What hurts?
Some possible conditions • Foot Pain – Top of Foot – Forefoot – Toes
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Ingrown Toenail -
Corns -
Arthritis -
Bunion
Some possible conditions • Foot Pain – Top of Foot – Forefoot – Toes
One of the most common problems in the foot are ingrown toenails, also coined as “pincer” or “incurvated” nails. They get their name from growing deep into the skin, or from their curved shape that might resemble pincers. In the medical community, ingrown toenails are referred to as “onychocryptosis.” Most people experience them at least once in their lifetime, and they can be quite painful. However, the symptoms can range from mild to severe. In some cases, they may only be a minor annoyance but when progressed or left untreated, they can be extremely painful and become infected.
The most obvious and common symptom is pain at the corners or along the edges of the toenail. Sometimes the toenail might not even appear ingrown, but it is simply painful to the touch, and can be mistaken for something else due to an otherwise normal appearance. When they get more severe, the ingrown toenail will be a lot more obvious, with redness and swelling of skin along the border of the nail. If left alone for too long, infection can set in and there may be a white/yellow pus, reddened tissue seemingly growing over the nail, and significantly more pain.
There are several different causes of ingrown nails. One common cause is cutting the toenails improperly. It is recommended to trim your nails straight across so that they do not grow into skin borders. When trimmed improperly, you can create a nail spike, which will dig into the skin as the nail continues to grow. The presence of ingrown toenails can also be dependent on activity, such as long hours on your feet, tight footwear, or even having flat feet. With flat feet, the arch can be lowered, causing the foot to roll onto the inside of the big toe and cause additional pressure on the nail borders. One of the most unfortunate causes of ingrown toenails is simply that it is genetic and they tend to grow that way naturally, either from birth, or damage to the nail bed.
The first step most people take when they have an ingrown toenail is to try and clip it out. However, the toe is the furthest part of the body that you can reach with your eyes and hands, so it can be difficult to see and maneuver around there. Improper “removal” can make the ingrown toenail even worse. It is best to see a professional, such as a Chiropodist or Footcare Nurse, before trying anything that can aggravate or infect the ingrowing nail. If an infection is already present, a Chiropodist can write a prescription for an antibiotic. There are a few home remedies that can be tried before coming in:
• Soaking the feet in epsom salts can reduce inflammation and prevent infection.
• Applying over-the-counter antibiotic cream (Polysporin) to keep the area clean.
• Packing cotton wisps (from a cotton ball) underneath the nail edge to relieve some pressure
Corns can occur on various areas of the foot, but commonly affect the toes if they endure pressure from footwear. Toes that are bent or curved, can result in more pressure from shoes and walking around. A corn is a circular area of thickened skin known as hyperkeratosis. They can occur on the tips and tops of the toes. A corn on the tips or top of the toes is known as a hard corn or heloma durum, and they are often mistaken for warts, but certain features differentiate the two lesions.
A corn can be quite painful when pressure is directly applied. This can make walking and activities of daily living challenging at times. A corn is round and varies in size. The area of thickened skin appears yellow or darkened and can be smooth or slightly rough in texture. If left untreated, the corn can begin to break down causing an opening in the skin. This can lead to a wound, infection and/or significant pain.
Ill-fitting footwear that presses on toes or does not provide proper support may cause corns to occur. Shoes with narrow, shallow or pointed-toes will restrict natural movement of toes. Hammer toes and bunions may increase a person’s risk for developing these lesions as they tend to place more pressure and friction on particular areas. Wearing shoes without socks may result in more friction on toes. Some people have more of a genetic predisposition for these thickened areas of skin.
When a corn is painful or if the sight of it is undesirable, treatment is advised. A medical footcare clinician can assess the lesion and provide treatment by reducing the thickness. If there is a nucleus or core, it may need to be enucleated or removed. Treatment at home may include soaking, using a file or pumice stone, applying cream and making sure to wear socks inside footwear that fits properly. At BioPed, all staff are footwear fit certified and can help you find the right shoe fit!
Arthritis is a common inflammatory condition that affects bony joints. The most common type of arthritis is Osteoarthritis (OA). It occurs when the cartilage, which acts as a cushion between the bones of the lower limb wears down over time. As the cartilage deteriorates, the bones begin to rub against each other causing pain and inflammation. While it is most common in older adults, osteoarthritis can occur in at a younger age. Other types of arthritis include psoriatic arthritis, rheumatoid arthritis and gout.
The most common symptom of foot arthritis is pain, which can range from mild to severe. Depending on the affected joint, pain can be felt throughout the foot. Psoriatic and rheumatoid arthritis primarily affect the toes and cause changes in shape, alignment, and may cause swelling. Along with pain, people with foot arthritis may also experience stiffness, as well as decreased range of motion. These symptoms may be worse after sitting or standing for long periods of time, or with physical activity. Gout can be acute or chronic, but when it first presents, pain, swelling and redness of the joint are the primary indicators.
Osteoarthritis is caused by a combination of genetic and environmental factors. With age comes the natural breakdown of the cartilage. The most common joint in the foot to be affected by OA is the big toe joint. Biomechanics plays a significant role in the development of osteoarthritis because the position of our foot joints and how they move can cause increased pressure throughout the area affected. Previous foot injuries or surgeries can cause damage to overall joint structure/cartilage, which can be another factor. Overuse of certain joints is another cause of foot osteoarthritis as the more we work our foot joints, the faster cartilage breaks down. This is why jobs that involve a lot of walking and kneeling will have higher rates of workers with foot osteoarthritis. Psoriatic and Rheumatoid arthritis are a by-product of the disease processes, and have genetic and auto-immune causal factors. Gout is primarily precipitated by diet but ultimately, is a by-product of faulty handling or producing of uric acid by the body. These crystals build up within a joint and are very painful.
Treatment for foot arthritis begins with non-surgical approaches, such as medication, physical therapy, weight loss, bracing/splinting, orthotics and well-fitted shoes. Physical therapy can help to reduce pain and improve function by strengthening the muscles around the joints. Weight loss is also an important aspect of treatment as it can help to reduce the pressure on the foot joints. Often a brace, splint, orthotic or shoe with a forefoot rocker may be recommended to offer support and aid in pain reduction.
Big toe bunions, also known as hallux abducto valgus, are a common foot deformity most characterized by a painful bony bump on the inside of the foot located near the big toe joint. They usually develop slowly, with increasing pressure to the bony bump causing the big toe to drift toward the lesser toes. The normal position of the bones, tendons, and ligaments begin to deform resulting in the bump appearance. Bunions also exist on the outside of the foot below the fifth toe. We call these, tailor’s bunion or a bunionette.
Pain, tenderness, redness and swelling around the bony prominence of the big toe or fifth toe joint is the most common presentation. Callus can form on the bottom or inside of the big toe joint, or on the outside of the fifth joint due to increased pressures from shoe gear and rub. There is often stiffness and restricted motion in the joint, which can lead to difficulty walking.
There are multiple causes of bunions, with heredity being the most common. Over 50% of adult bunion deformities are due to genetics, the remaining are due to poorly fitting shoes, biomechanics and inflammatory conditions, such as rheumatoid arthritis or charcot marie tooth disease. Ill-fitting shoes often have a narrow pointed toe box and increased heel height. A small percentage of big toe bunions appear in kids and are most commonly found in girls aged 10-15.
Many bunions can be treated without surgical intervention. Bunions that cause no pain are monitored for progression only. Following evaluation by a Registered Chiropodist or Canadian Certified Pedorthist, non-surgical treatment is aimed at reducing pain and preventing worsening of the deformity. Changes in shoe gear such as a wider or open toe box, can reduce the compression on the toes. Protective silicone pads can be worn over the bunion area to reduce rub in shoe gear. Toe spacers are often worn to help reduce the big toe from pressing on the lesser toes. Toe alignment splints/braces can be worn to help reduce the ligament and tendon changes in the great toe joint, but do not permanently fix the issue. A professional, such as a BioPed Clinician, can aid with devices such as orthotics to help reduce the pressure to the deformity, slow progession and improve foot alignment. Lastly, non-steroidal anti-inflammatory (NSAID) medications either over-the-counter, such as ibuprofen, or prescription medication can be utilized to reduce the pain and inflammation present with bunions. Bunions that fail to improve after utilizing non-surgical treatment options may require surgical intervention.
