Up to 90% of us will suffer from a foot problem during our lives. The good news? There are podiatrists who specialise in musculoskeletal function – how feet, ankles and lower legs interact with shoes, terrain and gait – who can help prevent or manage niggles. And for persistent ailments, orthopaedic surgeons consult on the latest medical and surgical solutions to help us keep the spring in our step.
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Bunions
These happen when the big-toe bone drifts towards the second toe as a result of the long foot bone behind the big toe – the first metatarsal – moving outwards, forming this painful bump. It’s not known what causes a bunion, but arthritis, flat feet, overly-flexible ligaments and abnormal bone structure – all of which can be hereditary – as well as too-tight footwear are thought to play a part.
Self-care: Choose shoes with wide toe boxes and heels under 3cm.
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Medical treatment: As the first line of therapy, a podiatrist may offer toe separators and custom-made orthotic inserts – worn inside shoes – to help improve alignment and ease pressure. Bunions invariably get worse, so surgery may be on the cards. In the past, it was notoriously painful and involved a long recovery, but procedures have improved greatly in recent times. Two favoured surgical techniques, usually done in combination under general anaesthetic, are scarf and akin osteotomies, which involve removing portions of bone, then aligning bones and fixing them in place with compression screws to eliminate the offending bump. An orthopaedic surgeon aims to preserve the joint to allow big-toe movement, but if you’ve left it a long time and have secondary arthritis of the big toe, the joint may have to be fused, eliminating motion. Your surgeon will advise on the best option; ask your podiatrist for a referral.
Heel pain
A big culprit is plantar fasciopathy, caused by gradual wear and tear on the strong ligament that runs from the heel bone to the toes, more common post-50. Age-related thinning (atrophy) of the heel fat pad is also common past 40. Or it could be Achilles tendinopathy – swelling and stiffness of the Achilles tendon that joins the heel bone to the calf muscles – thought to be caused by repetitive strain on the tendon.
Self-care: Resting, applying cold compresses four times a day, and taking an over-the-counter non-steroidal anti-inflammatory drug can help.
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Expert advice: A physiotherapist or podiatrist can advise on stretching and strengthening exercises, massage, and orthotic inserts/night splints to support the foot in the best position. Steroid injections may ease any persistent pain.
Medical treatment: If other measures fail, a physiotherapist can treat plantar fasciopathy and Achilles tendinopathy with non-surgical extracorporeal shock wave therapy (ESWT), where high-energy acoustic waves are fired at the affected area, triggering the body’s natural healing response. Surgery in all three cases is only considered if all other options have failed after a period of six months.
Ingrown toenails
This occurs when the side of the nail curls round and grows into the skin, leading to pain, inflammation, swelling and sometimes infection. Genetics, ill-fitting shoes, nail trauma, and cutting nails round (not straight across) or too short can play a part.
Self-care: For mild cases that aren’t inflamed, soak feet in warm water and use a cotton bud to gently push the skin away from the nail.
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Medical treatment: See a podiatrist if the area becomes infected (is warm, swollen and red, with pus discharge), as you may need antibiotics. To fix the problem, a partial nail avulsion, done under local anaesthetic by a podiatrist, involves surgically removing the ingrown nail section and applying a chemical to the root to prevent regrowth. Recovery takes between three to six weeks.
Fungal nails
Fungal toenail infections, affecting about 5% of adults, but 20% of over-60s, are very hard to treat. Playing sports, using communal showers and pools, wearing closed shoes – which keep feet warm and moist – previous nail injury, diabetes, poor circulation, lowered immunity or a history of athlete’s foot are all possible causes.
Self-care: Over-the-counter topical antifungal agents can help in mild cases, but don’t always penetrate sufficiently into the nail bed to kill the infection.
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Medical treatment: Your GP may prescribe oral antifungals, taken for up to nine months. They’re effective, but you’ll need regular liver-function tests, as these meds can cause liver damage in rare cases. If antifungals don’t work, a podiatrist can cut back and thin the nail for better penetration of the antifungal treatment. As a last resort, a podiatrist may remove the infected nail under local anaesthetic. Regrowth takes up to 18 months. Depending on the severity of the infection, the nail root may also be removed, so the nail won’t regrow.
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5 Things Your Feet Can Reveal About Your Health
1 A painful, warm, red, swollen big toe… could be caused by gout. Sticking to a low-protein diet, staying hydrated and losing weight may help prevent future attacks.
2 Cold feet… could be a sign of an underactive thyroid. Your GP can request a blood test to check your thyroid hormone levels. Treatment involves taking levothyroxine to top up these levels.
3 A cut or sore on your foot that isn’t healing… could be an indication of diabetes. See your GP, who can do a simple finger-prick blood test to check.
4 Clubbed nails… could be a sign of heart or lung diseases that reduce blood oxygen. Consult your GP immediately.
5 Thick, crumbling, pitted, discoloured or lifting nails… can be due to psoriasis. A dermatologist may prescribe oral meds like methotrexate, steroid or retinoid creams, corticosteroid injections, or UV-light therapy.
