Each day, we take an estimated 8,000 steps. By the time we’ve lived 50 years, our feet have logged about 50,000 miles, says Dr. Johanna Youner, a Manhattan podiatrist. For all that distance, the entire body’s weight is supported by two small structures, each with 26 bones, 33 joints, and 107 ligaments.
They carry us through demanding jobs such as nursing and waitressing, and activities such as jogging, tennis, dancing, and aerobics. Yet we put those feet in shoes that are too tight, too high, that rub in the wrong places, and don’t support in the right ones. “People in their 20s are willing to put up with some pain for fashion’s sake”, Dr. Youner says. “People in their 40s and 50s are not. They realize the pain they’re suffering could lead to problems.”
Most of us start out with perfect feet and, unless we suffer an injury, continue problem-free until at least our 30s. But over time, the fatty pads that cushion the heel and the ball of the foot start to get thin. The skin gets drier and the muscles, ligaments, and tendons get stiffer. Weight gain puts more pressure on all those little pieces.
Our fashion tastes create even more problems.
“A high heel puts seven times the normal pressure of your body weight on the front of the foot,” Dr. Youner says. “The bones can grow in response to pressure. If you wear something that presses the bones together, they will grow in the shape of that shoe. If the forefoot of the shoe is pointed, it makes your foot look like a foot with a bunion and hammertoes.”
Bones and joints at the front of the foot can become inflamed. Nerves between the toes can get pinched, resulting in painful neuromas. The ankles are more easily sprained, especially with platform shoes, because they destabilize the whole body.
Hereditary problems start showing up by the late 30s, says Washington, D.C., podiatrist Arnold Ravick. Aches and pains that have been ignored suddenly flare up into real problems. The feet start spreading and hormonal changes make them ache. By our 50s, most of us are wearing shoes a size bigger than 30 years earlier.
By our 60s, our immune systems are generally weaker, so our feet are subject to more infections. Problems including arthritis, heart disease, lung disease, and diabetes can affect the feet. Stiff joints make it hard for many people even to reach their toes for regular maintenance. Yet many Americans exercise more at this age because they have more time for it.
The good news is, the heat, gentle massage, and callus-reduction offered during a pedicure service help relieve many symptoms of the foot’s ills. And because system-wide diseases often show up first in the feet, you have the added opportunity to watch out for your clients’ overall health.
Treating the 20-Something Foot
Because they generally have few foot problems and less money, younger clients typically get the least expensive pedicure and often only during summer months, technicians say. For this age group, their service is a good time to suggest strategies for avoiding foot problems in the future.
For example, they can limit their time in high heels and pointy-toed shoes. For jobs that require being on their feet all day or for extended walking, they should wear sturdy, well-fitting shoes and natural-fiber socks. Office workers can wear low-heeled, wider-toed shoes at the desk and keep high heels for meetings and evenings.
“Today, funkier shoes are OK,” Dr. Youner says.
Keep toenails cut straight across to avoid ingrown toenails, and keep calluses in check by having clients pumice them at home. And train your clients to stop picking at their cuticles, which makes them grow thicker. “Teach them to moisturize!” Ravick adds.
When clients become pregnant, their ligaments get looser and the foot expands. Exercisers may arrive with inflamed tendons or joints. In both cases, massage should be gentle, enough to help circulation but not aggravate the tissues. Heat treatments are not usually a good idea for swollen feet, Ravick says.
Other common problems are fungus and warts, picked up at public poolsides, health club showers, and, rarely, salons.
Athlete’s foot is a fungus that can look like dry, scaly skin, especially around the heel, Ravick says. When it’s on the skin, he recommends the infected person use over-the-counter medicines such as Tinactin or Lotrimin for at least three months to get rid of the infection, and use a medicated spray on shoes.
Warts are caused by a virus and are highly contagious. People often mistake them for calluses, and they may even have a callus grown over them (which should not be removed). A wart will show pin-dots of blood if you pumice it. “Suggest they go to the doctor first,” Dr. Youner warns. If you have already treated a client with warts, clean the footbath thoroughly.
Ingrown toenails can happen at any age. They are sometimes caused by occupational activities and often by too-tight shoes or a bunion. “It needs a little, gentle teasing out and trimming,” Dr. Youner says. Use a nail rasp to clean up the edges, pack cotton between the toes to give it space, then dab antiseptic on it. If the nail has penetrated the skin, it could require medical treatment.
Blood under the nails usually indicates a blow. If the blood has been there a couple of months, you can file down the thickened nail to remove it, Dr. Youner advises. But if the problem is chronic, the client should see a doctor; it could be caused by psoriasis.
Treating the 40-Something Foot
By the late 30s and early 40s, the physical signs of aging are showing. Ordinary wear and tear on the joints starts feeling like arthritis. “Old injuries are beginning to get tighter,” Ravick says. “If you’ve favored a side for 20 years, the effects will start to show.”
By the 50s, the toenails start to thicken. Because women of color already have thicker skin, they especially begin to see problems.
“The nail pushes into the toes and becomes uncomfortable,” Dr. Youner says. “If you have a rotary tool, you can thin it out lightly from the top or use heavy black emery boards. Work gently, from top to bottom. It will take a huge amount of pressure off the nail bed.”
For dry nails, she likes to file the surface of the nail before moisturizing with products such as DermaNail or olive oil.
Calluses form to protect an area from repeated friction, so a change in shoes may help reduce them. (A podiatrist could identify problems that affect the way your client walks, which in turn causes the callus.) They may be protecting a bone deformity, wart, or bunion. Thick calluses around the heel can crack, become painful and infected. Retail products can help clients control them by moisturizing and pumicing at home.
Corns are calluses that appear on the tops and ends of the toes or in between. They usually mean friction or pressure in the wrong places. Hard corns can be pumiced, not cut. Soft corns between the toes should be removed by a podiatrist.
When shoes are too tight or narrow, they can pull the big toe outward to form a bunion, a deforming bone growth that enlarges the joint connecting the big toe to the foot. Gently pumice the calluses that build up around it. Massage can break up the inflammatory tissue. Paraffin treatments bring deep heat and increase circulation, Dr. Youner says.
Narrow-toed shoes also can cause a neuroma, scar tissue that forms around a nerve after many tiny injuries. The painful lump usually occurs between the third and fourth toes. Massage can worsen it. If a client’s neuroma has been treated, take care not to inflame the area again.
During dry weather, people in this age group are more prone to dry, flaky, and cracked skin. Hot paraffin treatments and rich moisturizers after the pedicure will help. Retail moisturizers your clients can slather on at night, have them wear socks to bed, and then use their pumice stone in the morning. Dr. Youner recommends over-the-counter AmLactin.
Nails that appear to be infected with a fungus could just be overly dry. Dr. Youner suggests your client take time off from nail polish for a season to let them recuperate and avoid drying chemicals such as toluene and formaldehyde.
Hammertoes and clawed toes both are genetic and grow more severe with age. Little can be done to change their shape, but suggest to your client that she massage and exercise them daily by pressing them down gently. “It will help them from becoming so contracted and slow down the process,” Dr. Youner says. Massage and heat treatments during the pedicure will help.
Treating the 60-Something Foot
With advancing age, the fatty pads beneath the heel and the ball of the foot get very thin, making the bones there more prominent. This can cause pain in both areas.
“Padding the shoes helps immensely,” Dr. Youner says.
Age and illness can make the nails thin and brittle. “Biotin and B-vitamins are very good for nails. They’re very safe,” Dr. Youner suggests. “Over a couple months, they will truly help the nails, especially for the elderly.”
Hygiene may grow difficult if the client cannot easily reach her feet. Before a service with an elderly client, you could use an alcohol-daubed cloth or cotton swab to gently wipe the foot and areas between the toes to remove dead skin and dirt.
Half of people over age 65 have fungal infection on their feet because their immune systems are weaker. Fungus on the nail should be treated medically. Trim, but don’t polish the nail until the fungus is gone. And take special care to avoid cutting the skin, because they heal more slowly.
Arthritic joints can be caused by a variety of problems. Heat and gentle massage can soothe the symptoms, but be cautious not to cause pain. If a client complains of heel pain during the massage, her arch muscle may have pulled away from the bone and caused a bone spur.
Suggest that older clients moisturize two or three times a day to ease dryness, Ravick adds.
Link Up With Podiatrists
You can help your clients and your reputation by linking up with local podiatrists, Dr. Youner suggests. They may be willing to offer free presentations to a group of interested techs.
At the Mentor, Ohio, spa Jenniffer & Co., a local podiatrist came in to describe common medical conditions of the foot and nails. “He told us we are the missionary podiatrists,” laughs Debbie Brew, artistic director for the nail department. “We can’t diagnose, but we can say, ‘You know, I’m not a medical person, but I really think you should talk to your doctor about this.’”
The American Podiatric Medical Association offers a podiatrist search, lists state and regional chapters, and offers information about the foot on its website, www.apma.org.