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After

Have you ever asked yourself,“Will I be passing my achingbunions and hammer toes

on to my kids?” “Are these foot is-sues genetic?”

There are many different typesof foot problems that occur formany reasons. Body weight andother environmental factors (suchas footwear) are considered prob-able causes of many foot condi-tions, but genetics has recentlybeen shown to play an importantrole as well. Here is a brief list ofsome common foot ailments andtheir causes.

Bunions. Bunions are the mostcommon problem of the forefoot(the front part of the foot). Theyoccur in about 23% of 18 to 65-year-olds and 36% of people over 65years. This is a condition where thebig toe points toward the secondtoe, causing a bump on the insideedge of the toe. This bump is an en-largement of bone or tissue aroundthe joint at the base of the big toe.Bunions are generally caused bybone structure and ligamentous lax-ity or "loose ligaments”. They tendto occur more often in women. Wenow know that genetics does play arole in the development of bunions.In fact, the results of the recentFramingham Foot Study, published

in the September 2013 issue ofArthritis Care and Research, showsignificant inheritability for bunions.This study showed that bunionswere inherited in 39% of thewomen and 38% of the men in thestudy; while a whopping 89% of par-ticipants with bunions under theage of 60 had inherited the condi-tion. But, keep in mind that narrow-toed, high-heeled shoes cancertainly aggravate the problem.The condition can progress and be-come quite painful. On the otherhand, sometimes bunions are notbothersome at all.

Hammer toes. This is a condi-tion where one, or both, joints ofthe second, third, fourth, or fifthtoes (the “little toes” or “lessertoes”) bend. The abnormal bendingis caused by an imbalance betweenthe flexor and the extensor ten-dons of the toes. This imbalance isoften caused by ill-fitting or high-heeled shoes. However, we nowknow that genetics does play arole. High arches and flat feet, andthe pressure from a bunion can allincrease the risk of developinghammer toes. Additionally, some-times a hammer toe is caused bygenetically inherited conditionsthat cause nerve damage in thefoot. Recent studies have shownthat lesser toe deformities as agroup (e.g., claw toe, hammer toe,mallet toe) have a significant inher-itability, ranging from 0.5 heritabil-ity to 0.9, depending on age and

sex (scale is from 0–1; with 0 mean-ing genes do NOT contribute at allto the observable differences be-tween individuals and 1 meaninggenes are the ONLY reason for theobservable differences between in-dividuals; or, to put it another way– an inheritability of 0.5 meansthat, on average, 50% of the differ-ences among individuals that weobserve in the “little toes” is attrib-utable to genetic differences).

Corns. A corn is a circular, thick-ened area in the skin of the footthat usually forms after repeatedpressure on the skin, such as therubbing of an ill-fitted shoe. Cornsare caused by footwear. No genet-ics involved – so you can’t blameGrandma Rose for this one, but, thisalso means you won’t pass this con-dition on to your children. In fact, insome third world countries wherepeople don’t generally wear shoes,this problem is extremely rare.However, other foot conditions cancontribute to the problem, such ashammertoes where the tops of thebent toes tend to rub against thetops of shoes.

Ingrown toenails. This condi-tion occurs when the rim of the nailgrows down into the skin of thetoe. Genes do play a small part inthis. In some cases a genetic predis-position has been noted and famil-ial cases have been reported.Additionally, congenital ingrowntoenails, though uncommon, arebelieved to be due to intrauterine

Footwear and Genetics Are Both To Blame

WE NOW KNOW THATGENETICS DOES PLAY A ROLE

IN THE DEVELOPMENT OFBUNIONS

by PEDRAM A. HENDIZADEH, DPM, FACFAS

WILL YOUR FOOT PROBLEMS GETPASSED ON TO YOUR CHILDREN?

WWW.IMAGEMAGONLINE.COM DECEMBER 2013 / JANUARY 2014 • IMAGE • 41

trauma or hereditary transmission.However, research shows that ac-tivity or shoes are the main culprits.Ingrown toenails occur most oftenin young athletes and in those thatsqueeze their feet into shoes thatare one size too small. Nail salonsthat give pedicures can also aggra-vate this problem when they at-tempt to dig the ingrown nail out.This can cause irritation or an infec-tion and is clearly not recom-mended. Additionally, make sureyour nail salon uses only sterilizedinstruments, especially consideringthe next common foot problem.

Fungal infections. The originsof this infection are completelyfrom the environment and arecaused by microscopic organisms(fungi) that can live on the skin. Themore exposure, the more likely askin or nail infection will develop. Itis usually acquired at the gym,hotel, locker room, or nail salonwhere the warm, damp environ-ments may breed higher concen-trations of fungi. You can pick upfungus from a loved one.

At the cutting edge of researchin foot disorders, scientists havebeen trying to identify genes in-volved in various inheritable footconditions. So far, new candidate genes have beenidentified that may help reveal the genetic basis ofstructural foot disorders. This research is currentlyongoing.

How to reduce the risk of these foot issues:

1. Wear comfortable shoes. The best are deep wideshoes that are not pointy. Wear sensible heels. Donot let your young girls/teenagers wear heels. Thesecan cause tendon imbalances that can lead to manyproblems in the future.

2. Let the feet and nails breathe. Don’t wear nail pol-ish 24/7 year-round. Give the nails and feet a break.

3. Have feet checked if any calluses, corns, bruises,blisters, or areas of irritation appear.

4. Once-a-week self-examination is recommendedto check for cracks on the bottom of the heels. Payparticular attention to the skin between the toes.

5. Moisturize. Using moisturizing cream can helpprevent cracks, particularly in the winter time.

6. If copious sweating is a major issue, consider teasoaks. Dilute caffeinated tea and soak for 15 minutes,twice a day. The caffeine and the tannic acid in thetea help constrict the sweat glands.

So, perhaps the answer to the question is both;footwear and genetics both play roles in the devel-opment of many foot issues. You may have a geneticpredisposition to certain foot issues, but poorfootwear will exacerbate it. For additional informa-tion regarding these and other foot health issues,consult with your Podiatrist or visit www.APMA.

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Dr. Pedram A. Hendizadeh practices at Associated

Podiatrists, with offices in Roslyn, Huntington, and

Connecticut. For more information, visit

www.greatfootcare.com.