Bunions (hallux valgus)
A bunion is a bony lump or swelling on the side of your big toe joint. It’s a common foot problem, caused by the big toe tilting over towards the smaller toes.
Shoes can put pressure on the bony prominence, which causes discomfort, pain and sometimes the bunion becomes red, blistered and infected. You may find that your foot becomes so broad that it’s difficult to find wide enough shoes.
Wide, well-fitting shoes and the use of a small pad over the bony lump may alleviate the pain and prevent the condition from getting worse.
Surgery may be your best treatment option if non-surgical measures aren’t working. There are many options for bunion surgery, depending on the severity of the deformity, your foot shape and whether you have arthritis in your big toe joint. Your podiatric surgeon will advise you on the best operation for your individual needs. Surgery will correct the deformity of your big toe and straighten it.
Stiff big toe (hallux rigidus)
Hallux rigidus is arthritis in the main joint of your big toe. This wearing out of the joint surfaces causes stiffness (rigidus) of the big toe (hallux). The joint may become inflamed and painful, often when walking, and a bony bump may develop on top of the joint.
Painkillers or anti-inflammatory medicine may relieve the pain and stiffness. Comfortable fitting shoes can prevent it getting worse. For very painful arthritic toes, joint injections may be recommended to reduce the inflammation inside the joint.
If non-surgical options fail to relieve your pain, then an operation may be recommended. If only the upper part of the joint is damaged, then your surgeon may perform a cheilectomy that trims and washes out your joint. If the whole joint is involved, a fusion (surgical joining together of the joint in the big toe that creates a single joint structure and immobilises the worn down joints) or joint replacement will be performed.
Pain in the ball of the foot (Morton’s neuroma)
Morton's neuroma is a swelling of the nerve that runs between your toes and causes a sharp shooting or burning pain in the ball of your foot which sometimes spreads to your toes.
The enlarged nerve happens when your toe bones press on the nerve as the space between the two toes is narrow. It most frequently occurs in the third and fourth toes.
Wearing poor-fitting or high heeled shoes, playing sports that put pressure on your feet and other foot problems can add to the pressure on the nerve.
Initially non-surgical options may be recommended such as: better fitting footwear, orthotic devices, painkillers, avoiding some sporting activities and losing weight if you’re overweight. You may be offered injections for pain relief.
If you’ve severe pain, surgery may be advised. It aims to relieve the compressed nerve by either increasing the space around the nerve by removing some of the surrounding tissue, or removing part of the nerve.
Toe deformity (hammer, claw and mallet toes)
A deformed toe is one of the most common conditions known to affect the foot. It’s caused by a tendon in your foot contracting and pulling one of your lesser toes. It can be painful, make it difficult to find shoes that fit, cause corns and calluses to develop and be unattractive. It’s thought to be associated with wearing badly fitting shoes, injury to the toe or an instability within the intrinsic musculature of the foot, causing the toes to bend at the toe joint.
There are three main types of lesser toe deformities, dependent on which toes are bent and how:
- hammer toe - the toe is bent at the middle joint causing the toe to curl and look like a hammer.
- claw toes – the toe bends upwards at the toe joint at the ball of the foot, then bends downwards in a claw-like fashion at the middle and sometimes the end joint as well.
- mallet toes - similar to a hammer toe except the toe is bent at the upper joint instead of the middle joint, giving a mallet-like appearance at the end of the toe.
Initially conservative treatment will be recommended such as changing your footwear, regularly doing toe exercises, trying orthotics, splints or anti-inflammatory injections.
If these don’t work, then surgery may be advised to straighten your deformed lesser toes. Surgery can include the release of trapped soft-tissue or fusion surgery. Your podiatric surgeon will discuss the type of surgery best suited to your needs. It often depends on if the deformity is fixed or flexible as well as the extent of the deformity, your age and health.
Nail problems (ingrown nail, fungal nail, thick nail)
Toenail problems can affect people of any age, but they tend to be more common in older people. We see many patients with an ingrowing toenail, a fungal nail infection and thickened nails. Causes of toenail problems include injury, ill-fitting shoes, infection, badly cut toenails, poor circulation and nerve supply. Toenail problems can be successfully treated by one of our podiatric surgeons.
You can get an ingrowing toenail in any of your toes. It develops when the side of your toenail cuts and grows into the skin next to your toenail and may cause it to become painful and inflamed. Hygiene, nail cutting and footwear advice will initially be provided. Surgery, known as nail avulsion, may be required to remove all or part of your toenail.
Fungal nail infections, medically known as onychomycosis, often develop slowly and make your nail discoloured, thickened, distorted, painful, brittle or crumbly. They are often the result of the fungi, that cause athlete's foot, infecting the nails. Treatment includes antifungal tablets or nail paints. Advice will also be given on good foot hygiene. If the infection is severe your podiatric surgeon may perform a procedure to remove the nail completely or use laser treatment to destroy the fungus.
Thick nails may be due to a fungal nail infection. They may also be due to trauma such as dropping a hammer on your toe, playing sport or wearing too small or narrow shoes, systemic diseases such as psoriasis, eczema, rheumatoid arthritis, cardiovascular disease, cancer and poor circulation. Treatment of thickened toenails depends on the cause of the problem. Chiropody can help, but sometimes the nail needs to be surgically removed so that a new healthy nail can grow.
Heel pain (plantar fasciitis)
Pain in the heel can be caused by many things such as being overweight, constantly being on your feet or a heel bone injury but the most common cause is plantar fasciitis.
Plantar fasciitis is when the plantar fascia (a ligament that’s stretches from your heel to your toes and supports the arch of your foot, acting as a shock-absorber) becomes inflamed and painful. It’s often caused simply by constant stress.
Weight loss, appropriate footwear, use of soft heel pads or insoles, physiotherapy including stretching exercises and pain killers may help. Your podiatric surgeon may suggest a splint or steroid injections if these self-help measures don’t work. If the pain still continues then an operation may be required to release part of the plantar fascia from your heel bone and reduce the tension in it.