Tobacco and Your.... Feet?

Everyone is aware of the dangers of smoking to your lungs and heart. But the effects of smoking go far beyond your heart and lungs. Are you aware of what smoking can do to your feet? When I tell patients that smoking cigarettes can affect their feet, many are surprised. But the fact is that smoking can lead to serious problems with your feet.

First, when you smoke, levels of carbon monoxide become elevated in the bloodstream. Carbon monoxide displaces oxygen in red blood cells, and the result is that the blood is not able to carry as much oxygen. Since the tissues in your body (and feet) need oxygen, this is serious. Once oxygen is displaced from the blood cell by carbon monoxide, that blood cell can no longer carry oxygen for the rest of its lifespan (about 3 months).
Secondly, nicotine, which is found in cigarettes, causes the blood vessels to constrict and become narrower. This decreases the amount of blood (that’s the blood that already is carrying less oxygen) that can get to the tissues. The effects of nicotine diminish after two weeks, so quitting can improve circulation in a relatively short period of time.

Thirdly, smoking greatly increases the risk of PAD (peripheral arterial disease). This occurs when the arteries become clogged with plaques, further decreasing blood flow. Of the three main effects of tobacco smoking on circulation, this is the slowest to reverse itself after smoking is stopped (see www.padcoalition.org).

Why should you care if your feet are receiving adequate blood flow? Patients with poor circulation often will develop a condition called claudication, which manifests itself by causing severe pain in the legs when a person walks for short distances. In essense, the pain is a result of the muscles being starved of oxygen. When blood flow is poor, your body’s ability to heal itself (such as if you have an ulcer) is greatly diminished. Bones are also slower and more difficult to heal with a smoker who has poor circulation. In fact, when the circulation is bad enough, healing will not occur at all. This leads to tissue death (gangrene), and ultimately, amputation of a portion of the foot, or even the leg. This is very serious, because studies have shown that the 5-year mortality rate following a major amputation was 68%! This is higher than those diagnosed with colorectal cancer (39%), breast cancer (23%), Hodgkin’s disease (18%), and prostate cancer (8%). Losing a leg is not something to be taken lightly. Lung cancer, as it turns out, has a higher mortality rate (86%), but then again, tobacco is the major cause of that cancer too.

So what can be done? First, if you don’t smoke, please don’t start. I know very few people who are happy about the fact that they’re addicted to cigarettes. Secondly, if you do smoke, talk to your doctor about ways to quit. It probably will not be easy, but will most definitely be worth not only saving a foot, but saving your life!

Your choice of shoes really matters!

On the average, I see more women patients than I do men. There are potentially many reasons for this, which can include men’s reluctance to see a doctor, and the type of shoes worn. Certainly, I would encourage men if they have a problem with their feet to seek treatment – it’s always easier to fix a problem early on before it gets out of hand. Quite often though, the shoes I see my patient’s wearing both in the office and out in public, lead me to believe that the choice of shoes some women make can be extremely detrimental to the health of their feet.

Perhaps few would argue the fact that wearing high heeled dress shoes alters the appearance of not only the foot, but the leg, hips and back as well. Wearing a shoe with a high heel lengthens the leg, and makes the foot appear smaller. Obviously, it also will make a women appear taller. But at what cost?

It should come as no surprise that wearing high heels places more pressure on the forefoot. To add to this, often the shoes worn have insufficient space for the toes. This leads to increasing pain and symptoms from hammertoes, bunions and neuromas. Corns and calluses are also more frequent and symptomatic. But the problems don’t stop there. Because the foot is plantarflexed when high heels are worn, chronic wearing of high heels can and does tighten the achilles tendon. This can make it difficult for women to wear flats as they get older. To accommodate for the plantarflexed position of the ankle, the knees are slightly bent. This causes the muscles surrounding the knee to work harder, leading to pain. Traveling up the leg, high heels alter the position of the hips and lower back, leading to pain there as well.

The pictures attached illustrate what high heels do to a foot. The body’s center of gravity is therefore moved forward over the forefoot. Normally, a body’s weight is distrubuted roughly equally between the heel and the forefoot. The structures of the forefoot are simply not up to the task of taking on the additional burden. You’ll also notice in the picture that shows the foot next to the shoe that the forefoot is actually wider than the shoe itself!

What can be done? Well, just between you and me, I have tried and have decided that my crusade against high heels is a losing battle. Some women will never give them up, regardless of the symptoms they cause. Here’s my compromise then…. If you feel you must wear high heels, limit the amount of time your feet are in the shoes, and equally as important, limit the amount of time you are standing and walking in the shoes. If you feel the urge to take your shoes off because your feet are hurting, don’t ignore it – take the shoes off! Perhaps you could have another pair handy to put in in their place that are more comfortable. Remember, your podiatrist can do some pretty amazing things. But what he/she can’t do very well is fix a foot and expect it to stay symptom-free when the very thing that is causing your symptoms is continued to be worn.