Information From The American Podiatric Medical Association
Answers to Frequently Asked Questions On Feet And Podiatric Medicine
1. Are foot problems widespread?
Seventy-five percent of Americans will experience foot health problems of varying degrees of severity at one time or another in their lives.
2. Are feet complicated?
The foot is an intricate structure containing 26 bones. Thirty-three joints, 107 ligaments, 19 muscles, and tendons hold the structure together and allow it to move in a variety of ways.
3. Are there a lot of bones in feet?
The 52 bones in your feet make up about one quarter of all the bones in your body.
4. Do more women have foot problems then men?
Women have about four times as many foot problems as men; lifelong patterns of wearing high heels often are the culprit.
5. How far does the average person walk during a typical day and during their lifetime?
The American Podiatric Medical Association says the average person takes 8,000 to 10,000 steps a day. Those cover several miles, and they all add up to about 115,000 miles in a lifetime -- more than four times the circumference of the globe.
6. How much pressure goes into your foot while you are walking?
There are times when you're walking that the pressure on your feet exceeds your body weight, and when you're running, it can be three or four times your weight.
7. What tips should I follow when shopping for shoes?
Shopping for shoes is best done in the afternoon, says the American Podiatric Medical Association. Your feet tend to swell a little during the day, and it's best to buy shoes to fit them then. Have your feet measured every time you purchase shoes, and do it while you're standing. When you try on shoes, try them on both feet; many people have one foot larger than the other, and it's best to fit the larger one.
8. How should toenails be trimmed?
Trim your toenails straight across with clippers specially designed for the purpose. Leave them slightly longer than the tips of your toes.
9. What exercise is safe for your feet and good for your overall health?
Walking is the best exercise for your feet. It also contributes to your general health by improving circulation, contributing to weight control and promoting all-around well being.
10. Can serious medical problems first show up in the feet?
Your feet mirror your general health. Such conditions as arthritis, diabetes, nerve and circulatory disorders can show their initial symptoms in the feet -- so foot ailments can be your first sign of more serious medical problems.
11. How many podiatrists practice in the United States?
There are about 13,320 doctors of podiatric medicine actively in practice in the United States. There is an average of one podiatric physician for every 20,408 people and they receive more than 60 million visits a year from people with any number of foot ailments.
Yet that's probably only a fraction of the number of foot problems. Mostly, say podiatrists, that's because many people have the erroneous notion that their feet are supposed to hurt.
13. Are all foot problems hereditary? Are you born with foot problems or do they develop later?
Only a small percentage of the population is born with foot problems, the American Podiatric Medical Association believes. It's neglect, and a lack of awareness of proper care -- including ill-fitting shoes -- that bring on the problems. A lifetime of wear and tear, plus neglect, accounts for the fact that the practices of most podiatrists are made up of older Americans.
14. What are corns and calluses?
Corns and calluses are caused by friction and pressure from skin rubbing against bony areas when wearing shoes. If the first signs of soreness are ignored, corns and calluses rise up as nature's way of protecting sensitive areas.
15. How much sweat do your feet produce each day?
There are approximately 250,000 sweat glands in a pair of feet, and they excrete as much as half a pint of moisture each day.
16. What are plantar warts?
Plantar warts are caused by a virus which may invade the sole of the foot through cuts and breaks in the skin. Walking barefoot on dirty pavements or littered ground can expose feet to this sometimes painful skin infection.
17. What education is involved in becoming a podiatrist?
The podiatric physician (doctor of podiatric medicine, or DPM) is the health care professional trained in the care of your feet. He or she receives conventional medical training, plus special training on the foot, ankle, and lower leg. All 50 states, the District of Columbia, and Puerto Rico require that they pass rigorous state board examinations before they are licensed, and most require continuing education programs for regular license renewal.
The seven colleges of podiatric medicine all have entrance requirements which, like institutions granting MD (medical doctor) and DO (doctor of osteopathy) degrees, anticipate completion of an undergraduate degree, though they will consider candidates who show unusual promise and have completed a minimum of 90 semester hours at accredited undergraduate colleges or universities. However, the colleges report that recent entering classes were, on the average, almost as likely to have more than four years of undergraduate/graduate work as less than four.
18. Are foot problems widespread?
About 19 percent of the US population has an average of 1.4 foot problems each year.
19. Do many people have athlete's foot or other foot infections?
About 5 percent of the US population has foot infections, including athlete's foot, other fungal infections, and warts each year.
20. Do many people have ingrown toenails?
About 5 percent of the US population has ingrown toenails or other toenail problems each year.
21. Are corns and calluses common?
About 5 percent of the US population has corns or calluses each year. Of the three major types of foot problems (infections, toenails, and corns and calluses), people are less likely to receive treatment for corns and calluses and more likely to continue to have corns and calluses as a problem without treatment.
22. Do many people suffer from fallen arches or injuries to their feet?
About 6 percent of the US population has foot injuries, bunions, and flat feet or fallen arches each year.
23. What are the most frequently occurring foot problems?
About 60 percent of all foot and ankle injuries, reported by the US population older than 17, were sprains and strains of the ankle.
24. Does income affect foot health?
As a person's income increases, the prevalence of foot problems decreases.
25. Do podiatrists treat the largest percentage of the population that require foot health care services?
Podiatric physicians are the major providers of foot care services, providing 39 percent of all foot care (orthopedic physicians provide 13 percent of all foot care, all other physicians provide 37 percent of all foot care, and physical therapists and others provide 11 percent of all foot care).
26. Is it more expensive to be treated by a podiatrist?
Podiatric physicians are four times less likely to use costly inpatient services than other physicians.
27. How would you further describe the treatment and care provided by podiatrists?
Podiatric physicians provide treatment for 82 percent of corn and callus problems, 65 percent of toenail problems, 63 percent of bunion problems, 46 percent of flat feet or fallen arches problems, and 43 percent of toe/joint deformities.
Patients with foot problems visit podiatric physicians an average of 3.7 times a year, orthopedic physicians 3.4, osteopathic physicians 3.2, all other physicians 3.0, and physical therapists and others 7.1.
28. Do more people visit podiatrists as they get older?
As people age, they increasingly choose podiatric physicians. Medicare data verifies that podiatric physicians are the physicians of choice for 83 percent of hammertoe surgery, 67 percent of metatarsal surgery, 77 percent of bunionectomy surgery, and 47 percent of rearfoot surgery. Medical Economics magazine reported that 56 percent of all older patients have seen a podiatric physician.
29. How many people see a podiatric physician each year?
About 5 percent of the US population sees a podiatric physician each year. There were more than 55 million patient visits in 1995 from about 14 million people.
In 1998, the average number of yearly patient contacts with a podiatric physician was 4,488.
30. Are podiatrists on the staffs of many hospitals?
About 81 percent of all US hospitals have podiatric physicians on staff. The larger the hospital, the more likely it is to have podiatric physicians on its staff.
31. Are podiatrists affiliated with many managed care organizations?
About 87 percent of podiatric physicians are affiliated with preferred provider organizations, 52 percent with nursing homes, 81 percent with health maintenance organizations, 21 percent with academic institutions, and 12 percent with insurance companies, utilization review firms, or peer review organizations.
32. How many podiatric physicians graduate each year?
Over the past 10 years, an average of 592 new podiatric physicians graduated yearly from the 7 podiatric medical colleges.
33. Are the majority of podiatrists additionally qualified by board certification?
In 1998, 53 percent of all active podiatric physicians were certified by one or more recognized podiatric medical boards.
34. How old is the average podiatrist?
On average, the podiatric physician in the United States is 42 years old and has been in practice 13 years.
35. Are there many women practicing podiatric medicine?
Over 14 percent of podiatric physicians are female.
36. Are most podiatric physicians in group or solo practice?
About 58 percent of podiatric physicians are in solo practice. They have an average of 3 employees.
37. Are podiatrists usually licensed in more then one state?
About 48 percent of podiatric physicians have a license in 1 state, 31 percent in 2, 19 percent in 3, and 2 percent in 4 states.
Sources for the data are the American Association of Colleges of Podiatric Medicine, American Hospital Association, American Podiatric Medical Association, Council on Podiatric Medical Education, Podiatry Insurance Company of America, United States Bureau of the Census, and United States Department of Health and Human Services.
Foot Skeletal Structure
Information From
The American Podiatric Medical Association
The disarticulated bones of the left foot, from above
(The talus and calcaneus remain articulated)
1 Calcaneus
2 Talus
3 Navicular
4 Medial cuneiform
5 Intermediate cuneiform
6 Lateral cuneiform
7 Cuboid
8 First metatarsal
9 Second metatarsal
10 Third metatarsal
11 Fourth metatarsal
12 Fifth metatarsal
13 Proximal phalanx of great toe
14 Distal phalanx of great toe
15 Proximal phalanx of second toe
16 Middle phalanx of second toe
17 Distal phalanx of second toe
Bones of the tarsus, the back part of the foot
Talus
Calcaneus
Navicular bone
Cuboid bone
Medial, intermediate and lateral cuneiform bones
Bones of the metatarsus, the forepart of the foot
First to fifth metatarsal bones (numbered from the medial side)
Bones of the toes or digits
Phalanges -- a proximal and a distal phalanx for the great toe;
proximal, middle and distal phalanges for the second to fifth toes
Sesamoid bones
Two always present in the tendons of flexor hallucis brevis
Origin and meaning of some terms
associated with the foot
Tibia: Latin for a flute or pipe; the shin bone has a fanciful resemblance to this wind instrument.
Fibula: Latin for a pin or skewer; the long thin bone of the leg. Adjective fibular or peroneal, which is from the Greek for pin.
Tarsus: Greek for a wicker frame; the basic framework for the back of the foot.
Metatarsus: Greek for beyond the tarsus; the forepart of the foot.
Talus (astragalus): Latin (Greek) for one of a set of dice; viewed from above the main part of the talus has a rather square appearance.
Calcaneus: from the Greek for heel; the heel bone.
Navicular (scaphoid): Latin (Greek) for boat-shaped; the navicular bone roughly resembles a saucer-shaped coracle.
Cuboid: Greek for cube-shaped.
Cuneiform: Latin for wedge-shaped.
Phalanx: Greek for a row of soldiers; a row of bones in the toes. Plural phalanges.
Sesamoid: Greek for shaped like a sesame seed.
Digitus: Latin for finger or toe. Digiti and digitorum are the genitive singular and genitive plural -- of the toe(s).
Hallux: Latin for the great toe. Hallucis is the genitive singular -- of the great toe.
Dorsum: Latin for back; the upper surface of the foot. Adjective dorsal.
Plantar: adjective from planta, Latin for the sole of the foot.
FACTS ON DIABETES AND THE FOOT
Information From The American Podiatric Medical Association
Total number: 18.2 million people in the United States which represents 6.3% of the population.
Diagnosed: 13.0 million people
Undiagnosed: 5.2 million people
There are 1.3 million new cases of diabetes diagnosed each year age 20 years or older.
Diabetes is the sixth-leading cause of death by disease in the United States.
Diabetes Prevalence by age
Age 60 years or older: 8.6 million, 18.3 percent of all people in this age group have diabetes
Age 20 years or older: 18.0 million, 8.7 percent of all people in this age group have diabetes
Under age 20: 206,000, 0.25 percent of all people in this age group have diabetes
Diabetes Prevalence by sex
In people 20 years or older:
Men: 8.7 million or 8.7 percent of all men have diabetes
Women: 9.3 million or 8.7 percent of all women have diabetes
Diabetes Prevalence by race/ethnicity:
In people 20 years or older
Non-Hispanic Whites: 12.5 million or 8.4 percent of all non-Hispanic whites have diabetes
African Americans: 2.7 million or 11.4 percent of all African Americans have diabetes, however, one-third of them do not know it. African Americans are 1.6 times more likely to have diabetes, than non-Hispanic whites of similar age. Twenty-five percent of African Americans between the ages of 65 and 74 have diabetes. African Americans experience higher rates of amputation than Hispanic or white Americans with diabetes.
Hispanic/Latino Americans: 2.0 million or 10.2 percent have diabetes. Approximately 24 percent of Mexican Americans, 26 percent of Puerto Ricans, and 16 percent of Cuban Americans between the ages of 45 and 74 have diabetes.
Hispanic Americans are 1.5 times more likely to have diabetes as non-Hispanic whites of similar age.
American Indians and Alaska Natives: 14.9 percent of American Indians and Alaska Natives have diagnosed diabetes. On average, American Indians and Alaska Natives are 2.3 times as likely to have diagnosed diabetes as non-Hispanic whites of a similar age.
Complications of Diabetes Nerve Disease
About 60-70 percent of people with diabetes have mild to severe forms of diabetic nerve damage (which often includes impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, etc.) Severe forms of diabetic nerve damage can lead to lower extremity amputations.
Ulcers and Amputation
During their lifetime, 15 percent of people with diabetes will experience a foot ulcer and between 14 and 24 percent of those with a foot ulcer will require amputation. Diabetes is the leading cause of lower extremity amputations in the United States occurring among people with diabetes. Each year, more than 82,000 amputations are performed among people with diabetes.
After an amputation, the chance of another amputation within 3 to 5 years is as high as 50 percent. The 5 year mortality rate after amputation ranges from 39 to 68 percent.
Heart Disease and Stroke
People with diabetes are 2 to 4 times more likely to have heart disease which is present in 75 percent of diabetes-related deaths. The risk of stroke is 2 to 4 times higher in people with diabetes.
Kidney Disease
Diabetes is the leading cause of new cases of end-stage renal disease, accounting for about 44 percent of new cases.
Blindness
Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years of age. Each year 12,000 to 24,000 people lose their sight because of diabetes.
Cost of Diabetes
The total annual cost for the more than 82,000 amputations is over $1.1 billion dollars. This cost does not include surgeons’ fees, rehabilitation costs, prostheses, time lost from work, and disability payments.
Foot disease is the most common complication of diabetes leading to hospitalization. In 1996, foot disease accounted for 6 percent of hospital discharges listing diabetes and lower extremity ulcers, and in 1996, the average hospital stay was 13.7 days. The average hospital reimbursement from Medicare for a lower extremity amputation was $13,512 and from private insurers $26,126. At the same time, rehabilitation was reimbursed at a rate of $7,000 to $21,000.
The risk for Type 2 diabetes increases with age. Approximately 18.3 percent (8.6 million) of the United States population age 60 and older have diabetes.
Medicare provides coverage for therapeutic footwear such as, depth-inlay shoes, custom-molded shoes, and shoe inserts for people with diabetes who qualify under Medicare Part B.
Prevention and Treatment of Diabetes
According to the National Diabetes Education Program (NDEP), a partnership among the National Institutes of Health, the Centers for Disease Control and Prevention and over 200 organizations, including the American Podiatric Medical Association, comprehensive foot care programs can reduce amputation rates by 45% to 85%. A comprehensive foot care program would include:
Early identification of the high risk diabetic foot
Early diagnosis of foot problems
Early intervention to prevent further deterioration that may lead to amputation
Patient education for proper care of the foot and footwear
Facts On Arthritis And The Foot
information from the APMA
40 million people in the United States have some type of arthritis. This represents 15% of the population or one in every seven persons.
The prevalence of arthritis is projected to increase 57% to about 59.6 million people with arthritis by the year 2020. This represents 18.2 % of the population.
Arthritis is a leading cause of work-related disability among people. An estimated 2.8% of the population or 7 million people had arthritis as a major or contributing cause of activity limitation. The prevalence of arthritis related disability is also expected to rise by the year 2020, when an estimated 11.6 million people will be affected.
There are more than 100 types of arthritic diseases. Arthritis was reported as the cause of disability more than any other chronic diseases, such as back pain, heart or lung conditions, diabetes, or cancer.
Prevalence of Arthritis by age and sex:
Arthritis affects all ages including a significant number of adults in the prime of their life (almost 9 million adults) . An estimated 285,000 children are affected with arthritis. There is a higher prevalence in people greater than 65, and in women. Arthritis affects one of every two people over age 65. Arthritis is the most prevalent chronic condition in women affecting 26.4 million. By the year 2020, an estimated 36 million women will be affected.
Cost of Arthritis
The estimated cost of arthritis is about $64.8 billion dollars. Twenty- four percent was due to direct medical costs, and 76% was due to indirect costs from lost wages. The cost including arthritis and other musculoskeletal conditions was 149.4 billion, which is about 2.5% of the Gross National Product.
Common Arthritis Diseases
Osteoarthritis
This is also known as degenerative joint disease, and is the most common type of arthritis, affecting an estimated 20.7 million adults in the United States, mostly after age 45. It primarily affects the joint cartilage. It usually affects the weight-bearing joints, such as the feet.
Rheumatoid Arthritis
This is a systemic inflammatory disease affecting the synovium or lining of the joints. It typically affects more than one joint and tends to be symmetrical. It affects 2.1 million people in the United States, or about 1 percent of the population. Onset is usually after age 45, but often occurs in the 20s and 30s . The cause is unknown, but it is an autoimmune disease.
Juvenile Rheumatoid Arthritis (JRA)
JRA is the most common form of arthritis in childhood. It affects 70,000 to 100,000 children in the United States. The cause is unknown, but it involves abnormalities of the immune system. JRA can cause altered growth, joint damage, and joint inflammation.
Ankylosing Spondylitis
This is a seronegative spondyloarthritis that primarily affects the spine and causes stiffness. A characteristic lesion is the formation of calcaneal spurs. Heel pain is a common complaint. It usually affects men between the ages of 16 and 35.
Gout
This results from a build-up of uric acid which forms sodium urate crystals that deposit in joints and cause inflammation. Gout commonly affects the first metatarsophalangeal joint of the foot. It usually affects men over age 40. Women with gout usually develop it after menopause
Systemic Lupus Erythematosus
This is also known as lupus or SLE. It is an autoimmune disease in which the immune system harms the body’s own healthy cells and tissues. Nine out of ten people who have lupus are women. Lupus is three times more common in black women than in caucasian women.
Psoriatic Arthritis
This is a seronegative spondyloarthritis which occurs in some people with psoriasis. About 95% have swelling in joints outside the spine. Swelling in the toes gives them a sausage appearance. Pitting of the toenails and other nail changes affect 80% of people with psoriatic arthritis. Psoriatic arthritis affects men and women of all races and usually occurs between the ages of 20 and 50.
Prevention and Treatment of Arthritis
Foot Problems According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the Arthritis Foundation early diagnosis and treatment of arthritis can prevent much unnecessary disability. People with arthritis need to self-manage their condition and engage in physical activity.
References:
Arthritis Foundation: Arthritis Information Sheets, 2000
Department of Health and Human Services: National Institute of Arthritis and Musculoskeletal and Skin Diseases: Questions and Answers about Arthritis and Rheumatic Disease, 1999
Arthritis Foundation Web Site: http://www.arthritis.org/
