Health Care Professionals

Skin/Soft Tissue Management of the Foot

IPFH defines skin / soft tissue management of the foot as the practice of protecting the skin/soft tissue(s) of the foot from injury. One of the most important aspects of this protection is preventing injuries caused by contact with the inside of shoes. The practice is characterized by the use of an integrated approach: properly selected and fitted padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional.

Skin/Soft Tissue Management in the Healthy Foot

The primary objective of skin/soft tissue management in the healthy foot is prevention of  foot problems. Inside the shoe, the feet are subjected to various pressure and impact points. In addition, when the foot moves inside the shoe, under normal circumstances it is subjected to shear forces.

Shear force damages the feet in two ways: First, the metatarsal bones glide over layers of the plantar fat pads and skin that are not moving in the same direction as the bones; over time, this causes the fat pads to degenerate and lose their protective capability.  Second, shear force creates friction on the surface of the skin, causing blisters in the epidermis.

Additional problems may arise when the various layers of the skin move in opposing directions, creating blisters below the level of the epidermis. Shear force is exacerbated by excess moisture created when feet perspire during vigorous (and even moderately strenuous) activities. Moisture retained inside the shoe softens the skin of the foot and makes it more vulnerable to blistering. Moisture also intensifies shear force.

Padded socks made from acrylic and/or man-made fiber blends have been shown to wick moisture away from the skin, thereby helping to reduce blistering, callus formation and the potential for other moisture-related skin damage.  By contrast, natural fibers (cotton, wool and silk) absorb moisture, and do not provide the wicking action and resiliency that helps control moisture inside the shoe. Peer-reviewed, published research has shown that clinically tested padded socks  protect the outer skin of the foot from pressure and shear forces, by virtue of their design as well as the fabric and yarns used in their production.

Properly designed and fitted shoes or boots have uppers made of mesh or another material that evacuates moisture while not allowing it in. If the shoe upper is made of leather, it should have vents or other openings that help evacuate moisture. Waterproof shoes do not evacuate moisture and may create a wet environment conducive to the growth of athlete’s foot fungus. Well-designed footwear also has few seams or raised areas that can cause pressure points or rub the skin.

Orthotics or inserts can  help reduce shear forces that cause blisters and the degeneration of the fat pads. These can be off-the-shelf or custom-made, depending on the biomechanical characteristics of the individual and his or her specific foot health status.

Finally, footwear that is well designed and appropriate for the activities and lifestyle of the individual helps protect the foot from external forces and enables all the components of the integrated approach to work together optimally.

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