CHAPTER 7: Daily Activities and Managing Limitations

Your Doctor as a Partner to Help Manage Limitations

Talk to your doctor honestly about your most important problems. When there are many problems, help your doctor understand the most important. Once you deal with your first priority, your doctor can work on the next problem. Big problems are best solved by breaking them into smaller pieces. The earlier the small pieces of the big problem are managed, the better the result.

• Talk to knowledgeable people and learn about what has worked for others. You are not alone. Others have been through similar problems. Your doctor should have lists of referral services, support groups, and reading materials.
• Don't just accept limitations. Many can be treated or managed.
• Be honest with yourself; recognize your strengths and limits. Be sure that you understand your feelings about accepting and giving help, changing behavior, dealing with change, and dealing with sickness. Make a list of strengths and limitations. Show it to your doctor.

Having a limited social life and reduced activities can lead to more difficulties. For example:

• Being inactive causes physical weakness which can cause more inactivity and depression.
• A lack of social interaction can lead to emotional problems which cause you to isolate yourself more, and think less clearly.

Your doctor should always try to recognize problems that limit your ability to perform your usual activities and take part in social events. When these problems are known the cause can be often be found and treated. You may also be referred to other health care providers who can help you with your specific needs. If the cause cannot be treated, you might want to try assistive devices. An assistive device is equipment that helps you to do most of the things you would like to do. The following may be recommended:

• assistive devices like canes or hearing aids
• transportation services
• social services
• homemaker services
• home health or personal care aides
• friendly visitors
• rehabilitative services
• counseling services
• recreational services
• financial and legal counseling
• home meal services
• day care and senior center support groups
• "house calls" by your doctor or nurse

Hearing Problems

Hearing is easy to take for granted. For people with hearing problems, words may not be understood, musical notes may be missed, and a ringing doorbell may go unanswered. Some people will not admit to themselves or anyone else that they have a hearing problem.

Hearing loss is greatest in those who spend time around noise. Ear protection is the best way to reduce your chance of needing a hearing aid.

Diagnosis of Hearing Problems

If a hearing problem is bothering you, your doctor will check to see if your ears are clear of wax. Your doctor can also estimate the amount of hearing loss you have by using simple tests like the "whisper test."

If you can't hear a whisper or you notice difficulty hearing in most situations, you may wish to consider using a hearing aid. Don't let poor hearing isolate you from other people.

If you have a moderate hearing problem, try facing speakers. Try "cupping" your ear with your hand. You may not need an aid.

The decision about a hearing aid often depends more on your needs than on the results of formal testing. If an aid is to be used, it is important that you want the help.

In some cases, your doctor will suggest that you visit a specialist to identify and measure hearing loss and to help with rehabilitation. Specialists use a device that makes sounds of different tones and loudness (an audiometer), as well as other electronic devices. Hearing measurements also test a person's ability to understand speech.

Ringing in the ears - tinnitus - is a common and bothersome problem. Although it may be caused by medications or a few medical conditions, most of the time the cause of tinnitus is not found. Treatments are often frustrating. Talk to your doctor before you spend money on a treatment for tinnitus. Find more information on the internet using the word "tinnitus".

Types of Hearing Loss

Conductive hearing loss involves the blocking of sounds between the ear drums and the inner ear. This may be caused by ear wax, fluid, abnormal bone growth, or infection. Many of these problems can be treated.

Nerve hearing loss involves damage to parts of the inner ear or auditory nerve. This leads to difficulties understanding speech but not total deafness. So, "Don't shout--I'm not deaf!" is often said by people with this type of hearing problem. This is the most common cause of hearing loss. Environmental noise adds to this disorder. The condition is permanent, but there are ways a person can function well.

Brain-related hearing loss is a rare type of hearing loss. It is caused by damage to the nerve centers within the brain. This problem cannot be treated medically or surgically. For some, special training by an audiologist or speech pathologist can help.

Tricks for Hearing Better

• Don't hesitate to ask people to repeat what they have just said. Face them when they speak and "cup" your ear with your hand.
• Try to reduce background noise (stereo, television, or radio).
• Tell people that you have a hearing problem.

Everyone should be aware of these important ways to deal with hearing problems:

• Speak at your normal rate, but not too rapidly. Do not try to change the way you say words. This distorts the sounds of speech and makes visual clues more difficult. Shouting will not always make the message clearer and usually distorts it as well.
• Speak to the person at a distance of 3 to 6 feet. Position yourself near good light so your lip movements, facial expressions, and gestures may be seen clearly. Wait until the hearing-impaired person can see you before speaking. Avoid chewing, eating, or covering your mouth while speaking.
• Speaking directly into the ear prevents the listener from making use of visual cues.
• If the listener does not understand, restate the idea in short, simple words and sentences.
• Arrange furniture so that no person is more than 6 feet apart and all are completely visible. In meetings or group activities, ask the speaker to use the microphone.
• Treat the hearing-impaired person with respect. Include the person in all discussions about him or her. This helps relieve the feelings of isolation common in people with hearing problems.

Hearing Aids

A hearing aid is a small device designed to make sounds louder.

Many hearing aids are on the market, each offering different kinds of help for different problems. If loss is mild, first consider an "on the body" model of hearing aid with single ear amplification. The cost should be very low. This will give you time and experience using hearing devices and may be enough for your needs. Among the much more expensive devices, those with "compression limited circuits" are often most preferred. Remember that you are buying a product and specific services. Services should include adjustments, training in how to use the aid, maintenance, and repairs throughout the warranty period. Before deciding where to buy your aid, consider the quality of service as well as the quality of the product. Your doctor may direct you to the most appropriate choice, but the choice is up to you.

Buy an aid with only those features you need. The most costly hearing aid may not be the best for you and the less costly may offer more satisfaction.

Also, be aware that the controls for special features are tiny and may be hard to adjust. Practice will make operating the aid easier. A hearing aid dealer should have the patience and skill to help you through the adjustment period. It is a good idea to accept help. It often takes at least a month to become comfortable with a new hearing aid. No matter what, you should try before you buy. Do not buy before you try!

Hearing Device Chart
Device	Reasons for Considering	Be Aware of Limitations	Comments
A number of personal devices are available; FM-radio and directed microphones, telephone amplifiers	Best for small group, home or public entertainment	Speaker must be near microphone	Must be personalized to your needs. May be compatible with systems wired for audio input. Inexpensive hardware systems are often available in large retail stores. Newer models may require a smart phone to adjust settings.
Hearing Aids	Nearby speaker and low background noise	Noisy settings; listening on the telephone; understanding words; ringing in ears; expense.	Lease or borrow to try out before you purchase. Order a switch for telephone calls to hear words on phone. On-the-body models are easily adjusted but may pick up noise of clothing. Eyeglass-type not reusable when new eyeglasses are needed. Adjustment requires good finger movement. Newer models may require a smart phone to adjust settings.

Vision Problems

• Floaters are tiny spots or specks that float across the field of vision. Most people notice them in well-lighted rooms or outdoors on a bright day. Floaters are usually normal and harmless, but may be a warning of certain eye problems, especially if they come with light flashes. If you notice a sudden change in the type or number of spots or flashes, call your doctor.
• Dry eyes occur when the tear glands make too few tears. The result is itching, burning, or even reduced vision. You can try eye drops ("artificial tears") to correct the problem.If dryness persists, you can have a simple test to see determine the cause.
• Too many tears may be a sign of increased sensitivity to light, wind, or temperature changes. In these cases, protective measures (such as sunglasses) may solve the problem.
• A gradual decline in the ability to see close objects or small print is common after the age of 40. People with this condition often hold reading materials at arm's length. Some may have headaches or "tired eyes" while reading or doing other close work. The focusing problem can be helped with inexpensive magnifying glasses sold at most drug and department stores.
• Cataracts are cloudy or opaque areas in part or all of the transparent lens located inside the eye. The lens is normally clear and allows light to pass through. When a cataract forms, light cannot easily pass through the lens and this affects vision. Cataracts usually develop gradually and without pain, redness, or tearing in the eye. Cataracts are usually most noticeable at night when oncoming car headlights glare. Some remain small and do not seriously affect vision. However, if the glare and blurred vision becomes very bothersome the cataract can be surgically removed. Cataract surgery (in which the clouded lens is removed) is a safe procedure that is almost always successful. Cataract patients should discuss the risks and benefits of this optional procedure with their doctor. After surgery vision is restored by placing a plastic lens in the eye or, less frequently, by the use of contact lenses or special glasses.
• Glaucoma occurs when there is too much fluid pressure in the eye, causing internal eye damage and gradually destroying vision. The basic cause of glaucoma is not known but, with early diagnosis and treatment, it can usually be controlled and blindness prevented. Treatment consists of prescription eye drops, oral medications, laser treatments, or in some cases surgery. Glaucoma seldom produces early symptoms, and usually there is no pain from increased pressure. For these reasons, have your doctor check for glaucoma unless you have already had an eye doctor do the same test. Glaucoma checkups should be done every two or three years.
• Retinal disorders are a leading cause of blindness. The retina is a thin lining on the back of the eye made up of nerves that receive visual images and pass them on to the brain. Retinal disorders include macular degeneration, diabetic retinopathy, and retinal detachment.
• Age-related macular degeneration is a condition in which the macula (a part of the retina responsible for sharp central and reading vision) stops functioning efficiently. The first signs may include blurring of reading vision, distortion or loss of central vision (for example, a dark spot in the center of the field of vision), and distortion in vertical lines. Early detection of macular degeneration is important since some cases may be treated well with laser surgery.
• Diabetic retinopathy, one of the possible problems of diabetes, occurs when the small blood vessels feeding the retina fail. In the early stages of the condition, the blood vessels may leak fluid, which distorts vision. In the later stages, new vessels may grow and release blood in the center of the eye, resulting in serious loss of vision. Laser surgery can reduce the rate of loss by half.
• Retinal detachment is a separation between the inner and outer layers of the retina. Detached retinas can usually be surgically reattached with good or partial renewal of vision.

Management of Vision Problems

Avoid problems

• Wear protective glasses when working near machinery of any type and playing contact sports or racquet sports like squash.
• Never overuse contact lenses. Always remove them when your eyes feel irritated. Do not use them again until the eye feels completely normal.
• Protect your eyes from the sun. Prolonged exposure increases your chances for cataract in later life.
• Some eye disorders and diseases occur more often as we age, but we can usually prevent or correct these conditions. Regular health check-ups are needed to find treatable diseases (such as high blood pressure or diabetes) which may cause eye problems.

An eye exam usually includes testing eye sight (with and without glasses), an eye muscle check, a glaucoma test, and looking into the eyeball. Doctors check more often if you have diabetes or a family history of eye disease. Please tell your doctor if you have new loss or dimness of vision, eye pain, fluids draining from the eye, double vision, or redness or swelling of the eye or eyelid.Low-Vision AidsRemember, as your eyes age the best low vision aid is brighter light! The aging eye just is not as good as it used to be and it needs more light to see. Use bright light for such tasks as reading, cooking or handiwork.

Self-manage

Many people get frustrated about not being able to see: "I just got new glasses, but they don't help very much." The quality of vision, even with glasses, decreases with age. This is because of eye diseases and a loss of the eye's ability to see differences in grays, blacks, and whites. To see well, a 65 year old will need brighter light than a 49 year old. A very bright bulb is a very effective and cheap way to improve vision.

Inexpensive "big print" products are sold in most large stores. Special insulin syringes and pillboxes are helpful for the people with sight problems.

Magnifying lenses can help people with partial sight read and close-up tasks. Less helpful are hand-held telescopes for short-term jobs. Prisms, mirrors, and reversed telescopes may be used for certain types of vision loss to allow automobile driving.

Many people with visual impairments can be helped by using low-vision aids. These are special devices that provide more power than regular eyeglasses. Low-vision aids include telescopic glasses, light-filtering lenses, and magnifying glasses, along with a variety of electronic devices.

Some are designed to be hand-held; others rest directly on reading material. Partially sighted individuals often notice surprising improvements with the use of these aids.

Vision Aid Chart
Device	Reasons for Considering	Be Aware of Limitations	Comments
More lighting	Close work and avoiding injury.	None	The first choice for close work
Big-print reading material; homemaking and leisure aids	Often helpful for all types of sight problems	None	Available in most large retail stores
Magnifiers (reading glasses, hand-held or stand)	Close work	Short working distance	Often bulky; some require good hand control
Video magnifiers and large print or talking devices	Reading	Expensive, not portable
Telescopic lenses	Distance	Expensive and bulky, distorts spatial relationships
Prisms, mirrors and reverse telescopes	Field defect	Distorts perception of space	Limited effectiveness

Mouth Problems

A healthy smile is a bonus at any age. Too many adults feel they don't need mouth and dental checkups. They are wrong. Mouth cancer often goes unnoticed in its early and curable stages. If you notice any red or white spots or sores that bleed or do not go away within 3 weeks, be sure to tell your doctor, nurse, or dentist. For smokers, regular checkups not only help keep a mouth healthy, but are needed for the early discovery of mouth cancer.

• Loss of Taste. The loss of smell reduces taste, which may reduce appetite. Taste and smell may also be changed by medications, oral cancer, poor oral care, and a very dry mouth or sinus infection.

• Tooth decay--or cavities-- is not just a problem for children. Adults can have cavities as long as natural teeth are in the mouth. Tooth decay is caused by bacteria that stick to teeth and form dental plaque. The bacteria in plaque live on sugars and make acids that dissolve minerals in the tooth. If you have gum disease, tooth decay can develop on the exposed roots of the teeth.

  Adding fluoride to the water supply is the best and cheapest way to prevent tooth decay. Fluoride is important for adult teeth. In addition to drinking fluoridated water, fluoride toothpaste and mouth rinses can add protection. Fluoride mouth rinses are available in two strengths: one for daily use and one for weekly use. Daily fluoride rinses can be bought without a prescription. Your dentist or dental hygienist may give you regular fluoride treatments in their dental office or prescribe a fluoride gel or mouth rinse for use at home.

• Gum disease (periodontitis), a common cause of tooth loss, is caused by the buildup of plaque. It may cause bad breath. If plaque is not removed every day, it may harden on the teeth to become tartar. Only your dentist or dental hygienist can remove tartar. Bacteria in plaque can irritate the gums, so they become inflamed and bleed easily. If untreated, the disease gets worse as infection forms between the teeth and gums and causes the gums to shrink. The infection spreads toward the roots of the teeth and eventually teeth become loose and are lost.

  Brushing and flossing your teeth each day to remove plaque is important for preventing tooth decay and gum disease. Also check your teeth and gums to find early signs of disease such as red, swollen, or bleeding gums. Be sure to contact your doctor or nurse or see your dentist if these signs are present. Good oral health care includes knowing how to brush and floss properly. Careful daily brushing with a soft brush removes plaque that forms on the teeth. Gently brush the teeth on all sides with a soft brush and fluoride toothpaste. Use circular and short back-and-forth strokes and carefully brush along the gum line. Lightly brushing your tongue also helps to remove plaque and food, and makes your mouth feel fresh. In addition to tooth brushing, the use of dental floss is necessary to keep the gums healthy. Proper flossing is especially important to remove plaque and leftover food that a toothbrush cannot reach. Your dentist or dental hygienist can show you the best way to brush and floss your teeth. See your dentist at once if tooth brushing or flossing results in bleeding, pain, or irritation. Use of soft rubber gum picks along the gum line and between teeth prevents deep pockets from forming and destroying the base of the teeth. Mouth rinses are not a substitute for careful daily brushing and flossing and a trip to the dentist's office. Chlorhexidene rinse reduces plaque but stains teeth and should only be used short term by someone who is unable to brush. An inexpensive way to clean your mouth is to use a "toothpaste" made of a mix of baking soda and hydrogen peroxide. Just pour the peroxide on a flat tablespoon of baking soda and dip your toothbrush into it. Plaque removal toothpaste is not necessarily better than regular fluoride toothpaste, or peroxide and baking soda.

In addition to good oral care at home, regular dental checkups are important whether you have natural teeth or dentures. It is also important to have special treatments that will improve your oral health. For instance, if you have sensitive teeth caused by receding gums, your dentist may suggest you use a special toothpaste for a few months. Teeth are meant to last a lifetime. By following preventive measures, you can protect your teeth and gums for years to come.

If you have false teeth (dentures), you should keep them clean and free of food deposits. Food on dentures can cause permanent staining, bad breath, and gum irritation. Once a day, brush all surfaces of the dentures with a denture-care product. Before going to sleep, remove your dentures from your mouth and place them in water or a denture-cleansing liquid. It is also helpful to rinse your mouth with a warm saltwater solution in the morning, after meals, and at bedtime.

Partial dentures should be cared for in the same way as full dentures. Bacteria tend to collect under the clasps of partial dentures. It is important that this area be cleaned well.

Dentures might seem awkward at first. While learning to eat with false teeth, select soft non-stick food, cut food into small pieces, and chew slowly using both sides of the mouth. Dentures can make your mouth less sensitive to hot foods and liquids and less able to feel harmful objects such as bones. If you have continued problems eating, talking, or simply wearing dentures after the first few weeks, call your dentist who can make further adjustments.

In time, dentures need to be replaced or adjusted to the changes in the tissues of the mouth. Do not try to repair dentures at home since this can damage the dentures and injure your mouth. If your dentures wobble when you push up with your finger on one side next to your cheek, they probably will need replacement.

Dental implants are designed to look like teeth and are placed surgically. Implants are useful only for a patient with good bone structure. If you are considering an implant, select an experienced specialist with whom you can discuss your concerns to be sure it is right for you.

Problems with Arms and Hands

Many devices exist to help make your arms and hands as useful as possible.

Aids for dressing, cleaning, eating, and homemaking can help you with limited joint motion and strength. Many aids can be made from inexpensive materials (e.g. wrapping handles of utensils with foam tape for better gripping when hands are weak or painful and joint motion is limited).

Splinting is sometimes prescribed for a painful joint. Common splints include "cock-up" wrist splints and elastic wrist/hand supports. Splints for arthritis are extremely useful. When both sides are involved, try the splint on your most important side first.

Arms and Hands Chart
Device	Reasons for Considering	Be Aware of Limitations	Comments
"Soap on a rope"; long-handled back sponge; tub seat; shower bench, toothbrush grip, rotary edge electric razor; reaching devices	Bathing, mouth care and grooming	You need to have some grip, pinch, and wrist movements	Available in most large retail stores; You often need to be shown how to use the these devices
Microwave oven, push cart to organize and deliver things; special grips; high edge plates; reaching devices	Homemaking and eating devices	You need to have some grip, pinch, and wrist movements
Splints large print or talking devices	Wrist pain	You must use them; bulky; wear out; limit some activities

Problems with Legs and Balance

Older persons are at risk for falls if they are unable to stand from a chair without using their arms and have poor vision. Prevention of falls is important. The best ways to prevent falls are to:

• review the list of things you can do to make your house safe ( see chapter on "Health Habits and Health Decisions")
• keep your upper thigh muscles strong by doing exercises (See knee exercises in Exercise and Eating Well).
• talking to your doctor if you have fallen. Medications can be a cause for falls - persons on three or more medicines are at the highest risk.

Problems with your legs can affect your balance. Your doctor usually checks your balance by asking you to "get up and go" from a chair and stand for a few seconds on one foot.

If you are unsteady with these tests, exercise the legs (see Exercise) and practicing balance can be helpful. A walker, cane, or crutches may also be needed.

Canes and crutches increase stability, support a weak leg, and reduce stress in the hips, knees, ankles, and foot joints. A cane most often is used on the side opposite the painful or limited leg. The grip should be large and positioned to cause only a slight bend at the elbow when leaning on the device. When you stand straight, the handle should just reach the wrist joint. A four-legged "quad" cane is more stable than a simple cane and is used for people whose legs are weak and not stable. Only 25% of your body weight can be carried by a regular cane, but a lower arm crutch is able to support twice as much. Crutches that reach your armpit may increase the risk of falling backward.

If you have poor balance and leg weakness, and also have weak arms, a walker is a better aid, since the base provides maximum support. Using a walker may improve strength to allow you to graduate to a cane or crutch. Wheeled walkers are useful for people who may not be able to lift a walker. Such walkers can be hard to move over thresholds and plush carpets. Walkers should be fitted in the same way as a cane.

Ankle-foot supports stabilize the ankle when you are standing. At the same time, they help people lift the toe area of the foot when walking.

A few people require a wheelchair at home because of limited endurance or because they are at an exceptionally high risk for falls. With long-term wheelchair use, the main issues are ease of transfer, stability, cushioning, and the angle of the backrest. Before selecting a wheelchair, a home assessment must be performed to evaluate floor surfaces, door widths, ramp widths, and height of the stair tread.

Aids are very helpful to assist movement from a sitting to a standing position or to use the bathtub and toilet. Proper installation and adjustment of the height of these aids is important. A home visit by a physical or occupational therapist may be needed to ensure their safety and usefulness. Safety bars and rails should be mounted on wall studs, the floor, or clamped to the tub or toilet where the most useful side of your body can help the transfer.

When transferring to the bed, chair, or toilet, it is generally easier to move on the most functional side. The "good" side will be used to lift or support you until you can pivot 90 or 180 degrees. Once the turn is complete, you must be certain to feel the seat touch the back of your calves before sitting.

Balance problems can also be caused by nerve damage or medications. See your doctor if you feel dizzy or fall often.

Legs and Balance Chart
Device	Reasons for Considering	Be Aware of Limitations	Comments
Reaching devices; long shoehorns; Velcro straps; elastic shoelaces	Dressing and grooming	Dexterity necessary
Canes and crutches	Severe joint of leg pain	Arm weakness or lack of coordination Four legged canes can be awkward	Lower arm crutches are better for longterm use; platform attachment for wrist, hand or elbow problems
Hip protector	High risk for falls	Bulky, seldom used; not very effective
Walker	Serious imbalance or weakness	Awkward	Large-wheeled walkers with brakes are very useful; platform and seat is available
Braces	Isolated and severe joint or muscle limitations	Difficult to put on; skin irritation
Wheelchairs	Limited endurance; paralysis	Poor access to buildings; weight of the wheelchair; car transport	Type of chair should fit needs of user
Bathroom grab-bars; raised toilet seat; tub seat;	Transferring	Need proper installation	Inexpensive assistance that can make life easier

Problems with Feet

Most common foot problems develop from years of wear and tear, ill-fitting or poorly designed shoes, improperly trimmed toenails, poor circulation to the feet, and diseases like diabetes.

Preventing Foot Trouble

The major preventable cause of foot problems is wearing shoes that are too small or narrow. When standing, your shoe should not bulge. One finger's width should fit between the tip of the longest toe and the end of the shoe. The toe box should be deep enough to prevent pressure. The shoe should not show signs of uneven wear. Heels should be low.

To fit your shoes, place a piece of white paper on the floor and stand on it with no shoes on. Ask someone to trace the outline of your foot on the paper. Now hold the outline of your foot up next to your shoes. If your shoes are smaller than the outline, you know what you have to do. Take the outline to the shoe store and buy shoes that are slightly larger than the outline.

The upper part of the shoes should be made of a soft, flexible material to conform to the shape of the foot. The part of the shoe that houses your toes (the toe box) should be deep enough so that your toes do not rub hard against the top. The heel should be cushioned. Shoes made of leather allow the feet to "breathe" and can reduce possible skin irritations. Shoe soles should provide solid footing and not be slippery. Thick soles lessen pressure when walking on hard surfaces. Low-heeled shoes are safer and less damaging to the feet. They are more comfortable. If you have properly fitting shoes, you will have enough room to use foam supports, forefoot pads (for pain in the front of the foot), and heel pads (for "spurs").

Many high-collared, "athletic type" shoes provide good support and prevent falls. Check them for their flexibility, width, and capacity to allow the feet to breathe.

Improving the circulation of blood to the feet may also help prevent problems. Blood flow to the feet is reduced by exposure to cold temperatures, wading or bathing in cold water, pressure from poor fitting shoes on the feet, long periods of sitting or resting, and smoking. Even sitting with your legs crossed or wearing tight, elastic garters or socks (long elastic hose tend to be better) can affect circulation. On the other hand, elevating the feet, standing up and stretching, walking, and other forms of general exercise promote good circulation. Gentle massage and warm foot baths (95°F) can also help increase circulation to the feet.

Common Foot Problems

The most common foot problems are calluses, nail problems, and bunions.

Corns and calluses are caused by the friction and pressure from bony areas rubbing against shoes. Layers of dead skin cells build up and the pressure of this hard mass on sensitive nerves in the skin can be painful. Wherever you see a corn or callus, you know that either the bone under the abnormality is not shaped correctly, the shoe is too tight, or you have both an abnormal bone and a poorly fitting shoe. Treatment should include obtaining better fitting shoes or special pads. Over-the-counter medicines, advertised as cures for corns, contain acids that destroy the tissue but do not treat the cause. These medicines can sometimes reduce the need for surgery when used under proper supervision. Treating corns or calluses yourself may be harmful, especially if you have diabetes or poor circulation. Your doctor will recommend the type of padding and shoe change you need.

Ingrown toenails occur when a piece of the nail pierces the skin. This is usually caused by improperly fitting shoes or improperly trimmed nails. Ingrown toenails are especially common in the large toes. Your doctor will usually put some cotton soaked in peroxide under that part of the nail that is cutting into the skin. Then your doctor will remove the part of the nail to allow the area to heal and control any infection. Ingrown toenails can usually be avoided by cutting the toenail straight across and level with the top of the toe. To do this, you will usually need to soak your foot in warm water for 10 minutes before using heavy cutters.

Thick nails are a problem because they can cause pain and skin damage. If you are able to see your toenails and you are not a diabetic, you can best treat thickened nails by filing the thickened top of the nail with an emery file after every bath or shower. Gradually you will thin the nail enough so that you can keep it clipped.

Bunions develop when toe joints are out of line and become swollen and tender. Bunions may result from poor-fitting shoes that press on a deformity or from an inherited weakness in the foot. If a bunion is not severe, wearing shoes cut wide at the instep and the toes may provide relief. Protective pads can also cushion the painful area. For overlapping toes your doctor will usually recommend the use of a foam toe separator. Other methods for treating bunions include the application or injection of certain drugs, and the use of whirlpool baths. Painful bunions can sometimes be repaired surgically.

Hammertoe results from a shortening of the tendons that control the movement of the toes. The knuckle of the toe is usually enlarged and the toe is drawn back. Over a period of time the joint gets larger and stiffens as it rubs against the shoe. This can cause a loss of balance since the affected toes provide less help in standing and walking. Hammertoe is treated by wearing shoes and stockings with plenty of toe room. In advanced cases, surgery may be needed.

Foot Chart
Device	Reasons for Considering	Be Aware of Limitations	Comments
Shoes with flexible soles, wide and deep toe box, and supple materials	Deformed toes and calluses	None
Orthotic (rigid heel counter, steel shank, insoles)	Calluses, corns, and forefoot problems or toes drag when walking	Shoe must be deep enough
Toe separators	Hammertoes, toe corns, pop up toes	Short-term relief	Not effective if toe box is narrow
Special shoes	Failure to respond to simple measures; diabetes; leg length differences	Expense and appearance	Use the internet to find shoes with low heels, rocker soles, or mid-foot bars often without a custom fit charge

What about Driving?

Any of the following are risks for accident. When in doubt, have a driving test.

• vision that cannot be corrected to at least 20/40
• limited movement of the neck or reduced vision to the sides
• a history of falls or very poor memory

Many localities sponsor safe driver programs. These may not only make you safer at the wheel, but may also help you lower your insurance premiums. The most common driving problems are failing to look and signal when changing lanes, not responding to signals and not following at a safe distance.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.

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Last reviewed: January 2023 ©1997-2023*FNX Corporation and Trustees of Dartmouth College. *All Rights Reserved.