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Health Matters | News, Sports, Jobs

Conway McLean, DPM, Journal columnist

The pandemic has brought many dramatic changes to the lives of people on this planet. From stay-at-home orders to the use of masks and the controversy over vaccine protection, COVID-19 has profoundly affected the daily existence of every American. A lot of work is now done remotely, usually on a Zoom tele-meeting, sitting in front of a laptop.

These changes had some unexpected repercussions, while others were more predictable. Many Americans have spent less time socializing, which has led to feelings of isolation. The pandemic has certainly not been good for our mental health, nor for our physical well-being since many of us are doing much less activity. What about the consequences of walking around the house in pajamas and socks? It is surprising to many how important they can be.

Many of us take our shoes off as soon as we walk through the door. It feels good, doesn’t it? Let the toes run free and stretch the sore arch muscles. But in these pandemic times, humans are spending more time at home than ever before. This means that more activities are carried out in the home environment than ever before. And too often, that means barefoot!

But I have shocking news: the laws of gravity apply….. even at home! For many, weight bearing (standing and walking for most of us) is stressful. For a multitude of reasons, problems can arise if we stand without the support, protection and cushioning of a shoe. Who will have trouble doing without shoes at home? This is a multi-faceted question.

Age is of paramount importance in this conversation, with time affecting the human body as it does. Reduced blood flow, called PAD (peripheral arterial disease), is incredibly common and often overlooked. One of the consequences of this process is impaired wound healing. Walking without the protection provided by shoes means that minor skin trauma is more likely to occur, damage that will heal only slowly, if at all, in the face of PAD.

The passing years have the effect of thinning and weakening many structures. The special padding under the ball of the foot is important to protect the bones and tendons there. As it thins or moves out of position, pain and inflammation may develop. And, when present in combination with a tight Achilles tendon (another common and unrecognized condition), this area of ​​the foot can hurt with every step.

There are complications worse than pain. For people with diabetes, the nerve changes that often accompany the disease make it easy to suffer a skin injury and not feel it. Associated with reduced resistance to microorganisms, infections are too common, a diagnosis associated with an increased risk of amputation. The answer is simply to wear some kind of footwear at home, the recommendation of all diabetes experts.

Although some people have good foot and leg mechanics, meaning all the bones and muscles, tendons and ligaments are all working together correctly, at the right time, in sufficient quantity, many of us don’t don’t. A common variation is a foot type where the arch rolls too much when standing and walking. This can lead to various structures experiencing abnormal forces…over time. Again, age is relevant. This kind of foot problem will almost always be made worse by spending more time barefoot or with socks (which is the same thing). Wearing some sort of supportive shoe gear is the simple solution.

I don’t mean that everyone has to wear shoes at home. Instead, be smart about it. If you are an athlete in your twenties, you have the vitality of youth on your side. Fabrics are stronger, more resilient and better able to withstand the rigors of everyday life. The support provided by a sports shoe is less necessary. Healing of any skin lesion is quick and easy. All of these factors change over time.

Understandably, some people worry about bringing germs into the house. Studies have looked at this, and surprisingly, it’s not really a problem. Debris, mud, and all manner of physical contaminants, however, can be carried onto our shoe soles. The answer is obviously a pair of indoor shoes or slippers.

But are slippers acceptable indoor footwear? There are too many variables except to say, “for some people.” What is the quality of an individual’s skin or foot structure? Again, the most compelling question is how old is a person? Then look at the variety of different slippers. Some are supportive and protective, two very important characteristics of a shoe. Claims of special padding get good publicity, but it’s a shoe’s least important feature, despite advertisements proclaiming the virtues of their special foam (which is worthless under the forces of body weight).

The conclusion of this diatribe is simple: think about what lies under your feet. If you are elderly or have poor circulation, protect yourself. People with diabetes should learn the important elements of good diabetic foot care and the importance of protecting their feet. In these colder climates, the protection against freezing soils is simply better. Of course, if you’re young and healthy, that’s a different discussion. But older people need to take their shoes seriously at home. Your feet and your well-being will thank you.

Editor’s Note: Dr. Conway McLean is a physician who practices foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now in Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally and written dozens of articles on wound care, surgery and diabetic foot medicine. He is certified in surgery, wound care and lower extremity biomechanics.

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