The Ultimate Guide to Foot Problems
Your feet provide an important function for your body. So any problems you are having with your feet, could turn out to be a major problem for your health. With more than 26 bones (the number can vary from person to person) and a complex framework of muscles, tendons and ligaments, your feet absorb the impact of your entire body weight with every step, keeping you balanced and upright in the process.
Other than carrying your body weight around, they provide the foundation of everyday life. Statistical evidence highlights that many people suffer from foot problems, which may be caused due to injury, ill-fitted shoes, genetics, weak ligaments in the feet or inappropriate foot care. Let's take a look at a few of the problems that could be affecting you.
I've written the "Ultimate Guide to Foot Problems" to help you understand what the most common problems are that I see with people's feet. If you are suffering from these conditions, I urge you to seek professional medical advice and get treatment!
- Ankle Sprain
- Arch Pains
- Blisters on your Feet
- Corns and Calluses
- Fungal Skin and Nail Infections
- Plantar Fasciitis (heel pain)
- Ingrown Toenails
- Joint and Arthritis pain in your feet
- Plantar Warts
- Shin and Knee pain caused by bad feet
- Stress Fractures
Sprained Ankle Bruising (Medial)
What is an Ankle Sprain?
ANKLE sprains are an acute injury where the ankle is rolled past its normal range of motion. Ankle Sprains typically occur when the foot is rolled over onto the outside of the foot (lateral ankle sprain). Not as common, but it is also possible to roll the foot inwards (medial ankle sprain).
How do Ankle Sprains Present?
They can present in varying degrees of severity. From minor discomfort and bruising, with no loss of motion or structural damage, to a severe ankle sprain which can cause rupture of ligaments, tendons and bone fractures.
Appropriate assessment and management of an ankle sprain is important as any loss of strength or stability from a poorly managed ankle sprain, dramatically increases the risk of further injury in future.
How to manage an Ankle Sprain
Initially any ankle sprain is best managed with RICER (Rest, Ice, Compression, Elevation, Referral to healthcare professional if required). It is important to obtain a full diagnosis of the extent of your injury to ensure the appropriate management plan is followed. This also includes a functional restoration program to ensure full strength and mobility of the injured ankle prior to returning to full sporting activity.
It is never too late to have an injured ankle assessed. However it is best that assessment takes place as soon as possible following injury, to ensure a fast and complete recovery.
Further Ankle Sprain Resources:
What Causes Arch Pain?
Arch pain can be caused by a variety of different factors and can originate from different structures within the foot. Therefore when diagnosing it is important to determine which structure is the source of the pain and what factors have contributed to the injury. This will allow for the most accurate solutions to reduce the symptons associated with Arch Pain.
Arch pain is commonly felt when wearing flat or unsupportive footwear, particularly if you have a foot that tends to pronate or roll in.
Reduced support from footwear increases the stresses on the structures within the foot, often overloading them and causing pain.
Arch pain can present as an aching or sharp pain and is often aggravated by activity.
What can you do about Arch Pain?
Initially you can try wearing supportive footwear and rolling the foot over a frozen drink bottle which may help to settle or resolve the pain.
If pain persists a qualified Podiatrist (me!) can appropriately assess your feet, footwear and any other factors which may be contributing to your pain, to ensure a rapid recovery. See the video below for some simple exercises that can help with arch pain.
Severe Blister above the base of the heel
How do we get Blisters?
So often blisters are simply a nuisance that flair up, after wearing a brand a new pair of shoes.
However for many people (particularly the sporting population) they are a chronic concern that are not only uncomfortable but can be debilitating and result in retiring early from events.
They can also be a huge source of concern in the diabetic population as a source of injury and infection.
What is a Blister exactly?
Blisters are essentially an overuse injury to the skin. Blisters are caused by friction – sometimes caused by footwear, and can become very painful! Blister management considers prevention blisters, rather than providing a cure. There is little we can do for blisters once they have developed such as padding and dressings to offload the area and reduce pain levels.
How can we avoid getting Blisters?
The best scenario is to aim to avoid the occurrence of blisters with prevention techniques such as avoiding footwear with prominent seams, ensuring feet remain dry and correctly fitted footwear that is appropriate to your activity. Technical socks that offer moisture management and padding can be very useful and also lacing techniques to reduce movement within shoes.
I've have seen and treated some incredibly painful and nasty blisters at Oxfam Trailwalker Melbourne events in previous years and have plenty of tricks up my sleeve to help you beat this common yet painful problem.
What are Bunions?
BUNIONS (also know as Hallux Abducto-valgus deformity) are a common bony deformity in the feet, that range from a minor structural change with no discomfort to severe deformity accompanied by debilitating pain.
Bunions are a large bump or exostosis on either the inside (more commonly) or outside of the foot caused by deviation of the bones around the ball of the foot.
They are caused by a variety of factors including genetics, tight or narrow footwear, high-heeled footwear or poor foot mechanics.
Whilst bunions more commonly present in the middle-aged to elderly population, they can also be seen in children and teenagers.
Watch this video to see just how bad bunions can be.
How can Bunions be treated?
The goal of treatment for bunions is to reduce pain and prevent further deformity. This can be done with footwear modifications, orthotics and padding options. Pain can also be limited with rest, ice and medications. It is also important to treat any other pathology such as corns and callouses resulting from the structural change of the foot.
As bunions are a structural change around the big toe joint effecting the position of the bones, the only way to change the alignment is through surgery. Whilst surgery is usually seen as a 'last resort' treatment, it may be the best course of action in some individuals depending on the degree of deformity, pain and their activity levels.
Bunion Treatment Plan
I can determine the factors which are aggravating your bunions and design the best treatment plan to ensure your feet are comfortable and your bunions are not holding you back. When bunions are assessed and managed in the early stages of the deformity, you are most likely to prevent the progression and avoid the need for surgery in the future.
More Bunions Resources
What are Corns and Calluses?
CORNS and calluses are lesions of hard skin as a result of friction or high pressure. For many people they are an ongoing source of discomfort requiring regular treatment and debridement.
Callous is the skin's natural protective defence to increased pressure over a small surface area. Callous usually presents as hard, thickened, dry skin, however it can also be moist or splitting.
Corns result when there is an excessively high amount of pressure over a small area of skin resulting in callous with a crystalised or glassy centre. Corns often develop over joints or bony prominences and can be described as 'feeling like there is a stone under the skin'.
Both corns and callous can be influenced by foot structure and function and also poorly fitting footwear.
What is the treatment for corns and callous?
Treatment of corns and callous involves reducing or debriding back the layers of hard skin to reduce pressure on the underlying healthy tissue. You can do this yourself by filing the area with a pumice stone or emery board. Alternatively for thicker callous a Podiatrist can carefully debride the area with a scalpel. You should NOT attempt to do this yourself as serious injury can result if not done properly. Hard skin is easier to remove if you keep the skin soft with regular applications of moisturiser. Urea based creams available from your pharmacist are best for this.
Corns are much deeper and usually require removal/enucleation by a Podiatrist. You should NOT attempt to use acid based corn pads (particularly if you are diabetic) to remove these hard lesions as serious tissue damage can result. The acid in these pads will breakdown any tissue it comes into contact with, not just that of the corn and can cause wounds and ulcers to develop.
A Podiatrist can determine the cause of your corns or callous and aim to reduce these stresses as much as possible. This can be done through footwear changes/modifications, padding and cushioning, orthotics and inter-digital toe wedges. The importance of having corns and callous properly treated, if you suffer from diabetes, should not be under-stated, as the hard lesions increase the risk of breakdowns and ulcers.
Don't put up with the pain associated with these common problems!
Far too often I see people who have been putting up with the pain of a corn for years which can be dealt with in just a few minutes!
Further information on Corns..
Thickened Fungal Toenails
How did I contract a fungal infection?
FUNGAL infections are unfortunately easy to catch and a lot harder to treat. Fungal conditions of the foot can range from simple Tinea or athlete’s foot infections to onychomycosis or a fungal infection of the nail.
Whilst fungal infections of the skin and nails do not have any detrimental effect on your general health, they can be itchy, unsightly and uncomfortable. They also have the potential to spread to other parts of the body and other members of the family.
Fungal infections thrive in warm moist environments and are easily passed between individuals where conditions allow. Commonly fungal infections are contracted in public bathing areas such as gyms and public swimming pools, however can also be caught from hotel floors and carpets or sharing shoes and socks. Unfortunately fungal infections are also spread through the use of un-sterilized instruments in nail salons.
Skin Fungal infections, can present as:
- Red rash
- Dry flaky skin
- Moist/macerated skin
- Splitting or fissuring of skin.
Nail Fungal infections, present with the following signs:
- White or yellow discoloration
- Splitting or crumbling of the nail
- Thickening of the nail
- Onycholysis - lifting of the nail and separating away from the nail bed
- Strange odour
- Onychophosis - excessive build up of debris under the nail
How can a fungal infection be treated?
There are many different treatment options available to manage fungal infections.
Unfortunately many of these treatments are not 100% effective and treatment may take many months to years to fully resolve the condition.
A Podiatrist (me!) can help you to determine the most appropriate treatment option for you as well as manage hard peeling skin or thickened nails which can delay the effectiveness of treatment.
Fungal infections are best avoided by always protecting feet by wearing thongs or footwear in public areas and avoiding nail salons who don't sterilize their instruments.
Athletes running in a triathlon
What is Plantar Fasciitis?
HEEL Pain or Plantar Fasciitis is one of the most commonly treated conditions by podiatrists.
Plantar Fasciitis can present in different ways depending on the individual person, however is often noted as sharp, stabbing, burning, throbbing or aching sensation underneath or on the inside of the heel.
Pain associated with plantar fasciitis is often felt when first weight bearing in the morning or after periods of rest. The pain often improves as it ‘warms up’ or after a few minutes of activity. Pain is also aggravated by flat or unsupportive footwear, changes in footwear or changes in activity.
Plantar fasciitis is an overuse injury or inflammation of the plantar fascia which is a thick band of connective tissue which supports the arch of the foot.
Stresses on the plantar fascia are increased with any of or a combination of the following:
- Excessive pronation or rolling in of the foot
- Rigid high arched foot that struggles to absorb shock
- Flat soled or unsupportive footwear
- Increases in weight-bearing activity
- Excessive muscle tightness
- Standing on feet for many hours a day - particularly on hard surfaces
- Repetitive activities such as walking and running
- Changes from high-heeled to flatter footwear
- Plus many more contributing factors.....
Plantar fasciitis usually develops as a result of many of the above factors interacting. Therefore it is important to determine which factors are contributing to the occurrence of pain in your particular case and address all of them accordingly. Stretching can be important, see the video below for some simple stretching exercise that can help.
Plantar Fasciitis Treatment
I can take you through a thorough history and assessment in order to build a treatment plan appropriate for your individual needs. This may include things such as stretching, anti-inflammatory treatments, orthotics, footwear changes and activity modifications.
What are Ingrown Toenails?
Ingrown toenails can be an ongoing and very painful problem. Ingrown toenails are particularly common in children and teenagers and can be caused by poor nail cutting technique, pressure from footwear (particularly in tennis and ballet dancing) or an involuted or curved nail shape.
How can Ingrown Toenails be treated?
In some cases an ingrown nail may only cause minor discomfort and can be easily settled by appropriately cutting the nail and clearing the nail edge or sulci. In some cases however ingrown nails can become very deep and infected requiring a more aggressive approach. If the nail is infected - (red, swollen with signs of pus), you must see your doctor for prescription anti-biotics. Once the infection has settled I can properly remove the ingrown section of nail to reduce discomfort. Podiatrist's are qualified to administer local anaesthetic where required to enable a thorough treatment without the presence of pain.
Where an individual has an ongoing problem with ingrown toenails the problem section of nail can be permanently removed with a surgical procedure called a Partial Nail Avulsion. This is a simple surgical procedure undertaken under local anaesthetic in the clinic. It involves removal of the problem section of nail right from the nail root and then application of phenol, a chemical which prevents the nail from growing back.
As this is a surgical procedure there is always risks involved and I can discuss with you whether or not you would be an appropriate candidate for this procedure.
Podiatrist's and Arthritic Foot Pain
Joint or Arthritic pain does not have to be an ongoing discomfort preventing you from enjoying exercise and activity. Appropriate assessment of function and mobility of your joints can enable your Podiatrist to design a treatment plan to reduce you symptoms and prevent further arthritic changes.
Arthritis or joint pain can be aggravated by numerous factors including exercise/mobility, footwear choices, foot structure and function or even the weather!
As we all have different foot structure and biomechanics it is important to individually assess each joint and movement as arthritis may change the structure and function of a joint. We need to ensure we are working within the limits of the joint, not trying to push it past it's capabilities.
I can work closely with your doctor to control your pain levels and enable you to stay active and comfortable. We can reduce the stress through your joints with the aid of cushioned innersoles and footwear, orthotics and gentle exercise.
I can also discuss different exercise options which enable you to stay fit without exacerbating pain.
Where required I can refer to other practitioners for Physiotherapy, Massage or Pilates, to further improve your quality of movement and reduce discomfort.
What are Plantar Warts?
Plantar warts, also known as Verruca Pedis, are a viral infection on the skin caused by the human papillomavirus and commonly occur on the toes or plantar surface of the feet. Plantar warts are a self-resolving condition - meaning they will eventually resolve themselves, however treatment is recommended to reduce pain and the potential for the warts to spread.
How do you contract Plantar Warts?
The spores which lead to plantar warts thrive in warm moist environments, such as public showers and bathing areas, and are highly contagious. Plantar warts have the potential to increase in size, multiply and spread to other parts of the body or other members of the family. Plantar warts can also be very painful upon weightbearing.
Removal and Treatment of Plantar Warts
Plantar warts are best treated in the early stages as the smaller the wart, the easier it is to resolve. There are various different treatment methods available for plantar warts, from over the counter preparations, to natural remedies, to freezing with liquid nitrogen, all with varying levels of effectiveness. I can discuss with you the most appropriate option for you to reduce your pain and the potential for the warts to spread.
Further Plantar Wart Treatment
I recommend always wearing thongs or footwear to protect your feet in public bathing areas to reduce your risk of contracting plantar warts.
What causes Shin an Knee Pain?
Shin and knee pain is often the result of poor foot mechanics - particularly in the sporting population. Shin or knee pain is often exacerbated by exercise and very common in teenagers, however can affect individuals of any age.
There are various factors that can influence the development of shin or knee pain, often including a combination of the following:
- poor shock attenuation, through footwear, surfaces or gait patterns
- poor foot alignment, causing torsional stress on the leg and knee
- poor footwear, lack of support, cushioning or stability
- training errors - eg. rapid increase in activity, not allowing the body time to compensate
- rapid growth - children and teenagers
- muscle tightness, weakness or imbalance
Treatment Plan for Shin and Knee Pain
I can assess the factors contributing to your pain and tailor a treatment plan to ensure your return to full activity without pain holding you back. Treatment often includes footwear prescription, orthotics, stretching and strengthening programs, and massage or dry needling.
I can also refer to other health practitioners where required to ensure a full recovery.
How are Foot Stress Fractures caused?
Stress fractures are an overuse injury to the bony structures in the foot.
There is usually no associated event or injury corresponding with the onset of pain which often gradually increases over a period of weeks to months.
Symptoms usually present as a dull ache, however can also be a throbbing or sharp pain.
Pain can be aggravated by exercise and is commonly noticed as an aching sensation at night, during activity or on first weightbearing after periods of rest. The onset of pain is often associated with a rapid change in activity type or intensity.
Frequently people with stress fractures have recently started a new activity, such as running or personal training, or their rapidly increased there amount of training prior to an event. Poor foot posture, foot structure, footwear and training surfaces can also increase the likelihood of developing as stress fracture.
Our bones are constantly undergoing a re-modelling and re-building process throughout our day to day life. Stress fractures occur when too much stress is applied to bone at a vulnerable point in this process, leading to the micro-fracture of bones. Other factors such as hormone levels, rapid weight loss, diet and phases in menstrual cycles can also influence the development of a stress fracture.
Diagnosis of Foot Stress Fractures
Early diagnosis of stress fractures is important as if left untreated a full fracture of the bone can result. Diagnosis involves clinical assessment along with the use of imaging such as X-Ray, bone scan or CT Scan.
Treatment of Foot Stress Fractures
Treatment of stress fractures depends on the location, severity and causative factors for the individual. I can assess your training history, gait and biomechanics, plus footwear and other contributing factors to determine the best course of treatment of you, as well as reducing your risk of further stress fracture.
Foot problems can affect day to day activities and hinder mobility. Sometimes, your foot problems can subside with time, rest, hot and cold treatment, wearing appropriate footwear and taking medication.
But, at times, these problems won’t go away and may cause complications. Therefore, it is advisable to see a medical professional, like a Podiatrist, so they can determine which foot problem is affecting your situation. The well-timed intervention and expert advice of a Podiatrist can manage the foot problem without further complications. To see services at my Melbourne Podiatry Clinic, click here
Written by Leah Waters