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Feet are the whipping boys of the body. With every mile we walk, 200,000 to 300,000 pounds of stress bears down on our tootsies, and by the time we’re 50, most of us have walked 75,000 miles. That’s a lot of action for two narrow islands of 26 bones and more than 30 joints. And yet despite the central role feet play in our lives, most of us ignore them.

Experts say orthopaedic disorders, including foot problems, are a leading cause of inactivity and disability in the United States. “Feet degenerate like tires on cars,” says Washington, D.C.-based podiatrist Arnold Ravick, a spokesperson for the American Podiatric Association. “Just like the rest of our body, our feet spread out, muscles weaken and skin thins.”

We begin to lose flexibility and elasticity, and our shock absorbers simply don’t work as well as they used to. Add arthritis, and you have a double whammy. Joints inflamed and distorted by arthritis find no comfort from a day’s pounding in ill-fitting shoes or from feet whose padding has grown thin.

If we pay attention to our feet, we can head off potential problems. If we already have arthritis, more surveillance and care taking of our feet and joints not only makes sense, it’s crucial.

What Years Bring

Feet age as the rest of our body does. Around our mid-40s, joints creak and joint tissues stiffen. Our feet begin to lose their once-plump cushion. “If you think of a honeycomb, that’s what the anatomy of your heel looks like, honeycomb-shaped sacs filled with fat,” explains Glenn Pfeffer, MD, an orthopaedic surgeon specializing in feet and ankles, and assistant clinical professor at the University of California in San Francisco. “Each sac is a beautifully constructed pillow made to decrease the stress walking puts on our bodies. Without those pillows, it can begin to feel like you’re walking on pebbles.”

Our feet also change size from fluid retention, loosening ligaments and the flattening effects of gravity and weight. Heredity pops up as well – a predisposition to flattened arches, for example, or pronated feet (feet that turn toward the inside of the arch, placing abnormal stress on the foot muscles).

Years of wearing the wrong shoes also take their toll. Problems can crop up like bunions (an enlargement of the bone and tissue around the joint of the big toe), hammertoes (a buckling, or contraction, of the toes) or neuromas (an irritated nerve often between the third and fourth toes). As we enter our fifth and sixth decades, our feet are in our face, so to speak.

Add Arthritis to the Mix
Neglect foot problems, and we’re much more likely to develop osteoarthritis (OA) in our feet. In fact, almost half of people in their 60s and 70s have arthritis affecting the foot or ankle.

As the condition progresses, bony spurs form around joints and limit movement. “You can have a painful foot from wearing high heels or running too much,” says Sharon Feldmann, a physical therapist and orthopaedic specialist at the Arthritis Center of the Rehabilitation Institute of Chicago. “But it’s not arthritis until the irritation changes the joint tissues. Once there’s enough damage to initiate inflammation, then you have an arthritic foot, not just a painful one.”

Another problem is that pain – whether it’s from arthritis or other foot problems – changes the way we walk. And once we change the way we use our feet, we also change the way we turn our ankles, knees, hips and spine. “If you have a limp, you put more weight on one leg than the other,” says Anastasia Willis, a physical therapist who works in the arthritis program at the Schwab Rehabilitation Hospital in Chicago. “Then you have more stress on the other foot. It’s almost as if your body is a tower of stacked blocks. If you move one block, all the other blocks have to shift so the tower doesn’t fall.”

“You’re caught in a vicious cycle,” Feldmann agrees. “If you pronate (tilt your foot to the inside), for instance, cartilage in the ankle degenerates, causing you to pronate more, further wearing out the cartilage. That causes stress on the knee joint, forcing the knee to turn in and then you have a non-alignment of the knee, which can degenerate the outside of the knee joint. When the foot isn’t aligned, it affects everything – the way the knee, hip, pelvis or lower back is stressed. And if stress is abnormal, it leads to problems in those joints, which may result in deterioration of joint surfaces, or arthritis.” If you already have arthritis, joint difficulties worsen.

Prevention: A Necessary Step
“If your hand looked as beat up as your foot looks,” says podiatrist Arthur E. Helfand, chairman of the Department of Community Health, Aging and Health Policy at Temple University School of Medicine in Philadelphia, “you’d do more to take care of it.” It’s true most of us ignore our feet, but most problems can be avoided or corrected if we pay attention.

If you already have arthritis, have your feet checked by a rheumatologist, an orthopaedic surgeon or a podiatrist experienced with arthritis. Your doctor will likely suggest X-rays, determine any problems and prescribe a treatment plan.

Whether you have arthritis or not, your foot problems probably stem from or are exacerbated by ill-fitting shoes. “Hammertoes, neuroma and bunions are conditions in which the foot is beginning to take the shape of the shoe,” Dr. Pfeffer says. “But wear a more comfortable shoe, and it’s like getting a facelift without the surgery. A lower heel and roomier shoe box will make a foot feel young again.”

Shoes that fit and feel good are even more important for people who have arthritis, says rheumatologist Roland Chang, MD, director of the Arthritis Center at the Rehabilitation Institute of Chicago. “Often people with rheumatoid arthritis will lose their arch, so they need arch support. And joint capsules stretch as a result of inflammation.”

Another key to foot health is exercise. Stretching out the Achilles tendon (the cord at the back of the heel) and the tendons in the balls of your feet and toes can minimize stiffness and pain. “A foot that doesn’t have mobility will have abnormal stresses,” says Feldmann.

If your feet continue to be sore, consider self-massage, kneading the ball of your foot and your toes top to bottom. For pain, Helfand suggests nonsteroidal anti-inflammatory drugs, heat and ultrasound. Topical medications such as those containing capsaicin sometimes help, but as Helfand says, nothing is 100 percent effective.

The most important thing is to take care of your feet. Pain is not normal or inevitable.

Boot Camp
The most important thing you can do for your feet – whether affected by arthritis or not – is to wear shoes that fit, feel comfortable and don’t hurt. But picking the right shoe isn’t always easy. Below are some tips for sizing up the best pair.

Stretch and Go
Although your feet will never look buff like well-exercised abs do, exercise will help keep them strong, flexible and pain-free. Below are several sets of exercises to keep your feet fit. Check with your doctor before embarking on any exercise regimen.

Last modified: March 30, 2007