He is the Head of the Department of Orthopedics at St. Elisabeth Hospital Herten, part of the PROSELIS Foundation Hospital – and is regarded as an experienced expert in all areas of his discipline: Priv.-Doz. Dr. med. Dariusch Arbab enjoys an excellent reputation in knee, hip and shoulder surgery, as well as in rheumatological orthopedics and pain management. However, he specializes in foot and ankle surgery. He told the Leading Medicine Guide what we can do to look after our feet better and what treatment options are available for a wide variety of foot conditions.
Our feet bear our entire body weight every day and provide the necessary balance. This makes them the parts of our body that are subjected to the greatest strain in everyday life. Our body weight rests primarily on the balls of our feet and our heels. The foot is an extremely complex structure: it consists of almost sixty muscles, over a hundred ligaments, more than two hundred tendons – and the ankle joint contains a total of 26 bones. And although we generally put our feet under considerable strain every day, most people pay too little attention to their feet and do not look after them properly.
Anatomy of the foot © bilderzwerg #54960419 | AdobeStock
In fact, over the course of a lifetime, our feet carry us the equivalent of a single trip around the Earth. It is therefore clear that wearing the wrong shoes can cause foot problems. However, genetic factors also play a role, for example in the case of toe deformities. There are essentially four common types of toe deformities: hammer toe, claw toe, terminal joint hammer toe and tailor’s bunion. Women in particular suffer from the widespread condition of hammer toe: “Hammer toe is often associated with hallux valgus of the big toe. The big toe no longer functions properly, so the other toes have to take over and become overloaded. Patients mainly notice this because their toes bump against the top of their shoes,” explains Dr Arbab. This type of deformity often arises in connection with the flattening of the arch of the foot in cases of fallen arches, also known as flat feet.
“First of all, I naturally try to treat the condition conservatively. I advise on the choice of footwear and provide my patients with customized insoles. I can fit pads for existing and painful corns, demonstrate manual stretching exercises and recommend regular repetition,” explains Dr Arbab regarding the initial conservative treatment measures. If conservative treatment methods do not help, surgical treatment must be considered. “There are essentially two options here: open surgery, in which the metatarsophalangeal joint is repositioned, or minimally invasive surgery, in which a drill is used to correct the misalignments,” says Dr Arbab, describing the two treatment options.
Walking barefoot helps the foot!
“Anyone who has the opportunity should walk barefoot as often as possible. This takes the pressure off the foot completely; it is not constricted or restricted by footwear, and the many muscles in the foot get a good workout,” recommends Dr Arbab. Many people get up in the morning and slip into their slippers, drink coffee, take a shower, and then get dressed, with shoes being part of that routine. Walking barefoot is completely left out. Of course, walking barefoot leads to increased callus formation, which isn’t necessarily part of the ideal of beauty. But this is something one should accept, and the calluses can always be removed during the next pedicure.
Numerous types of foot deformities can occur, ranging from flat feet, fallen arches and splayfoot to pes cavus, which can develop particularly after surgery. So-called pes equinus can develop as a result of prolonged bed rest in hospital, when movement is completely restricted due to illness. “In particular, patients who, for example, were in a coma for a long time following a severe case of COVID-19 and were ventilated in a prone position have developed pes equinus. This is a shortening of the calf muscles, meaning the heel is raised so high that the foot can no longer touch the ground, which is why patients walk on their tiptoes or, without orthoses, are unable to move at all,” explains Dr Arbab. Functional orthoses are worn while walking and aim to achieve a heel-to-toe gait, whereas positioning orthoses are worn exclusively at night while at rest, stretching the muscles and improving joint mobility.
Of course, genetic factors also play a role when it comes to foot deformities. For instance, some young people already have pronounced flat feet, just like their grandfather did.
The flat-footed foot
In a drop foot, the arch of the foot collapses and the foot is much flatter than normal. If the foot is only slightly lowered, this is referred to as a fallen arch. If it is severely lowered, it is referred to as a flat foot. “If a flat-footed foot is detected at an early stage, it can be treated effectively with individual foot exercises. For example, walking on sand, wearing insoles and performing various foot exercises can help the foot. The aim here is to support the inner sides of the foot,” explains Dr Arbab, describing the conservative treatment method. In children, a temporary flat-sagging foot is completely normal and usually corrects itself between the ages of eight and ten, as the arch of the foot has then developed.
Splayfoot
The entire forefoot is much wider, and the metatarsal bones fan outwards. This makes it very difficult for the person affected to put on shoes at all. The causes of splayfoot can include poor footwear, being overweight, prolonged standing, or connective tissue weakness. Common signs of a splayfoot include painful calluses and corns under the ball of the foot. If a splayfoot is left untreated, it can lead to bursitis. “Here too, the first step is to attempt conservative treatment using orthopedic shoes, foot exercises and insoles. Only if these measures do not lead to an improvement should surgical treatment be discussed,” says Dr Arbab.
Various forms of foot deformities © Henrie / Fotolia
A link to type II diabetes?
“If a person has type II diabetes, the blood supply to the blood vessels and nerves is poor – and consequently to the foot as well. If the nerves in the foot are damaged, the very unpleasant consequence is that you no longer notice when, for example, you develop a callus. Due to the reduced sensitivity to pain, those affected take no action; the foot may have an open wound, allowing germs to form and take hold more quickly, and the delayed healing process also makes things difficult for the patient,” explains Dr Arbab regarding diabetic foot syndrome.
Almost ten out of every hundred patients with type 2 diabetes suffer from diabetic foot syndrome. It is treated in accordance with the guidelines of the German Diabetes Society, which follow the RIA principle.
The abbreviation RIA stands for the following measures:
R = Revascularization, i.e. improving blood circulation
I = Treating infection, using, for example, antiseptics and/or antibiotics
A = Amputation; approximately 39,000 amputations are performed in Germany each year
The severity of the condition can be classified on a scale of 0–5: from 0 = no risk foot, no injuries, but possibly foot deformities, to 5 = dead tissue (necrosis) across the entire foot.
Amputation of toes, feet or the entire leg is only carried out in extremely severe cases and is only considered once all other options have been exhausted.
“Every diabetic should keep a close eye on their feet and examine them daily. They should also visit their GP or the treating diabetologist or podiatrist regularly for a foot check-up,” advises Dr Arbab to patients. Another important preventive measure is not to smoke, as smoking promotes circulatory problems.
The best way to treat diabetic foot is by controlling blood sugar levels, so that the blood vessels and nerves do not suffer further damage. High cholesterol levels and any high blood pressure must be treated. “If the patient’s vascular narrowing is at an advanced stage, the vessel can be dilated using a catheter, for example with balloon angioplasty. To do this, a tube is inserted via the leg artery in the groin and advanced to the narrowed area, where the balloon then expands the narrowing via the tube,” says Dr Arbab, describing the catheter treatment. If this does not help, a stent can also be inserted here. Only if the narrowing extends over a larger section of the vessel should bypass surgery be considered.
Do more for foot health!
“The foot has fallen into a bit of a bad light. Many people are ashamed of their feet and hide them. Feet also have a bad reputation for being ‘unclean’. Unfortunately, however, feet are also neglected by a great many people. Shoes, for example, should be changed regularly so that they can dry out properly after being worn. Foot health urgently needs to be promoted!” urges Dr Arbab, concluding our conversation with his recommendations.
Dr Arbab, we would like to thank you very much for the informative conversation and for raising awareness of this issue. Direct contact with our specialist can be made via his profile page on the Leading Medicine Guide.
