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Information From The American Podiatric Medical Association


Seven Miles Overhead

When it comes to the feet, unfortunately, the cabin of an airplane can be a uniquely unfriendly workplace.

Being a flight attendant requires walking backwards at steep angles, up and down cramped aisles, seven miles high, pushing and pulling 250-pound carts that are unexpectedly shaken and jostled by turbulence without notice, and getting tripped by passengers whose crossed legs and carry-on baggage creeps into the aisle.

After work, it's walking on what seems like miles of non-yielding concrete floors or airport corridors, only to turn around and do it again the next day, and then the next.

Foot problems are sometimes painful enough to be debilitating, but more often hurt just enough to be a chronic workplace nag - ignored at the start of a shift and nearly unbearable by the end.

Several kinds of doctors can treat foot problems. Podiatric physicians, with four years of podiatric medical school as well as additional postdoctoral training, can make independent diagnoses and judgments regarding treatment, prescribe medications, and treat all foot and ankle problems medically and in some cases, surgically.

Conservative treatment by podiatrists can prevent, reverse, and often alleviate foot problems before they become debilitating. Patients often feel better after a single visit.

Four Times Around the World

With 26 bones (the two feet contain more than a quarter of all bones in the body), 33 joints, a network of more than 100 tendons, muscles, and ligaments, and scores of nerves and blood vessels, the human foot is a biological masterpiece.

The components of the feet intricately work together all the time, sharing the tremendous pressure of daily living. An average day of walking brings a force equal to several hundred tons to bear on the feet. The average person walks about 115,000 miles in a lifetime, or more than four times around the world.

Such structural complexity and daily stress make foot problems among the most common health complaints. Studies show at least three-quarters of Americans will experience foot problems of some degree of seriousness in their lifetimes, but only a small percentage of them actually seek professional treatment. Most suffer unnecessarily from foot pain.

This results from a common misunderstanding that foot pain is normal. Foot pain is most definitely not normal. Healthy feet are a key element in doing a job well, especially for people like flight attendants, whose jobs require them to constantly be on their feet.

Helping Feet Stay Healthy

Common foot ailments that can be effectively treated by podiatrists include:

bulletPlantar fasciitis (heel pain). This inflammation of the plantar fascia, the long band of connecting tissue running from the heel to the ball of the foot, is a main cause of heel pain. Sometimes precipitated by faulty biomechanics, or abnormalities in gait, heel pain can be treated with orthoses which restore the foot's proper balance. Often caused by shoes that cramp the feet in the arch area, especially women's pumps, the condition is treatable medically through anti-inflammatory medication, padding, and orthoses.
bulletHeel spurs. Repeated strain on the plantar fascia sometimes pulls away the band's attachment to the heel bone. Bony tissue may build up, creating a heel spur. These growths, identified through X-rays, are treated with anti-inflammatory medication, padding, and orthoses. In severe cases, surgery may be required.
bulletMetatarsalgia. A general term for pain in the ball of the foot, metatarsalgia can be caused by many problems, such as tight shoes, calluses, and high heels. Conservative treatment can effectively alleviate the pain of metatarsalgia.
bulletBunions and hammertoes. Although they tend to be hereditary, bunions and hammertoes are often aggravated by ill-fitting footwear. Bunions are misaligned big toe joints, which swell and become tender. Hammertoes result when the toes contract into a claw-like position.
bulletNeuromas. Enlarged, benign growths of nerves, most commonly between the third and fourth metatarsal bones, result in pain, burning, or a tingling sensation in the foot. Orthotics, cortisone injections, and oral medication are used to treat neuromas.


The Foot Specialist
Regular visits to a podiatrist, the foot specialist, will help your feet stay healthy and pain-free through prevention and early detection of problems. Systemic diseases, such as diabetes (which often goes undiagnosed) and circulatory problems, are frequently spotted first in the foot. As part of an integrated medical team, podiatrists can identify these pathologies, treat manifestations in the foot, and refer patients to other specialists for care in other areas of the body. If your feet already hurt, there are a variety of conservative treatment methods at a podiatrist's disposal. Custom shoe inserts known as orthoses can solve many painful problems by redistributing the bodyıs weight on the feet. Inflamed muscles and joints frequently can be treated with oral or injected anti-inflammatory medication. Casting, strapping, and padding also help alleviate minor foot discomfort. In the case of bone malformation or other problems causing serious pain and difficulty walking, a podiatrist may recommend surgical intervention.

In-Flight Footwear

Although footwear regulations for flight attendants vary among carriers, some flight attendants now have the opportunity to wear attractive shoes that are also comfortable and promote good foot health while at work in flight. Women who are required to wear heels in airports, or feel that they are, should get out of them and into comfortable, supportive shoes as soon as possible.

As a rule of thumb, women should never wear heels higher than one and one-half inches. Wider heels offer more support than narrow ones. Podiatrists recommend a new breed of "walking" pumps (also known as "comfort" or "performance" pumps), designed to blend fashion considerations and comfort during long work hours.

The best shoes for men are good quality oxfords, ordinarily associated with wing-tip or cap designs. For both sexes, podiatrists say, shoes constructed of materials that "breathe," as well as support and cushion the feet, are essential for flight attendants.

When shopping for shoes, always have both of your feet measured while standing. Try on both shoes, and walk around the store for a few minutes to get a good feel of the shoe.

Be aware that one foot frequently can be slightly larger than the other, and always buy for the larger foot. Don't rely on the size of your last pair; shoes sizes differ among manufacturers, and adult feet do get larger. Shop for shoes late in the day, when feet naturally swell slightly. Finally, only buy shoes that immediately feel "right." Don't rely on hopes that a "break-in" period will make an uncomfortable shoe feel better. That really doesn't happen.

The American Podiatric Medical Association (APMA), which represents 75 percent of practicing podiatric physicians (the major providers of foot care services in the United States), is committed to helping flight crews enjoy long, pain-free careers on their feet.

Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manners of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.

Reprinted with permission from the American Podiatric Medical Association.


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