Common foot problems

Foot pain is a common problem. Figures vary, but by the time we reach the age of 75, we will have walked the equivalent distance of three times round the earth.
The foot is made up of 26 bones and a number of muscles, ligaments, tendons and joints. Problems in any one or combination of these can cause pain.

Flat feet are also known as pes planus, this is when the arch of the foot collapses, dropping the sole of the foot down to the ground.

Cause:

Babies are born with flat feet and as they grow, the foot arches should gradually form, but in a small percentage of the population, they never do.  Flat feet can also develop later in life, due to illness, pregnancy, injury, excessive stress on the feet or as part of the ageing process.

Symptoms:

Many people who have flat feet don’t complain of any accompanying symptoms, but some develop foot arch pain, or problems further up the leg such as knee pain or back pain.  They may find their feet tire quickly when they are standing or walking, and that it is difficult to rise up onto their tiptoes. Someone who is experiencing pain on the bottom of the foot or elsewhere due to their flat feet may benefit from exercise and orthotics as well as correctly fitting shoes.

A bunion is where the big toe gradually deviates inwards towards the second toe and in severe cases may even start to cross over the top or underneath.  As the top of the toe moves inwards, the base of the toe, pushes outwards producing the characteristic lump (bunion) on the outer side of the big toe.

The term for a foot bunion and deviation of the big toe is hallux valgus.  “Hallux” means big toe. They can also occur in the little toe, but these are much less common. The bursa (small fluid filled sac) that sits over the big toe bunion may become inflamed, known as bursitis.

Cause:

There is some debate about the main causes, but they tend to fall into two categories:

Genetics:

There is a definite genetic link, meaning that if someone in your family suffers from a hallux valgus, there is a high chance that you will too.  It may be due to an abnormal foot position such as flat feet, or a medical condition such as hypermobility (where your joints are overly flexible) or arthritis (e.g. rheumatoid arthritis).

Ill-Fitting Footwear:

Poorly fitting shoes are thought to be the other common cause.  Frequently wearing tight fitting shoes, especially shoes with pointed toes or high heels places excessive pressure on the big toe, squashing it into the classic hallux valgus position.  There is much debate as to which is the major cause, but it is likely to be a combination of the two, though they are more common in females, most likely due to choice of footwear.

Painful bunions are more common with increasing age.  They develop gradually over time from repeated force through the big toe and, left untreated, become more pronounced with worsening symptoms.

Symptoms:

The most classic symptom of a foot bunion is the change in position of the toe and a bony lump forming on the outer side of the base of the toe joint. This will develop gradually and progressively, rather than coming on suddenly.  At first, there may not be any discomfort associated with the changing to position, but after a while it may well become a painful bunion.

Other symptoms you may experience with a bunion are pain, particularly when walking, redness and hard skin as the bony lump rubs against your shoe and stiffness as movement in the toe joint becomes restricted.

Calluses are areas of hard thickened skin that can develop due to repetitive friction on an area of the foot. This may be due to overuse or an overloading of a particular area of the foot if the foot has other problems, eg flat foot or hallux valgus.

Corns are usually smaller than calluses and are again due to a build up of friction and pressure in an overloaded area of the foot. Corns can be quite painful as they penetrate deep into the skin.

Another issue caused by overloading and friction are blisters. These are small pockets of fluid formed under the skin in response to the friction. The fluid is normally clear and again the can be quite painful. Hammer, clawed or mallet toes

Hammer, Claw and Mallet Toe are similar conditions, all caused by deformity of the toe joints.  They usually develop slowly from wearing poor fitting shoes, but can also be due to muscle or nerve damage.  Muscle imbalance causes the toes to bend into odd positions which can be extremely painful, limiting walking and activity.  They become more common with ageing and affect approximately 10-15% of the population.  Women are five times more likely to suffer from hammer, claw or mallet toe than men.

Hammer Toe is caused when the middle joint bends down towards the floor.  To compensate, the joints above and below bend up.  The result is that the middle part of the toe lifts up. Hammer toe is the most common deformity of the lesser toes (i.e. not the big toe).  It tends to only affect one toe, most commonly the second.

Mallet Toe occurs when the joint at the end flexes on a permanent basis.  This prevents the toe from being able to straighten and causes the tip to point downwards.  Mallet toe most commonly occurs in the second toe.

Claw Toe occurs when the final two joints flex to curl the toe downwards.  To compensate, the first joint hyper-extends so the toe bends up where it meets the foot. It often affects the four outer toes at the same time.

Plantar fasciitis is where the plantar fascia has become swollen or inflamed.

The plantar fascia is a thick, tough, fibrous band made up of collagen fibres, which runs along the sole of your foot.  It originates from the heel bone, extends along the bottom of the foot and attaches to the bottom of the toes.  It helps to support the arch of your foot .

Causes:

Plantar fasciitis symptoms can develop for a number of reasons: Overuse: Being on your feet for long periods, be it standing, walking or running, especially on hard surfaces Foot changes:  Abnormal foot positions such as flat or high foot arches or excessive pronation increase the strain on the plantar fascia

Weight: Being overweight places more strain through the tendon.

Muscle Tightness: The plantar fascia is closely linked with the Achilles tendon and calf muscles.  Tightness and weakness in the calf therefore predispose the plantar fascia to injury by causing it to repeatedly overstretch.

Poor footwear: Wearing shoes that are worn, lack good arch support and cushioning

Exercise: Suddenly increasing the amount you exercise (frequency or intensity), or changing the surface you exercise on e.g. from track to road

Symptoms:

Plantar fasciitis symptoms develop if too much strain is placed on the plantar fascia, usually from overuse or repetitive actions, causing small tears to develop.  This results in swelling and inflammation.

Pain is usually felt underneath the heel and is usually tender to touch.

The most common symptom of plantar fasciitis is pain that is worse after rest, either first thing in the morning or after sitting for long periods.  This is because the fascia tightens slightly.  As you walk around, it then stretches out slightly and symptoms often improve.  However, if you are on your feet too much, the plantar fasciitis symptoms return.

In a number of cases, plantar fasciitis symptoms are accompanied by the presence of a bone spur.  When there is repeated tension on the plantar fascia, it pulls on the area of bone where the tendon attaches to the heel bone.

The body responds by laying done excess bone, known as a heel bone spur, to try and protect itself from injury.  People often mistakenly think it is the bone spur that causes the plantar fasciitis, but in actual fact, the bone spur develops as a result of the condition.