the agony of da feet

Injuries and diseases involving the feet are considered (bad pun alert) pedestrian by most ER staff. Stubbed toes, warts, ingrown toenails, and athelete's foot are given low acuity ratings by the triage nurse. There is no smell more offensive and lingering than the funk emanating from a street person's tootsies. Feet are the Rodney Dangerfield of the human body.

Warts, corns, and callouses are usually treated by our podiatrist colleagues and more power to them. Occasionally someone will present with an infected growth on the foot, usually caused by the patient's inept and unsterile attempt at self-treatment. The diabetic's foot is a mine field for the patient and the health care professional. The loss of sensation and poor circulation associated with diabetes can lead to ulcers, gangrene, ischemia and all too often amputation of toes or parts of the foot. Good foot care includes well fitting shoes and socks, cleaning and throughly drying the foot and a regularly scheduled appointment to the podiatrist.

Arthritis can effect the joints of the foot. The foot contains lots of bones and joints (see Gray's Anatomy, the text, not the TV series). Gout, a form of arthritis has a propensity to involve the great toe. Uric acid crystals occur in the joint and lead to extreme pain, redness, and swelling. The only way to confirm the diagnosis is to stick a needle into the joint and examine the fluid under a polarizing microscope. Osteoarthritis, and rheumatoid arthritis can also cause painful and swollen joints in the feet. The poor foot has to bear the weight of the entire body. Each step can be agony when the foot joints are diseased.

Being encased in socks and shoes and having sweat glands, the feet are ripe for the growth of bacteria and fungi. The limberger cheese odor of some people's feet come from this overgrowth of microorganisms. Athelete's foot is a fungal infection that causes burning and itching. Non-prescription medication are very effective in treating this condition. Soap and water cleaning, complete drying, and frequent changing of laudered socks all help to combat these annoying infections. When the weather permits, let yours dogs breath free. Flipflops, however, should not be worn in the winter or when you are participating in sports or even prolonged walking.

Injuries to the feet can be devastating. The movements of the foot and ankle allowed us to be the bipedal hunter of the African plain. Humans can walk and run barefoot with amazing grace. A recent trend in running for exercise involves taking off the expensive shoes and going au natural.
When the bones and joints of the foot are disrupted by fracture or dislocation, the outcome can be less than ideal.

Falls from a height onto one's feet, front end MVC's where the feet are crunched against the pedals, and motorcycle or bicycle accidents often cause these crippling injuries. The ligaments and articulations of the many joints in the feet are tight and strong. This is a necessity when every foot fall can bring up to three times the body's weight onto the foot. It takes a great deal of energy to fracture or dislocate the ankle, ankle-foot and mid-foot bones and joints. X-rays and CT are needed to assess the amount of damage. Many if not most of these injuries require the skills of the orthopedic surgeon. The ER docs and PA's must have a high degree of suspicion based on the mechanism of injury.

The lowly (another bad pun) foot is not the subject of poetry or art. Bunions, veiny, discolored toenails and frequently stinky lead to jokes and neglect of proper care. Treat your feet well. Clean them, dry them, wear the appropriate foot wear for the activity (no sandals while motorcycling). The ER will be ready to treat your foot emergencies.