Foot Care
with John Schuller, M.D.
John Schuller, M.D., a podiatrist with Advanced Healthcare, described the majority of his patients are walk-ins, though hobble-ins is likely a better term. "Most of my patients have a pretty clear way of knowing they need to see a physician. It's called pain," he said.
The pain comes from many problems, including corns and calluses and plantar fasciitis (inflammation of the soft tissue that extends from heel to the ball of the foot).
"There is really is a large range of joint and soft tissue problems based on malalignment of the foot structure and the type of compensation that one goes through because of it. This is most evident, in layman's language, in flat feet, a problem which causes a huge number of problems," Dr. Schuller said.
While the doctor prefers to treat foot problems without surgery, he does do soft-tissue surgery, usually to cut or lengthen a tendon, redirect a tendon to stabilize a joint, permanent nail removal because of disease, removal of cysts, injections for pain and other procedures.
Who is at risk?
These two groups of people are most likely in need to see a foot specialist sometime in their lives are:
• Those who are genetically predisposed to foot problems, often because they were born with a tendency to flat feet or malaligned joints such as with club feet.
• Those who have jobs which keep them on their feet a lot. This would include those who walk or stand a lot, though standing is a lot harder on feet than walking.
"Your muscles are made to contract and relax as you go through your gait. In standing you demand that your muscles contract and hold…hold…hold. Feet just aren't made for that," Dr. Schuller explained.
John Schuller, M.D., Podiatrist
Advanced Healthcare
"The majority of foot problems can often be taken care of without surgery. These include arthritic foot pain, neuromas (localized inflammation of a nerve) and bunions."
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Avoiding Foot Problems
Foot problems have always existed. "Before flat surfaces, the uneven surfaces our ancestors walked on could have exacerbated their aching feet and ankles. The problem with many modern surfaces is that they are less shock absorbent," Dr. Schuller said.
Proper fitting shoes help keep feet pain free. "A good pair of oxford style shoes will provide for proper alignment, but a pair of women's fashion shoes puts style far over proper function. People should wear shoes which don't put excessive pressure on any one area and seek professional attention if foot pain persists for more than month after trying over-the-counter arch supports," he said.
The doctor advises that the single most important thing for individuals to do to protect their feet is to stretch the muscles of the Achilles tendon. "From a biomechanical standpoint the two biggest factors for foot problems are too much motion in the arch and not enough motion at the ankle so the leg can't flex far enough forward without the heel lifting. Controlling the excessive motion in the feet with proper fitting shoes, including arch supports when necessary, and increasing the range of motion in the ankle with stretching can together offer significant protection," Dr. Schuller said.
Benefits of healthy feet
In a properly aligned foot, the bones bear the weight and the soft tissue holds the bones in the right position. "When things are not aligned properly, the soft tissue becomes at least partially weight bearing, which is not its function," the doctor explained.
Alignment is usually done with arch supports. People can try over-the-counter supports first. They can also be fitted for custom arch supports that redistribute weight in the arch, or for devices to adjust the angle on the heel or ball of the foot.
"My advice is that someone seek professional attention if foot pain persists for more than a month after trying over-the-counter arch supports," Dr. Schuller said.
When problems require it, Dr. Schuller refers his patients to orthopaedic surgeons, rheumatologists (specialists in treating inflammation) neurologists (who deal with problems in the nerves) and physiatrists (doctors who specialize in physical therapy) "Neurologists and physiatrists are consulted because sometimes nerve pressure in the trunk will cause pain in the foot," the doctor explained.
