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Plantar warts, caused by the human papillomavirus (HPV), are a common and often persistent foot condition encountered by podiatrists and general healthcare professionals. While many treatments exist, ranging from topical keratolytics to cryotherapy, some cases prove resistant to conventional therapies. In recent years, cimetidine, a histamine H2-receptor antagonist traditionally used for gastric acid suppression, has been explored as an off-label immunomodulatory treatment for recalcitrant warts, including those on the plantar surface.

Pathophysiology of Plantar Warts

Plantar warts develop when HPV infects the epidermal layer of the skin, typically through microabrasions. These warts can cause significant discomfort, especially when located on weight-bearing areas of the foot. Immunocompromised patients and those with persistent lesions often require alternative therapeutic strategies beyond standard topical or destructive modalities.

Cimetidine: Mechanism of Action

Cimetidine is primarily indicated for peptic ulcer disease and gastroesophageal reflux. However, it has been found to possess immunomodulatory properties, particularly through the inhibition of suppressor T-cell activity. This effect is hypothesized to enhance cell-mediated immunity, thereby increasing the host’s ability to clear HPV-infected cells and resolve warts.

Evidence for Cimetidine in Wart Treatment

Several studies and case reports have investigated the efficacy of cimetidine for treating warts. Some open-label studies and small randomized trials have demonstrated promising results, with clearance rates ranging from 30% to 80% in various patient populations. The typical dosing regimen for wart treatment is higher than that used for gastric conditions, commonly 20–40 mg/kg/day in divided doses for 2–3 months.

However, the literature is mixed. Larger, placebo-controlled trials have failed to consistently demonstrate a significant benefit over placebo, especially in immunocompetent adults. The strongest evidence for benefit appears in pediatric populations and in patients with multiple or recalcitrant warts. Notably, cimetidine is generally well tolerated, with mild side effects such as headache or gastrointestinal upset.

Clinical Application and Considerations

For podiatrists and clinicians, cimetidine may be considered in the following scenarios:

• Multiple, persistent plantar warts unresponsive to topical or destructive therapies
• Pediatric patients or those averse to painful procedures
• Patients with contraindications to conventional treatments

Before prescribing cimetidine, clinicians should review the patient’s medication history for potential drug interactions (e.g., with warfarin, phenytoin) and assess for contraindications such as hepatic or renal impairment.

Limitations and Controversies

While cimetidine offers a non-invasive option, its efficacy remains controversial. The heterogeneity in study designs, patient populations, and dosing regimens complicates interpretation. Furthermore, spontaneous resolution of warts is common, making it challenging to attribute clearance directly to cimetidine.

Cimetidine represents a potentially useful adjunct in the management of plantar warts, particularly for cases resistant to standard therapies. Its favorable safety profile and oral administration make it an attractive option for select patients. However, clinicians should counsel patients regarding the variable success rates and the limited high-quality evidence supporting its use. Further large-scale, randomized controlled trials are needed to clarify its role in the treatment of plantar warts.

References:

• Brodell RT, et al. Use of cimetidine to treat recalcitrant warts in adults. Arch Dermatol. 1996.
• Orlow SJ, et al. Cimetidine therapy for recalcitrant warts in children. J Am Acad Dermatol. 1993.
• Kwok CS, et al. Topical and systemic treatment of cutaneous warts: an updated review. Br J Dermatol. 2011.

Celiac disease is a chronic autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. While the condition is well-known for its gastrointestinal manifestations, its effects extend far beyond the digestive tract. Among the less commonly discussed but clinically significant consequences are the ways in which celiac disease can impact the feet. Understanding these associations is crucial for both healthcare professionals and individuals living with celiac disease, as foot health is integral to overall well-being and mobility.

Overview of Celiac Disease

Celiac disease affects approximately 1% of the population worldwide. In genetically predisposed individuals, gluten ingestion leads to an immune-mediated inflammatory response in the small intestine, resulting in villous atrophy and malabsorption of nutrients. Classic symptoms include diarrhea, abdominal pain, bloating, and weight loss. However, the disease is increasingly recognized for its extraintestinal manifestations, which can be the first or only signs of the condition.

Nutritional Deficiencies and Their Impact on the Feet

Malabsorption is a hallmark of untreated or poorly managed celiac disease. Deficiencies in essential nutrients—such as vitamin D, calcium, iron, vitamin B12, and folate—can have direct and indirect effects on foot health:

• Bone Health: Osteopenia and osteoporosis are prevalent in individuals with celiac disease due to impaired calcium and vitamin D absorption. These conditions increase the risk of stress fractures in the foot, particularly in the metatarsals and calcaneus. Patients may present with unexplained foot pain or recurrent fractures, often requiring podiatric assessment and management.
• Peripheral Neuropathy: Vitamin B12 and other B vitamin deficiencies can contribute to peripheral neuropathy, characterized by numbness, tingling, burning sensations, and loss of proprioception in the feet. This can lead to balance issues, increased risk of falls, and unnoticed injuries or ulcers, especially in older adults.
• Anemia: Iron deficiency anemia, common in celiac disease, can cause generalized fatigue and weakness, potentially affecting gait and increasing the risk of falls or mobility issues.

Dermatological Manifestations

The skin is another organ system frequently affected by celiac disease, and several dermatological conditions have implications for foot health:

• Dermatitis Herpetiformis: This is a chronic, intensely itchy, blistering skin condition associated with celiac disease. While it most commonly affects the elbows, knees, and buttocks, it can also occur on the feet. Lesions on the feet can lead to discomfort, secondary infection from scratching, and difficulty wearing shoes.
• Other Skin Changes: Chronic malnutrition may lead to dry, cracked skin on the feet, increasing the risk of fissures and secondary infections, particularly in individuals with diabetes or other comorbidities.

Musculoskeletal and Structural Changes

Celiac disease has been associated with several musculoskeletal complications that may manifest in the feet:

• Muscle Cramps and Weakness: Electrolyte imbalances, particularly involving calcium, magnesium, and potassium, can cause muscle cramps and weakness in the lower limbs and feet. This may impact walking and overall mobility.
• Joint Pain and Arthritis: Some individuals with celiac disease develop arthralgia or arthritis, which can affect the small joints of the feet. This may present as pain, swelling, and stiffness, particularly after periods of inactivity.
• Delayed Growth and Development: In children, untreated celiac disease can result in delayed growth and skeletal development, potentially leading to structural foot abnormalities such as flat feet or altered gait patterns.

Increased Risk of Infections

Impaired immune function due to chronic malnutrition can increase susceptibility to infections, including those affecting the feet. Fungal infections (tinea pedis), bacterial infections (cellulitis), and delayed wound healing are more common in individuals with poorly controlled celiac disease.

Gait and Balance Disturbances

The combined effects of neuropathy, musculoskeletal pain, and general weakness can lead to significant gait disturbances. Patients may adopt compensatory walking patterns, increasing the risk of falls and further foot injuries. Regular podiatric assessment is recommended for early identification and management of these issues.

Considerations for Podiatric Care

Podiatrists play a vital role in the multidisciplinary management of patients with celiac disease. Key considerations include:

• Screening for Nutritional Deficiencies: Awareness of the potential for malnutrition-related complications can prompt timely referral for medical evaluation and nutritional support.
• Assessment for Neuropathy: Routine neurological examination of the feet should be performed, particularly in patients reporting sensory changes.
• Management of Dermatological Conditions: Prompt recognition and treatment of skin conditions can improve comfort and reduce the risk of secondary infections.
• Education: Patients should be educated about the importance of foot care, particularly if they are at higher risk of neuropathy, fractures, or infections.
• Interdisciplinary Collaboration: Collaboration with gastroenterologists, dietitians, and primary care providers is essential to ensure comprehensive care.

Celiac disease is a complex systemic condition with the potential to significantly impact foot health through a variety of mechanisms. Nutritional deficiencies, dermatological manifestations, musculoskeletal complications, and increased infection risk all contribute to the spectrum of foot-related issues seen in this population. Early recognition and multidisciplinary management are key to preventing complications and maintaining mobility and quality of life for individuals with celiac disease.

Diabetes mellitus is a chronic metabolic disorder that affects millions of people worldwide. Among its many complications, foot problems are particularly significant due to their potential to cause serious morbidity, reduce quality of life, and even lead to amputation. Effective care of the diabetic foot is essential for preventing complications and ensuring optimal health outcomes for individuals with diabetes. This guide explores the key principles, preventive strategies, and clinical approaches to diabetic foot care.

Understanding Diabetic Foot Complications

Diabetic foot complications arise primarily from two interrelated factors: peripheral neuropathy and peripheral vascular disease. Neuropathy leads to a loss of protective sensation, making the foot vulnerable to injury. Vascular disease impairs blood flow, reducing the body’s ability to heal wounds and fight infections. These factors, combined with impaired immune response, create an environment where minor injuries can escalate into serious infections and ulcers.

Principles of Diabetic Foot Care

1. Prevention First: The cornerstone of diabetic foot care is prevention. This involves patient education, regular foot inspections, and early intervention when problems are detected.
2. Multidisciplinary Approach: Effective care requires collaboration between podiatrists, endocrinologists, nurses, and, when necessary, vascular and orthopedic surgeons.
3. Patient Empowerment: Educating patients to take an active role in their foot care is critical. This includes teaching proper hygiene, self-examination, and the importance of seeking prompt medical attention for concerns.

Daily Foot Care Routine

• Inspection: Patients should inspect their feet daily for cuts, blisters, redness, swelling, or nail problems. A mirror can help view the soles.
• Hygiene: Wash feet daily with lukewarm water and mild soap. Dry thoroughly, especially between the toes, to prevent fungal infections.
• Moisturizing: Apply moisturizer to prevent dry skin, but avoid the area between the toes to reduce the risk of fungal growth.
• Nail Care: Trim toenails straight across and file the edges. Seek professional help if vision or dexterity is impaired.
• Footwear: Wear well-fitting shoes with adequate support and cushioning. Avoid walking barefoot to prevent injury.

Risk Assessment and Screening

Regular foot examinations by a healthcare professional are essential. Risk factors to assess include:

• Loss of sensation (using monofilament or tuning fork)
• Foot deformities (bunions, hammertoes)
• Poor circulation (absent pulses, cold feet)
• Previous history of ulcers or amputation

Based on risk, patients are classified as low, moderate, or high risk, with follow-up intervals adjusted accordingly.

Early Detection and Management of Problems

Early identification of problems such as calluses, corns, blisters, or small wounds is vital. Even minor issues can rapidly progress in diabetic patients. Management includes:

• Offloading pressure from affected areas
• Debridement of calluses or necrotic tissue by a professional
• Use of appropriate dressings and topical treatments
• Antibiotic therapy for infections

Ulcer Prevention and Treatment

Foot ulcers are a major concern in diabetes. Prevention strategies include:

• Custom orthotics to redistribute pressure
• Regular podiatric care
• Glycemic control to promote healing

Treatment of ulcers involves wound care, infection control, and sometimes surgical intervention. Multidisciplinary input is often required for complex cases.

The Role of Glycemic Control

Maintaining optimal blood glucose levels is fundamental to preventing and managing diabetic foot complications. Poor glycemic control impairs wound healing and increases infection risk. Patients should work closely with their healthcare team to monitor and manage blood sugar levels.

Education and Support

Continuous education and support improve adherence to foot care routines and reduce the risk of complications. Resources include:

• Educational materials
• Group classes
• Support groups

Final Word

The care of the diabetic foot is a collaborative, patient-centered process that emphasizes prevention, early detection, and prompt management of problems. By following evidence-based guidelines and empowering patients, healthcare providers can significantly reduce the burden of diabetic foot complications and improve quality of life for those living with diabetes.

Human gait is a complex, coordinated process involving numerous anatomical structures and biomechanical principles. Understanding gait is essential for clinicians, researchers, and allied health professionals, as it provides the foundation for assessing normal and pathological walking patterns. Among the most influential frameworks in gait analysis is the concept of the “six determinants of gait,” first described by Saunders, Inman, and Eberhart in the 1950s. These determinants represent biomechanical strategies that minimize energy expenditure during walking by reducing the vertical and lateral displacement of the body’s center of gravity (COG).

1. Pelvic Rotation

The first determinant, pelvic rotation, refers to the forward rotation of the pelvis in the transverse plane during walking. As the leg swings forward, the pelvis on that side rotates anteriorly by approximately 4 degrees. This rotation effectively lengthens the stride, reducing the necessary vertical displacement of the COG. By increasing step length without requiring greater hip flexion or extension, pelvic rotation contributes to a smoother, more energy-efficient gait. In clinical settings, restricted pelvic mobility can lead to compensatory patterns and increased energy expenditure, often observed in patients with hip pathology or neurological disorders.

2. Pelvic Tilt (Obliquity)

The second determinant, pelvic tilt, involves a slight downward tilt of the pelvis on the swing side, typically about 5 degrees. This movement lowers the COG at midstance, mitigating the rise that would otherwise occur as the body passes over the supporting limb. Pelvic tilt is primarily controlled by the hip abductor muscles, particularly the gluteus medius and minimus. Weakness or dysfunction in these muscles can result in a Trendelenburg gait, characterized by excessive pelvic drop and lateral trunk lean. Clinically, assessing pelvic tilt is crucial in the evaluation of gait abnormalities associated with hip abductor weakness or neuromuscular conditions.

3. Knee Flexion in Stance Phase

During the initial contact and loading response phases of gait, the knee flexes by approximately 15 degrees. This third determinant reduces the vertical displacement of the COG as the body transitions from heel strike to foot flat. Without this knee flexion, the COG would rise sharply, increasing the energy cost of walking. Proper knee flexion also facilitates shock absorption and smooth progression of the limb. Pathologies such as knee arthritis, ligament injuries, or extensor mechanism dysfunction can disrupt this determinant, leading to a stiff-legged gait and increased energy expenditure.

4. Foot and Ankle Mechanisms

The fourth determinant encompasses the complex interplay of foot and ankle movements that occur during stance. At initial contact, the ankle is slightly dorsiflexed, and the foot is supinated. As the body progresses over the foot, the ankle plantarflexes and the foot pronates, allowing for shock absorption and adaptation to the ground. Just before toe-off, the ankle plantarflexes, and the foot supinates again, providing a rigid lever for propulsion. These coordinated motions reduce the vertical displacement of the COG and optimize energy transfer. Dysfunction in the foot and ankle—such as limited dorsiflexion, excessive pronation, or rigid deformities—can impair this determinant and lead to compensatory gait patterns.

5. Knee Mechanisms

The fifth determinant refers to the dynamic changes in knee alignment during the gait cycle, particularly the interplay between flexion and extension. As the limb transitions from stance to swing, the knee extends, lengthening the limb and facilitating forward progression. This mechanism also helps to smooth the path of the COG, minimizing abrupt changes in vertical displacement. Inadequate knee extension, as seen in conditions like cerebral palsy or post-stroke hemiplegia, can result in inefficient gait and increased risk of falls.

6. Lateral Displacement of the Body

The final determinant is the lateral displacement of the body’s COG, which occurs as the weight shifts from one limb to the other during walking. This side-to-side movement is minimized by the anatomical configuration of the femoral neck and the relative width of the pelvis. Excessive lateral displacement, often observed in individuals with wide-based gait or hip abductor weakness, increases energy expenditure and may predispose to instability. Clinically, careful observation of lateral trunk movement is vital in assessing gait deviations and planning rehabilitation strategies.

Clinical Relevance

The six determinants of gait collectively serve to optimize energy efficiency during human locomotion by smoothing the trajectory of the COG. Disruption of any determinant—due to musculoskeletal, neurological, or structural abnormalities—can lead to compensatory mechanisms, inefficient gait, and increased risk of injury or falls. For clinicians, a thorough understanding of these determinants is essential for gait assessment, treatment planning, and rehabilitation. By analyzing each determinant, podiatrists and allied health professionals can identify underlying deficits, tailor interventions, and ultimately improve patient outcomes.

In summary, the six determinants of gait provide a foundational framework for understanding the mechanics of walking. Their clinical application extends across disciplines, informing the diagnosis and management of gait disorders and enhancing the quality of care for individuals with foot and lower limb pathology.

Heel pain is a common complaint encountered in clinical practice, affecting individuals across all age groups. Among the various diagnostic tools available, the Calcaneal Squeeze Test stands out as a simple yet valuable clinical maneuver. This test is particularly important in differentiating causes of heel pain and guiding subsequent management. Understanding the meaning, application, and interpretation of the Calcaneal Squeeze Test is crucial for clinicians, especially podiatrists, sports medicine practitioners, and allied health professionals.

What is the Calcaneal Squeeze Test?

The Calcaneal Squeeze Test, sometimes referred to as the “heel squeeze test,” is a hands-on clinical examination technique used primarily to assess for pathologies of the calcaneus (heel bone). The test involves applying a gentle but firm lateral compression to the calcaneus, typically at its medial and lateral aspects. The patient’s response to this maneuver—especially the presence, location, and character of pain—can provide valuable diagnostic clues.

Clinical Indications

The Calcaneal Squeeze Test is most commonly indicated in patients presenting with:

• Acute or chronic heel pain
• A history of trauma to the heel
• Suspected calcaneal stress fracture
• Pediatric patients with heel pain (e.g., Sever’s disease)
• Athletes and active individuals with overuse injuries

Technique

The test is performed with the patient either seated or lying supine, with the foot relaxed. The examiner uses their thumb and fingers to grasp the medial and lateral sides of the calcaneus, then applies a gentle squeezing force. The maneuver is usually performed bilaterally for comparison.

A positive test is indicated by the reproduction of the patient’s typical heel pain during compression, often localized to the calcaneal body.

Interpretation

Positive Result

A positive Calcaneal Squeeze Test—where squeezing the calcaneus elicits pain—suggests pathology within the calcaneal bone or its adjacent structures. The most common causes include:

• Calcaneal Stress Fracture: Microfractures within the calcaneus, often due to repetitive impact, are a leading cause of a positive test. This is especially prevalent among runners, military recruits, and athletes.
• Sever’s Disease (Calcaneal Apophysitis): In children and adolescents, a positive test is strongly associated with this condition, which is an inflammation of the growth plate in the calcaneus.
• Other Pathologies: Less commonly, bone tumors, infections (osteomyelitis), or severe contusions can yield a positive result.

Negative Result

A negative Calcaneal Squeeze Test (i.e., no pain on compression) may suggest that the cause of heel pain is extra-osseous, such as:

• Plantar fasciitis (pain is more prominent on the plantar aspect, not the calcaneal body)
• Achilles tendinopathy
• Bursitis
• Nerve entrapments

Clinical Relevance

Differential Diagnosis

The Calcaneal Squeeze Test is particularly valuable in distinguishing between bony and soft tissue causes of heel pain. For example, plantar fasciitis—the most common cause of heel pain—rarely produces a positive squeeze test, as the pathology is in the fascia rather than the bone.

Pediatric Considerations

In children, a positive test is highly suggestive of Sever’s disease. This is a self-limiting condition that occurs during periods of rapid growth, and the test helps to avoid unnecessary imaging or interventions.

Sports Medicine

For athletes, especially those with a history of increased training intensity or volume, a positive test raises suspicion for a stress fracture. Early diagnosis is essential to prevent progression and facilitate appropriate management.

Limitations

While the Calcaneal Squeeze Test is highly useful, it is not definitive. False positives can occur in cases of severe soft tissue injury adjacent to the calcaneus, and false negatives may occur in early or mild stress fractures. Imaging (X-ray, MRI, or ultrasound) may be required for confirmation.

The Calcaneal Squeeze Test remains a cornerstone of clinical assessment for heel pain. Its simplicity, speed, and non-invasiveness make it an essential tool for podiatrists and other clinicians. By helping to localize pain to the calcaneus, the test guides further investigation and management, improving outcomes for patients with heel pain. However, like any clinical test, it should be interpreted in the context of a thorough history and examination, and followed by appropriate imaging when necessary.

Foot orthotics are widely used in the management of a range of foot pathologies, providing structural support, redistributing plantar pressures, and enhancing gait biomechanics. Among the various orthotic modifications available, the cuboid notch is a specialized feature designed to address specific biomechanical and clinical needs. This essay explores the rationale, design, clinical indications, and evidence supporting the use of a cuboid notch in foot orthotics.

What is a Cuboid Notch?

A cuboid notch is a deliberate cut-out or depression incorporated into the lateral aspect of an orthotic device, corresponding anatomically to the location of the cuboid bone. The notch may vary in depth and width, depending on the patient’s anatomy and clinical requirements. Its primary function is to reduce direct pressure on the cuboid and allow for normal lateral column function during gait.

Biomechanical Rationale

The cuboid bone plays a key role in the lateral column of the foot, acting as a stabilizer and a fulcrum for peroneal tendons. Excessive pressure or restriction in this region—often caused by rigid, poorly contoured orthotics—can lead to discomfort, altered gait, and even lateral foot pain. The cuboid notch modification is designed to:

• Offload the cuboid bone, reducing focal pressure and irritation
• Facilitate normal movement of the lateral column during propulsion
• Accommodate bony prominences or subluxed cuboid positions
• Improve comfort and orthotic tolerance, especially in patients with lateral foot pathology

Clinical Indications

The cuboid notch is not a standard feature in all orthotic prescriptions but is indicated in several clinical scenarios, including:

• Cuboid Syndrome: Characterized by subluxation or malalignment of the cuboid, resulting in lateral foot pain. A cuboid notch can help reduce direct pressure and facilitate recovery.
• Peroneal Tendon Pathology: The peroneal tendons course around the cuboid. Offloading this area can reduce irritation and allow for optimal tendon function.
• Lateral Column Overload: Patients with lateral foot overload, often due to biomechanical imbalances or high-arched (cavus) feet, may benefit from a cuboid notch to redistribute forces more evenly across the foot.
• Bony Prominences or Exostoses: In cases of cuboid exostosis or prominent cuboid bone, a notch can prevent orthotic-induced discomfort.
• Post-traumatic or Post-surgical Cases: Where changes in foot structure or sensitivity exist, a cuboid notch offers targeted relief.

Design Considerations

The size, depth, and shape of the cuboid notch should be tailored to the individual’s anatomy and pathology. Key considerations include:

• Precise anatomical placement to align with the cuboid
• Gradual contouring to avoid abrupt transitions that may cause pressure elsewhere
• Material selection to maintain orthotic integrity while providing adequate relief
• Integration with other modifications (e.g., lateral skive, forefoot posting) for optimal biomechanical correction

Evidence and Clinical Outcomes

While there is limited high-level research specifically on the cuboid notch, clinical experience and case studies support its use in appropriate patients. Reports indicate improved comfort, reduced lateral foot pain, and higher orthotic compliance when the cuboid notch is used judiciously. Its application is particularly valued by practitioners managing complex lateral foot pathologies.

Practical Application

The process for incorporating a cuboid notch typically involves:

1. Careful assessment of the patient’s foot structure, pain location, and gait pattern
2. Marking the cuboid position during casting or scanning
3. Customizing the notch during orthotic fabrication
4. Evaluating fit and comfort at dispensing, with adjustments as needed

The cuboid notch is a valuable orthotic modification that, when used appropriately, can enhance patient comfort and clinical outcomes in lateral foot pathologies. Its success depends on careful patient selection, precise anatomical placement, and integration with other orthotic features. As with all orthotic interventions, ongoing assessment and adjustment are essential to ensure optimal results for each individual.

Crocs have become a global phenomenon, instantly recognizable for their lightweight design, ventilated upper, and distinctive look. Loved by many for their comfort and convenience, Crocs are worn everywhere—from the beach to the hospital ward. But are Crocs actually good for your feet? As podiatrists and foot health professionals, it’s important to look beyond trends and marketing to assess the clinical impact of Crocs on foot health.

The Design of Crocs: Comfort and Convenience

Crocs are made from Croslite, a proprietary closed-cell resin material that is soft, flexible, and lightweight. Their most notable features include:

• Wide toe box
• Slip-on design
• Ventilation holes
• Cushioned sole

These elements make Crocs easy to wear and popular among people seeking relief from foot pain or those who spend long hours on their feet.

The Benefits: Where Crocs Excel

1. Cushioning and Shock Absorption

Crocs provide excellent cushioning, which can be beneficial for people with sensitive feet or conditions such as plantar fasciitis. The soft, shock-absorbing sole helps reduce pressure on the heel and forefoot, making them a reasonable option for short-term comfort.

2. Wide Fit and Toe Space

The wide toe box allows the toes to splay naturally. This is particularly helpful for individuals with bunions, hammertoes, or other forefoot deformities, as it reduces crowding and friction.

3. Lightweight and Breathable

Crocs are extremely light and ventilated, reducing fatigue and keeping feet cool. This can be advantageous in hot climates or for people prone to sweaty feet.

4. Easy to Clean

For those who require footwear that can be easily washed and disinfected, Crocs are a practical choice, especially in healthcare or hospitality settings.

The Drawbacks: Clinical Concerns

Despite their popularity, Crocs are not without clinical concerns, particularly when worn for extended periods or inappropriate activities.

1. Lack of Support

While Crocs are cushioned, they do not provide adequate arch support or rearfoot control. For individuals with flat feet, overpronation, or a history of foot injuries, this lack of support can lead to discomfort or exacerbate existing conditions.

2. Instability and Risk of Injury

The loose fit and slip-on style may increase the risk of trips and falls, particularly on uneven surfaces. Children and elderly individuals are especially vulnerable. The absence of a secure fastening can also contribute to instability during walking or running.

3. Not Suitable for High-Impact Activities

Crocs are not designed for sports, long-distance walking, or hiking. Their flexible sole and lack of structural support make them unsuitable for activities that require stability, protection, or shock absorption beyond casual wear.

4. Potential for Overuse Injuries

Extended use of Crocs, especially by individuals with pre-existing foot problems, can contribute to overuse injuries such as plantar fasciitis, Achilles tendonitis, or metatarsalgia due to inadequate support and poor biomechanics.

Clinical Recommendations

When Are Crocs Appropriate?

• Short-term use: Crocs are suitable for brief periods of wear, such as around the house, at the beach, or in the garden.
• Post-surgery or acute foot pain: For some patients recovering from foot surgery or experiencing acute pain, the cushioning and easy fit can offer temporary relief.
• Individuals with forefoot deformities: The wide, accommodating fit can be beneficial for those with bunions or hammertoes.

When to Avoid Crocs

• Extended walking or standing: For all-day wear, especially on hard surfaces, footwear with proper arch support and heel control is recommended.
• Sports or vigorous activity: Crocs should not be used for running, hiking, or sports due to their lack of stability and support.
• Individuals with diabetes or neuropathy: People with reduced sensation in their feet should avoid loose-fitting shoes to prevent injury and ensure proper protection.

Crocs can be a comfortable, convenient choice for short-term use or specific situations, but they are not a substitute for supportive, well-fitted footwear—especially for individuals with foot problems or those who spend long hours on their feet. As podiatrists, we recommend choosing footwear that matches your activity and foot type, prioritizing support, stability, and protection.

If you’re experiencing foot pain or have concerns about your footwear, consult a podiatrist for a professional assessment and personalized recommendations.