Interview with Dr Myriam Barroso, from Hospital Ochoa’s podiatry service.
Feet are one of the most important parts of our bodies. They provide the balance we need in order not to fall over, they keep us upright, and they are in charge of walking. They are our shock absorbers and they help cushion all floor impacts. But do we give them the care and attention they deserve? Do we know the basic guidelines for keeping this part of the musculoskeletal system healthy? We talked to Myriam Barroso, a podiatrist at Hospital Ochoa, about these and many other issues.
I imagine that going to the podiatrist today is not the same as it was two decades ago. Has this field changed a lot in recent years?
It’s actually changed quite a lot. In the old days, we used to think of the podiatrist as the person who was exclusively dedicated to cutting nails and removing calluses. The figure of the podiatrist is now much broader because, in addition they perform foot footstep studies, injections, ultrasounds, and surgeries to improve patients’ quality of life, as well as prescribe medicines.
Should everyone go to a podiatrist to learn the mechanics of their feet?
That would be advisable. Sometimes we feel pain in other parts of our bodies such as knees, hips or back, and this may be due to a bad tread, and can be corrected with a simple insole. This would prevent certain disorders. If we wish to identify issues and make corrections, it is a good idea for children to see a podiatrist between the age of three and eight. The later we leave it, the more difficult it becomes and, rather than correcting the defect, we just compensate for it.
What is the most widespread error regarding our feet?
Maybe it’s self-treatment. People often go to the pharmacy and ask for medication for something they think they have, but in actual fact they are purchasing medication that they do not know whether they need, or whether it will cure their ailment.
Do people give their feet the importance they deserve? Are they the part of the body that endures the most wear and tear?
Feet are one of the body parts that endures the most wear and tear, and it is true that people do not give their feet the importance they deserve. I think the reason is that because we cover them with footwear they are not as visible as, say, a smile, which stands out in plain sight. We are on our feet all the time and, depending on our physical activity, work or sport, they will endure more strain.
How many health issues can be avoided by looking after our feet?
Lots. We can avoid fungal infections such as plantar warts, which are usually contracted by walking barefoot in damp areas such as public showers and swimming pools. Toenails can become ingrown and infected if they are not trimmed correctly. Calluses can be prevented with the use of insoles. By going to a specialist, many pathologies can be prevented, including some hip, knee and back problems.
What are the most common health issues: orthopaedic ones or fungal infections? And which have the greatest impact on quality of life?
It depends on the season. In summer we see many patients with athlete’s foot caused by a fungus on the sole of the foot, and frequent cases of plantar warts and other infections. During the rest of the year, orthopaedic cases predominate, which are the most complex because, in many cases, they require surgical treatment. The ones that cause the greatest impact on quality of life are related to deformities that can last for years and, sometimes, the lack of awareness prevents the patient from considering the possibility of an intervention that alleviates the pain or discomfort.
Is this a branch of medicine where prevention is important?
Yes, and so is education. It is important that children are educated from an early age to take care of their feet and go to the podiatrist, in the same way that we try to guide them, for example, regarding dental health.
Nowadays people wear athletic footwear on a daily basis, and shoes made of harder materials are no longer in use. Is this beneficial on an orthopaedic level?
Our main priority should always be comfort when choosing shoes. It is true that shoes made of hard materials, such as plastic, are used less frequently because they can cause pain; it should be noted that although athletic footwear is generally better, it should not be overused because excessive cushioning also entails greater energy expenditure. When walking, the ground returns the force of the foot’s impact, and the softer the shoe’s sole the lower the force. For example, walking on wet sand will always be less taxing than walking on dry sand.
Are summer sandals the worst footwear?
In general, sandals and very high heels are not ideal footwear. Flip-flops do not support the ankle, and this causes our toes to form a claw shape in order to keep the sandal in place, which can cause a claw-like toe deformity. Being so flat, sandals can also cause plantar fasciitis. High heels can cause problems with our hips and knees, and even a shortening of our calves.
I have read that the health of our feet can even affect our mental state. Is this true?
That’s right, all pathologies can affect our mental state. Pain or discomfort will end up influencing the patient’s emotional state because they will be unhappy with discomfort that is not only physical, but also internal.
Many athletes learn the optimal mechanics for running, but is there a proper way to walk?
Yes, there is a proper way to walk. Podiatrists study the patient’s biomechanics and pathological mechanics, which are sometimes difficult to correct due to femoral anteversions or internal tibial rotations. In such cases we compensate with the help of insoles.
What advice can you give us for maintaining healthy feet and legs?
The most important thing is to pay attention to daily hygiene: wash your feet and change your socks, preferably made of cotton so that they can breathe. Wear correct footwear that supports your feet and allows you to walk comfortably without your feet feeling squeezed. Heavy footwear makes our legs feel tired, so shoes should preferably be light. It is also important to cut your toe nails properly, and to always wear flip-flops in public showers in order to prevent contagion.
Should people with diabetes take special care of their feet?
Yes. Diabetics have neuropathies (loss of sensitivity) and vasculopathies (their blood does not circulate properly). So when an injury occurs diabetics often fail to detect it, and due to their insufficient blood circulation the injury may not heal as it should, which may lead to ulcers, and in more serious cases, amputations.
Where is the future of podiatry heading?
In the future, there should be much more basic education of podiatry from a very early age so that the population at large gains better awareness. I believe that podiatry should be covered by the public health system, thus avoiding many amputations in diabetic patients who, at present, are not being monitored adequately because they do not have access to specialists in this field.
In terms of technology, a great deal of progress is being made in the manufacture of orthopaedic insoles. Although materials such as phenol foam are still used today, the CAD-CAM system has emerged. This 3D scanner analyses the footprint and prints a customised die-cut insole in three dimensions. Platelet-rich plasma is another key element of the present and future. It is injected, for example, in cases of plantar fasciitis or bunion surgery, because these stem cells accelerate the process of bone healing.