Archive For: Staying Active

Thinking on Your Feet: The Latest on Warning Signs from Below

HealthWise-Fall-2015 Hasson FINAL 1 292x300

Every step you take is a physiological marvel, made possible by the 26 bones, 33 joints and over 100 ligaments of the foot working together to ensure maximum movement. The intricate sequence begins as your heel hits the ground, and ends with a push off the big toe at the same time the Achilles tendon lifts the heel, requiring a force that is about 50 percent greater than your body weight. Now consider that during a typical day, people spend about four hours on their feet and take 8,000 to 10,000 steps – that means the feet support a combined force equivalent to several hundred tons every day.

While feet were designed to propel you through life with powerful ease, many factors can affect function. Age, obesity, long periods of standing, certain diseases such as diabetes, some types of exercise, faulty foot mechanics, overuse or misuse of muscles, even ill-fitting shoes, result in pain that can sideline even the most determined walker. However, today’s treatment of choice – a combination of non-invasive measures and time – will get most people back on their feet without the complications of surgery.

Plantar Fasciitis, the most common cause of foot pain. Although it is known as jogger’s heel, there are multiple causes of plantar fasciitis, responsible for one million visits to the physician each year. Exercise such as dance and aerobics can contribute to plantar fasciitis, as can being flatfooted or having a high arch, carrying extra weight, or working in an occupation that requires frequent standing or walking on hard surfaces. The plantar fascia is a band of tissue from the heel to the ball of your foot that supports your arch like a bowstring; too much tension on it creates small tears. Repetitive stretching and tearing causes the fascia to become inflamed and irritated, and results in a stabbing pain felt most acutely in the morning or after any period of inactivity.

Physical therapy can help relieve the pain, which is often aggravated by tight muscles in your feet and calves. Exercises to stretch the plantar fascia and Achilles tendon and strengthen lower leg muscles are often prescribed initially. Notably, one of the most effective treatments for plantar fasciitis may also be the simplest. Patients who tried slowly raising and lowering the affected heel while standing barefoot on a stair or a box, 12 times every other day, reported a vast improvement in pain and disability in three months, compared with those who adhered to a standard regimen of pulling toes toward the shins several times daily. When performing that exercise, it is best to roll a hand towel and place it under the toes to increase the amount of flexion.

In addition to therapy, other conservative measures are recommended initially, including:

  • avoid flat shoes and barefoot walking
  • cut back on activities that may aggravate the
  • condition (running, dancing, jumping)
  • over-the-counter silicone heel shoe inserts
  • short-term trial of anti-inflammatory drugs

Plantar fasciitis can persist, however, and additional treatment may include:

  •  single glucocorticoid (cortisone) injection
  • molded shoe inserts (orthotics) or arch supporting shoes
  •  night splints
  • cushioned walking boot

Fancy Footwork: Expert Advice to Keep You on Your Toes
Preventive stretching
. Add conditioning exercises to your daily routine, such as rolling your foot over a golf ball for a few minutes to work the plantar fascia ligament, or tracing the letters of the alphabet with your feet. Wrap a TheraBand (a resistance tool) around the sole of your foot while sitting on the floor with your legs straight out in front, and flex and point.

Size check. The size of your foot can change over time, especially in women whose feet become longer and wider after pregnancy. Ask for a professional measurement the next time you shoe shop.

Find the right fit. Too-tight shoes weaken the muscles in the ball of the foot and the ligaments that hold the toes straight, causing corns, ingrown nails and bunions. Make sure your shoe is roomy enough to provide a finger’s breadth between its tip and your big toe.

Stand tall, naturally. High heels are the most common cause of foot pain among women, leading to corns, calluses, bunions and neuromas (pinched nerve or nerve tumor). Choose shoes broad in the toes, with a low wedge and shock absorbent sole.

The good news: almost 90 percent of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods, say experts.

Stay Strong, Flexible and Balanced with Exercise

HW Spring 2014 Web Tipping point 300x188

Much of life is a balancing act…from learning to sit up as an infant through avoiding falls in the later years. Balance is the ability to distribute your weight in a way that enables you to remain upright and steady. This requires multiple systems in your body to be working in sync with your brain, including: the central nervous system (spinal cord), the vestibular system (inner ear), the visual system (eyes), as well as position-sensing nerves, muscles and bones.

While balance is important at every stage of life, changes associated with aging such as weaker, more inflexible muscles, slower reflexes, worsening eyesight and fewer cells in the vestibular system can affect your balance. Inner ear disorders, Parkinson’s disease, stroke, neuropathy and dips in blood pressure can also impact balance. According to the Centers for Disease Control and Prevention, at least one out of every three people over 65 experiences a fall each year.

The good news is that a wide variety of exercises, from weight training and aerobics to simple daily walks, can help you maintain and significantly improve balance as you age. A consistent regimen of training rehabilitates and strengthens muscles and improves stability and postural alignment. The benefits extend to a person’s emotional and psychological well-being. According to experts, “fear of falling” is ironically one of the biggest predictors of a fall, and faithful adherence to an exercise routine that includes balance-specific training replaces the fear with confidence.

A program to improve balance does not need to be complicated. Begin slowly with regular walks, and try simple exercises such as balancing on one foot or following along with a guided routine on a DVD. More targeted balance training may be done at a fitness center or through the use of a personal trainer or physical therapist. Professionals can assist you in conditioning the core—the set of muscles, bones and joints that link the upper and lower body and enable you to bend, twist, rotate or stand in one spot without losing your balance. An effective core workout may include exercises such as squats, lunges, twists and ab crunches. Exercise experts also can introduce you to the use of specific equipment to challenge you while improving your balance, such as a BOSU (both sides utilized) balance trainer, a stability ball, or standing on a spongy, unstable surface.

Pilates, yoga, and the ancient Chinese art of tai chi, are also excellent for improving balance and core strength. Tai chi combines meditation with slow, graceful movements and deep breathing and relaxation, helping people achieve an inner serenity. This approach benefits both mind and body, shown in multiple studies to: build up bones, stabilize joints, lower blood pressure and heart rate, bolster cardiovascular health and immunity, enhance quality of sleep, reduce stress and enhance mood. Practicing tai chi has been shown to reduce falls in seniors by up to 45 percent, and has proven effective in helping people with Parkinson’s disease achieve better balance.

A fall can occur anywhere at any time at any age. Therefore, the importance of body balance in one’s daily life should not be minimized. The American College of Sports Medicine recommends a program that combines strength, balance, flexibility and endurance. Explore one of these options you believe may work for you, call my office…and get started!

Body Mass Index (BMI)

The Body Mass Index (BMI) is a quick, easy and efficient screening tool to identify weight problems in adults. While BMI is a strong indicator of body fat percentage, it can vary for age, race and sex. It is important to note that the BMI should only be utilized as a screening tool and is not, in and of itself, diagnostic. For example, older people tend to have more body fat that those who are younger, and women tend to have more body fat than men. Also, some athletes may score a higher BMI because they have increased muscle mass; therefore, they weigh more because the weight is muscle not fat. In fact, some patients notice when they combine diet and exercise, they may go down a clothing size while their weight remains the same. Overall, learning your BMI is a great starting point for a discussion of your health goals with your physician.

How is BMI determined? Body Mass Index calculates a person’s fat level by using a complex mathematical formula based an individual’s height and weight. Automatic calculators can be found online at http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html.

Screen Shot 2014-02-27 at 3.25.01 PM

The chart to the right, created with information provided by the Centers for Disease Control, highlights BMI scores and their correlating weight status.

Once it is determined that you have a weight problem through this calculation, follow up with appropriate assessments for specific health risks that may be associated with a BMI of “underweight,” “overweight” or “obese” is recommended.

Body weight is only one indicator of disease risk. Combined with a high BMI, the following factors can place you at an even greater risk for certain diseases:

  • High blood pressure (hypertension)
  • High LDL cholesterol (“bad” cholesterol)
  • Low HDL cholesterol (“good” cholesterol)
  • High triglycerides
  • High blood glucose (sugar)
  • Family history of premature heart disease
  • Physical inactivity
  • Cigarette smoking

In conjunction with BMI numbers, a person’s waist circumference is also an effective way to assess weight and health risk. People who carry most of their fat around their waist, an appleshaped body, are at greater risk for type 2 diabetes and heart disease. The risk increases with a waist size that is more than 35 inches for women and greater than 40 inches for men. Scientific evidence shows that when people carry weight around their waistline, abdominal fat tends to surround internal organs, impairing their function. Conversely, people who carry their weight around their hips, a “pear shaped” body, accumulate fat directly under the skin, and thus the fat does not interfere with their organ function.

Just as a BMI over 25 can have negative health implications, so too can a BMI of 18.5 or lower, categorized as “underweight” for an adult. A BMI this low could indicate a variety of medical conditions. People with underweight body mass indexes are at increased risk for poor bone health, such as osteoporosis. Younger women classified as underweight may have disruptions of their menstrual cycle and difficulty getting pregnant. Other issues from being underweight can include anemia or a weakened immune system.

Together we can discuss appropriate options for diet and exercise that are tailored for you, and that will put you on the path of minimizing your future health risks. Learning your BMI is a great step in this direction.