Although most young people have no complaints about their feet, ag workers are prone to foot issues that often worsen with age. Foot pain from any cause can result in a stilted gait, which increases the risk for injury.
Dr. Antony Merendino, DPM, and assistant professor in orthopedics and rehabilitation, University of Florida, explained how the foot is unique and reviewed several common foot issues.
“There are 26 bones in each foot and more than 30 joints and over 100 soft tissue structures (ligaments, muscles, tendons),” said Merendino. “Foot pathologies can limit productivity and can take you out of work for a long time.”
Fungal infections happen frequently in ag settings because fungus thrives in chronically moist, dark environments.
Fungal nails can separate from the underlying nail bed and make the nails thick and painful. “Most nail fungus is secondary to foot fungus,” Merendino said. “Untreated, it tends to go to a nail fungus.”
Fungal infections of the foot and nails can also lead to secondary bacterial infections. The culprit in most cases is footwear that holds moisture. Many cases of nail fungus can be treated with over-the-counter topical products.
Nails that are cut too short can grow into the skin and may lead to infection. Merendino said people ignore this issue or attempt to self-treat by trimming and soaking, but doing so without medical supervision can lead to serious infection.
Soaking is appropriate, but Merendino prefers patients use warm water and a cup or two of white vinegar rather than Epsom salts. “Vinegar acts as an astringent and kills bacteria,” he said. “It’s also cheaper and easier.”
Structural deformities of the foot can cause significant pain. Tight or ill-fitting shoes can contribute to deformities and result in pain and job limitations. “These can also lead to calluses, or hard tissue, which are painful,” said Merendino. “Bunions are visible bumps that cause pain and tenderness, with redness and swelling around the outside or inside of the foot or on the toes.” Bunions may lead to stiffness, limited motion and difficulty walking.
“Bunions and hammertoes tend to be caused by the mechanics of how you walk,” said Merendino. “Podiatry helps with biomechanics to reduce the risk of bunions forming.” Orthotics can help control foot motion to reduce this progression and prevent future issues. Managing mechanical issues also slows the progression of arthritis.
Plantar fasciitis is a common foot problem that manifests as heel pain. Most patients experience foot pain first thing in the morning or after rest. The plantar fascia is a ropy structure that holds the heel to the ball of the foot.
“As your arch drops, the rope pulls, and as the rope pulls, it causes pain and discomfort. Controlling the mechanics of the foot helps to reduce pain, and in most cases, gets rid of it,” Merendino said. “If you don’t treat it, it can be painful for months.”
Common plantar fasciitis treatments include physical therapy, stretching, medications and sometimes injections. Most importantly, the podiatrist will manage the mechanics of walking. Exercises and rolling the bottom of the foot on a frozen water bottle can help reduce pain and discomfort, but for full relief, the mechanism behind tendon irritation also must be treated.
Underlying disease, primarily diabetes, can lead to serious foot issues. Diabetes often leads to neuropathy (loss of feeling).
“If you have diabetes or neuropathy from a back issue, it’s important to inspect your shoes and feet daily,” he said. “Don’t assume there’s nothing in your shoe.” Those who have difficulty seeing the soles of their feet can sit in a chair and use a mirror.
Footwear is a critical aspect of foot health. Merendino recommended ag workers choose footwear made of materials that allow for maximum air flow.
“Leather has been one of the most common materials for shoes,” he said. “It’s water repellant and breathable. Rubber is also a common material for farm footwear, which is waterproof but doesn’t breathe at all.”
Muck boots are often made of rubber or PVC. “It’s 100% waterproof but holds heat,” said Merendino. “Newer shoes are both waterproof and breathable and have removable insoles that can be removed and replaced with a more supportive insole.”
Cotton socks are the most popular choice among farmers, but they aren’t the best option because cotton holds moisture close to the skin for extended periods of time, potentially leading to fungal and bacterial infections.
“Wool absorbs moisture and doesn’t hold moisture next to the skin,” said Merendino. “It wicks moisture away or holds it in the center of the fiber so your foot feels dry.” He added that wool socks make feet feel warmer in winter and cooler in summer.
Different foot structures require different types of support. The goal of support for flat feet is to create an arch. Supportive material for flat feet should be rigid and non-forgiving, like plastic, to control the arch collapse, and the material should support the person’s weight. Merendino said over-the-counter supports for flat feet aren’t the best choice.
“A high arch foot is a non-forgiving, non-shock absorbing foot,” he said. “Patients with high arches tend to have pain in the heel and ball of the foot because the foot doesn’t absorb shock. Every step causes a reverberation to the knee and hip. The goal [for high arches] is to absorb the shock on the outside of the foot.” Good orthotics can absorb 90% of the impact of shock for high-arch feet.
Foot structures that change with age are usually related to soft tissue. As the arch drops, the foot can elongate. “The foot isn’t actually growing – the arch is collapsing,” he said. “Patients who have orthotics should be assessed once a year to see if there have been changes in the feet. A tell-tale sign is that shoe size has increased, which means the arch is collapsing.”
When Merendino recommends footwear, he’s more concerned about materials than brand. The components of a shoe or boot, such as rigidity of the heel, how flexible the sole is and how the forefoot bends at the toes, all contribute to healthy feet. Those who have insoles or orthotics should take them when they try on shoes.
Farmers tend to sustain foot injuries due to walking on uneven terrain. Stable footwear is an important aspect of preventing injuries. If an injury occurs, Merendino recommends immediate treatment. Walking on an injured foot or ankle can worsen an injury and lead to more serious problems and potential for significant arthritis in the future.
by Sally Colby