In our clinics, we see patients with a wide range of issues relating to their feet. Discomfort caused by these problems can affect their ability to carry out normal activities. Sometimes the problems relating to their feet are minor and will go away with rest or on their own. Other times, a patient may have experienced a high impact or sudden injury that needs immediate attention. Or the pain has increased gradually over time and now they think it’s time to seek advice from a professional podiatrist. Whatever the condition or cause, pain and discomfort isn’t something anyone needs to live with.
Here, we describe some of the most common foot problems and their causes; how they are treated and what you can do to look after your feet.
Pain in your toes and toenails
Many patients suffer problems related to their toenails. So let’s start with why we have them in the first place.The purpose of toenails is to protect the foot. Their hard surface prevents injury to the delicate soft tissues, nerves, blood vessels, and muscles underneath them. Occasionally you might find that one or more of them become more thickened. This is generally caused by trauma to the toenail such as dropping something heavy on it or wearing shoes that are too small. This causes the nail to thicken up to protect the nail bed, the bone and structures underneath.
Ingrown toenails
Ingrown toenails are most common amongst teenagers for two main reasons. Firstly, when they experience growth spurts, the nails grows quicker than the skin around it. This causes the nail to be too wide for the nail bed. Secondly, this is often the age when they take over cutting their own toenails. If they don’t do this properly, they can leave a spike in the corner and this grows into the skin.
Fungal toenails
Fungal toenails are caused by a fungus that gets under the nail and rots it. In most cases, the condition causes the nail to change colour to a yellow/brown and become thick and crumbly. If it’s not treated, it can spread to more toenails and to other people so we recommend that it is treated early. There are a range of treatments and not all are effective. A step by step process is usually advised to see what works for each individual case. There are three options that are most readily available. Usually this means starting off with a topical paste and then maybe light or laser therapy. If neither of those are effective, tablets may be prescribed.
Corns
Corns are thick build ups of tough skin at a point of irritation or pressure on the foot or toe. They sometimes look like horns. This hard skin build up is more commonly on the skin rather than the nails themselves. They are primarily caused by repeated pressure on certain areas of the toe. The body’s response is to protect the area by thickening up the skin.
A podiatrist will often treat corns by cutting out the centre core of tissue. This is not usually painful and is effective at alleviating the pressure on the area. If footwear rubbing on the foot is the cause, then we advise taking the pressure off entirely by changing the shoes (perhaps to wider ones) to allow the skin to settle back down.
Calluses
Calluses can sometimes be confused with corns on the feet. Calluses are wider areas of tough skin buildup on the toes or feet. Similarly to corns, they occur as a result of irritation, friction or pressure. The body protects the area from this pressure by producing more skin.
Both calluses and corns are generally caused by ill-fitting footwear. Calluses tend not to be as painful as a corn as they are general thickened skin and don’t have the cone which forms in the middle of a corn. The calluses treatment tends to be the same as we would administer for a corn – removing the extra skin and taking the pressure off by providing padding or suggesting more appropriate footwear.
Gout
Gout is a form of arthritis and causes pain in the toes (often the big toe). Crystals collect in toe joints and this causes the swelling and pain. It is diagnosed through a blood test and patients are prescribed medication from their GP which usually resolves the condition quickly.
Bunions
A bunion is a degeneration of the big toe joint which causes a change in the angle of the joint itself. It’s quite often an inherited condition but can also be caused by footwear so tends to be more common in women wearing pointy, narrow, high heel shoes. Bunions tend to be seen more in older patients but can affect people of any age depending on activity – for example girls that do ballet and dancing often have bunions.The focus of bunion treatment is generally on preventing the condition getting worse by addressing the causes. This means that we look at the biomechanics of the patient’s foot and provide extra support for the foot to take pressure of the big toe joint. Bunions, though, can only be fully corrected through surgery.
Pain in your heel
If a patient is experiencing pain in their heel and under the arch of their foot, they may have plantar fasciitis. This condition is caused by an irritation or inflammation of the band of tissue connecting the heel bone to the toes. The pain is often worse in the morning when first getting out of bed.
At first, it is usually mild so it’s not unusual for people to just ignore it. It may even disappear without treatment. If it persists it can become chronic and debilitating, inhibiting a person’s usual movement and limiting everyday life activities, which causes people to seek advice and treatment from a specialist.
For more information on the specific condition of plantar fasciitis, read our blog which tells you all about Plantar heel pain.
Achilles tendon pain
Patients also sometimes present with pain at the back of their heel – or Achilles tendon to be more precise. This is often caused by tight calf muscles and so the Achilles pulls the back of the heel. The Achilles becomes strained and thickened at the back of the ankle and this causes discomfort.
There are multiple causes of Achilles pain from activities such as running and jumping, tight calf muscle/s, or wearing inappropriate shoes on a regular basis. When flat or high heeled shoes are worn, the difference in heel height can inversely increase or decrease pressure on the calf muscles and Achilles.
The treatment plan is to try and load and strengthen up the muscle with specific exercises and make modifications to footwear such as a heel raise. Shock wave therapy is really effective and can also be carried out by a podiatrist.
Children aged 8 – 14 can suffer from a similar condition where they experience pain at the base of the heel. If children are very active and play a lot of sport then the Achilles can pull on the growth plate in the heel bone. This causes discomfort. It can be treated by giving them a heel raise which takes the tension of the Achilles, essentially offloading the stress whilst activity is taking place. In terms of treatment, patients are encouraged to manage their activity carefully and ice the area.
Sesamoiditis
Another area of the foot which can become painful is the area directly under the big toe joint. A condition called sesamoiditis is inflammation of the two bones under this joint: called the sesamoids. Pressure with activity or from footwear causes stress in this area. The condition can be managed by reducing the pressure with padding so it can heal.
Plantar plate tear
A plantar plate tear can occur if someone has done an activity where the toes are bent back too far. The ligament gets stretched and strained and causes inflammation. The treatment for a plantar plate tear is rest, ice, reduce the pressure from the affect area and stop doing the activity that caused it.
Bursitis
Bursitis is inflammation and swelling of a bursa. A bursa is a sack of fluid which acts as a cushion between tendons and bones to alleviate areas of friction. They can develop under the skin in between joints anywhere in the body including the feet.Treatment usually involves taking pressure of the site with padding, orthotics or appropriately fitted footwear. To reduce the inflammation rest, ice, heat and massage are recommended and sometimes an ultrasound guided cortisone injection depending on the severity of the condition.
Morton’s neuroma
Morton’s neuroma is an inflammation of the nerve in between the third and fourth toes – most commonly, because of compression caused by tight shoes. It can also just be the result of the biomechanics of your feet. Either way, it creates too much pressure on the nerve and causes it to become inflamed.
This is a very specific condition and is best diagnosed through an ultrasound. There are several ways to reduce pressure and relieve stress in the area but an ultrasound gives a clear picture so that the appropriate treatment can be provided.
Pain in the arch of your foot
Plantar fasciitis is the most common cause of arch pain. Plantar fasciitis, as we talked about above, can affect the heel, arch, or both. Treatment is the same regardless of the location and – depending on the length of severity – may include rest, ice, heat massage using shoe inserts and heel pads, making shoe adjustments, shockwave therapy, stretching and strengthening exercises or an ultrasound guided cortisone injection.
Flat or high arched feet
Extreme variations to the arch height in someone’s feet can put strain on the ligaments that support the arch of the foot. It’s common for people who have pronation (otherwise known as ‘a flat foot’) for the structures of their feet to have to work harder to hold the foot up. Because the muscles work harder, they fatigue and can tear, causing swelling. People with higher arches are unable to absorb shock as well and so pressure is attenuated a lot more through the heel and balls of the feet. Treatment options vary and can include using shoe inserts, changing the shoes the patient wears, stretching and strengthening exercises or physical therapy.
Pain in your lower leg
When seeing a patient suffering from lower leg pain, we will always start by asking what sort of pain it is so that we can start to diagnose the problem. Most leg pain results from wear and tear, overuse, or injuries. These can affect the joints, bones, muscles, ligaments, tendons or other soft tissues of the foot.
There are many causes of this kind of pain, including:
- An injury – for example a sprains, break or fracture
- Arthritis – which is inflammation of the joints
- Tendinitis/tendinosis – inflammation of tendon structures that attach to the bones of your feet (e.g. the Achilles which connects your calf muscle to your foot).
Tendonitis is a common sports overuse injury but can strike anyone, regardless of activity levels. Two common types of tendonitis that would cause lower leg pain around the ankle area are Achilles tendonitis and posterior tibial tendonitis.
Tendonitis causes pain that increases with activity or stretching of the affected tendon. Other signs and symptoms may include swelling that worsens with activity as the day progresses, thickening of the tendon, and pain after rest.
Treatment options focus on reducing the load on these tendons and allowing them to heal. Examples of this can be strapping, orthotics or footwear modifications. Managing the inflammation at the site can be done through rest, ice, heat massage and possibly anti-inflammatory tablets. Shockwave therapy can also be used effectively in more chronic cases. When ready, the tendons and muscles are loaded again to regain strength and prevent the injury from reoccurring.
Top tips for self care at home
If you want to care well for your feet at home and try to prevent injury or discomfort, then here are a few top tips:
- When you get home from work take your shoes off and massage your feet with a tennis ball. This loosens up the muscles that have been cramped up and working hard all day. As little as two minutes on each foot can make a difference.
- Stretch your calf muscles because tightness in these muscles can cause foot pain. Light calf stretching increases the range of motion at the ankle so your foot can function at its best.
- Look after the protective surfaces of your feet. Cut your toenails so that they are not too long, tidy up corns and calluses before they build up and cause more pressure. Don’t neglect small issues as they arise.
If at-home treatments and rest, for any type of foot or leg pain, haven’t helped resolved the issue then don’t continue to be in discomfort. Make an appointment to speak to a specialist Podiatrist who can assess your condition and make recommendations for treatment options to resolve the issue.