Scott Webb (Host): Most of us don't think about the health of our feet and ankles unless we have to. But there are a number of things that we can do to keep our lower extremities healthy. And my guest is here today to share her expertise and perspectives. And I'm joined today by Dr. Sarah Lewis. She's a Foot and Ankle surgeon with HealthFirst.

This is Putting Your HealthFirst, the podcast from HealthFirst. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about foot health and what that means exactly, and cover a wide range of topics. I told you that I have plantar fasciitis, so this podcast isn't just for me, it's for everybody, and perhaps those who are also suffering from plantars. But let's just start there. What exactly does that mean? When I say foot health, what does that mean to you?

Dr. Sara Lewis: I think, to me, foot health is having two healthy feet that can allow us to do what we would like to do on a day-to-day basis. I think, in general, foot health is critical to our overall quality of life. Therefore, taking care of our feet is very important.

Host: Yeah. I wonder just how often we think of our feet. I know you think of feet a lot, right? And maybe all that you think about most days. But, you know, for the rest of us, how often do we really think of our feet and take care of our feet? And I guess just to get a sense from you, like why is it so important? Does perhaps taking care of our feet or not doing that really have a lasting impact on our bodies?

Dr. Sara Lewis: I think a lot of times we often take our feet and ankles for granted, and we don't realize how much we depend on our lower extremities on a day-to-day basis until something occurs, such as an injury that causes pain or limits our mobility. So, I think, in general, foot health definitely has a lasting impact on not only our bodies, but also on our careers and passions, and even on our mental health.

You know, being able to have two pain-free functioning lower extremities is a gift that allows us to continue to work in jobs that requires to be on our feet or allow us to explore the world through various passions, such as like hiking, mountaineering, and running. But I also think it's important to note that just because someone has lost a limb or has had partial loss of a limb, they also can continue to live a very happy and healthy lifestyle as well. With today's technology, there continues to be advancements in prosthetics that allow our patients to continue to live very active lifestyles.

Host: Yeah, for sure. And I definitely know what I've been suffering from the last few months, I wouldn't wish it on my worst enemy. Like when I used to hear that people had plantar fasciitis, I was like, "Oh, get back in the game. You'll be fine." You know, "Rub some dirt on it." I had no idea just how sort of debilitating it was, how much it was going to affect my quality of life. And we'll get to that. But just in general, what are some things that we can do for better foot health?

Dr. Sara Lewis: I think there's varying things that we can do to increase our foot health. And I think it depends on each person, their medical history, their foot type, and overall the goals they're trying to achieve. But in general, things the general public can do for better foot health are washing our feet with soap and water daily, making sure we get in between the toes, drying our feet thoroughly before putting socks and shoes on.

If we have special areas that tend to be more dried or cracked skin, applying lotion to these areas. Wearing supportive, comfortable shoe wear. Avoiding barefoot walking in public places. And frequently stretching our calves. Because as you've alluded to, a lot of people deal with plantar fasciitis, especially in middle age and elderly age, and a lot of times, because as we get older, our flexibility decreases and the lack of mobility really can lead to a lot of foot and ankle issues.

Host: Yeah, it really can. And, you know, doctor, walking around Florida, I see a lot of people strolling around in flip-flops, they look real comfortable, you know, or I see folks even barefoot, walking down the sidewalk. Are those good options for foot health?

Dr. Sara Lewis: As a native born and raised in Satellite Beach, a street from the beach, I myself am a flip-flop girl. I do advise my patients though of an 80/20 rule. So I recommend 80% of the time trying to be in a good supportive shoe. There are definitely some flip-flop brands that tend to have better arch support and support in general compared to others. My personal favorite brand for flip-flops is OluKai, but there are a lot of good brands out there. And I also do see a lot of people walking barefoot. But for me, from a professional standpoint, I'm not a huge fan, especially outside of your own home. There are just so many objects on the ground that can penetrate the foot leading to infections such as glass, dirty needles, or even small pebbles.

Host: Yeah. Yeah. And now, doctor, when I was younger, I used to buy shoes based on how they looked. And then, I would worry later about whether or not they were comfortable and they actually fit well and all that. My daughter's 17, she's a basketball player, so, you know, if a shoe looks cool, that's probably her highest priority. But I want to get a sense from you, when we're shopping for shoes, trying to find shoes just for everyday life, you know, what should we be looking for, maybe for those who work in offices, that kind of thing? Like, what are your recommendations?

Dr. Sara Lewis: Sure. And I think that there's been more of a trend for comfortable shoes. You'll see, like even in big cities, women will walk to work in their comfortable shoes and they'll bring like their flats or their high heels in their work bag. So, I think there is a trend going to more comfort as opposed to fashion. The question of good options for shoes, this is always such a hard question to answer. I typically tell my lady patients that it's like finding a good pair of jeans that fit. Every body shape and everybody's preference is different. But overall, my recommendation is finding something that's comfortable, that doesn't rub or cause blisters, and a shoe that is definitely not too big or too small because both of those can cause other issues.

There are many good shoe brands out there today. Over the past decade or so, a lot of money and time for research and design has gone into the shoe industry. My personal favorite for athletic shoes are Brooks, Altra Hoka, Asics, and New Balance. And then, there are a couple of options for work shoes such as Birkenstock or Clarks. But again, I think just finding the right fit for each individual patient is the most important.

Host: Yeah. Maybe this is pun intended, but there's no one-size-fits-all. I just want to find out from you, like are there warning signs for foot issues that we should maybe be on the lookout for? I mean, in my know, in my case, just pain. My foot hurts. But are there some other warning signs?

Dr. Sara Lewis: In general the number one issue would be a new onset of pain. I think that's a big indication of an underlying issue for a lot of patients.

Another thing for patients to be on lookout for is neuropathy, which can lead to numbness, which can become an issue, especially for patients who are diabetic. Significant changes in muscle strength or size of muscles, the way that you're walking, if there's a major change in your gait pattern, frequently tripping or falling, or if you notice any new soft tissue masses or localized swelling in area, those would all be warning signs that you should probably try to get in with your local podiatrist.

Host: Yeah. And as I were saying before, you know, a lot of us don't think about our feet or maybe just ourselves medically, until there's a problem, right? We go to the doctor when we're sick or when something hurts. But as you say, there are some warning signs, of course. So, let's talk about some of the causes, the greatest hits, if you will, of foot pain.

Dr. Sara Lewis: I think the most common non-traumatic, meaning no injury-related causes of foot pain are plantar fasciitis, Achilles tendonitis, flat feet, arthritis, bunions, and hammer toes, along with other foot deformities. And the common traumatic injuries that we deal with in the foot and ankle are just general sprains, fractures, tendon ruptures, or injuries of the foot and ankle.

Host: Yeah. And I had mentioned, plantar fasciitis. I want to have you explain that, like what that is and go really slow for me, because I'm just a lay person here. Really explain that and how I could have prevented it. And then, what we should be doing for treatment.

Dr. Sara Lewis: Plantar fasciitis is one of the most common things that podiatrists typically see in our office. It's a common condition that causes heel pain. It is inflammation of a soft tissue structure that basically starts underneath the heel bone and runs along the arch of the foot to the toes. The plantar fascia helps support our arch, and absorb shock during walking and running.

Plantar fasciitis can be prevented by stretching the calves and plantar fascia, and utilizing good, supportive shoes. Once somebody comes to me and they have plantar fasciitis, I talk to them about several treatments that they can perform on their own at home, including changing their shoe wear, possibly adding in an arch support insert, avoiding barefoot walking.

I frequently educate my patients on stretching not only the plantar fascia, but the back of the calf. Patients can freeze a water bottle and roll their arch back and forth over the water bottle. This ices, stretches and massages the plantar fascia. Patients can also perform manual massage at the arch with different over-the-counter topical pain alleviators. Another option is obtaining a night splint, which can help prevent the foot from dropping and causing increased tightness of the plantar fascia and the calf. And if no medical contraindications, patients can certainly try anti-inflammatories over-the-counter as well.

Host: Okay. I'm just taking some notes here for myself. Freeze a water bottle. Got it. Good stuff. Thank you so much.

Dr. Sara Lewis: Oh, you're welcome.

Scott Webb: Yeah. So, how about bunions and hammer toes? Are those things that we can prevent and what are some of the treatment options?

Dr. Sara Lewis: There are a lot of reasons why bunions and hammer toes occur. We can try to avoid bunions and hammer toes by wearing appropriately-fitted shoes that have a wider toe box. We should try to avoid tight fitting shoes, shoes that have a small toe box or high heels that put a lot of pressure and weight to the front of our foot.

When somebody does have a bunion or hammer toe, there are ways to slow the progression of those, such as utilizing a toe separator or a bunion protector. And for hammer toes, wearing things such as a hammer toe crest pad. But unfortunately, once a bunion or hammer toe deformity is present, it will not go away without more aggressive care.

Host: Yeah. And this is sort of related. I saw a picture recently, doctor, of LeBron James' foot, you know, and his toes. You're talking about these types of things, bunions, hammer toes, things like that, these sort of deformities in a way that, once you have them, they're not probably going to go away. And it was pretty gruesome. And I guess I'm just trying to get a sense from you, like, how can we prevent some of this stuff? Like, should we just not play basketball for 40 years? Would that be a start?

Dr. Sara Lewis: No. Being a prior college athlete, I played soccer for several years. I'm all for people remaining active. I think we just have to really find comfortable, supportive shoes. And our shoe wear is just so critical to preventing long-term foot issues.

Host: Yeah. When we think about at home, you gave us a sense there about planners. But just things like, should we be doing things on a daily basis? Are there things that we can do to bring some relief to our feet and, you know, before we go to bed and sort of prepare us for the next day? Like, what can we do at home?

Dr. Sara Lewis: One of the simplest things that patients can do if they're having foot pain, especially at the end of the evening when they get home from work, is icing and elevating or soaking their feet in Epsom salt and warm water.

There are a lot of over-the-counter home treatment options depending on the issue. For example, over-the-counter topical medications are good to help with pain such as tendonitis or arthritis. There are several options including Biofreeze or Voltaren Gel. Lidocaine patches are also a great pain alleviator. We commonly think about utilizing lidocaine patches for our back, but we can also cut those into smaller strips and utilize them on our foot and ankle.

I think another simple fix is, if a patient is walking barefoot in their home and has certain conditions, just simply getting a supportive shoe. It could even be a slide or a flip-flop, but trying to prevent the barefoot walking in the home. When a patient has a new injury, you know, rest, ice, compression, elevation are a great start. And then, performing stretching exercises just to try to keep our mobility again with that calf in the plantar fascia to try and prevent common conditions such as plantar fasciitis and Achilles tendinitis.

Host: Right. Are there some diseases or health conditions-- I'm thinking like maybe diabetes-- that can contribute to foot pain. And for those that are affected, what can they do to sort of prevent some of these foot health issues?

Dr. Sara Lewis: I think diabetics can be affected certainly by a lot of foot and ankle issues. Most of these are stemming from something called neuropathy, which we kind of touched on earlier. And neuropathy can lead to a lack of sensation. Frequently, this lack of sensation can then lead to over wear and tear of the skin and soft tissues without the patient feeling it, which can lead to wounds and unfortunately sometimes even bone infection and limb loss.

So, my greatest advice to diabetics is to make sure they're controlling their sugars and keeping their A1c in the range that their primary care or endocrinologist has recommended for them. Other patients that experience increased foot issues are smokers. Unfortunately, they can deal with increased foot pain due to lack of blood flow and oxygenation to the lower extremities, so even just cutting back on smoking. Optimally, it would be for them to quit smoking altogether.

And then, other conditions that we less commonly think of, but actually can cause a lot of foot and ankle issues and pain, are conditions such as rheumatoid arthritis or psoriatic arthritis that can lead to severe bunions or hammer toes. And then, also, patients who have had severe traumatic injuries. They can end up with something called post-traumatic arthritis, which can lead to a lot of pain, throbbing, aching day to day for those patients.

Host: Right. So, maybe the $64,000-question for folks that are old enough to get that reference, and you're probably not, but that's okay, when do we reach out to someone like yourself? Like, when is it time to see a podiatrist for our foot issues?

Dr. Sara Lewis: Someone should see a podiatrist not only foot issues, but also foot and ankle issues. And I feel like if you're dealing with a new onset of pain or having a new issue with your foot or ankle, or even the calf, I would recommend patients seeking out care. I know here in Brevard County, we have lots of great podiatrists who are ready and willing to help guide you with your foot and ankle conditions, so they'd be more than happy to help you out.

Host: Right. All right. Lastly here, doctor, just want to get a sense from you, like if you could give one piece of advice, the thing that you wish everyone knew about their feet, what would it be?

Dr. Sara Lewis: I think again, just touching back, finding a few good pair of shoes that fit you well and are comfortable for you to wear for several hours. That's my biggest piece of advice for foot health.

Host: Yeah, good shoes. They don't necessarily have to be expensive, right? But just the right shoes, good shoes.

Dr. Sara Lewis: Yep. The right shoes for you.

Host: That's it. That's perfect. Well, thank you so much for your time today. Appreciate it.

Dr. Sara Lewis: Thank you. Thank you for having me.

Host: And don't let foot pain stop you in your tracks. To learn more and schedule an appointment with a HealthFirst foot and ankle surgeon or podiatrist, visit hf.org/ortho. And if you enjoyed this episode, please be sure to tell a friend, share on social media, and check out our entire podcast library. We look forward to you joining us again.