ASK THE DOC

Surgeon and lecturer Dr Sarah Rayne weighs in on unsightly bunions, excessive sweating, and the link between hormones and anxiety.

I’m embarrassed to wear open-toed shoes because of my bunions. Other than surgery, what can

I do to get rid of them?

Bunions are caused when the big toe slowly becomes more angulated, squishing the smaller toes, causing pain and making it difficult to fit your feet into shoes. Eventually the pain (and sometimes arthritis) can make surgery necessary – to cut the bones straight again. But it can take months to recover.

Bunions are far more common among women and are caused by weak ligaments and toes being forced into narrow shoes. While surgery is the only solution to removing bunions, by making use of padding and good footwear you can make your feet more comfortable. It’s okay to wear gorgeous shoes on occasion, but try to treat your feet well for the most part. Simple tips are to pick everyday footwear that’s the same shape as your foot (not pointed), not too high (which puts pressure on the front of your foot) and is the right size. Foot size changes as we age, so have your feet measured regularly, and see a podiatrist for more advice.

I sweat profusely, so much so that I end up with pit stains no matter what I wear. I’ve tried so many remedies including Botox, but nothing seems to work. What can I do?

The Victorians used to say ‘horses sweat, men perspire and women merely glow’ – it’s just that some of us glow A LOT! No matter how unsightly, we all need to sweat: it cools our body and keeps it at the right temperature. Hyperhidrosis is when you sweat far more than is needed. It’s usually worse under the arms and on the palms, and affects one in 20 to 30 people.

Most treatments limit the effect of sweating rather than being able to stop your body from wanting to sweat so much. Check any medication you may be taking that could be causing it – antidepressants and some painkillers can. Medical antiperspirants can slow down the sweat glands and Botox paralyses them, but both need to be repeated to keep up the effects.

There are newer topical and electrical therapies which have had some successes in small trials, and it’s worth seeing a dermatologist with a special interest in sweating to explore those. The International Hyperhidrosis Society (sweathelp.org) is a brilliant website that will help you understand this more; it also offers advice on clothes and bed sheets that draw away moisture and help to avoid that sweaty look.

I suffer from severe anxiety – is there a link between anxiety and hormones?

Hormones are the body’s messengers. They’re sent out from glands by the brain, and influence every cell in the body in various ways. They guide growth, development, how we act and feel, even how we fight infections. Sex hormones cause us to mature from girls into women, have periods and bear children; they eventually decrease in menopause.

There are strong links between mental wellbeing and sex hormones. Before puberty, boys and girls experience similar amounts of anxiety, but this increases in girls as they develop. By way of the menstrual cycle, oestrogen and progesterone can affect the brain, increasing anxiety in one in five women before their period. An extreme form of this is premenstrual dysphoric disorder, a mix of physical and mood-related symptoms that can severely affect your life. Anxiety can be a strong component of pregnancy and can peak after birth. Even women with low natural levels of anxiety may well experience an increase during menopause. And all of these hormonal moments are likely to affect women with underlying anxiety or panic disorders more strongly.

Sadly, it is common for medicine to separate the experience of being a woman with ‘hard’ medical problems, but the two are very much linked, so managing one can help with the other.