'Healthy Feet, Healthy Life': Foot Q&A with NP, Faculty Member
Having healthy feet is imperative for a healthy lifestyle. Foot pain or injuries, or another condition that inhibits your mobility and impacts your ability to be active, puts you at risk for other things, too, like obesity, insulin resistance or diabetes, and heart problems. Happy feet? Healthy life, says nurse practitioner and UVA School of Nursing clinical instructor Ginger Pettengill Freese, who answered foot-related questions about everything from fish pedicures to ingrown toenails, warts, and why not to wear socks to bed.
Q: Do pedicures come with risks?
GF: Pedicures can be a great way to feel pampered. If you do go for a pedicure, make sure you’re going to a licensed facility where you can observe sanitizing processes, such as making sure they’re draining the water out of the foot baths, washing them out well, and always using clean, sterilized tools.
Certain people might want to avoid getting pedicures, especially those with cardiovascular disease, diabetes, or neuropathies because, with poor circulation or nerve damage, they might not feel a sore and therefore have a higher risk of infection. Anyone with diabetes should check their feet daily for any signs of injury or infection.
It bears mentioning that if you have plantar warts, athletes’ foot, toenail fungus—anything contagious—you should not get pedicures. Instead, do them at home, yourself, with clean tools.
There’s a kind of foot treatment called a “fish pedicure” that involves putting your feet in a tub full of Garra ruffa fish that eat dead calluses off the feet using their suction cup mouths. It can be dangerous, create injuries, unevenness, and there can be bleeding involved, though, none of which are good. Though these are offered across Asia, fish pedicures are legal and offered across Virginia, too. Because you cannot sanitize a tub full of fish, of course, you put yourself at a high risk of infection because the fish may create puncture areas that are easy sites for bacteria or fungus to enter, leading to an infection.
Q: Should we shave off or sand down foot calluses?
GF: A callus is like armor for your skin. Think of a guitar player’s fingers that develop tough spots. It’s a place that’s been exposed to trauma, a tough area, and is something that’s helpful, which is why I wouldn’t ever recommend shaving calluses off. It’s OK to soak a callus to help soften it or partially remove it. You can use Epsom salts and warm water for a 20-minute soak, followed by a gentle scrape with a pumice stone, but you don’t want to get rid of a callus entirely. By shaving or forceful removal, you have potential to open wounds and create sites for infection.
What’s better if you’re getting calluses is to think about how you might want to prevent them by ensuring properly fitting shoes, using a product like moleskin, or regularly applying a really good moisturizing cream. Washing your feet every day is important, too, especially in the summer. If we’ve been outside barefoot or in sandals, a warm soak can be really relaxing and restorative for our feet. If calluses, dry skin or ingrown toenails are an issue, an Epsom salt soak followed by some good moisture offers a nice rhythm before bedtime. Overall, I would say gentle exfoliation is fine, but remember your calluses are there to protect you.
Gentle exfoliation is fine, but remember your calluses are there to protect you . . . By shaving or forceful removal, you have potential to open wounds and create sites for infection.
Q: Should we wear socks to bed?
During the day, I advise people to wear moisture-wicking or cotton socks. Having good socks can help our feet from becoming too sweaty and moist and a breeding ground for fungus. I don’t recommend that people wear socks to bed, though. Feet should, at the end of the day, have a chance to breathe.
Q: Should we deal with toe fungus? Is it bad if we don’t?
GF: If you get burning, scaly areas, especially between the toes and feet, it’s likely a fungus that we call athletes’ foot. You don’t have to be an athlete to get athletes’ foot. Fungus likes moist environments, and sweaty feet, shoes, and socks are a great environment for those things to grow. We can easily pick up the fungus just by walking across a germy floor or surface, so it’s helpful to always wear flipflops or protectives shoes when walking out by the pool or in a locker room.
When the infection is on the skin, and not in the toenail, it’s a lot easier to get rid of and treat. There are some good over-the-counter creams and sprays you can use that feel really good, but it’s also probably not going to be devastating if you leave the fungus untreated forever. I would say, though, that if the fungus gets into the nails, it’s a lot more difficult to get rid of.
Q: How do you know if it’s in the nails?
GF: You get toenails that are yellow and brown and cracked. They might become thick. There aren’t big consequences to leaving this alone unless it impacts your mobility. Then you’re down that path again of a less active lifestyle which brings with it other problems.
Once the infection is in the nails, it can take several months to get rid of it. I do recommend seeing your provider if it gets in the nails. Prescription pills take about six months to rid the infection but can be harmful for the liver. There is some good research that tea tree oil can be both helpful for nails and athletes’ foot skin fungal infections, but it takes about six months, too, and you have to be vigilant, cleaning your feet every day, and applying the tea tree oil up to twice a day. Tea tree oil is something somebody could try if they didn’t want to take medicine or use chemical ointments. If you’ve tried over-the-counter therapies and you’re not seeing improvement, I would recommend seeing your primary care provider.
Q: What about blisters? Should we pop them or leave them alone?
GF: A blister is your body’s way of creating a protective area for the skin underneath. A blister happens like a callus: it’s a reaction to trauma to the area. Because of rubbing, the top layer of the skin detaches, and fluid collects underneath. If we pop the blister, we introduce a possible source of infection. Ideally, you want to let it heal on its own. I tell my patients to cover blisters with a Band-Aid or moleskin.
If you feel a hot spot in your shoe, you can put a protective covering on it to protect it from further rubbing. If you plan to hike or run again before it’s healed, you can make a donut-shaped bandage that’s bigger than the blister and then cover it with a Band-Aid. As a runner, if a blister is taller than the moleskin, you can double stack it. A lot of times it might pop from the pressure. If that happens, a wash with good soap and water once a day will keep it clean until it heals.
I have seen patients that have blisters that get infected. If there is thick white, green, or yellow fluid inside, it’s likely infected. Clear, thin drainage from a blister is usually fine and expected. If it’s red or painful to touch, and if the surrounding skin is swollen, and it doesn’t go away, you should have it looked at.
Having good socks can help our feet from becoming too sweaty and moist and a breeding ground for fungus. I don’t recommend that people wear socks to bed, though. Feet should, at the end of the day, have a chance to breathe.
Q: What’s your wisdom about plantar warts?
GF: The good news about most warts is that very often, they’ll go away on their own. The bad news is that sometimes it can take up to two years. If you have a plantar wart, and it’s not bothering you and not getting any bigger, it’s fine to let it be. There’s some evidence that having a healthy amount of vitamin A in your diet can help get rid of it—Vitamin A is in fish, eggs, dark leafy greens, and orange fruits and vegetables, like cantaloupe and carrots, and also in multivitamins. But if the wart is hurting, or growing, or sensitive, I’d go see a primary care provider, a dermatologist, or podiatrist. There are a couple of different ways we can deal with a planters’ wart: we can core it with surgical tools, treat it with cryotherapy, or prescribe topicals like salicylic acid. It can be difficult to treat plantar warts due to the thick overlying callus.
It bears mentioning that if you have plantar warts, athletes’ foot, toenail fungus—anything contagious—you should not get pedicures. I’ve read that some people are more likely to go get a fish pedicure if they have these issues, as they wouldn’t generally be allowed to get a traditional pedicure, but all the same precautions apply. I’d encourage people instead to do their own home pedicure and clean their own equipment to prevent the spread of infection.
The best way to prevent ingrown toenails is to wear the right sized shoe and leave the corners of your toenails, especially your big toes, a little long and cut the nail straight across.
Q: What about ingrown toenails? Should we pick them out or do something else?
GF: These can happen if you stub a toe badly, or do a repetitive sport, like running, where your toe hits the end of your shoe’s toe box. They usually affect the big toe. They’re also more likely after a pedicure, if your toenail edges have been rounded and cut short.
The best way to prevent ingrown toenails is to wear the right sized shoe and leave the corners of your toenails, especially your big toes, a little long and cut the nail straight across. If you feel like you’re getting one, give yourself a warm soak (20 minutes in warm water and Epsom salt-see the trend here?), and take something like a piece of dental floss, put it under the ingrown part, and gently lift it out. Try doing all of this daily for about a week and it may help. If it’s so painful you can’t even touch that area, go see a provider. We can numb the big toe and cut the ingrown piece out, so it heals.
Prevention is best, though; nobody likes getting a shot of lidocaine in their toe. We all hate it together!
Q: What’s gout, and are there special foods you can eat to relieve it?
GF: Gout usually occurs in the big toe, too. It’s an inflammatory condition caused by high uric acid levels. Middle aged men tend to be more at risk for this. The area affected by gout becomes suddenly red, hot, and swollen. It’s actually a form of arthritis that causes severe pain. When the kidneys break down certain foods that are high in purines, and there’s an overload of uric acid, there can be an accumulation of sharp, needle-like crystals that build up in the joints and surrounding tissues, leading to gout.
Healthy foods, a diet that’s high in fruits and vegetables, lean meats, and healthy grains, is protective against gout. Food triggers for gout include red meat, sugary drinks, and alcohol. I had a patient once who was 24 years old and ate healthfully during the week, was big into CrossFit, but on weekends would binge and eat a lot of junk food and drink lots of alcohol. His body reacted with a gout flare that lasted about two weeks. Again, prevention is key!
Q: Are swollen feet always a sign of something bad?
GF: There are a lot of reasons feet can swell, including standing a lot over the course of a day. If there’s no trigger event, and the swelling is new, it should be noted and addressed. Putting your feet up often helps the problem subside, and if, after that, the swelling goes down, it’s probably OK. But, swelling in the feet can also be caused by many serious conditions, including heart problems and high blood pressure, pregnancy, or even certain medications. Generally speaking, swollen feet are not a good thing, especially if there’s pain involved. In those cases, see a provider.
Q: Any last pieces of advice about putting your best foot forward?
GF: Wear protective shoes that match the activity you’re in. I love flipflops, but don’t wear them beyond the beach or the pool to places like amusement parks, or for hiking, biking, or even just shopping. Feet need arch support and protection. I was just out hiking and almost stepped on a copperhead snake. I’d been thinking, “I might see a bear!” And I was looking all around and almost failed to look down at the snake. Thankfully I was wearing good hiking footwear that may have protected me from a bite if I had stepped too close.
Also: When you’re out in the sun, at the beach or the pool, don’t forget to put sunscreen on the tops of your feet where the skin is thin. People forget their feet a lot! But they really are our foundation. Take care of them, so they can continue to lead you where you want to go!
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