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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

What Your Doctor Is Saying What Your Doctor Is Saying

Feet Matter

September 12, 2012

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center

Healthy Lifestyle
What Your Doctor Is Saying
Feet Matter
Feet Matter
Feet are important. Until you've had a foot problem, you may not realize just how important they are.
Harvard Medical School Commentary

There's little doubt about it: Feet are important. Until you've had a foot problem, you may not realize just how important they are.

In medical school, I had a professor who said, "You can't cheat on your feet." He meant that while you could rest a sore elbow or shoulder, you can't do much with a bad foot.

While the same could be said of ankles, knees and hips, the foot is a rather small structure that must bear the full weight (or more) of your body during everyday activities, such as walking or running. It's remarkable that the foot can do its job so well most of the time.

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Important Foot Terms

Medical terminology reflects the importance of feet. Many terms come from the Latin (pes) or Greek (pous or podos) words for foot. There are pages of words in my medical dictionary referring to foot-related problems. Here are just a few of my favorites — and the most useful.

    • Pes planus – An abnormally flat foot (a foot with little or no arch)
    • Pes cavus – An abnormally high arch
    • Podagra – A combination of "pod" and "agra" (meaning seizure), this term refers to sudden pain in the first toe, a condition most commonly caused by gout
    • Podiatrist – A foot specialist
    • Plantar fasciitis – An inflammation of the tough, specialized ligaments that line the foot's arch; this common condition causes the sole of the foot to be painful, especially first thing in the morning
    • Bunion – A firm, painful bump that forms over a bony bulge at the base of the big toe. In most cases, the big toe joint also is enlarged and has degenerative arthritis. The toe also may be pushed toward the other toes.

Of course, plenty of words deal with the feet that aren't particularly medical. Pedicure, pedal, and pedometer (a gadget that counts the number of steps you take) are good examples.

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Feet: Window to Your Health

Most foot problems are just about your feet. They may be due to an injury or improper footwear. Bunions, for example, may be caused by wearing shoes that are too tight. Many foot problems are preventable.

But, there are a number of body-wide (systemic) conditions that can also affect the feet. Sometimes, the first indication of trouble is in the feet. Among the most important are:

    • Diabetes – Numbness or tingling in the feet may be an early sign of neuropathy (nerve disease) due to diabetes. People with diabetes may have reduced sensation and poor circulation in their feet. This makes them susceptible to skin ulcers and infection. That's why people with diabetes have to keep a close eye on the skin of their feet.
    • Peripheral arterial disease (PAD) – Cool toes with a purple or deep red discoloration may be an indication of PAD. With PAD, not enough blood flows to the legs. With or without diabetes, poor circulation in the feet can lead to unhealthy skin that heals poorly.
    • Systemic infection – Certain infections tend to cause rashes or other foot abnormalities. For example, hand-foot-mouth disease is caused by Coxsackievirus that spreads from the throat to the rest of the body. Small blisters on the hands and feet are typical. Heart-valve infections and syphilis are other infections that can cause a rash on the feet.
    • Lung disease – People with cystic fibrosis, lung cancer and other lung diseases may have "clubbing" of the toenails. The nail is rounded, like a dome, as it grows. Clubbing can also affect the fingernails and is seen in many other diseases as well.
    • Swelling – If your feet swell at the end of the day (with improvement first thing in the morning), you may have "edema" or excess fluid accumulating in your feet. Although there are many causes, edema could be a sign of kidney, liver or heart disease.

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The Bottom Line

Take care of your feet. Resist the temptation to cram them into highly fashionable shoes that, oddly enough, are not shaped like your foot. Bring questions about your feet to your doctor — it might be good for your feet and for the rest of you.

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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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