FEET FIRST
Whether you’re setting off for a run or a potter around the patio, healthy, pain-free feet are essential. Here’s what the experts want you to know…
Advice from the experts to keep you on your toes
Feet are our freedom pass to be up, out and about but, rather like the car that we assume will always start, are easily ignored until an ‘ouch!’ moment stops us in our tracks. Our feet are, in fact, a minor miracle of bioengineering, with 26 bones, 30 joints and more than 100 muscles, tendons and ligaments. In other words, a lot can go wrong – but expert tips and the right care can help save our soles and all the other parts, too. ‘Foot and ankle injuries are related to a number of factors, but from midlife they can be caused by the thinning of subcutaneous fat that occurs naturally and means there is less protective padding, especially around the heel,’ says specialist physio Annette Chase of the Association of Foot & Ankle Physiotherapists (afap.org.uk). ‘This can result in new injuries or the recurrence of past ones, while arthritic changes tend to take place from the mid-forties onwards, too.’
The circumstances of the past year haven’t helped, she adds: ‘Many of us walked more or took up running during the lockdowns, and seeing people in pain after taking up higher-impact sports than they are used to has become common.’
But even for those who haven’t adopted new activities, corns, calluses, verrucas and nail issues can strike at any time and are common reasons to need the help of a podiatrist, says Emma Mcconnachie of the Royal College of Podiatry (cop.org.uk).
So what can you do to avoid these issues and get help? Read on to find out…
Ever swung your feet out of bed in the morning and suddenly found it’s painful to stand? Heel pain is common and most often due to plantar fasciopathy, often referred to as plantar fasciitis. The plantar fascia is a thick, fibrous band attaching the heel to our five toes. It supports the arch of the foot and takes the strain when we stand, walk or run, so it’s a vital piece of our foot architecture, which we tend to only become aware of when it starts to complain.
‘Pain first thing in the morning when you try to stand is a frequent symptom,’ explains Leanne Antoine, physiotherapist and spokesperson of the Chartered Society of Physiotherapy (csp.org.uk), who has a special interest in feet. ‘Suddenly changing the load that your plantar fascia is happy with by exercising more or working out on a hard surface (for example, your living room instead of the sprung floor of a gym), spending more time on your feet, weight gain or poorly cushioned shoes can all contribute.’
It is most common in the 40 to 60 age group, accounts for up to 15% of all foot complaints and occurs in up to one in 10 regular runners (plus non-sporty people, too), says podiatrist Tony Gavin of Osgo Healthcare (osgo.co.uk).
The good news is that, for most people, symptoms resolve or improve with simple treatment, according to the Royal National Orthopaedic Hospital. There isn’t one agreed therapy, but in the immediate term rest, ice therapy and painkillers will help. A physiotherapist will diagnose and give exercises, progressively increasing activity. Other treatment techniques include manual manipulation, taping or prescribing that insoles be worn.
Plantar fasciopathy can come on from overuse but also for no obvious cause as we get older, explains Annette. ‘Tendon problems can also be common among the more athletic, such as Achilles tendinopathy,’ she says. ‘Our tendons stiffen and thicken as we age so we lose our “elastic recoil” and have less ability to absorb shock. A common misconception in both instances is that stretching helps but this is, in fact, detrimental.’
If plantar fasciopathy or Achilles tendinopathy fail to respond to simple therapies, extracorporeal shockwave therapy (ESWT) or laser treatment may be an option. Shockwave therapy involves applying audible, low-energy sound waves to the area, usually in three sessions over three weeks. It is thought to speed the healing process by increasing blood flow to the injured area. It can be painful but is adjustable to a tolerable level. Laser treatment, which is not painful, is thought to work in a similar way.
Bunions and toes
High heels and tight shoes used to be blamed for bunions but, although this may exacerbate an existing problem, it’s now known that simple genetics is the main factor. Bunions develop when the big toe drifts inwards towards the second toe causing the bone at the base of the big toe to become prominent. If you spot this tendency or other misalignment in toes, always seek advice before pain develops. A bursa, or fluid-filled sac, may develop over the joint and, in some cases, other toes can turn under, known variously as hammer toe, claw toe or curly toe. Initially flexible, over time these toes can become stiff.
‘A bunion may also be associated with arthritis, usually of the big toe joint but sometimes in the middle part of the foot,’
Our feet are, in fact, a minor miracle of bioengineering
says orthopaedic surgeon Don Mcbride of the British Orthopaedic Association (boa.ac.uk). ‘There is now considerable interest in synthetic implants for dealing with arthritis of the big toe.’
Don adds that surgery will only be considered when there is no other option but that the success rate for both bunion and toe surgery is now very good, at about 90%. With this in mind, he recommends asking your surgeon about their individual success rate and says that most will be able to supply this.
Recovery from bunion or toe surgery (which is usually conducted under local anaesthetic) varies, but most people can put weight on their foot after two weeks and resume normal daily activities after six weeks – though full recovery may take six to 12 months.
Nail the problem
Fungal toenail infections are common and especially frustrating in summer when you want to flaunt those feet. Nails become discoloured, thick, distorted and crumbly over time and nails feel tender and pressure is painful. Take heart because they can be treated, though some patience is required.
‘Toe nails grow at 1mm a month so it may take as long as six months to see the full benefit of treatment,’ says dermatologist and nail specialist Dr Rhiannon Llewellyn of the British Hair and Nail Society (bhns.org.uk). Although hard to shift completely with over-the-counter treatments that don’t reach the nail bed, prescription antifungal tablets (most commonly terbinafine) succeed in more than 75% of cases.
Scraping or cutting away infected parts increases success rates and so, too, does a process called fenestration, where tiny holes are drilled into the nail plate (painlessly) to allow medication to reach the nail bed, says podiatrist Tony Gavin. Laser treatment and phototherapy to destroy the fungus shows promise but is not yet available on the NHS.
Avoiding the problem requires vigilance about treating and preventing other contagious skin infections, such as athlete’s foot. Sweaty footwear, repeated nail injuries, genetic disposition, diabetes and poor peripheral circulation are factors, too.
Ingrowing toenails can usually be dealt with by podiatrists, and surgeons will only get involved if there are more complex medical needs, such as peripheral neuropathy or nerve damage to the feet and toes as a result of diabetes.
Feelgood feet
When was the last time you stood on your toes? Simple exercises such as this can keep feet and ankles flexible and there are suggestions everyone can try from the charity Versus Arthritis (versusarthritis.org). Walking is the best natural workout for feet, say the experts, but maintaining muscle mass overall with resistance-based exercise is important to strengthen feet and ankles, too.