Heel and arch pain can be debilitating, affecting walking and posture. The most common cause is Plantar Fasciitis, when the ligament that runs under the heel becomes swollen. It can affect anyone at any age, but is most common in those in their 40s or athletes. Changes to activity levels can cause it to develop.

What can I do to help prevent or manage it?

• Wear well-fitting shoes, with good heel cushioning and arch support – trainers are ideal. Avoid shoes with memory foam liners.
• Avoid walking or exercising on hard ground.
• Rest regularly and try not to walk or run too fast.
• Wear a raised heel (no more than 6-10mm higher than normal).
• Do regular calf stretches.
• If your heel pain continues for longer than 3 weeks, consult a Podiatrist to have the cause assessed and a treatment plan put in place.

Morton’s neuroma is when fibrous tissue develops around the nerve between the toe, which becomes irritated and compressed. This causes severe pain on the ball of the foot and at the base of the toes. Morton’s neuroma can occur on one foot or both feet. It usually affects the nerve between the third and
fourth toes, but sometimes any toes can be affected. You may initially experience a tingling sensation in the space between your toes, which gets worse over time. This may lead to cramp in your toes and a sharp shooting or burning pain on the ball of your foot or at the base of your toes.
The pain is often worse when walking or wearing shoes that press on the affected area.

What can I do to help prevent or manage it?

• Wear shoes with a wider toe box and orthotic devices to offload the affected area would be recommended. You can also take painkillers to help ease the pain.
• Steroid injections are shown to be a suitable treatment option for severe cases.
• If these other treatments do not work surgery may be needed, this involves removing the thickened tissue around the nerve or the nerve itself to release the pressure.

Ingrown toenails develop when the side of a toenail pierces through the flesh of your toe, making it red, inflamed and painful. It most commonly affects the big toes.

Anyone can get ingrown toenails, but particularly people who cut their nails incorrectly, leaving small spikes of nail behind. Some people may have nails that are naturally curved and press into the side of the toes. Sporty people and teenagers are more prone because they are likely to get moist, sweaty feet – this can make the skin around the toenails softer and easier for a nail to pierce.

What can I do to help prevent or manage it?

• Cut your nails properly – straight across, making sure not to trim them too low at the edge or down the side. Leave the corner of the nail so it’s visible above the skin.
• Avoid moist feet by rotating your shoes and choosing well-fitting socks and shoes made from natural materials.
• If an ingrown toenail develops you should apply a clean, dry dressing. A podiatrist can treat the ingrown toenail including those that are swollen and infected. It is best to seek treatment sooner rather than later as delaying treatment can result in longer term issues.
• Nail Surgery can be provided for recurring or severe ingrown toenails to permanently remove the side of or whole of the nail.

Thickened nails can appear distorted, thick and yellow, often with ridges in them. It is more common in older people, and those who have lead very active lifestyles involving running or hillwalking, or those who have had a trauma to their nails. It can also be caused by a fungal infection with the nail/base of the nail (known as Onychomycosis).

What can I do to help prevent or manage it?

• You may find cutting them to be difficult, so instead try filing your toenails once or twice a week to help keep the length down. You can use an emery board or a nail file made of metal or crystal – all are easily available.
• Avoid using home treatment such as nail thinning products or electric machines to thin the surface of the nail.
• If you find it difficult to manage thickened nails from home, a Podiatrist will be able to provide routine maintenance to help trim and thin the nails for you.
• Topical medications can be recommended to apply to the nail in cases of fungal infections. In severe cases a GP can prescribe an oral medication, however this is not always recommended.

Corns and callus are simply described as hard, thickened areas of skin, caused in response to rubbing, friction or pressure on the skin. They can often be caused by badly fitting shoes or a biomechanical irregularity in your feet.

What can I do to help prevent or manage it?

• Gently rub the area with a pumice stone or foot file when you are in the bath
• Moisturising cream may help to soften the thickened skin. Avoid applying cream between your toes.
• Avoid self-treatment with acid based products such as corn plasters, unless directed to use them by your podiatrist.
• A Podiatrist can safely remove corns and calluses and determine the cause.

Cracked heels are splits and fissures around the heels which can often be painful. They are common in people with very dry skin, those who wear backless and slip on shoes and where build ups of callus are present on the heels. Deeper cracks can sometimes become infected.

What can I do to help prevent or manage it?

• Apply a urea based foot cream every day. Varying formulations are available including some specifically for cracked heels – we often recommend ‘Flexitol’ or ‘CCS’.
• Avoid applying foot cream between your toes. It may take a week or two to start seeing results. A Podiatrist can safely remove any callus and advise on prevention.

Bunions are a bony lump on the side of your foot where the big toe angles excessively towards the second toe. Although anyone can get a bunion, they tend to be more common in woman an they can sometimes be hereditary.

Hammer toes occur when any of the small toes of your foot become bent and
prominent. The 4 small toes of your foot are each made up of 3 bones with
joints in between them. Normally these bones and joints are straight. A hammer or claw toe occurs when your toe becomes bent at the first or second joint. Sometimes a bursa (like a deep blister) is formed over your joint and this can become inflamed

What can I do to help prevent or manage it?

• Give your toes room to move by opting for wider shoes. Keep heel heights to 4cm or less – and very your heel heights from day to day. Choose shoes with laces or a strap or buckle.
• Podiatrists can advise on measures to prevent a bunion from worsening including orthotics and footwear changes. Referrals for surgery are also available in severe cases.

Athlete’s foot is a fungal infection that commonly shows as dry, flaky areas of skin on the sole of the foot – but can also occur on moist areas of skin, such as between the toes. Itchiness and red dots are also common. Walking barefoot around communal areas such as swimming pools or changing rooms makes you more likely to pick it up and those with sweaty feet are more prone to the infection.

What can I do to help prevent or manage it?

• Over the counter treatments are easily available. We commonly recommend the ‘Daktarin’ range. If an infection persists after treatment, consult a Podiatrist for assistance.
• Athlete’s foot spreads easily so avoid walking barefoot and sharing towels as you may pass it on to others.

Fungal toenails are very common and typically start after having a fungal skin infection for a few months or more, which then spreads to the toenails. Over time this can cause the nails to thicken, become flaky and become discoloured.

What can I do to help prevent or manage it?

• Fungal toenails can be very difficult to treat. Over the counter treatments are available and can be effective when only the top end of the nail is infected. If your nail is very thick or the infection has spread to the cuticle, then they will have little effect.
• A Podiatrist can advise on a range of treatments. In recent years the variety of treatments has increased, including many topical treatments and oral medications, and a podiatrist can discuss what options are right for you.

Verrucae are viral infections of the skin caused by the Human Papilloma Virus (HPV). They often appear as a flat and distorted or cauliflower like lesion on the foot. Anyone can develop a verruca but they are more common among children and teenagers.

What can I do to help prevent or manage it?

• Verrucae often resolve themselves within 6 months to 2 years and are usually painless. If they start to hurt or spread then you should seek advice.
• A Podiatrist can advise you on the best treatment to to try. There is no guaranteed cure and several treatments may be required. Some treatments are available over the counter at the pharmacy and other via a Podiatrist only.

Gout is a type of arthritis that affects men more than women and causes sudden severe joint pain. It usually starts in the big toe, but other joints can be affected such as the ankle, knee or foot. It is caused by an imbalance of uric acid in the body resulting in a build-up of uric acid in the blood. When there are high levels of uric acid in the blood, small urate crystals form which collect in and around the joint, causing irritation, inflammation and severe pain.

The main symptom of gout is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen, then doesn’t return for a few months.

What can I do to help prevent or manage it?

• You can reduce your chances of developing gout by leading a healthy lifestyle including: Maintaining a healthy weight, Eating a healthy diet including what you drink and making sure there is plenty of Vitamin C in your diet.
• Gout can be controlled and regulated with anti-inflammatory drugs, and these will alleviate the attack over 24 hours or so. An immediate measure to an acute attack is to levitate your leg to help reduce swelling and apply ice or cooling lotions while waiting for your medication to take effect.
• Podiatrists will also be able to help alleviate issues by adapting your existing footwear with orthoses or other appliances which fit easily into your shoes and help redistribute pressure away from the affected parts. Made-to-measure shoes can also be prescribed: your podiatrist will be able to advise you on the correct type of shoes to wear and where to obtain them. They can also provide protective shields for your toes or padding to relieve pressure and reduce friction. Any secondary problems like ulcers or corns can also be treated. They can also refer you to a specialist for more serious cases.

Podiatry for people with diabetes is one of the most overlooked aspects of diabetes management. Diabetes can impact all areas of your health, especially your feet so it is important for all diabetics to visit a podiatrist at least once a year.

Many people with diabetes are entirely unaware that they need to take special care of their feet and visit a podiatrist at once if problems arise. Higher levels of blood glucose can damage the nerve endings in many areas of the body and organs, which is why tight blood glucose control is an essential aspect of diabetes care.

Podiatrists are one of the essential professionals within diabetes care, and have a much underrated role to play in preventing and managing foot complications amongst people with diabetes. Podiatrists are on hand at every stage, be it prevention, concern about a foot problem, and dealing with genuine problems once they occur.

A variety of foot problems can arise when poor foot care fails to catch issues at an early stage. These may include Damage to the foot, Foot ulcers, Foot infections, Charcot’s joints and Amputation.

A flat or low arched foot is not considered abnormal and the height of the arch does not have any bearing on how well a foot can function. A foot that rolls in excessively with most of the weight passing over the inside border may be a cause for concern.

Surgical treatment is required in the severe cases when the poor alignment of the foot causes pain or fatigue or has a high chance of doing so. These patients are considered to have a pathological flat foot. The majority of these cases respond well to a combination of muscle stretching exercises, orthoses (shoe inserts), braces and supportive footwear. If you do not respond to conservative treatment, then surgery might be considered.

Cases of a pathological flat foot

• Congenital (born with)
• Tendon injuries, typically tibialis posterior (on the inside of the ankle)
• Neurological and muscular diseases
• Joint hypermobility
• Abnormal joining of two bones (coalition) resulting in a rigid flat foot
• Inflammatory Arthritis (e.g. rheumatoid arthritis)
• Trauma or injury

Types of flat foot

1. Flexible
   The foot is poorly aligned when a person is standing but when sitting with the weight off the foot the deformity usually corrects itself. It can be manipulated into a better position by hand.
2. Rigid
   The foot remains in a poor position whether the person is weight bearing standing or not. It cannot be manipulated into a straight position by hand.

Diagnosis
The diagnosis is made following an examination of the foot. In certain cases, further investigations may be required such as X-ray, ultrasound, MRI or CT.

Treatment Options

1. Conservative care
2. Surgical management – The majority of patients who undergo surgery to correct a flatfoot need to go through a long and challenging postoperative regime.

For the diagnosis of walking problems or gait imbalances

Here at The Foot Clinic, we offer a full biomechanical (gait) analysis, if we suspect that your foot problems stem from either a foot posture or foot function imbalance. This is a service we can offer at any stage of life. If we observe significant issues in childhood, orthotics could help to prevent issues in later life.

What is an Orthotic and how could this help me?

An Orthotic is an insole which can rebalance your foot and aid with your walking. Sometimes, a flat or over pronating foot can lead to arch, heel or knee pain. We would assess and measure the degree of imbalance, when we undertake the gait analysis, and incorporate these findings into our prescription. Orthotics can be simple i.e manufactured in house or bespoke.

There are many varieties of insoles such as those you can buy over the counter, semi-bespoke (individual pre-fabricated insoles to which we can add your prescription) or fully bespoke insoles. With bespoke orthotics we cast or scan your feet and we can request any combination of factors to be accommodated and addressed with bespoke orthotics as these are tailor-made for your feet alone. If someone has a severe foot imbalance, we would suggest a higher degree of control. This could mean, for example, a deeper heel seat or a more rigid material in the foot plate of the orthotic. If someone needs fore-foot protection, we can also request accommodative padding to protect specific areas of the foot.

For deep seated arch or heel pain

For the analysis and determination of suspected fungal infections

For the relief of foot pain, and as an aid in the treatment of verrucas

For stubborn warts or verrucas

Revolutionary new treatment for warts and verrucas

Globally recognised treatment for the successful resolution of Foot Pain. Research has shown it to be of great benefit in conditions such as Plantar Fasciitis, Arch, Heel and Achilles Pain.

K-Laser uses selected wavelengths of light to stimulate key molecules in human tissues. It delivers energy from superficial to deep tissues activating a cascade of photochemical reactions that promotes cell function, enabling treated tissues to accelerate the stages of the healing process and reduce pain sensation. This is a safe and non-invasive technique that uses the body’s own reparative processes.

It can be used for a multitude of conditions including, but not limited to:

• Warts and Verrucas
• Onychomycosis (Fungal Nail Infection)
• Wound Healing
• Muscle repair
• Pressure Ulcers
• Joint Disorders
• Sports Injuries
• Osteoarthtitis