Ahhh…shoes

8/19/2014

They used to be so simple. As a child, and before China was a major trade partner, just two pair sufficed: sturdy Buster Browns for school, and sneakers for play. Most of my friends’ parents subscribed to the same sound, practical philosophy of shoes, bought on sale but with an eye for quality and endurance, always gauging what size would be the best for the unpredictable growing foot.

“Too big,” the salesman would say as he pressed down hard at the big toe. “Nevermind,” was my mother’s reply, “she’ll grow into it.” And I learned how to wear fat socks, and turn the toes under to bunch up so my feet wouldn’t slide around so much. Occasionally an over-large pair would require tissues stuffed in as well (a skill I transferred later to other garments…). If I was lucky I’d fit into the shoes before they wore out.

These, I realize now, were important lessons for a budding shoe maven. A woman learns in childhood how to accommodate the foot to the shoe. Perfect sizing is a choice, a luxury. Women are malleable on size: even if the shoe does not fit, we may wear it, if the price and the color are right.

My grandmother lured me down the road to shoe decadence with a pair of black patent leathers adorned with the tiniest kitten heel. Oh, I remember them, with a lovely little strap that buckled at the ankle, and delicate cut-outs on top of the slender, tapered toe. Dorothy’s ruby slippers were no more precious as I turned my eight-year old foot this way and that, admiring them below the hem of my dress. For church and dress-up, she explained to my mother, who raised an eyebrow at my preening baby-steps, no doubt fully aware of the potential pitfalls of this approach as she comprehended the gleam in my eye. Of course it would be many years before I had the financial wherewithal to indulge this acquired taste; there was no way I was going to squander my childhood capital begging my parents to buy me things that their history of growing up in the shadow of the Great Depression would allow. Nevertheless, the die was cast.

Ah, the shoes that are available to a medium-sized foot at the end of a shapely leg when one is in one’s prime! While still on the budget of a college student negotiating the cost of textbooks and tuition, I made my first forays to the clearance racks of department stores. For a song I bought a stylish pair of olive suede Hush Puppies with a 2” heel and a kiltie fringe (no laughing, olive green was in then, and kilties). Then I got half off the second pair, so who could resist strappy, 4” vamp sandals for smart evening wear?

My feet complained if I had to walk very far or dance all night, but I remained deaf to their grumbling as I stuffed the floor of my closet over the ensuing years with precious pairs in a rainbow of colors and a kaleidoscope of prints: heels and flats, sandals, and thongs (that’s what we called them—say that now and you’ll get a startled look from your teenager), running shoes, and deck shoes, hiking boots and snow boots, ski boots and après ski slippers, and, I confess, a pair of boudoir do-me pumps (these were difficult to walk in, much less do a pole dance on the bedroom carpet…after a few tries, I just dangled them in front of my husband, and elicited much the same response as wearing them did, minus the laughter).

I packed for trips without considering the shoes, choosing outfits first, throwing shoes in to match at the last minute, without a thought for how many pairs I was packing, how far I would be walking. Style, glamour was king. Or princess so to speak. I was tricked out in those shoes I tell you. No matter what changes my body was springing on me over the years, pregnancy, post pregnancy, water retention, mid-life adjustments, empty-nesting, strands of gray poking through the scalp, smile lines, furrowed brows, the shoes were always a flashy or classy, sexy, professional or refined statement of who I was.

It’s not clear to me when I made the transition in the other direction, it was so subtle. The direction of what can only be called decrepitude. Incredibly, startlingly, at an age I thought was far too young, I found myself looking at shoes for the queen-mother…who was about a hundred the last time I saw a picture of her. That’s suddenly how my feet felt. I would put on a new pair, fresh from the tissue caressing them in the box, and find they were too tight. Way too tight. Hadn’t I just tried them on last week? Or last night? I would peer at my foot, sit down and strain it, cross-legged, into my lap, examining it for flaws, fat, fluid. None were obvious. Shove it back into the shoe. Toes squeezed by pointy leather fronts, canted alarmingly forward by the now insensible heels. Crying for room, oxygen, blood flow, the comfort of the fleece-lined slippers I’d just kicked off. Flats. I put them on. Looked in the mirror. My heart cried, “ugh!” My feet said ahhh.

For next few years I balanced the ugh with the ahh, sacrificing the style of my shoes more and more over time for the comfort of my feet. I am now firmly encamped in the comfort zone, occasionally making a foray back to heady moments of style. Along the way I discovered that Chinese women walk a lot. And they like style. This translates into an abundance of stylish flats in the marketplace in Shanghai, a concept that has just begun to trickle into America. Kitten heels. Wider widths. Squared off toes. Elastic in key places. Colors and prints galore. Ahhh and lovely in the same shoe. What a concept. How did American designers miss this boat?

I now start packing for travel from the bottom up, carefully considering where and how much I’ll be walking, what misery I am willing to put my sole through for the sake of beauty. I concern myself less and less with which treasures will match my wardrobe.

Word has it the next step is buying shoes built for safety. Are you kidding me? It’s too much to stomach, this journey from style to comfort to safety. I see these shoes, lurking, hunkering down on the shelves, giant sphinxes of footwear ready to leap onto my feet, then sit there as immobile as stone. I have a palpable anxiety as I walk past them—how they blend in here and there with the comfortable shoes. Will I unwittingly buy a pair of these dreaded shoes mistakenly confounding solace with style? And if I accidentally purchase this mark of aging, will I know it? Or will a soon-to-be-former friend have to tell me? Will they pity my blind descent into safe shoes and keep quiet to spare me?

It’s too much to contemplate on such a beautiful summer day, a day for those strappy little coral patent leather flats and the matching capris. Anyway, there is no shoe shopping in my immediate future because there is no room for even one more pair in my closet. And I can’t bear to ponder which pair I might give up to make room for another. Ah, now that’s another kind of relief.

This is a short description of foot problems, many of which (but not all) are caused by a lifetime of wearing ill-fitting shoes:

Bone spurs are small extra growths of bone that often form at the edges of bones or joints. They protect the deeper bone from damage caused by chronic wear and tear. Bone spurs themselves are not painful, but may cause pain if they push against a nerve or sensitive softer tissue.

Bunions. A bony growth that forms at the base of the big or the little toe (bunionette—isn’t that cute?) forcing the toe outward, and often involving pain as the bunion enlarges. Shoes that are too tight in the toebox are often the cause.

Heel spurs. A bone spur anywhere on the heel. May not have any symptoms at all or may cause pain in the bottom of the foot, especially after resting the foot for a period of time, or in the arch of the foot (plantar fasciitis).

Morton’s neuroma. A collection of fibrous tissue usually between the base of the 3rd and the 4th toes. Sharp and/or burning pain occurs between those toes when the foot strikes the ground.

Mallet toe/ hammer toe/ claw toe. Fairly descriptive all by themselves, these are deformities of the toe joints caused by years of wear and tear, often from ill-fitting shoes. Mallet toe bends the very tip of the toe toward the ground, hammer toe the joint behind that bends to the ground, and claw toes bend up where the toe meets the foot and then bend to the floor. Imagine Cinderella’s evil stepsisters trying to shove their feet into the glass slipper: the contortions the toes have to make temporarily to squeeze in eventually end up as these permanent deformities.

Warts. Ugh. Viral infections on the surface of skin. Harmless, but ugly.

Plantar fasciitis. Inflammation of the tough fibrous tissue that connects the heel to the toes, and forms the arch of the foot. The pain usually starts at the part of the arch closest to the heel. Since 10,000 steps per day is recommended for healthy exercise, this condition can be very painful for those of us who walk.

Gout is pretty hard (though not impossible) to miss. It usually starts at the base of the big toe, and consists of painful redness and swelling. The pain is usually out of proportion to the appearance of the toe: it hurts like the dickens. Caused by a combination of dietary habits and possibly genetics.

Ingrown toenails occur when the end of the nail embeds itself in the soft skin around it as it grows. This usually happens only in the big toe and can create infection, characterized by increased redness and swelling, or it can simply cause pain. Avoid clipping toenails too far back at the sides. Leave a small amount extending past the soft tissue. Consider filing your big toe nails instead of clipping which can fracture the nail in ways you can’t control nearly as well as with a file. Don’t use the same file on your fingers due to risk of fungal infection.

What You Should Be Afraid Of

August 14, 2014 

Ebola is in the news. Earlier this year it was MERS (Middle-eastern respiratory syndrome); SARS and bird flu before that. I don’t know about you, but Ebola seems to me a particularly horrific way to die. It’s pretty far away at this point – but air travel makes it possible and even probable in the U.S. if the outbreak continues to expand. Whether it’s Ebola or some equally infectious agent, some day a bug this bad will be on our doorstep. History is an excellent teacher and it informs us that biological threats are far more destructive of human life than war. Consider that the 1919 Pandemic (it was also called the Spanish flu) took the lives of 50 to 100 million people by the latest estimates. There were fewer than 2 billion people on the planet then. You could do the math, but I’ll do it for you: that means up to 5 out of every 100 people alive at the time died from it. It infected 500 million or 1 out of every 4 people in existence. That’s more people than all those killed in all the wars of the 20th century – yup, WWI + WWII + Korea + Vietnam. By the way, the best guess is that the flu that swept the world started in Kansas.

I don’t say this to incite panic. But I do say it to get you thinking about what worries me: the fact that we can and should be prepared for a variety of these contagious disease disasters, but we are not. Why not? In a word: research. What businesses do you think are lining up for the chance to cure a disease that afflicts a mere few hundred people a year in poverty-stricken countries? Which pharmaceutical companies are hard at work finding vaccines to prevent these fatal scourges? You know the answer. Private industry engages in profit-making research; there is no profit in reading tea-leaves about what might eventually head our way.

This is why basic medical research in this country has always been conducted first and foremost by labs associated with our federal government: the National Institutes of Health, Centers for Disease Control, and a multitude of private labs funded predominantly by grants from the federal government. Scientists at these facilities are charged with investigating the obscure, the non-profitable, the what-may-never-be-but-might-be that lies in our future. No venture capitalists line up to hire these researchers, no Silicon Valley entrepreneurs can afford to fail repeatedly before they succeed. But the federal government, charged first and foremost with protecting the people can, and does, often fail at the science of prevention and cure before it succeeds. In fact, that is one of the basic tenets of research – to keep trying until you succeed.

This is expensive, to fail repeatedly before succeeding. So the NIH fell victim to the budget wars, just like nearly everything else in front of our notoriously inept current Congress. For each of the last 4 years 1 million dollars has been slashed from the NIH’s budget. We are losing the best and brightest scientists to political grandstanding and a public that is focused on the shortcomings of our current government without an appreciation for the good, indeed great, things only government is capable of accomplishing. The premier research institutions in the U.S. are drowning with the government baby in the bathtub. This might be good political theater but it’s really bad for our health. Some day we will be overrun by a biological organism we could have been prepared for. We throw our treasure at military threats, and withhold it from that which historically is more likely to do us in. When it comes to protecting us, we need good government at our backs with more than just guns.

New Cholesterol Guidelines

March 7, 2014 

Latest guidelines advise more people should be using statins and at younger ages. Not so fast. Internationally, doctors are debating this intensely. Count me on the side of the skeptics because there is much to be suspicious of here.

Too many current recommendations are based on flawed data produced in studies commissioned by and for makers of drugs. Research is inherently unsound when it is designed to produce certain results, no matter which prominent names in the field of science are attached: if researchers are taking money from the drug companies, they are by definition biased. Most of the doctors who’ve come together in this paper to advise younger people and those with minimal elevations of cholesterol to take statins directly benefit financially from the giant pharmaceutical companies that make the drugs they are recommending.

What we do know is that statins as a class of drugs (lipitor, mevacor, zocor etc.) are effective in bringing down total cholesterol and LDL’s (one of the bad kinds of fat in the blood). We are also pretty sure that statins can reduce the amount of plaque already formed in some blood vessels and that these actions may stave off disease and death for some people at high risk of vascular disease (heart attack, stroke, etc). But the latest study does not tell us that low risk patients would benefit from using these drugs or at what levels or age they should start. There are poitential harms to using any drug and when your risk of disease is low then the risk of taking the drug is more likely to outweigh the benefit. As many as 23 people would have to take a statin for 10 years to prevent a heart attack in one person. That’s a lot of pills, a lot of side effects and a lot of money for 22 out of those 23 people. As previous blunders have proven before (think vioxx and heart attack as a recent example) drugs are often rushed to market before benefits and safety in widespread use are proven.

My advice: take a statin if your doctor recommends it based on your atherosclerotic disease risk – that is your lipid profile combined with your personal and family history, but don’t go on it just to make your numbers lower. Regardless of whether you would benefit from a statin, keep doing all those other things you are capable of to keep your cholesterol in line. Every personal intervention you can make (weight management, exercise, stop smoking) is better than any drug… in other words, an ounce of prevention is worth…

New Cholesterol Guidelines

March 7, 2014 

Latest guidelines advise more people should be using statins and at younger ages. Not so fast. Internationally, doctors are debating this intensely. Count me on the side of the skeptics because there is much to be suspicious of here.

Too many current recommendations are based on flawed data produced in studies commissioned by and for makers of drugs. Research is inherently unsound when it is designed to produce certain results, no matter which prominent names in the field of science are attached: if researchers are taking money from the drug companies, they are by definition biased. Most of the doctors who’ve come together in this paper to advise younger people and those with minimal elevations of cholesterol to take statins directly benefit financially from the giant pharmaceutical companies that make the drugs they are recommending.

What we do know is that statins as a class of drugs (lipitor, mevacor, zocor etc.) are effective in bringing down total cholesterol and LDL’s (one of the bad kinds of fat in the blood). We are also pretty sure that statins can reduce the amount of plaque already formed in some blood vessels and that these actions may stave off disease and death for some people at high risk of vascular disease (heart attack, stroke, etc). But the latest study does not tell us that low risk patients would benefit from using these drugs or at what levels or age they should start. There are potential harms to using any drug, and when your risk of disease is low then the risk of taking the drug is more likely to outweigh the benefit. As many as 23 people would have to take a statin for 10 years to prevent a heart attack in one person. That’s a lot of pills, a lot of side effects and a lot of money for 22 out of those 23 people. As previous blunders have proven before (think vioxx and heart attack as a recent example) drugs are often rushed to market before benefits and safety in widespread use are proven.

My advice: take a statin if your doctor recommends it based on your atherosclerotic disease risk – that is, your lipid profile combined with your personal and family history–but don’t go on it just to make your numbers lower. Regardless of whether you would benefit from a statin, keep doing all those other things you are capable of to keep your cholesterol in line. Every personal intervention you can make (weight management, exercise, stopping smoking) is better than any drug. In other words, an ounce of prevention…you know the rest.