Feet are the furthest thing from our minds when it comes to health concerns.
Asked which of eight factors are very important to their overall health in a survey by Edge Research, only half of adults named care of the feet — the lowest ranking among the eight and well below concerns such as eye and tooth care.
Podiatrists, the doctors who specialize in foot care, say people often don’t think much about foot health until there is a painful problem.
People don’t get routine foot exams, but that is changing for a growing group of Americans who have diabetes. Standard care for diabetes recommends regular foot exams as a cost-effective way to help prevent serious conditions that can lead to amputation and even death.
For everyone else, there are three foot conditions most likely to bring someone to the care of a podiatrist, said Dr. Gregory J. Mowen, whose practice is in Ventnor.
One is heel-pain syndrome, often caused by inflammation of a tendon beneath the foot as a result of bad shoes, weight gain or a variety of other factors.
Another is nail problems, especially ingrown nails and fungal infections.
But because of where he practices, Mowen sees a disproportionate share of the third main category of podiatric care patients: overuse injuries such as strains, stress fractures, pinched nerves and tendonitis.
“Our population has so many casino workers who, because of the nature of their work, tend to be standing on their feet every day,” he said. “That’s very problematic, from the foot all the way up.”
Typical treatments, he said, involve reducing the stress that caused the condition — “We try to get them off their feet for a few weeks” — adding support with shoe inserts or some type of brace, or in some cases injecting medicine or performing surgery.
Fungal infections are caused by a very resistant organism, Mowen said, and leading the range of treatments is oral antibiotics, which are the most effective but have significant side effects. Topical treatments are easier, but much less effective.
Mowen is among podiatrists experimenting with a new treatment that uses an infrared laser to kill fungal cells without much effect on normal skin. “It’s not as good as oral antibiotics, but it’s another treatment option,” he said, although one not currently covered by health insurances.
Mowen, 50, of Brigantine, said podiatric practice in the region has seemed fairly stable in the 17 years his office has been open, with some new doctors coming in and some existing ones retiring.
Federal figures bear out that impression. Atlantic County podiatrist offices slowly increased from 13 in 2005 to 18 in 2010, while the number of employees of such offices grew more slowly from 49 to 56. In Cape May County, offices have declined from six to five in the same period.
A different category of podiatric patients dominates the practice of another doctor of podiatric medicine, Dr. James Walsh in Rio Grande, Middle Township.
Since the southern end of Cape May County has a lot of retirees, he sees “more seniors and super seniors,” he said, a group in which diabetes and peripheral arterial disease are more likely to be present.
Those conditions greatly increase the need for and value of podiatric care.
The Centers for Disease Control and Prevention says there were 65,700 limb amputations among diabetics in 2006, and it estimates foot care programs can reduce the rate of such amputations by 45 to 85 percent.
A Thompson-Reuters study last year for the American Podiatric Medical Association found that preventive foot care also reduces costs, whether patients were covered by Medicare or private insurance.
The study compared the experiences of two groups of more than 7,500 patients each — one that received podiatric medical care in the year before the onset of a foot ulcer, and one that didn’t get such care.
The limb amputation rate for patients getting early podiatric care was lower, 5.8 percent vs. 8.5 percent of those privately insured, and 4.7 percent vs. 6 percent for those on Medicare.
In the two years after the diagnosis of the foot ulcer, patients who had gotten early podiatric care averaged $13,474 less in health-care costs if privately insured and $3,624 less if on Medicare.
Walsh, 58, of Palermo, Upper Township, typically gives patients with diabetic or peripheral artery issues vascular exams and sensory tests to see if they’re losing sensation anywhere on the foot.
“That can be correlated with a recommendation for shoes and gear to help prevent those ulcers,” he said.
People meeting the diabetic and loss-of-sensation criteria of the Centers for Medicare & Medicaid Services are eligible for a pair of shoes and three pairs of inserts a year, he said.
A CDC study published in January credited improvements in foot care, blood-sugar control and diabetes management with reducing foot and leg amputations among diabetics 40 and older by 65 percent from 1996 to 2008.
Such progress is especially important for the Jersey Shore region, which economists expect will see a surge in retiring baby boomers in the next two decades. The CDC estimates 27 percent of people age 65 and older have diabetes.
Diabetes already has increased from 4 percent of New Jersey’s population in 1994 to more than 8 percent in 2009, affecting 562,000 people, CDC figures show.
Another podiatrist whose practice serves mainly seniors, Dr. Jay W. Slepner, has a different niche: people who are housebound or prefer not to go out for their foot care.
“All I do now is house calls,” said Slepner, 69, of Margate.
He started practicing in 1975 and was in Philadelphia, and came to this area about eight years ago, he said. Most of his patients are on Medicare.
Slepner said he typically gets calls from diabetics and from patients who need care for their nails.
“There are people who can’t come out, and they can take advantage of my services,” he said.
For people who are diabetic or have peripheral arterial disease, the benefits of regular podiatric care are obvious. But how should other people decide when to seek professional help?
Half the people in the Edge Research survey reported having foot pain or discomfort, a higher percentage than reporting skin issues or dental pain.
Mowen said people should seek care right away for a foot injury that interferes with walking.
But if an injury leaves the foot painful but still functional, icing the foot and resting can be tried for up to three or four days, he said. If that doesn’t result in substantial improvement, a podiatrist’s care is probably needed.
Considering the demands people make of their feet — supporting all of their weight in complex movement and balanced on just two of them instead of the animal kingdom’s standard of four — tired, sore and aching feet are to be expected. But there’s a limit.
“When it gets to the point where the condition is affecting the activities of daily living, then it’s time to seek intervention,” Mowen said.
Contact Kevin Post: