Common foot disorders (Part 1)
A weekly column by Dr Balwant Singh’s Hospital Inc.
By Dr Suhel Kotwal, MS (Orth)
Each of your feet has 26 bones, 33 joints, and more than 100 tendons, muscles and ligaments. No wonder a lot of things can go wrong as you grow old having subjected your feet to years and years of wear and tear.
Ill-fitting shoes often cause these problems. Being overweight also increases your chances of having foot problems.
The ability to walk comfortably without pain is a key part of aging successfully. Foot problems are common among older adults and can lead to both pain and disability, and almost always cause difficulty in walking for older adults. When foot problems limit your activity and do not get better, a visit to your podiatrist is required.
Throughout our lives, our feet are constantly stressed from bearing our weight and from the additional impact caused by walking and running. This can lead to inflammatory changes in bone and soft tissue, resulting in one or more foot problems. The risk of serious foot problems as we age, increases with diseases of the blood vessels, nerves, skin, joints, and hormones (eg, diabetes).
Types of foot problems
Foot pain can result from a variety of conditions, including the following:
* Deformed toes * Gout
* Warts, corns, and calluses * Diabetes
* Ingrown toenails * Arthritis
* Ill-fitting shoes * Stress fractures
* Blood vessel disease * Trauma
* Neurologic disease * Tumours
When the above mentioned conditions cause foot pain, your ability to walk and get around is limited.
Pain in the ball of the foot
Pain in the ball of the foot has many causes, and it is one of the most common foot problems in older adults. It seems to be more common in women than in men, possibly because many women wear shoes with pointed toes that force the weight to the front of the foot. A variety of conditions can cause pain in the ball of the foot.
Bunions
A bunion is an inflammation, swelling, and sometimes bony growth near the joint at the base of the big toe. The big toe turns sideways, almost pointing directly toward the little toe of the same foot. This causes crowding of the other toes. A bunion can be caused by arthritis in the foot, or by years of wearing shoes with pointed toes.
Pain can be caused by the bunion itself or by irritation where the bunion rubs against the shoe. Also, as the big toe turns to the side, the second toe may lie on top of the big toe and develop corns on its top surface because of friction with the shoe. Occasionally, the bunion places pressure on the nerves of the foot, resulting in tenderness and tingling in the areas around and just behind the toes.
Hammertoe
Hammertoe is a general term applied to several deformities caused by the toes contracting (ie, bending under tightly). Other terms include mallet toe, claw toe, and cock-up toe, which are all variations of the same condition. These deformities usually develop in the smaller toes, but can occasionally be seen in the big toe. They are related to loss of muscles in the foot and tightening of tendons. The toes may also turn and sometimes even dislocate. Hammertoes increase the formation of corns, especially if shoes do not fit well. The tips and bases of the toes commonly get larger as we age, resulting in degenerative changes in the toe.
Corns and calluses
Corns and calluses are caused by friction around bony bumps and are particularly seen when shoes do not fit correctly. Corns are especially common over bunions or other abnormalities in the feet. Corns and calluses can sometimes lead to pressure ulcers.
Other problems
Causalgia is a severe burning pain in the foot that develops after a large (trunk) nerve in the leg has been injured. Plantar warts, which resemble corns and calluses, are flat and surrounded by extra skin growth. They can be very tender and may appear anywhere on the sole of the foot. Other conditions, such as flat feet or high arches, can also result in pain in or near the ball of the foot.
General considerations for treatment of foot problems
Treatment for foot problems should be directed to the underlying cause. Most foot problems can be handled conservatively, without drug treatment or surgery. However, if not properly managed, some foot problems, such as infections related to diabetes, can lead to hospitalization and amputation.
Many problems can be corrected by simply modifying your shoes. This may mean stretching your current shoes, buying more comfortable shoes, or having shoes specially made to help your specific foot abnormalities. Treatment of corns with corn pads or plasters may reduce pressure on the affected area. Pain relievers (eg acetaminophen, aspirin, ibuprofen) are often helpful, and those with anti-inflammatory properties are especially useful for minor swelling and redness. Sometimes weight-bearing activities must be stopped for a few days to control symptoms, but some weight-bearing exercises (eg, swimming or cycling) should still be done to maintain strength and movement.
At times, surgery may be needed to correct foot problems, but this is usually a last resort. Surgery can involve quite a bit of discomfort and limit standing and walking for weeks to months. People who undergo foot surgery must be sure to keep up their muscle strength during the recovery period.