. Although bunions often develop because of wearing shoes that don't fit correctly, they most frequently accompany flat feet. Pain that is not too severe can be relieved by the application of heat; the condition may eventually be cured by doing foot exercises recommended by a physician, who will also help in the choice of correct footwear. A bunion that causes acute pain and difficulty in walking can be treated by a simple surgical procedure.

Calluses

A callus is an area of the skin that has become hard and thick as a result of constant friction or pressure against it. Pain results when the callus is pressed against a nerve by poorly fitting shoes. A painful callus can be partially removed by rubbing it—very cautiously—with a sandpaper file or a pumice stone sold for that purpose. The offending shoes should then be discarded for correctly fitted ones. Foot care by a podiatrist is recommended for anyone with recurring calluses and corns (see below), and especially for those people who have diabetes or any disorder of the arteries.

Corns

A corn is a form of callus that occurs on or between the toes. When the thickening occurs on the outside of the toe, it is called a hard corn; when it is located between the toes, it is called a soft corn . The pain in the affected area is caused by pressure of the hard inside core of the corn against the tissue beneath it. The most effective treatment for corns is to wear shoes that are the right size and fit. Corns can be removed by a podiatrist, but unless footwear fits properly, they are likely to return.

Treatment

To remove a corn at home, the toes should be soaked in warm water for about ten minutes and dried. The corn can be rubbed away with an emery file, or it can be treated with a few drops of 10 percent salicylic acid in collodion, available from any druggist. Care should be exercised in applying the solution so that it doesn't reach surrounding tissue, because it is highly irritating to normal skin. The area can then be covered with a corn pad to relieve pressure. This treatment may have to be repeated several times before the corn becomes soft enough to lift out. Diabetics or those suffering from any circulatory disorder should never treat their own corns.

Bursitis

Bursitis is a pain and swelling in a joint caused when the bursa, a sac-like cushion between the bones and tendons, becomes worn or torn from constant use.

Forms of bursitis include: housemaid's knee, characterized by a swollen kneecap that has become inflamed by injury or constant pressure; bunions, where the joint of the big toe is swollen and inflamed by poorly fitting shoes; and weaver's bottom, where the bursa around the pelvic girdle become damaged from long periods of sitting on hard surfaces.

Bursitis can be treated by resting the inflamed joint, applying heat, taking an anti-inflammatory drug, such as aspirin or ibuprofen, or getting a corticosteroid injection or antibiotic therapy. For chronic bursitis, surgery may be required, and physical therapy to repair the joint may follow treatment.

Tendinitis

Tendinitis is inflammation of a tendon, and tenosynovitis is inflammation of the tendon sheath from injury. These problems tend to occur together. The tendon becomes injured by excessive or unusual use, such as a weekend athlete might experience, or from extreme strain on the tendon by over-exertion in lifting, carrying, or moving something heavy. The tendon may also be injured by repetitive movement. The areas most susceptible to tendon injuries are the shoulder, hips, hamstrings, ankles, and heels.

Tendinitis can be treated with aspirin or ibuprofen, corticosteroid injections, elevating the injured limb and applying ice, and using a sling. Tendinitis can be avoided by doing warm-up exercises before engaging in an athletic activity, and by not overexerting.

If the pain is persistent or causes you to avoid using the limb, you should seek professional medical advice. Because rest and then gradually increased exercise of the injured area is required, your doctor will have to help you develop a plan for recovery.

Carpal tunnel syndrome

Carpal tunnel syndrome is caused when a median nerve, which provides feeling in the wrist, thumb and fingers, is compressed and becomes swollen and inflamed. The result is a painful stiffness of the hand, wrist, or fingers. The pain also can reach an arm or shoulder.

The debilitating condition is caused by repetitive motion caused by overusing the wrist. It typically affects people who type, such as secretaries and reporters, and is common among carpenters, meat cutters, gymnasts, knitters, racquetball players, and supermarket checkers. Water retention and weight gain in pregnant women often causes them to develop carpal tunnel syndrome which disappears after the baby is born.

Treatments include halting the activity that caused the syndrome, performing the activity differently, and using a splint to keep the wrist from bending while it heals. Anti-inflammatory drugs are also used. In severe cases, a carpal tunnel sufferer may be injected with corticosteroid drugs or undergo surgery to cut the bandlike ligament that is pressing on the median nerve.

Unnecessary delays in treating carpal tunnel may cause loss of function, although the condition need not reach such a stage.