How to tend to your tootsies.

If you rocked to Elvis and the Rolling Stones, marched for peace, got your sweat on with Jane Fonda, and did your part to make jogging a national pastime, it’s no wonder that nowadays your feet may be feeling the strain. Add to all that activity the complexity of the human foot (it includes 26 bones, 33 joints, 107 ligaments, and 19 muscles and tendons) and the magnitude of the job our feet do for us—balancing and stabilizing our bodies and absorbing all kinds of shock—and there are lots of opportunities for pain and discomfort. How best to treat your tootsies? Bay Area experts weigh in on how to deal with pesky problems like bunions and plantar fasciitis, what to look for in a great shoe, and what kinds of tools and therapies can help you put your best foot forward.

The first place to start for foot health is to stay fit, says Michael DiGiacomo, a podiatrist with the California Ankle and Foot Clinic in Oakland.

“Being overweight stretches the ligaments that bind the joints together and damages cartilage,” he says. “It’s best to keep your weight at a healthy BMI [body mass index].”

Not only can foot size change as we age, but we lose some of the fat in the pads that cushion our stride. And much like the skin on other parts of our bodies, the skin on our feet gets thinner and drier as the years roll by, according to Johanna Youner, spokeswoman for the American Podiatric Medical Association.

“At about age 50 our ligaments stretch, and the foot flattens half a size,” she says. “Even if all you’re doing is living, at about that age your shoe size will probably increase. It’s important to respect this change—otherwise you can encounter problems like a neuroma, which is an inflamed nerve that can cause searing pain.”

Arthritis can crop up as well, especially in the big toe, ankle, and midfoot joints. Bunions—those pesky bone deformities that form at the big toe—appear after years of wearing ill-fitting shoes, and plantar fasciitis (an inflammation of the connective tissue on the bottom of the foot) can hobble even the healthiest of us.

Foot pain isn’t normal, DiGiacomo says, and rather than putting up with pain, we can take a proactive approach instead. He recommends performing daily head-to-toe “body scans,” much like one might do in meditation, to identify sore points early when they’re easier to address.

“I have a patient who came to me three years ago with a painful bunion,” DiGiacomo says. “When I saw her again recently she was complaining of significant pain in her lower back. By accommodating the initial discomfort from that bunion for three years, her situation only got worse. It’s important to recognize that foot and ankle problems can create more serious secondary problems as time goes on.”

———

Those stilettos may look great, and the “barefoot” shoes even better, but don’t assume that the latest trends are good for your particular feet, says podiatrist Mark Wolpa of Bay Area Foot and Laser in Berkeley.

“When folks come in we assess their foot and body type, as well as what activities they’re doing,” he says. “If someone has a flat foot, they need a firmer shoe, not a minimalist one. Other people have very high arches and need softer shoes that can provide shock absorption.”

And it’s crucial to pick the right shoes for the right activity, DiGiacomo says.

“The ligaments in our feet weaken as we age, and it’s really important to wear supportive shoes, preferably a pair with a slightly elevated heel,” he says. “I get patients in my practice who come in with severe arch pain, and it turns out they’re just back from vacation—walking all over Paris in espadrilles, which offer no support at all.”

After 50, our feet just aren’t as resilient as they used to be, and shoes need to be more supportive, Youner says. And ditch any heels higher than two inches.

“Really, over 50 you’re dressing more for function rather than style,” she says.

But for the footwear fashionista, all is not lost: Youner recommends checking out comfortable but still stylish brands like Ariat, Beautifeel, Ecco, Munro, and Rockport—which can be easily found in the East Bay at stores like Elmwood Village Shoes, Shoes on Solano, and the Walk Shop.

“If you must indulge in the latest sky-high heel, keep the wearing to two hours and go one-half to one size bigger than you normally wear,” Youner says. “You’ll be more comfortable and your feet will thank you.”

On the sport shoe side, the Optimal Performance Index System can help you find the best option for your particular foot. The company tests and ranks shoes by how supportive they are, using equipment designed to imitate the foot’s physical force. Marathon runners to weekend warriors can use the website (opistest.com) to evaluate their past injury profiles, their foot patterns (are you supinated, pronated, neutral, or flat?), and to look up shoe rankings.

———

Knowing your foot pattern and rocking the right kicks can only pay off, especially since baby boomers are staying much more active than their forebears, and tend to already be in the habit of exercising daily, says Wolpa. But the mind may not be caught up with the body’s actual capabilities.

“A lot of patients I see have always been involved in fitness, and really took to the running boom in the ’70s and ’80s,” he says. “Now they’re experiencing the downside of all those years of running, and it’s hard for them to accept this, despite their body’s signals.”

Wolpa encourages people to expand their exercise routine by adding new activities: If they’re runners, they could spend time hiking, swimming, or biking during the week as well.

“We find most of our patients end up enjoying varying their workout,” he says.

Flexibility needs to be part of a healthy feet protocol as well, since as the body ages, flexibility diminishes unless a person consciously makes it part of a fitness program.

“As we age, the muscles in the back of the leg can contract, forcing the foot to compensate,” Wolpa says. “Or if the knee isn’t functioning properly, the foot works overtime. The more flexible a person is, the lighter the load through the joints in the ankle and foot.”

Finding good shoes for your body type and activity and staying fit go a long way toward maintaining healthy feet. But if you need an extra boost, orthotics are also an option. Orthotics support the foot by distributing pressure or realigning foot joints while a person is standing, walking, or running.

“Shoes can only do so much—being as they’re made for the average person,” Wolpa says. “But most people don’t have average feet. We can make 100 different types of foot orthotics to help the foot and leg function normally.”

Reflexology is another way to boost not only foot health but overall body health, says certified reflexologist Johanna Thaxter, owner of Reflexology Wellness in Oakland. Reflexologists believe that applying pressure to certain points in the feet sends signals that restore equilibrium to the nervous system and release chemicals such as endorphins—thus reducing stress and pain.

“Reflexology improves circulation in the feet as well as the whole body,” Thaxter says. “It can improve ankle range of motion and joint flexibility. However, the focus of reflexology is to help relax and balance the entire body via the reflexes in the feet and hands that correspond to various organs.”

A new technology for dealing with some forms of foot pain and inflammation (tendonitis, arthritis, and plantar fasciitis for example) is MLS laser therapy, which applies laser energy at a cellular level to decrease swelling and pain and accelerate the healing, Wolpa says.

“We like to use MLS laser therapy in conjunction with orthotics, as opposed to steroids, which can have significant side effects,” he says.

And of course, if a foot problem proves intractable, surgery may be the best option: Repetitive stress can lead to bone spurs—bony projections that develop along the edges of bones and can inhibit range of motion in the ankles, feet, and toes—which, once removed, resolve the issue.

What about pedicures? Do they belong in the foot health toolbox? Yes, but take care, Youner says.

“You really need to know where you’re going and what their hygiene practices are,” she says. “There have been serious problems with pedicures, with people developing deep ulcers in their legs from being exposed to microbacterium in the water. Make sure the water at the salon isn’t re-piped.”

The more realistic your attitude to your body and what it can do, the healthier your feet will be. But accepting age-related limitations can be hard, Youner says.

“I’ve seen a lot of people who have had to experience multiple injuries before they really start to take care of their feet,” she says. “They’ve had knee and back surgeries, plantar fasciitis—which can be really painful. It’s as if until the problem forces people not to walk, they won’t change their behavior.”

The bottom line? Don’t neglect your feet, Youner says.

“Don’t try to be a hero,” she says. “If something’s bothering you, get it checked out.”

————
Kate Madden Yee is an Oakland-based freelance writer. She still remembers with fondness the summer she got her first pair of Birkenstocks.