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Sore feet and tired, achy legs. These are long-standing issues for nurses who must spend hours upon hours on their feet.

No one would know that better or appreciate preventive measures more than Ramona Conner, MSN, RN, a specialist in the Center for Nursing Practice at the Association of Operating Room Nurses headquarters in Aurora, Colo. She's been a perioperative nurse for 25 years and once worked a 36-hour shift as part of a transplant team at the University of Colorado.

"I was much younger then," she confessed.

"Anybody practicing in an operating room at one time or another has experienced leg pain," Conner said. "Certainly, as we age it's becoming more common. What I did was wear comfortable shoes," she said.

Conner also shifted positions frequently. "Support hose are particularly helpful for those long days. Of course, any time you get a break, you put your feet up."

Good shoes and proper hosiery are the preventive measures that certified wound specialist Julia Overstreet, a doctor of podiatric medicine, recommends. They're also where treatment begins for problems she sees in practice as a podiatrist and surgeon at Overstreet Health Center in Bellevue, Wash.

"One of the biggest problems I see with the population as a whole, and certainly with my nurse patients, is plantar fasciitis, which is basically heel pain," Overstreet said.

The plantar fascia is a triangle-shaped band of tissue, widest across the ball of the foot and narrowing to a single point in the heel. The tissue stretches and can tear under the pressure of prolonged walking and standing, particularly on hard surfaces, causing pain. It's commonly known as a "fallen arch" as opposed to a "flat foot." The remedy is artificial support.

While some people require custom supports, Overstreet said she first recommends patients use the over-the-counter variety found at sporting goods shoe stores.

The important part of the protocol, she said, is that once arch supports are needed, they always are needed. She said, "Even if someone gets up to go to the bathroom in the middle of the night, they need to have that in their slippers. They can be barefoot in bed and in the shower. That's it.

"One of the hallmarks of plantar fasciitis is that it hurts worst the first thing in the morning or if you've been sitting for a while," she said. "That's because while you're sitting or while you're sleeping, it starts to heal. Then when you take that first step, it tears that plantar fascia again. It starts all over."

Supportive shoes from the get-go may prevent or forestall plantar fasciitis. "Tennis shoes, for instance, are great," Overstreet said, referring to today's athletic footwear. Flimsy canvas tennis shoes "twist like a towel" and offer no support.

Good nursing shoes
At Birkenstock, the Novato, Calif., shoe manufacturer, brand manager Tim Grimmer ran through qualities common to good nursing shoes. In February, Birkenstock will launch a line based on current models but tailored for physicians and nurses with polyurethane finishes on leather, colors that complement medical uniforms and Velcro enclosures for micro adjustments, he said.

In any shoe brand, Grimmer advises nurses to look for:

Finally, he said price is a poor way to judge shoes. Price may indicate the quality of leather, midsole and other materials used, but it says nothing about design.

When it comes to caring for legs, Overstreet said support hose pay a lifetime of dividends for those in their 40s or 50s who are on their feet all day and perhaps are a little overweight or have a hereditary predisposition to varicose veins. "If your mother had them, you're more than likely to have them," she said.

"What support hose do is help your veins function better so that your legs don't get swollen. You are less tired, your legs are less tired and you are not at risk for the pathologies like open ulcerations and varicose veins."

Swelling is the bane of healthy legs, acting as a vascular tourniquet. By restricting blood flow, it starves legs of nutrients, oxygen and ultimately strength.

Overstreet said there is a misconception, though, that support hose get rid of swelling. They don't. Hosiery is preventive and should be donned first thing in the morning before any swelling occurs, she said. Knee-highs, as long as the top band fits well, are fine. Some physicians prefer pantyhose, but Overstreet said, "Hose don't need to be higher than [knee-high] because most of the venous mechanism is at work down there around the ankle area."

Besides the handy function of making us mobile, legs-and particularly calf muscles-work as pumps, circulating fluid from the extremities as you walk, Overstreet said. They are to the venous system what the heart is to the arteries.

"If you have to sit, say you're on an airplane or you're at a desk job, if you pump your foot like it was on an accelerator-up and down-that pumps the calf muscle. Walking is the best, but moving the toes up and down with the heel stationary helps get rid of some of that swelling."

Additionally, nurses can choose medical-grade support hose as opposed to drugstore hose that provide the same compression from bottom to top. Medical-grade hose have a two-number rating such as 8-15, meaning 15 mm of mercury pressure at the ankle and 8 at the calf," which is more effective at "milking" fluid and swelling from legs, Overstreet said.

"Vein problems are cumulative, so even if you just wore the support hose through the workday and not the weekend, you're that much further ahead as far as developing varicose veins and other skin problems," she said.

Considering life spans of 80-plus years, choosing and using support hose is "important, not just in the sense of keeping your workday as pain-free as possible, but for how that's going to affect you for a lifetime on your feet when you're 60, 70 and 80.

Another 40 years of walking on swollen legs and you are going to get problems-serious ones-after you retire," Overstreet said.