The neglected feet

Appeared in: Nassau Guardian

By: Shavaughn Moss

Twice yearly most people visit their dentist to ensure that there is nothing wrong with their teeth. Most people also visit the eye doctor at least once a year for an eye exam - again just to ensure that things are going well. Most people also visit their general practitioner for a yearly physical to ensure that everything is as it should be. Unfortunately, the part of the body that most people neglect is the part that takes a major beating every day - their feet.

But according to a podiatrist, your body should be separated into quadrants and you should have each quadrant checked yearly, which means your feet should be checked by a foot doctor.

"The greatest force in the universe is gravity and your feet take a major beating every day," says Dr. Daniel Johnson who practices out of The Foot and Ankle Institute on Dean's Lane. "What people don't realize is that if something goes wrong with their feet, say your arch falls, they're going to get ankle pain, they get knee pain, they get back pain, because there's a biomechanical chain from that going up, not the opposite way going down."

In his practice, Dr. Johnson deals with foot and ankle ailments from corns and calluses to bunions, heel or arch pain, injuries (foot and ankle), diabetic foot conditions, hammer toes, warts/skin problems, ingrown nails, sports medicine and foot arthritis.

The foot doctor, whose extensive academic journey began with an interest in the human mind and saw him earning degrees in Neuropsychology and in Classic Psychoanalysis, changed his focus when doctors told his mother, Sylvia Roberts Johnson (deceased), that she would lose the use of her left foot and leg due to complications of diabetes. After taking over his mother's care, Dr. Johnson says she never lost the limb that doctors wanted to remove, and that she got back up and was walking, driving her own car and traveling. He had proven the doctors wrong, that changed his focus. He turned his studies to Podiatric Medicine and Surgery and limb preservation.

Dr. Johnson says people with chronic problems like diabetes, and high blood pressure that are also overweight will have foot problems all the time and should be assessed on an ongoing basis like going to the dentist.

"You don't wait until you get a cavity to go to the dentist. You go every year, you get a cleaning, you see something you repair it. That's the same way you want to treat the rest of your body. Like your eyes, you get a check-up annually. You see a bleed, you repair it, you don't wait for something major to happen."

Tonya Tynes is one of those persons who wishes she had seen a foot doctor as soon as she felt a pain in her big toe which wouldn't go away.

In mid-Septembr 2009 she says she fell, hitting her toe on a step she felt a little pain, but thought it would be okay and needed a few days to stop being sore. She ditched her shoes for sandals to give her toe some relief, and thought nothing of it after that.

Three weeks after the initial fall, and the pain still persistent she decided to see a doctor and went to a walk in clinic where she was diagnosed with a damaged ligament and told it would take two to three weeks to heal. By November, Tynes said her toe was still painful, but she still didn't think to do anything about it. In early December, with the pain still persistent and knowing that she was heading off to a cold U.S. state for the Christmas holidays, and knowing that she would have to wear shoes, she decided to visit a foot doctor. She was diagnosed with a broken cartilage. Since her return in early January, she has had to visit the foot doctor three times per week, and says she now realizes if she'd gone to see the proper medical practitioner earlier she probably wouldn't still be suffering.

According to Dr. Johnson, not just Bahamians, but people the world over take their feet for granted.

"Podiatric surgery is akin to dentistry, as it was many years ago - people went to the dentist when they had a toothache, otherwise they never went. But in that age, basically you went to the dentist and had the tooth extracted because by the time it's hurting you that much the tooth is destroyed. Same thing with podiatric - people would only go to the doctor for foot and ankle surgery if they had severe pain and injury, ankle pain or banged the foot."

Dr. Johnson who focuses on lower extremity amputation prevention in diabetics says many of his patients now do annual foot checkups which allows him to correct any changes that he sees.

According to the foot doctor, many people who have limbs amputated simply missed the warning signs. "They missed the vascular change, missed the neurological change, missed the boney problem, missed the arthritic crisis, and got their foot cut off. If you practice prevention with foot care, you reduce your rate of amputation. He says that less than 10 percent of people really needed to have an amputation, and that the removal of a limb could be avoided through early detection and treatment.

According to Dr. Johnson it costs $40,000 for an amputation procedure, and about $400 for a preventive program where you visit your health care practitioner annually and make sure you never have an amputation.

"Amputations start out with ingrown toe nails, blisters, a little heel pain, a cut on the back of the ankle, sore on the inside, varicose veins, discoloration, swollen legs. It looks so simple and innocuous. That changes the blood flow, blood flow damages the skin, you get an infection, it hits bone, you lose your foot."

The foot doctor said that many changes occur in people's feet that are warning signs of the conditions."

People with any of the risk factors - hypertension, cancer, boney problems, arthritis, rheumatoid arthritis or gout should see a doctor as soon as they see any change in their body. He further said when people get their annual exam from their family practitioner they should ensure that the examination is done from head to toe. That exam he says should take half-an-hour to an hour.

Dr. Johnson has seen the impact of amputation, which he says is preventable. He says amputation is connected to lifestyle diseases - diabetes, hypertension, cancer, arthritis, obesity which are connected to simple things that people can change, which could change the outcome.

According to the doctor, there are 50,000 diagnosed diabetics in The Bahamas, and only two podiatrists.

Dr. Johnson encourages Bahamians to pay attention to their bodies and to examine their feet, and observe appropriate hygiene taking a day during the week to care for their nails. He says to always wear accommodating footwear that is comfortable.

"Avoid dangerous high fashion - whatever that may mean for various people. I was at the shoe store the other day, I asked for a size nine, the guy says I only have a 10. Why would I want to wear that? That's all kinds of problems. Then a lady came in and asked for a nine in a shoe, they said they only have an 8 1/2 and she said she would take that. That's what I mean by dangerous high fashion - wearing it just because. Try to avoid it as best you can."

He also says that everyone should have some level of professional help when it comes to their feet.



* Do you have pain in your feet?

* Are you on your feet all day?

* Do you have skin or nail problems (ingrown or discolored toenails), corns, skin rashes, areas of hard skin on your feet)?

* Do you have any sores on your feet that are not healing?

* Do you have foot odor?

* Do you have a foot injury?

* Do you have health problems such as diabetes or arthritis?

* Do you trip or fall often?

* Do you have problems finding shoes that fit comfortably?

* Do you have lumps or bumps, bunions or misshapen toes?

* Do you regularly wear heals that are two inches or higher?

If you answered yes to one or more of these questions you need to see a podiatrist.


* Don't ignore foot pain - it's not normal. If the pain persists, see a podiatrist.

* Inspect your feet regularly. Pay attention to changes in color and temperature of your feet. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin.

* Peeling or scaling of the soles of feet could indicate athlete'' foot. Any growth on the foot is not considered normal.

* Wash your feet regularly, especially between the toes, and be sure to dry them completely.

* Trim toenails straight across, but not too short. Be careful not to cut nails in corners on or the sides, it can lead to ingrown toenails. Persons with diabetes, poor circulation or heart problems should not treat their own feet because they are more prone to infection.

* Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest, and replace worn out shoes as soon as possible.

* Select and wear the right shoe for the right activity that you are engaged in (example, running shoes for running).

* Alternate shoes - don't wear the same pair of shoes every day.

* Avoid walking barefooted - your feet will be more prone to injury and infection. At the beach or when wearing sandals always use sun block on your feet, just as you do on the rest of your body.

* Be cautious when using home remedies for foot ailments; self-treatment can often turn a minor problem into a major one.

If you have diabetes, it is vital that you see a podiatrist at least once a year for a check-up.

Daniel Johnson, DPM, graduated from the California School of Podiatric Medicine (CSPM) formerly known as California College of Podiatric Medicine (CCPM), in 1978.


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