Foot health: corns, big toe pain, puffy ankles & more

Many minor foot problems can be effectively treated by a podiatrist, who can also advise you on how to keep your feet in the best possible shape. You can find a local podiatrist on the NHS directory of Podiatrists and Chiropractors. If you have any concerns about your health it is always better to consult your GP, who may then refer you to a specialist for treatment.

Problem: I get a stabbing pain in the soles of my feet when I walk. What could it be?

Pain in the soles of the feet or at the heel is usually caused by plantar fasciitis, inflammation of the thick band of fibrous connective tissue, which runs from the heel bone to the bases of the toes and helps to maintain the arches. Badly fitting shoes, pronation (rolling your foot in when you walk), tight calf muscles, or sudden exercise can all trigger it.

Daily calf muscle stretches, switching to more sensible shoes, orthoses or a type of acupuncture known as dry needling may relieve symptoms. In extreme cases your podiatrist may be able to offer you a cortisone injection or refer you to your GP for one. If all else fails surgery may be an option, although this is not recommended.

Extracorporeal shockwave therapy can also be used to treat plantar fascia. The therapy involves a surgeon shooting high-energy soundwaves from a hand-held ‘gun’ to trigger the formation of new blood vessels and activate healing. This can help with debilitating pain that has lasted six months or more.

Problem: My feet are very stiff – how can I make them more flexible?

Feet tend to become more rigid as you get older and arthritis may be a contributing factor. Walk as much as possible and keep moving your feet. Daily exercises such as extending and flexing your toes, or circling your feet while sitting down can help and standing on tiptoes can increase flexibility. Regular foot massages or reflexology can also help.

Problem: Can anything be done about bunions?

Contrary to popular opinion wearing badly fitting shoes does not cause bunions although they may make them worse. Your foot type increases your risk: for example, if you have excessive pronation (flat feet that tend to roll inwards as you walk) or feet that are 'hypermobile', meaning they are more flexible, you may be more susceptible.

Wearing sensible shoes, exercises, orthoses (special devices inserted into shoes) or night splints, which hold toes straight overnight, can help to keep early bunions in check. Surgery is the only way to correct the deformity but is not always completely successful and full recovery can take months. A different form of operation called a scarf osteotomy can have better results and a shorter recovery time.

More recently, minimally invasive foot surgery has become popular. Small incisions are made in the toe, under general or local anaesthetic, through which instruments can be passed to realign it. Because less soft tissue is stripped away than during conventional open surgery, the procedure is less painful, with easier recovery.

You will usually wear a special surgical shoe for around six weeks, after which you can do low-impact exercise. Minimally invasive foot surgery is also used for other foot conditions, including hammertoes, big toe or ankle arthritis, and plantar fasciitis.

Problem: My big nail is starting to crumble and go yellow. What could it be?

This is a sign of a fungal infection under the nail, which has usually spread from an area of athlete’s foot somewhere else on your foot.

A topical anti-fungal nail cream may clear it up but in severe, long-standing cases you may need tablets on prescription from your GP. A more drastic solution involves removing the whole toenail.

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Problem: Why do I get puffy ankles?

Poor circulation due to heart problems, varicose veins, lymphatic problems, liver disease or an ankle injury can all cause ankles to swell. Self-help measures for swollen ankles include wearing support stockings (which should be properly fitted), putting your feet up as much as you can and gentle exercises. If the problem persists see your GP who will look for any underlying causes and prescribe appropriate medication.

Problem: Why are my feet often cold?

Some of us are naturally more susceptible to cold feet than others, but poor circulation is the most likely culprit.

Wearing an extra pair of socks and keeping your feet moving can help. Insulated insoles available over the counter at the pharmacy are also worth a try. It is important to try to keep the temperature of your feet constant – suddenly going from cold to hot may cause chilblains.

Problem: I've got a pain in my big toe, could it be gout?

Sudden, acute painful swelling of the big toe joint is the first sign of gout. It is caused by a build up of uric acid deposits in the joint or arthritis. Gout can be inherited but foods containing purines, such as beans and peas, may exacerbate it, as will alcohol. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help relieve swelling in the short term. However if a podiatrist suspects gout they will advise you go to your GP who will take a blood test and prescribe the appropriate medication.

You might also experience toe pain from osteoarthritis. One possible option for big toe pain caused by arthritis (but not gout) is a Cartiva implant, a synthetic cartilage implant that cushions the big-toe joint. The procedure takes just 40 minutes and you can put weight on your foot almost immediately. Healing takes six to eight weeks, after which you can wear normal shoes. Many surgeons were previously cautious to use Cartiva due to lack of proof of efficacy, but research found it an ‘excellent alternative’ to the most usual operation, ‘fusion surgery’ (arthrodesis), which, as the name suggests, fuses the bones in the toe.

Problem: I get a stabbing, burning pain on my feet

Morton’s neuroma is a swelling of the nerve between the bones of the toes. It causes a sharp, burning, or shooting pain that often worsens over time, and can often feel like you've got a stone in your shoe. Treatment can include special insoles, painkillers, heat treatment or surgery.

A more advanced treatment is Morton's neuroma cryotherapy. During cryotherapy, a -50°C ‘iceball’ is injected into the foot to freeze and destroy the offending tissue.

Problem: Can anything be done about fallen arches?

Painful flat feet, also called fallen arches, become more common as we get older. The reasons? Problems with the posterior tibial tendon in the foot, overuse, arthritis, trauma, injury or simply the ageing process itself.

You don't usually need to seek treatment for fallen arches as they rarely cause too many problems. Rest, ice and stretches can help, as well as supporting insoles. It is also possible to have them corrected surgically, although this is a last resort option for if the other methods have not worked or there is a problem with the bones, tissue or muscle. A tendon transfer involves taking a different tendon from the leg and replacing the faulty tendon to restore function.

Find out what your feet say about your overall health

Problem: Why do I keep getting corns?

Pressure or friction from badly fitting shoes or skin rubbing against prominent bony areas of the feet while walking or running are the usual reason.

In the first instance emollient creams, emery boards and a pumice stone may help to alleviate the problem. Self-use of blades is not recommended nor are corn plasters containing acids. If corns keep returning, regular visits to the podiatrist will help to keep them under control.

Shoes should:

• be foot shaped
• be laced or strapped and barred with a small heel ( ideally no more than 1/2in)
• have a firm heel counter (heel feels firm when pressed on either side)
• have a manmade sole
• have leather uppers that are neither too floppy or soft

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