DEAR DR. GOTT: I used to wear size 10 shoes until a couple of years ago when my shoes started bothering me as they were too short. I am female, 47, 179 cm tall, 150 pounds, who exercises daily. I look and feel younger than my age and try to take calcium and vitamins B and E daily.
I bought some size 11 shoes in the last couple of years but now my right toes are touching the shoes again. My feet don’t seem to hurt more than is normal except for the toes hitting the shoes. My feet are not getting wider or swelling, just longer. I also have fairly high arches, long narrow feet that are fairly shallow, with long toes.
I saw a doctor this past year or three and mentioned my concern. She examined my feet but didn’t see/say anything.
I can’t afford to keep buying larger shoes every year or two. It was hard enough to find shoes in size 10 that fit! Size 11 for women is much more difficult to find, but if one foot is a different size and they are both rare sizes, it is really going to be a struggle to find shoes that fit. Can you give me your idea of what might be happening and where I can go for help? Also, is there a place that makes shoes that are long-lasting, versatile, not luxury items or orthopedic looking?
Thank you.
DEAR READER: Adult foot growth (lengthwise) is not normal. Certain activities such as walking or running for exercise can widen the foot, but shouldn’t make it longer.
One consideration is your high arches that, with exercise and age, may have flattened some, leading to a longer foot.
Also, while not at the top of my list but not to be ruled out is Marfan syndrome, a connective tissue disorder. In most instances, this syndrome is inherited; however, in up to 30% of all reported cases, there is no known family history. Sufferers generally have a tall, slender build and disproportionately long arms, legs, fingers, and toes. A high arched palate with crowded teeth, a curved spine, heart murmur, nearsightedness, flat feet, and a breast bone that either protrudes outward or dips inward may also be present. Symptoms can range from mild (relatively unnoticeable) to severe and typically worsen with age. Without knowing anything else about your general health and appearance I cannot determine if this is a possibility, but in any event, you may wish to discuss this with your physician who may choose to order an echocardiogram or fibrillin-1 mutation test, since Marfan is caused by a gene defect of the same name as the test.
Another possibility is that you may have acromegaly, a rare but serious condition that occurs when the body produces excess growth hormone. The condition can cause enlargement of the facial bones, kyphosis (curvature of the spine), sleep apnea, enlargement of the heart, thyroid gland, liver and kidneys, and an increase in the size of the hands and/or feet. Diagnosis is generally made when a person is between 40 and 45 years of age. The disorder affects men and women equally and those in every ethnic group.
By way of explanation, our hormones are chemicals that control metabolism, growth and development. A portion of the brain known as the hypothalamus produces a hormone that stimulates the pituitary gland to manufacture growth hormone that is released into the bloodstream. The hypothalamus also produces another hormone known as somatostatin that timely halts that production. Growth hormone in the bloodstream stimulates the liver to produce still another hormone referred to as insulin-like growth factor 1 (IGF-1) that promotes bone and tissue growth. When everything works according to the plan, we get the average individual; however, with disruption of this and countless other hormonal factors, an endocrine system disorder can result. In almost 95% of the cases of acromegaly, excess growth hormone is produced by a pituitary gland tumor known as an adenoma, a benign tumor that can enlarge and cause problems when it presses against surrounding tissues. The remaining 5% of cases are caused by other types of tumors that secrete growth hormone.
Some adenomas grow rapidly, while others enlarge more slowly and take longer to diagnose. Symptoms are essentially divided into two groups — those that appear because of the tumor pressing on surrounding tissues or else from those with excess growth hormone and IGF-1 in the blood. In the first instance, headache and partial visual loss in one or both eyes are the initial and most commonly recognized symptoms. In the latter, symptoms from excess growth hormone are more diverse and might include an increase in finger or shoe size, arthritis, a thickening of the neck because of the goiter, sleep apnea, pain, skin tags, and more.
Acromegaly is not an easy diagnosis to make. Some signs may be subtle, while others may take an extended period of time in which to develop. Laboratory testing ordered by a physician will likely include an IGF-1 level, an IGF-binding protein-3 level and glucose non-suppressibility testing. There are other tests that might be ordered as well, but your physician will likely follow with a CT of the abdomen, pelvis and chest. The purpose of the testing is not only to diagnose you correctly, but to choose the best treatment to relieve and reverse the symptoms.
Treatment depends on the cause. In the vast majority of cases caused by pituitary adenomas, this may include surgery, drug therapy and radiation in an effort to put the disease into remission. No one combination is successful across the board and each person can respond differently. If surgery fails to bring you into remission, drug therapy will follow. Radiation is commonly reserved for adenomas that are not cured by surgery, while drugs may be recommended for those who cannot undergo radiation. Acromegaly is considered a life-long disorder and drug or radiation therapy may continue for several years.
I recommend you ask your physician for referral to a podiatrist or endocrinologist who can determine if this is actually the cause of your foot enlargement or if there is another entirely different cause for it that I have failed to cover.
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