Just a few simple steps can help keep feet healthy and you happy.
Healthcare professionals are working longer hours at the hospital or in offices. The demands are higher as clinicians work three 12-hour shifts regularly. As a result, there are many more injuries and ailments seen than ever before. Our feet are connected to our body. Unfortunately, we do not think about our feet until they fail us. As clinicians, having direct access to health professionals as the first line of evaluation is imperative for optimal health.
There are number of simple, yet often forgotten, tips and parameters that should be followed to make clinicians more functional and comfortable to help avoid both short- and long-term pain and injury.
Footwear Facts
It is critical you change your shoes at least two times per shift, especially if you are working longer hours. Using the same type of shoe day after day can create mechanical problems that lead to pathological issues to the feet, legs and LS spine. You may think changing your shoes on the job won’t make a difference, but I encourage you to try it. The shoe gear should not be old. If you like a particular company or brand, you should stay with the company that works for you. It is a common misconception you must wear flat shoes. While this is not the case, heels should be avoided. There should be a differential between the heel height and forefoot rather than a platform style shoe or clog. A shoe should not be chosen based on heel height, but rather on the flex point of the forefoot of the shoe.
When purchasing a shoe, it should feel good when on in the store. There should be a very minimal or no break-in period. Once purchased, the shoe should be worn around the house for three to five days and then returned for exchange or store credit if they are still uncomfortable or not meeting your needs. When it comes to sizing, keep in mind the shoe industry does not stay true-to-size. Most shoe companies today are now running a half size to one full size smaller than previously sized. Do not go by size; go by fit. The tip of the longest toe of the foot should be at least one thumbnail spacing between the tip of the toe and the end of the shoe. When purchasing a shoe, you should also document the purchase date inside the shoe or make a note of it on your phone. This will help remind you when it is time to get a new pair.
The way shoe laces are tied also can make a big difference. I have found most people in the workforce do not tie their laces properly or tight enough. Take the time to tie your laces tightly, as loose fitting shoes and improperly tied shoes can eventually contribute to pain, deformity, overuse injuries, and even fractures. It also is critical to retie laces throughout the day, as laces can become loose based on daily activity at work and the synthetic nature of laces. The foot and shoe/sneaker should move as one unit, avoiding micromotion, which can cause injury and overuse problems. Slip-on style shoes should be used with caution, as these tend to be more convenient rather than functional, and can also cause problems.
Covering the Feet
In regard to hosiery and socks for daily use, the sock should be a cotton and acrylic blend for absorption and wicking away moisture. The sock, however, should not be 100 percent cotton as our mothers and grandmothers taught us. Below-knee compressive stockings and socks at 15-20 mmHg should be used to help the long hours of sitting and standing on feet. These socks decrease the heaviness after being on your feet for long hours, and decrease swelling and potential venous ulceration. There is also less fatigue with compressive sock use.
It is also important to address issues of prolonged sitting, standing and lifting, which are common among health professionals and can lead to misuse, overuse, and acute injury. Prolonged sitting, specifically, causes posterior hamstring and calf tightness. I often hear clinicians have no time to themselves, no time to work out, and no time to go to physical therapy or exercise class. Remember: it’s what you do off the floor that helps you perform better on the floor! Rotation exercises – as well as flexion and extension exercises, including stability and hamstring strength and flexibility – are imperative. Rotation exercises are often not included in our daily routines, but should be, considering much of our daily activity involves flexion, extension, and rotation.
Maintaining Your Health
This next strategy may sound obvious – as daily hygiene is part of a typical routine – but take a moment to think about the last time you physically bent over and washed your legs and feet. It is imperative you wash (don’t scrub), rinse, and dry well. Skin and nail issues are extremely common, but most always can be avoided by performing this task on a regular basis. Controlling the environment of dark, moist, and warm prevents yeast, fungus, skin-related dermatitis, warts, ingrown nails, and athlete’s foot. Try to avoid excessive use of liquid soap and instead opt for a bar of soap. Many liquid soaps can cause excessive drying, cracking, and scaling of skin, which sets up the potential for skin-related problems.
While taking care of the feet and wearing proper shoes can help alleviate discomfort and the other issues mentioned above, it is also important to acknowledge that the feet may be impacted by other serious health issues.
It is all too common that we see systemic problems because of healthcare demands and working long hours. As an example, acute and chronic systemic and local gout episodes because of poor diet, dehydration, excessive caffeine, excessive soft drinks, and lack of sleep or poor sleeping habits, are becoming more and more common among clinicians.
According to the Gout & Uric Acid Education Society, more than 8.3 million people in the U.S. are living with gout, yet only 10 percent are getting the ongoing treatment that they need. Gout is one of the most painful forms of arthritis, caused by an accumulation of uric acid crystals in the joints. The first signs of gout are commonly seen in the foot and ankle. Because of this, gout is sometimes misdiagnosed as a sprain or strain – or even ignored all together once the pain subsides. Not taking care of the issue, however, can lead to permanent damage and even loss of use of the joint. Any time prolonged pain or discomfort is experienced, a physician should be consulted to determine the cause of the problem and help prevent future occurrences.
The feet are connected to the rest of the body, and problems with your feet can affect your overall health and well-being. Because of this, it is imperative to have a professional perform a functional screen to determine your weaknesses, muscle imbalances, and compensation mechanisms to avoid injury, pain, and fatigue. The health professional can also rule out any problems caused by more serious systemic health issues. Once parameters are established, a program can be implemented for strengthening, flexibility, core stability, and movement patterns needed to perform daily duties with pace, efficiency, and effectiveness for long hours of patient care and our daily demands. It is also critical to have daily ergonomics evaluated so overuse injuries do not occur.
Running sneakers (not walking shoes/sneakers), specifically, are the preferred type of shoe for hospital and office work. This running shoe should have laces, not Velcro. The heel counter of the shoe should be high and firm. The toe box should be mesh. The depth of the shoe should be deep enough to possibly accommodate over-the-counter arch support pads, insole or custom orthotics. It is beneficial to physically go to a running store to select a first pair of shoes rather than ordering online or through a catalog. Only once proper shoe style, type, and sizing are correct can the shoes be ordered online if necessary. Running shoes must also be replaced periodically, with the average running shoe lasting about 435-450 miles – or five or six months – depending on usage and other factors.
