Chiropody and Podiatry Services in Bedfordshire

Flat Feet

A flat or low arched foot is not considered abnormal and the height of the arch does not have any bearing on how well a foot can function. A foot that rolls in excessively with most of the weight passing over the inside border may be a cause for concern.

Surgical treatment is required in the severe cases when the poor alignment of the foot causes pain or fatigue or has a high chance of doing so. These patients are considered to have a pathological flat foot. The majority of these cases respond well to a combination of muscle stretching exercises, orthoses (shoe inserts), braces and supportive footwear. If the patient doesn’t respond to conservative treatment, then surgery might be considered.

Cases of a pathological flat foot

Congenital (born with)
Tendon injuries, typically tibialis posterior (on the inside of the ankle)
Neurological and muscular diseases
Joint hypermobility
Abnormal joining of two bones (coalition) resulting in a rigid flat foot
Inflammatory Arthritis (e.g. rheumatoid arthritis)
Trauma or injury

Types of flat foot

1. Flexible

The foot is poorly aligned when a person is standing but when sitting with the weight off the foot the deformity usually corrects itself. It can be manipulated into a better position by hand.

2. Rigid

The foot remains in a poor position whether the person is weight bearing standing or not. It cannot be manipulated into a straight position by hand.

Diagnosis

The diagnosis is made following an examination of the foot. In certain cases, further investigations may be required such as X-ray, ultrasound, MRI or CT.

Treatment Options

Conservative care
The vast majority of patients find that they can control their symptoms with the use of non-surgical treatments. Footwear is a key factor. The correct size, width and depth of shoe are key with adequate support to hold the foot in position (laced up). You will be advised on the best shoe for your problem. Flexible footwear is to be avoided. If inadequate shoes are worn, the rest of the non-surgical treatments are unlikely to be effective over the longer term.

Often, a combination of the following options are used:

When active, a firmly laced, rigid sole with a cushioned inlay should be used. For example; a hiking shoe or MBT style shoe
Special shoe inserts called orthoses
Ice packs
Anti inflammatory and pain killing medication
Cortisone injections in combination with the above treatments
Physiotherapy / Stretching exercises for the calf and hamstring muscles
The Swede-O Ankle Lok brace with laces (see image below) can be very effective in supporting the foot in an improved position. These generally fit easily into shoes and can be purchased online.

Verrucae

What are verrucae?

Verrucae are plantar warts that commonly occur on the soles of the feet or around the toe area. They are caused by the Human Papilloma Virus (HPV), which is contagious through direct person-to-person contact. There are various forms of HPV, which all relate to various parts of the human body.

What causes verrucae?

The HPV virus is thought to thrive in moist, damp environments such as swimming pools, changing room floors and communal shower areas. It is possible to contract verrucae simply by walking across the same floor area as someone with a verruca, especially if you have any small or invisible cuts or abrasions that make it easier for the virus to penetrate.

Who gets them?

Verrucae are most commonly seen in children, teenagers and young adults – largely those who use communal changing rooms. It is possible to develop an immunity against the virus over time but most people remain susceptible, although some more than others.

How do I know I have them?

The most common appearance is that of a small cauliflower-type growth on the soles of your feet with tiny black dots. If it is painful when you pinch the area (like when you squeeze a spot), you are likely to have a verruca. They can grow to 1cm in diameter and may spread into a cluster of small warts. If you are unsure, seek advice from a podiatrist.

Are they serious?

Verrucae are harmless but can be uncomfortable and painful if they develop on a weight bearing part of the foot. In addition, hard skin (callus) can form over the top of the verruca, increasing the discomfort in this area. There are also some strains of the virus that spread very quickly and can look unsightly.

What are the treatments?

In the first instance, avoid touching or scratching a verruca as it may spread into a cluster of warts. Instead, cover it up with a plaster. Evidence suggests that, in many cases, verrucae will disappear of their own accord, within six months for children but taking longer for adults (up to two years). This is because the body’s immune system recognises the presence of the virus and fights the infection naturally but it can take many months for this to happen. If it is painless, no treatment may be required as some treatments can be painful, especially for children, and can cause side-effects.

For painful and/or unsightly verrucae or ones that are spreading, you can self-treat using ointments and gels from your local pharmacist following the instructions carefully. Sometimes, merely rubbing away the dry skin over a verruca and applying a plaster helps to stimulate the body’s immune system to fight the infection. However, if your verruca becomes unusually painful or the surrounding skin area goes red, stop treatment immediately and see a podiatrist. This is because if the healthy tissue around a verruca is damaged, you could hamper further treatment.

A podiatrist will assess your general well-being and foot health before deciding on a treatment plan. This may include:

Acid-based treatments, which are stronger than regular ‘over the counter’ (OTC) treatments from your local pharmacy
Cryotherapy, which involves freezing the verruca with liquid nitrogen or nitrous oxide gas
Electrosurgery, which requires a local anaesthetic to be given
Excisional surgery, which is similar to the above
Laser surgery, particularly for larger areas of verrucae.

Two newer treatments that your podiatrist may offer are:

Microwave therapy, where the verruca has a microwave pulse sent through it
Needling, where the entire area of the verruca is pricked with a needle to stimulate the body’s immune system.

How can I prevent them?

To avoid catching verrucae, keep your feet in a healthy condition. Always dry them thoroughly after washing and if your feet are sweaty, treat them with surgical spirit; if they are dry, moisturise them with suitable creams or lotions, but avoid applying between the toes.

Other tips include wearing flip-flops in communal areas, not sharing towels, shoes and socks, and treating conditions such as Athlete’s Foot with a specialist treatment from the pharmacist.

If you do have a verruca and want to go swimming, wear special verrucae socks to avoid passing on the virus. These can also be worn as a preventative measure.

When should I see a podiatrist?

If you have diabetes or poor circulation, are pregnant or have any other condition affecting your feet (or your immune system), it is important never to treat a verruca yourself and instead visit a podiatrist
If you are worried about your verruca and/or self-treatment is not working and/or the verruca appears to be getting larger or more painful, visit a podiatrist.

If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional.

Sweaty Feet

What is it?

Most of us have suffered from foot perspiration and odour from time to time, yet for some people, sweaty feet (along with sweaty palms and armpits) are a persistent problem, which can be uncomfortable and embarrassing. For some people, this can significantly affect their day-to-day life, and result in decreased social contact with others. But the condition is treatable.

There are more sweat glands per inch in our feet than anywhere else in the body. Their function is to keep the skin moist and supple and regulate temperature when the weather is hot, if you have an unnaturally high temperature or while exercising. They secrete all the time, not just in response to heat or exercise, like elsewhere in the body.

Excessive sweating, also known as hyperhidrosis, has a lot to do with how the sweat glands in the feet work. With 250,000 sweat glands, feet do tend to sweat more than other parts of the body, but with a daily hygiene routine few people should suffer from the embarrassment that it may cause.

What causes the problem?

Sweaty feet (along with palms and armpits and the face/scalp) tend to be symmetrical. The exact cause of sweaty feet is unknown but it is due mainly to overactive sweat glands. In some cases, the cause can be genetic.

Other possible causes include stress on the foot caused by a structural problem, or because the foot is under strain or tired, for example when you have been standing on your feet all day.

Is it serious?

Although hot weather can make matters worse, sweaty feet is both a summer and a winter problem as well as an inherited condition. It tends to be a long-term condition, which may require treatment over a sustained period of time.

In some cases, sweaty feet can lead to Athlete’s Foot or blisters.

Who gets it?

In adolescents and people under 25, sweaty feet are probably caused by overactive sweat glands triggered by changing hormone levels in the body. As the sweat glands on the soles of the feet (and palms of the hand) respond mostly to emotions, both mental and emotional stress is a common cause.

How do I know I have the condition?

An added problem that often accompanies sweaty feet and signifies its presence is foot odour caused by bacteria on the skin breaking down the sweat and releasing an offensive smell.

How do I prevent it?

Following a simple daily foot hygiene routine is usually effective in dealing with sweaty feet. This may include:

Washing your feet with anti-bacterial soap
Applying cream and/or using an absorbent foot powder
Not wearing the same footwear every day
Rotating what shoes you wear so they have a chance to dry out.

Wearing socks is also essential especially those that absorb moisture like wool, cotton or a wool/cotton mixture. In addition, detachable insoles (and medicated insoles that have a deodorising effect) are recommended as a lot of sweat is absorbed by insoles or the uppers of shoes.

In terms of footwear, well-fitting shoes made of leather, which allow your feet to breathe, are considered best.

What are the treatments?

For more serious cases where normal foot care is not effective and for more longer term conditions, your doctor may refer you for Iontophoresis (electrical stimulation) and Botulinum toxin injections (botox).

When should I see a podiatrist?

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional.

Rheumatoid Arthritis

What is rheumatoid arthritis and how do I know I have it?

Rheumatoid arthritis (RA) is a condition that causes inflammation in many joints of the body but particularly affects the hands, feet, wrists, ankles and knees. It tends to occur symmetrically: for example, if your right big toe is swollen and painful, chances are your left big toe will be too. As well as joint pain and stiffness, symptoms include muscle aches, anaemia (a low blood count leaving you feeling tired) and fever. The stiffness tends to be worse in the morning and after rest.

What causes it?

Unlike osteoarthritis, which is caused by wear and tear, RA is a chronic inflammatory disease where a faulty immune system attacks the tissue that lines and cushions the joints, leaving them swollen, painful and stiff. RA tends to affect the smaller joints such as the fingers and toes first, so feet are often one of the first places to be affected. Symptoms are usually felt in the toes first and then the back of the feet and the ankles. The joints may become enlarged and even freeze in one position so they can’t be fully extended.

Front of the foot

The metatarsal-phalangeal joints are often affected (where the long bones of the feet meet the toes) and can result in hallux valgus (a condition in which the big toe is angled excessively towards the second toe) and hammer toe deformities (where the toes curl up in a claw-like shape). Each of these deformities can cause further problems: for example, if you have hammer toes, you’ll be more likely to develop corns on the tops of your toes.

Midfoot

If the joints in the middle of the foot are affected, the arch can collapse, leading to a flat foot deformity and spreading of the forefoot (where the front section of the foot becomes wider). The fatty pads on the balls of the feet may slip forward, causing pain on the balls of the feet and backs of the toes. If this happens, it can feel as if you are walking on stones.

Back of the foot

If the joint where the heel bone meets the ankle (the joint that lets you rotate your ankle) is affected, it can lead to a condition known as valgus hindfoot (where the heel bends outwards), making it difficult to walk.

Is it serious?

The severity of the symptoms vary from person to person. According to Arthritis Research UK, about one in 20 people will have RA that becomes progressively worse leading to severe damage in many joints, while around one in five will have mild RA that causes few problems beyond a little pain and stiffness.

Any kind of foot deformity will cause an uneven distribution of pressure as you walk, making you more likely to develop corns, callus and ulcers.

You may also get rheumatoid nodules – fleshy bumps that usually occur below the elbows but can appear on the hands and feet too. They may form over bony areas such as the heels and occur in 30% to 40% of people with rheumatoid arthritis.

Who gets it?

Women are more prone than men to developing RA, although anyone can contract the disease. It tends to affect people over the age of 40.

How do I prevent it?

You can help yourself by understanding as much as possible about your disease and treatment. The best starting point is the website for the charity Versus Arthritis, which has numerous downloadable leaflets on all aspects of arthritis.

There could be many other causes of your joint pain but if it is arthritis, the sooner you are diagnosed the more effective treatment will be. Many rheumatology departments have early arthritis clinics which your GP can refer you to.

What are the treatments?

Your doctor can make a clinical diagnosis using blood tests (which may show changes in the blood caused by inflammation) and x-rays (which can show up damaged joints). It is likely your feet will be x-rayed because the changes caused by RA often appear in the feet before they appear in other joints.

Your GP will decide the most appropriate treatment for you. Your treatment will depend on how advanced your RA is. Drugs available include analgesics, non-steroidal anti-inflammatory drugs (NSAIDS) which reduce pain and swelling, and disease-modifying anti-rheumatic drugs (DMARDS) which slow down the effects of the disease on the joints. If your arthritis is advanced, you may be prescribed corticosteroids. It may take a while to find the drug that’s right for you but it’s worth persevering.

Specialist teams of rheumatologists, podiatrists/chiropodist, physiotherapists and occupational therapists, along with specialist nurses, will provide the most effective care and treatment for arthritic patients, especially those with RA.

When should I see a podiatrist?

There are many things a podiatrist can do to make walking less painful.

Orthoses
These are a special type of insole that can be fitted into your shoes. They will help you walk in such a way as to minimise the pressure on your affected joints.

Shoes
As well as a moulded insole, your podiatrist will help you find shoes that are roomy enough to accommodate your foot – and orthoses – without adding unnecessary pressure. If your toes are beginning to stiffen or curl, for example, it’s important for you to wear a shoe with an extra deep toe box. Your podiatrist may make a plaster of Paris copy of your foot, so a shoe can be tailored to your exact foot shape.

Protective shields
Your podiatrist can also provide protective shields for your toes, and/or padding to relieve pressure and reduce friction.

Surgery
Surgery can correct any bunions and hammer toes caused by RA. If your joint cartilage has been completely destroyed and the joints in your foot have been dislocated to the extent that it’s extremely painful to walk, they can be fused together (a process known as arthrodesis). This involves removing the joint cartilage (the substance that allows the bones to glide over each other). The bones are then held together with screws, plates or a rod and will eventually merge into one solid bone. Although this results in a loss of movement in that particular joint, it can reduce pain.

Any secondary problems such as ulcers and corns that have been caused by foot deformities can also be treated.

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional, such as your GP, to refer you to your local NHS trust for free treatment. If you do not qualify for this, or need urgent attention, you should contact a private podiatrist.

Osteoarthritis

What is osteoarthritis?

Osteoarthritis (OA) is often called the ‘wear and tear’ arthritis. It occurs when the cartilage of a joint (a thin layer of gristle that covers the end of the bones and allows them to glide over each other) becomes damaged. When the cartilage deteriorates, the bone underneath can thicken, causing pain, stiffness and swelling. The joints most affected are the knees, hips, hands and big toes.

In severe cases, the cartilage can deteriorate to the extent that the bones rub together, making it difficult to move the affected joint at all. Symptoms vary from person to person and some people may have OA without experiencing many symptoms at all.

What causes it?

As our joints are being used continuously through daily movement, wear and tear is inevitable, but for some people the natural repair process does not function properly and causes severe wear and tear (OA).

OA can affect any of the 33 joints in the feet but mostly affects those at the base of the big toes. This joint is more prone to wear and tear from the pressures of walking, especially if you over-pronate (ie roll your foot inwards excessively as you walk). Wear and tear at the ends of the bone causes the cartilage to erode and the bone ends may begin to join together. Eventually your big toe may become rigid (a condition known as hallux rigidus), which makes walking difficult, or your big toe may drift towards your other toes (hallux valgus), which can lead to bunions.

Is it serious?

In most cases, the symptoms of OA tend to be mild, but symptoms can vary and can come and go over time.

Who gets it?

OA is uncommon before the age of 40 and is more common in women than men. Though the exact cause of OA is unknown, it is probably due to the fact that as we age, we tend to put on weight and thereby put more pressure on our joints, our muscles become weaker and our body loses its ability to heal itself.

When OA occurs in younger people, it is usually because the joint cartilage has been damaged through injury (such as a sprain or fracture), a bacterial or viral infection, or even through overuse of a particular joint as is common in farmers (hips), plumbers (knees) and footballers (knees and ankles). Arthritis Research UK estimates that eight million people in the UK are affected by OA but only one million seek treatment.

How do I know I have it?

You may initially feel a toothache-type ache in the affected joint that gets worse when you’re active, wearing high heels or when it’s cold and damp. It may progress to the stage where your feet ache at night. In severe cases, the range of movement in the joint may fail to the extent that you can’t move it at all. If you are worried that you have OA you should see your GP or a podiatrist. The earlier you are diagnosed, the more effective any treatment will be

What can I do to ease the problem myself?

If you develop OA in your feet, there are many things you can do yourself to help ease the condition.

Footwear
Minimise the stress on joints by wearing well-cushioned shoes. Choose shoes with lace-up fastenings or an adjustable strap – these will keep the heel in place and stop the toes being pushed to the front of the shoe. Your feet should keep their natural shape when in shoes. There should also be a centimetre between the end of your longest toe and end of the shoe. Shoes shoud be roomy enough to accommodate any swelling so a wide, deep pair are best.

Exercise
We don’t often think about exercising our toes, but by doing so and stretching them regularly, you can help nourish the joint cartilage and strengthen the muscles and tendons around the joints. For example, try putting your feet side by side (say while you are in the bath) and then try to move your big toes towards each other; do this regularly three or four times a day.

Ideally you should exercise your whole body to keep your joints flexible, your muscles strong and your bone and cartilage tissues healthy. Yoga is a great exercise for all your joints, including your toes. Swimming is also great because it doesn’t put any pressure on your joints.

What are the treatments?

Your GP may recommend painkillers or steroids to ease the pain. There are also creams and gels which can be absorbed into the bloodstream if rubbed on the affected joints when they are painful, such as after exercise or at the end of the day. Ideally, you should be seen by a team of rheumatologists, physiotherapists, occupational therapists and podiatrists.

When should I see a podiatrist?

Although there is no known cure for OA, there are many ways your podiatrist can help you ease the pressure on the affected joints and therefore reduce the pain and inconvenience.

Orthoses
Orthoses are special shoe inserts that help redistribute the pressure as you walk. They’ll help you walk in such a way that alleviates the pain in your joints.

Shoes
Your podiatrist can advise you on the best type of footwear to wear for your exact problem. If you develop hallux valgus (where you big toe drifts towards your second toe), your podiatrist may recommended a shoe with a stiff sole as these relieve pain by reducing the movement of the big toe. In some cases, a shoe with a slight heel raise may be more comfortable.

Strapping and padding
Your podiatrist may strap the feet for a short time to limit joint movement. They can also provide protective shields for your toes or padding to relieve pressure and friction.

Surgery
If your problem doesn’t improve with the above measures, you may be referred to a podiatric surgeon who will evaluate the extent of your problem and see if you are suitable for:

Excisional arthroplasty (replacement of joint surfaces)
Interpositional arthroplasty (placing soft tissue, especially joint capsule, between the resected bone surfaces)
Osteotomy (decompresses and realigning the joint surfaces)
Joint replacement (used for irreversibly damaged joints)
Arthrodesis (where the bones are fused together)

However, surgery is only used as a last resort.

Specialist teams of rheumatologists, podiatrists, physiotherapists and occupational therapists, along with specialist nurses, will provide the most effective care and treatment for arthritic patients, especially those with rheumatoid arthritis.

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, it is recommended to seek the help of a healthcare professional.

Ingrowing Toenail

What is an ingrowing toenail?

An ingrowing toenail is where a piece of nail pierces the flesh of the toe. It can feel as if you have a splinter, and be extremely painful and inflamed or infected. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect the other toes too. A nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin, isn’t an ingrowing toenail but can feel very painful and can also appear red and inflamed.

What causes it?

There are many genetic factors that can make you prone to ingrowing toenails, including your posture (the way you stand), your gait (the way you walk) and any foot deformity such as a bunion, hammer toes or excessive pronation of the feet (when your foot rolls inward excessively). Your nails may also have a natural tendency to splay or curl out instead of growing straight, encouraging your nail to grow outwards or inwards into the flesh.

One of the most common causes is not cutting your toenails properly, such as cutting nails too low in order to relieve the pressure and discomfort of an involuted nail.

Tight footwear, hosiery and socks can also push your toe flesh onto the nail so that it pierces the skin. If you sweat excessively or don’t rotate your footwear, the skin becomes moist and weak and is easily penetrated by the nail. If you have brittle nails with sharp edges or are in the habit of breaking off bits of nail that are sticking out, you are also more likely to get an ingrowing toenail.

Less common is a fungal infection or in some cases particular types of medication, for example isotretinoin.

Who gets it?

Active, sporty people are particularly prone, because they sweat more. Younger people are more likely to get it (as they pick their nails more, compared to older people who may not be able to reach their toes!).

How do I know I have it?

The most common symptom is pain followed by inflammation in the surrounding nail area.

However, not everyone identifies an ingrowing toenail correctly. Sometimes, they have a curly nail which has a lot of debris (dirt or fluff) underneath it or a corn or callus down the side of the nail, which can be just as painful. However, if it’s a corn, you tend to experience a throbbing pain as opposed to the sharp pain you get with an ingrowing toenail. If this is the case, your podiatrist will remove the debris, and, if necessary, thin the nail.

Is it serious?

Not usually, unless you have an existing condition such as diabetes, poor circulation or a reduced immune system. However, if left untreated, infection can develop in the rest of the toe and foot, and in very rare cases get into the blood stream. The quicker you deal with it, the less painful the treatment.

What are the treatments?

Before you are seen by a podiatrist, you can relieve the discomfort by bathing your foot in a salty footbath which helps to prevent infection and reduces inflammation. Then apply a clean sterile dressing, especially if you have a discharge, and rest your foot as much as possible.

How a podiatrist will treat you will depend largely on the severity of your condition:

For the most basic painful and irritable ingrowing toenail, the offending spike of nail will be removed and the toe covered with an antiseptic dressing
For toes too painful to touch, a local anaesthetic will be injected before removing the offending portion of nail
For involuted nails, part of the nail that is curling into the flesh is removed and then the edges of the nail are filed to a smooth surface
For any bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, antibiotics will be prescribed to manage the infection as well as having the offending spike removed
For those particularly prone to ingrowing toenails from underlying problems such as poor gait, a partial nail avulsion (PNA) may be recommended along with finding a more permanent solution to the underlying condition. This procedure is done under a local anaesthetic where part of the nail is removed (including the root), leaving a permanently narrower nail. In some cases a total nail avulsion (TNA) may be performed, where the entire nail plate and root are removed. In either case, the chemical phenol is used to cauterise the nail and prevent it regrowing. This is over 95% successful. You will, however, have to go back to your podiatrist for a number of re-dressings

How can I prevent it?

Firstly, learn to cut your nails properly. Nail cutters aren’t a good idea because the curved cutting edge can cut the flesh, and nail scissors can slip. It’s best to use nail nippers (available from chemists) because they have a smaller cutting blade but a longer handle. Cut your nails straight across and don’t cut too low at the edge or down the side. The corner of the nail should be visible above the skin. Also, cut them after a bath or shower when the nail is much softer.

Good hygiene can go a long way to preventing ingrowing toenails. Avoid moist, soggy feet by rotating your footwear so each pair has a chance to dry out thoroughly. Avoid man-made materials (synthetics) and choose socks and shoes of natural fibre which fit properly. Keep your feet clean and dry and in the summer wear open-toed sandals to let air get to your toes as much as possible.

If you have diabetes, are taking steroids or are on anti-coagulants, don’t attempt to cut your nails or remove an ingrowing spikes of nail yourself.

When should I see a podiatrist?

You should see a podiatrist urgently if you have symptoms of infection, and also have diabetes, poor circulation or a reduced immune system. You should also visit a podiatrist if you experience any persistent pain in your toe from the ingrowing nail or have a condition that affects the nerves and/or feeling in your foot.

If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional.

Heel pain

What is heel pain?

The heel is a specialised part of the body designed to absorb the impact of your body weight when walking, running or undertaking any other form of physical exertion or weight-bearing exercise. When heel pain develops, it can be very disabling, making every step a problem, which in turn affects your overall posture.

What causes the problem?

Heel pain is a common occurrence. In most cases the pain is caused by some form of mechanical injury resulting from small repetitive injuries that occur at a rate faster than the body can heal them.

Heel pain can also be caused by lower back problems or inflammatory joint conditions.

The following types of heel pain are not exhaustive but may help you appreciate the complexity of heel pain and why specialist advice can be helpful.

Plantar fasciitis (or fasciopathy):

This is the most common form of heel pain, caused by damage to the fascia ‘band’ (similar to a ligament) which connects the heel bone to the base of the toes. This condition can be caused in various ways including extensive running, walking or standing for long periods of time, especially when you have a sedentary lifestyle. In particular, a change of surface (eg road to track), poor shoe support, being overweight, overuse or sudden stretching of your sole, as well as a tight Achilles tendon, can lead to this condition.

Heel bursitis (subcalcaneal bursitis):

This is an inflammation of a bursa (a fluid-filled fibrous sac) under the heel bone where the pain is typically more in the centre of the heel than that experienced with plantar fasciitis and significantly worsens during the day. This condition can be caused by a fall from a height on to the heel.

Heel bumps:

These are firm bumps on the back of the heel, usually caused by excessive shoe rubbing in the heel area, or the thickening of the tissues associated with a tight Achilles tendon.

Tarsal tunnel syndrome:

This can feel like a burning or tingling sensation under the heel within the arch of the foot with occasional loss of sensation on the bottom of the foot. This is caused by compression of the tibial nerve as it passes the inside of the ankle. Tapping of the nerve just behind the ankle bone (known as Tinel’s test) will stimulate the symptoms of the condition.

Chronic inflammation of the heel pad:

This is caused by a heavy heel strike or sometimes a reduction in the thickness of the heel pad which can give rise to a dull ache in the heel which increases during the day.

Fracture:

A fracture can be caused by falling from a height or landing on an uneven surface.

Sever’s disease (calcaneal apophysitis):

This painful condition affects young children, usually between the ages of 8 and 12, especially those who are physically active or undergoing a growth spurt. It results from inflammation of the Achilles tendon where it attaches to the heel.

Achilles tendonosis:

This condition occurs when the Achilles tendon is placed under more pressure than it can cope with and small tears develop, along with inflammation, which in some cases leads to tendon rupture. These tears become a source of further injury, which can lead to swelling within the tendon, hence the name ‘tendonosis’ (sometimes referred to in error as ‘tendonitis’).

Who gets it?

Heel pain can affect everyone, whatever your age, but those more commonly affected include people in middle age (over 40s age group), those who are overweight or stand for long periods of time, and athletes.

How do I know I have it?

With plantar fasciitis, there are often no visible features on the heel but deep localised painful spots found in or around the middle of the sole of the heel, and pain is usually worse on standing after long periods of rest, particularly first thing in the morning.

With bursitis, pain can be felt at the back of the heel when the ankle joint is moved and there may be a swelling on both sides of the Achilles tendon. Or you may feel pain deep inside the heel when it makes contact with the ground.

Is it serious?

Heel pain is a common condition and in most cases will diminish following some routine self-care measures. If the pain persists longer than three weeks, it is best to seek professional advice from a podiatrist, as there are many types of heel pain, each with their own different causes and separate forms of treatment.

What are the treatments?

If you experience heel pain, some simple self-care measures include:

Avoid wearing ill-fitting or uncomfortable shoes
Wear shoes with good heel cushioning and effective arch support
Minimise walking or exercising on hard ground
Rest regularly and try not to walk or run too fast
Wear a raised heel (no more than 6-10 mm higher than normal)
Lose weight if you are overweight

More specialist treatments include:

Plantar fasciitis (or fasciopathy):

Treatment can take many forms, from resting your foot as much as possible, stretching exercises and deep-heat therapy, to steroid injections and even medication or surgery to release the tight tissue ‘band’. In the acute stage, use ice compresses for 10 minutes twice a day, and ibuprofen (always check with your GP or pharmacist before taking any new medication). In some cases, padding and strapping is applied to alter the direction of stretch of the ligament to alleviate symptoms in the short term. However, for the long term, special insoles (orthoses) may be prescribed to help the feet to function more effectively and to make any possible recurrence less likely.

Heel bursitis (calcaneal bursitis):

Medication and ultrasound can give relief but for the long term, a shoe insert may be necessary. In addition, attention to the cause of any rubbing and appropriate padding and strapping will allow inflammation to settle.

Heel bumps:

Adjustments to footwear is usually enough to make them comfortable, although a leather heel counter and wearing boots may help. In more serious, recurring cases, surgery may be necessary.

Tarsal tunnel syndrome:

Special shoe inserts can reduce the pressures on the nerve and may be appropriate for certain foot types whereas, on other occasions, local injections of medication to the area where the tibial nerve is inflamed may be necessary.

Chronic inflammation of the heel pad:

A soft heel cushion can help this condition.

Fracture:

If this is suspected, an X-ray is required to confirm final diagnosis and to determine the extent of the injury and a follow-on treatment plan.

Sever’s disease (calcaneal apophysitis):

This condition is temporary and self-limiting but can be painful at the time. Rest and stretching exercises may help.

Achilles tendonosis:

Treatment involves special exercises that strengthen the tendon and increasing the height of the heel with an insole on a temporary basis.

How can I prevent it?

Follow the self-care measures above in the first instance.

When should I see a podiatrist?

If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, it is recommended that you seek the help of a healthcare professional.

Gout

Gout is a type of arthritis that affects men more than women and causes sudden severe joint pain. It usually starts in the big toe, but other joints can be affected such as the ankle, knee or foot.

What is gout and what causes it?

Gout is caused by an imbalance of uric acid in the body resulting in a build-up of uric acid in the blood. When there are high levels of uric acid in the blood, small urate crystals form which collect in and around the joint, causing irritation, inflammation and severe pain.

Is it serious?

Apart from the severe pain that gout causes, gout can also be responsible for kidney damage caused by crystals forming to create kidney stones which are notorious for being extremely painful to pass.

Who gets it?

One in 200 people is affected by gout. It commonly affects men rather then women, especially as they get older, but can run in families too.

How do I know I have it?

The main symptom of gout is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen, then doesn’t return for a few months.

How do I prevent it?

You can reduce your chances of developing gout by leading a healthy lifestyle including:

Maintaining a healthy weight
Eating a healthy diet including what you drink (ie avoiding too much alcohol and fizzy drinks)
Making sure there is plenty of Vitamin C in your diet

What are the treatments?

Gout can be controlled and regulated with anti-inflammatory drugs, which your GP will be able to prescribe, and these will alleviate the attack over 24 hours or so. An immediate measure to an acute attack is to levitate your leg to help reduce swelling and apply ice or cooling lotions while waiting for your medication to take effect.

Your local podiatrist will also be able to help alleviate issues by adapting your existing footwear with orthoses or other appliances which fit easily into your shoes and help redistribute pressure away from the affected parts.

Made-to-measure shoes can also be prescribed: your podiatrist will be able to advise you on the correct type of shoes to wear and where to obtain them. They can also provide protective shields for your toes or padding to relieve pressure and reduce friction. Any secondary problems like ulcers or corns can also be treated. They can also refer you to a specialist for more serious cases.

When should I see a podiatrist?

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional.

To talk to a podiatrist (also known as a chiropodist) about the options available regarding treatment, you can contact an NHS podiatrist or a private practice podiatrist. In both cases, always ensure that any practitioners you visit are registered with the Health and Care Professions Council (HCPC) and describe themselves as a podiatrist (or chiropodist).

Specialist teams of rheumatologists, podiatrists, physiotherapists and occupational therapists, along with specialist nurses, will provide the most effective care and treatment for patients with arthritis, especially those with rheumatoid arthritis.

Corns and callus

What are corns and callus and what causes them?

When we walk or stand, our body weight is carried first on the heel and then on the ball of the foot where the skin is thicker to withstand the pressure. When this pressure becomes excessive, some areas of skin thicken and form corns and callus, as a protective response to the friction of skin rubbing against a bone, shoe or the ground.

Callus (or callosity) is an extended area of thickened, hard skin on the sole of the foot. It is usually symptomatic of an underlying problem such as a bony deformity, a particular style of walking or inappropriate footwear. Some people have a natural tendency to form callus because of their skin type. Elderly people have less fatty tissue in their skin and this can lead to callus forming on the ball of the foot.

Corns are caused by pressure or friction over bony areas, such as a joint, and they have a central core which may cause pain if it presses on a nerve. There are five different types of corns, the most common of which are ‘hard’ and ‘soft’ corns:

Hard corns – these are the most common and appear as a small area of concentrated hard skin up to the size of a small pea usually within a wider area of thickened skin or callus. This may be a symptom of the feet or toes not functioning properly
Soft corns – these develop in a similar way to hard corns but they are whitish and rubbery in texture and appear between the toes where the skin is moist from sweat or from inadequate drying
Seed corns – these are tiny corns that tend to occur either singly or in clusters on the bottom of the foot and are usually painless
Vascular/neurovascular corns – these are corns that have both nerve fibres and blood vessels in them. They can be very painful and can bleed profusely if cut
Fibrous corns – these arise when corns have been present for a long time and are more firmly attached to the deeper tissues than any other type of corn. They may also be painful

What are the treatments?

It is not adviseable to cut corns yourself, especially if you are elderly or have diabetes. A podiatrist will be able to reduce the bulk of the corn and apply astringents to cut down on sweat retention between the toes in soft corns.

Always consult a podiatrist for advice before using commercially available products. In particular, be careful about using corn plasters, as they contain acids than can burn the healthy skin around the corn, leading to serious problems such as infection. Home remedies, like lamb’s wool around the toes, are potentially dangerous. People with diabetes, poor circulation or a reduced immune system should not self-treat, but instead seek advice from a podiatrist.

A podiatrist will be able to remove corns painlessly, apply padding or insoles to relieve pressure or fit corrective appliances for long-term relief. For callus, your podiatrist will also be able to remove hard skin, relieve pain and redistribute pressure with soft padding, strapping or corrective appliances that fit easily into your shoes. The skin should then return to its normal state.

Elderly people can benefit from padding to the ball of the foot, to compensate for any loss of natural padding. Emollient creams delay callus building up and help improve the skin’s natural elasticity. Your podiatrist will be able to advise you on the best skin preparations for your needs.

You may also need to wear more supportive or wider fitting footwear to reduce pressure on the affected area.

How can I prevent them?

If you have corns or callus, you can treat them yourself occasionally by gently rubbing with a pumice stone or a foot file when you are in the bath and applying moisturising cream to help soften thickened skin a little at a time, or relieve pressure between the toes with a foam wedge. Do not self-treat if you have diabetes, poor circulation or a reduced immune system. Instead seek help from a podiatrist.

When should I see a podiatrist?

If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional.

Chilblains

What are chilblains?

Chilblains (also called pernio) are small itchy, red (and sometimes purple) swellings on the skin, which can become increasingly painful, swell and dry out leaving cracks in the skin that expose the foot to the risk of infection. They occur on the toes (particularly the smaller ones), fingers, the face (especially the nose) and the lobes of the ears. They can also occur on areas of the feet exposed to pressure, for instance on a bunion or where the second toe is squeezed by tight shoes. They can also lead to blisters and break down to become a small ulcer prone to infection.

What causes them?

Chilblains are caused by the skin’s abnormal reaction to cold. They develop when the tiny blood vessels under the skin constrict under cold conditions reducing the flow of blood until the area warms up again and causes some leakage of fluid into the surrounding tissue. Not everyone develops them – it depends to a large extent on the efficiency of your circulation. People with poor circulation and other health problems involving their blood vessels are likely to be more prone to developing chilblains. In addition, damp or draughty conditions, dietary factors and hormonal imbalance can also be contributory factors. It is thought that rapid temperature changes from cold to hot can also be a cause: if the skin is chilled and is then followed by too rapid warming next to a fire or through using a hot water bottle, chilblains may result.

Who gets them?

Although chilblains are common, the condition mainly affects young adults working outdoors in cold places or people who do not wear socks or tights in winter. Elderly people whose circulation is less efficient than it used to be, people who don’t take enough exercise and those suffering from anaemia, are also susceptible.

How do I know I have them?

During the onset of winter, susceptible people will experience a burning and itching on their hands and feet which intensifies upon entering a warm room. There may also be some swelling or redness, and in extreme cases the surface of the skin may break down and sores (ulcers) may develop.

What are the treatments?

If you have developed chilblains do not scratch them. Instead use soothing lotions such as witch hazel and calamine to reduce the discomfort.

If the chilblain has ulcerated, apply an antiseptic dressing. If you have diabetes or are undergoing medical treatment, it is important that you have the ulcer assessed by your GP or podiatrist.

If the chilblain has not broken, you can paint it with a mixture of Friar’s Balsam and a weak solution of iodine which your pharmacist can make up for you, or an over-the-counter preparation. At night, rub some lanolin ointment into the feet to help retain the heat.

How can I prevent them?

The best way to prevent chilblains is to keep your legs, feet and body warm, especially if your circulation is poor and your mobility is limited.

The whole body, rather than just the feet, needs to be kept warm. Trousers, long boots, tights, leg warmers, long socks and gloves will also help.

When should I see a podiatrist?

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional.

Bunions (hallux valgus)

What are bunions?

A bunion, also known as ‘hallux valgus’, is a deformity of the big toe in which the big toe angles excessively towards the second toe and leads to a bony lump on the side of the foot. A large sac of fluid, known as a bursa, may also appear, and this may become inflamed and sore.

What causes them?

Bunions are most often caused by a defective mechanical structure of the foot, which is genetic; these foot types make a person more prone to development of a bunion. Poorly fitting footwear tends to aggravate the problem as tight or narrow footwear can squeeze the forefoot, crowding the toes together and exacerbating the underlying condition, causing pain and deformity of the joint.

Bunions can also be caused by the big toe pushing over on to the second, causing crossover of the toes, which makes it difficult to walk due to pressure on the toes from footwear. Once the big toe leans toward the second toe, the tendons no longer pull the toe in a straight line, so the problem tends to get progressively worse. This condition can also lead to corns and calluses developing.

Bunions can also be caused by age, arthritis or playing sport.

Who gets them?

Although anyone can get a bunion, they tend to be more common in women, possibly due to some of the more restrictive footwear typically worn (more than 15% of women in the UK suffer from bunions). Women also tend to have looser ligaments. If your parents or grandparents have them, you may also be more prone to developing them.

Are they serious?

Some people have large bunions that are painless but cause difficulties with footwear, while others have relatively small bunions that can be very painful. Although some treatments can ease the pain of bunions, only surgery can correct the defect.

In some cases, pressure from the big toe joint can lead to a deformity in the joint of the second toe, pushing it toward the third toe and so on. However, just because you have a bunion, does not mean you’ll get a bursa as well.

What are the treatments?

Your podiatrist may recommend the following:

Exercises
Orthoses (special devices inserted into shoes)
Shoe alterations or night splints which hold toes straight during sleep (helps to slow the progression of bunions in children)

These are all conservative measures and although they may help relieve symptoms there is no evidence they can correct the underlying deformity. Your podiatrist will be able to identify any significant deformity and/or defect and may refer you for surgery, which can involve a combination of removing, realigning and pinning of the bone.

Once referred, your podiatric surgeon will evaluate the extent of the deformity. A podiatric surgeon can remove the bunion and realign the toe joint in a common operation known as a first metatarsal osteotomy (‘bunionectomy’). However, there are more than 130 different types of operation that fall under this title, so each individual surgery is different.

The aim of surgery is to address the underlying deformity to prevent recurrence. As with all surgery, there are risks and complications, so it is not usually advised unless your bunions are causing pain or are starting to deform your other toes.

How can I prevent them?

Wearing sensible shoes that fit well is a good preventative measure. If you notice a bump developing where your big toe joins the foot, it may be time to switch your footwear. Try to opt for wider shoes that provide your toes with room to move and keep your heel height to no more than 4cm for maximum comfort. The following also serves as a useful guide:

Avoid backless, high-heeled shoes. Backless shoes force your toes to claw as you walk, straining the muscles if worn over a long period
Vary your heel heights from day to day, one day wearing low heels and the next day slightly higher heels
If you want to wear a heel every day, keep heel heights to 4cm or less
Wearing a shoe with a strap or lace over the instep holds the foot secure and helps stop your foot sliding forward
Calf stretches to counteract the shortening of the calf can help to keep feet supple

When should I see a podiatrist?

If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional.

Blisters

What are blisters and what causes them?

Blisters are painful, fluid-filled lesions produced by friction and pressure. They can be caused by the following:

Ill-fitting footwear
Stiff shoes
Wrinkled socks against the skin
Excessive moisture
Foot deformities

Are they serious?

Blisters can become a more serious concern if you have diabetes as they may not heal so easily. Please see your podiatrist for further advice.

What are the treatments?

It is important to act immediately if you feel any friction or discomfort as blisters can form very quickly. Stop walking or running and examine your feet and if nothing has developed, consider applying some material or padding to cushion the area or even a breathable waterproof plaster.

If a blister does occur, do not pop it. Cut a hole in a piece of foam or felt to form a doughnut over the blister. Tape the foam or felt in place or cover with a soft gel-type dressing. Treat an open blister with mild soap and water, apply an antiseptic ointment and cover with a protective soft gel dressing to prevent infection and speed up the healing process.

Most foot blisters last between three and seven days and will normally clear up if further excessive friction is avoided.

How can I prevent them?

As blisters are the result of friction, there are a number of simple techniques that can prevent your walking, running or social activity being ruined by a blister:

Keep your feet dry and your toenails trimmed
Always wear socks of the right size as a cushion between your feet and footwear and change your socks daily
Wear comfortable, good-fitting footwear, especially on long walks or runs
For very sweaty feet, use products that help control excessive moisture
Immediately remove any foreign bodies that accumulate in socks and boots
Ensure the tongue and laces of your boots are arranged correctly and evenly
Check your feet regularly for any sign of rubbing and tenderness.

When buying socks, choose socks made of fibres with good ‘wicking’ properties. Alternatively, look for special ‘dual layer’ socks where the inner layer moves with the foot, and the outer layer with the shoe – these help eliminate friction at the skin surface.

When should I see a podiatrist?

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, it is recommended to seek the help of a healthcare professional.

Athlete’s Foot

What is athlete’s foot?

Athlete’s foot is a fungal infection of the skin that can lead to intense itching, cracked, blistered or peeling areas of skin, redness and scaling. It can occur on moist, waterlogged skin, usually between the fourth and fifth toes initially, or on dry, flaky skin around the heels or elsewhere on the foot. Large painful fissures can also develop and the condition can also spread along all five toes and sometimes to the soles of the feet if left untreated.

What causes it?

It is caused by a number of fungal species that you can pick up from someone else shedding infected skin, typically in communal areas such as pools, showers and changing rooms, or anywhere that you walk around barefoot. Athlete’s foot can also be passed on directly by person to person contact, although people who sweat more are more prone to infection.

Once your feet have been contaminated, the warm, dark and sweaty environment of feet in shoes or trainers provides the ideal breeding ground for the fungus. However, athlete’s foot also occurs in dry, flaky areas. It’s quite common in summer with sandal wearers. The sun makes your skin dry out so it loses its natural protective oils. This combined with the constant trauma from sandals makes your feet more prone to infection.

Who gets it?

It’s not called athlete’s foot for nothing! Walking barefoot around swimming pools and spending your life in trainers may make you more likely to pick it up, but you do not need to be an athlete to get this condition.

Is it serious?

If left untreated, the fungus can spread to the toe nails, causing thickening and yellowing of the nail, which is much harder to treat. Fungal infections are highly contagious and can spread to anywhere on your skin, including your scalp, hands and even your groin. This is especially likely if you use the same towel for your feet as for the rest of your body.

What are the treatments?

It is always best to treat this condition as soon as symptoms are first noticed. Treatments depend on what type of athlete’s foot you have. Over-the-counter remedies are always a good starting point, and your GP or podiatrist can also recommend suitable treatments.

For athlete’s foot where the skin conditions are dry

If the condition occurs on a dry area of the foot, such as your heel, you need to restore moisture by rubbing in an anti-fungal cream or spray, sometimes combined with a steroid cream (all from your pharmacist). You must remember to wash your hands thoroughly afterwards, or use disposable gloves so you don’t get the fungus on your hands.

For athlete’s foot where the skin conditions are moist

This requires a different treatment. Wash your feet in water as cold as you can bear (hot water only makes your feet fungus-friendly) then dry them thoroughly, preferably with a separate towel or even kitchen roll. It is important to dab your feet dry rather than rub them, as rubbing tends to remove any healing skin. Although the skin may appear flaky and dry, never use moisturiser between your toes, and avoid powders as they can cake up and irritate skin. A spirit-based preparation such as surgical spirit can help – it’s cooling, soothing and antiseptic. This may sting a little but will help the moisture evaporate and allow the skin to heal. Only use on unbroken skin.

In severe cases, an anti-fungal tablet may be prescribed. However, tablets are not suitable for everyone, for example pregnant women, so always check with your pharmacist and follow the instructions carefully.

You should also avoid using anti-fungal powders between the toes, although they’re good for dusting inside shoes and trainers.

The mistake most people make is to stop their hygiene regime, shoe rotation and/or medication once their symptoms have gone. Although symptoms may disappear after several days or weeks of treatment, the fungus can lie dormant and could eventually reappear in the right environment. Some products require continued treatment for many weeks – always follow the instructions fully. Also, be alert to symptoms so that you can deal with any problems straight away.

Fungal nails

Prescribed oral medications from your GP or podiatrist can be used for fungal nails. These usually takes between three and six months to get rid of the infection but can take longer. Alternatively, over-the-counter remedies such as anti-fungal nail lacquer can be used. These can take up to a year or more to work as it takes this long for a nail to fully grow out .

How can I prevent it?

The most important tip for preventing athlete’s foot is to ensure your feet are completely dry after washing them and before you put your shoes and socks on. However, there are many things you can do to make your feet less hospitable to fungal infections.

Firstly, change your footwear on a regular basis. There’s no point treating your feet if you constantly re-infect them by putting them into damp, fungally infected shoes. It takes 24-48 hours for shoes to dry out properly, so alternate your shoes daily
If you really have to wear the same pair day after day (say, if you’re on holiday), dry them out by using a hairdryer on a cold setting; this will get rid of the perspiration quickly without creating more heat. To help shoes dry out more quickly, take any insoles out, loosen any laces and open your shoes out fully so that air can circulate. When buying, choose trainers with ventilation holes
If your shoes are so tight that they squeeze your toes together, this allows moisture to gather between your toes and encourages fungus. Instead, let air circulate between the toes by choosing footwear with a wider, deeper toe box and choose shoes made from natural materials. Of course, you should also change your socks daily
Wear flip-flops in the bathroom and in public showers. This will ensure that you don’t leave any shed skin for others to pick up, and it will also stop you picking up other species of fungus
Finally, never wear anyone else’s footwear

When should I see a podiatrist?

Athlete’s foot is usually treatable at home, but a podiatrist may help you pinpoint the best treatment for your particular type of athlete’s foot. Your podiatrist can also help if the fungal infection has spread to your nails by reducing the thickness and cutting back the nails thereby exposing the infected nail bed to a lighter, cooler environment.

Nail infections can be treated with topical or oral medications. Oral medication can have side-effects so if you have other medical conditions or are on other medication, your GP or podiatrist may recommend that you don’t take it.

If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, it is recommended that you seek the help of a healthcare professional.

Ageing feet

What problems are associated with ageing feet?

As we age, we naturally develop more problems with our feet due to normal daily wear and tear of joints, but also because the skin starts to become thin and loses its elasticity, as well as becoming dry and more fragile.

Foot pain can be debilitating. As we only have one pair of feet, it’s important to take good care of them. Foot pain can also lead to issues with walking and exercising, which are an important part of health and wellbeing as we age. Additionally, if we have trouble with mobility, this can impact on getting out and about and involvement in social activities, which become ever more important as we get older. As long as we take routine care of our feet, serious problems can usually be avoided. However, ageing can also mean that we develop other conditions, such as diabetes and arthritis, which in some cases can affect the foot and require treatment. Healing may also take longer.

What are the signs of ageing feet?

If good routine foot care is not practised, feet can start to show signs of ageing at any age, but generally it is most common from your fifties onwards.

General signs of ageing feet include more regular aches and pains, developing bunions, signs of clawing of the toes along with general circulatory problems.

What can I do to reduce the effects of ageing?

Painful and uncomfortable feet aren’t a natural part of growing old or something to put up with. A lot can be done to improve comfort, relieve pain and maintain mobility.

Exercise

Keeping active and on the move helps to keep feet healthy. It tones up muscles, helps to strengthen arches and stimulates blood circulation.

General foot care and protection

Keeping toenails cut and under control is key as nails that become too long can press against the end of the shoe causing soreness, infection and ulceration. Toenails that have been poorly cut can also become ingrown.

Additionally, checking your feet regularly, daily if necessary, and moisturising them (but not between the toes) will help to keep them supple as feet start to dry out and lose their natural oils as they age. We also start to lose the fatty pads that cushion the bottom of the feet, and soles and heels become dry and nails brittle and more difficult to manage.

Keeping your feet warm is also important, but do not warm them too close to the fire! Warm stockings or socks can help, but avoid anything too tight which can restrict your circulation or cramp your toes. Wearing fleece-lined boots or shoes or even an extra pair of socks will also keep you warm but do make sure your shoes aren’t tight as a result. Bed socks are also a good idea.

Footwear

The older you get, the more important it is to wear a shoe that is comfortable, well-fitting and holds your foot firmly in place to give adequate support. Many people wear slippers if their feet are hurting but this can make things worse as slippers encourage you to shuffle rather than letting the joints work as they should. A pair of running shoes is the best option as these provide a degree of shock absorption and stability and also support the arch.

Avoid plastic easy-clean uppers, which don’t allow the foot to breathe and won’t stretch to accommodate your own foot shape.

Many shoes have cushioning or shock-absorbing soles to give you extra comfort while walking. When buying shoes, ensure that you can put them on and take them off easily. Check that the heel is held firmly in place: you’ll find that a lace, strap, buckle or velcro-fastening shoe will give more support and comfort than a slip-on.

Your shoes should be roomy enough, particularly if you intend to wear them every day. If you suffer with swollen feet, it’s a good idea to put your shoes on as soon as you wake up, before your feet have had a chance to swell.

What are the treatments?

Treatments depend on which particular condition you are suffering from, e.g. bunions, and therefore the best advice is to visit your local podiatrist if your foot care routine is not alleviating the symptoms.

When should I see a podiatrist?

As we get older, an annual foot health check is as important as a sight or hearing test. Conditions like diabetes or circulatory problems can all be picked up by looking at the feet, and common problems like corns, cracked skin and ingrown toenails can be successfully treated.

If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, you should seek the help of a healthcare professional.

Toe deformities

What is a toe deformity?

There are various types of lesser toe deformity and depending on the shape, we call these hammer, clawed or retracted toes.

In the average person, there are three small bones (phalanges) in each of your four small (lesser) toes on each foot. These bones are connected by ligaments and have small muscles and tendons within the foot that control their movement and stabilise them against the ground when you walk. The larger muscles and tendons within the leg move these toes. Toe deformities can occur when there is an imbalance with the muscles within the foot and the leg. External pressures from shoes and direct injury can cause buckling of the toes that can result in toe deformity. Certain inflammatory and neurological conditions can cause toe deformity as well.

What causes the problem?

Like bunions, there is no single cause of lesser (small) toe deformities. They are most often caused by a defective mechanical structure of the foot which can be caused by genetics; certain foot types make a person prone to development of toe deformities.

Altered position of your lesser toes commonly results in pressure from shoes or the next toe which results in painful hard skin forming. It is very common to see corns and calluses around the tips of toes or on the small toe joints.

Poorly fitting footwear tends to aggravate the problem as it can squeeze the forefoot, crowding the toes together and exacerbating the underlying condition, causing pain and deformity of the joint. With advancing age, toe deformities may progress. Associated medical conditions like arthritis can alter the shape and position of your toes, as can trauma.

Is it serious?

Some people have significant toe deformities that are painless but cause difficulties with footwear, while others have relatively subtle toe deformities that can be very painful. Although some treatments can ease the pain, only surgery can correct the deformity.

In some cases, pressure from the surrounding toes can lead to a domino effect which results in further toe deformities and/or pain in the metatarsals (long bones in the forefoot). An example of this is when deformities of the small toes are made worse by progressive bunion deformities.

People who have altered nerve supply or blood supply to their feet and are deemed to be at risk of lower limb loss often first present with ulcers on their smaller toes. If left untreated, these seemingly small issues can progress rapidly to limb threatening problems.

Who gets it?

Anyone can have a foot structure that means they are prone to problems with their smaller toes, but they tend to be more common in women, possibly due to some of the more restrictive footwear typically worn. If your parents or grandparents have toe deformities, you may also be more prone to developing them. People who have medical conditions such as diabetes or inflammatory arthritis may also develop severe toe deformities as the disease progresses.

How do I prevent toe deformities?

Wearing sensible shoes that fit well is a good preventative measure. Try to opt for wider shoes that provide your toes with room to move and keep your heel height to no more than 4cm for maximum comfort. The following also serves as a useful guide:

If you want to wear heels, vary your heel heights from day to day, one day wearing low heels and the next day slightly higher heels
Wear backless, high-heeled shoes in moderation. Backless shoes force your toes to claw as you walk
Wearing a shoe with a strap or lace over the instep holds the foot secure and stable reducing the need for you to try to stabilise your foot with your toes
If you already have toe deformities, try to accommodate your toes by selecting shoes with a wider/deeper toebox

Your podiatrist may recommend the following:

No treatment (you can elect to live with your toe problems)
Regular review by a podiatrist who will reduce the callus build-up periodically
Advice on foot cream and topical medication for associated problems
Splints, shields, off-loading devices and shoe alterations/footwear advice
An opinion from a podiatric surgeon

Non-surgical treatments may help relieve symptoms but there is no evidence that they can correct the underlying deformity. Your podiatric surgeon will evaluate the extent of the deformity. They can remodel the shape of your toes so they have a greater chance of fitting inside the average shoe.

Stiff big toe (hallux rigidus)

What is hallux rigidus?

‘Hallux’ refers to the big toe and ‘rigidus’ suggests a rigid toe. However, this is not always a correct term for this condition as movement may be available but is reduced.

Hallux rigidus is occasionally confused with a bunion, or hallux valgus, as it is often associated, as part of the degenerative process (wear and tear), with new bone formation over the big toe. However, the bone bump is normally over the toe joint, not on the side as in bunion/hallux valgus deformity. The thinning/wear and tear of the joint may cause the toe to lean towards the other toes, further confusing this with hallux valgus deformity.

What is the cause of hallux rigidus?

Often there is no definite cause: as with other joints the big toe is subject to wear and tear and cartilage becomes progressively thinned and damaged. Past injury, such as a sprained or broken toe, can lead to early wear and tear. Hallux rigidus can also be secondary to gout or other inflammatory conditions that can cause damage to the joint.

Biomechanics: The foot primes itself to bear weight onto the great toe and to allow the toe to move. Certain foot types may predispose to early jamming of the big toe and wear and tear.

Common presenting problems

Although some people may have a stiff big toe without pain, the main presenting complaint is pain and stiffness. This can be a problem in certain occupations such as tiling or carpet laying where kneeling causes pain as the big toe is required to bend. It can also interfere with exercise such as yoga or pilates or even push ups – essentially any activity that requires movement of the big toe. Having a stiff big toe changes the way one loads the foot and can also give rise to pain in other areas of the foot and lower limb.

Footwear can be limited as the bone bump that forms over the toe joint can result in irritation of the overlying skin causing pain and limiting footwear choices. The stiff big toe also limits the heel height you can wear.

Treatment

Your podiatrist or podiatric surgeon can advise you on non-surgical as well as surgical ways of managing this condition.

Non-surgical

Footwear
Wearing shoes with a deep toe box will prevent irritation of the skin overlying the bone lump over the toe. Avoid thin-soled flexible shoes and wear a low-heeled shoe with a firm stiff sole. This is likely to help because if your shoe does not bend this will help protect/limit painful movement of your big toe.

Orthotics
Orthotics/insoles may be of some benefit by off-loading the big toe joint reducing the stress. These can also be used to reduce the flexibility of shoes.

Rocker soles or bars
Rocker soles or rocker bars added to your shoes will help you roll off your big toe, preventing painful movement.

Expert Chiropody & Podiatry in Bedfordshire

Common Foot Problems

Stiff big toe (hallux rigidus)

Toe deformities

Ageing feet

Athlete's Foot

Blisters

Bunions (hallux valgus)

Chilblains

Corns and callus

Gout

Heel pain

Ingrowing Toenail

Osteoarthritis

Rheumatoid Arthritis

Sweaty Feet

Verrucae

Flat Feet

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Our Services

General Chiropody & Podiatry

Biomechanical Assessments

Custom Insoles/Orthotics

Nail Care, Corns, Callus & Verruca Treatments

Diabetic Foot Assessments

Foot Pain & Injury Treatment

Bedford

Cranfield

Great Denham

Bedford

Cranfield

Great Denham