Monday 20 November 2023

Mr Trevor Prior, consultant podiatric surgeon

Most people ignore their feet until they go wrong, but there are ways of keeping them healthy and pain-free

No other creature on the planet has anything quite like the human foot. There are 26 bones in each one, plus muscles, ligaments, blood vessels, nerves… no wonder Leonardo was obsessed with them. Yet we neglect our feet.

When I was at Homerton Hospital in East London, we conducted a study and found 90 per cent of participants were wearing the wrong sized shoe. We put almost every other area of our health, and even our appearance, higher up the list. But as I say to patients: you won’t be able to get to the doctor, the dentist, the hairdresser or the shops if you don’t look after your feet.

Foot pain gets worse as we age. Studies suggest that anywhere between 71 and 87 per cent of older people will have it in some form – be it pain in the ball of the foot, bunions, arthritis in the big toe joint, corns and calluses, or heel pain. Severe foot pain is also associated with a 62 per cent higher risk of serious falls. So over the years, good foot care and footwear becomes ever more vital.

Be familiar with your feet

People tend to stick their feet in their shoes and forget about them, until they go wrong. It is not uncommon for me to see patients who have just noticed a problem that has clearly been worsening, visibly, for quite some time. Checking them regularly is important.

If you get familiar with their normal condition – colour, shape, smell – you will be much more likely to spot any troubling changes early.

Bob Marley died from a melanoma under his toe nail. If you bang your nail, it bleeds and goes black, but that discolouration will grow out. If you see discolouration that’s not getting better, it is best to get it checked by your doctor.

Recognise the importance of steadiness

We are all familiar with the concept of building core stability to develop better balance, but the condition of your feet also contributes to your balance and ability to stay steady in later life. Ten muscles in your leg have tendons that go into your foot and if you strengthen those, you can potentially boost stability right through your body from the bottom up.

There are lots of simple things you can do at home – try sitting down and drawing the alphabet with your feet, or rising up onto the balls of your feet repeatedly. Even walking on the outsides of your feet for a few paces will strengthen muscles that sometimes are not used.

Just remember to work within the bounds of your current stability and strength, don’t push yourself too far and topple.

Understand how conditions start from the floor up

Many conditions show up early in the feet. Inflammatory arthritis often manifests in the foot before anywhere else, various neuromuscular diseases too – people who have back problems sometimes show up first with foot drop (or difficulty lifting the front part of the foot).

Diabetes causes poor circulation and sensation in the feet. I had a patient who arrived with foot pain and it turned out he had leukemia, which had infiltrated the spinal-cord, hence the pain. Another presented with a hot swollen toe and it turned out to be from a sexually transmitted disease.

Choose the right shoes

With every walking step you take, up to three times your bodyweight will pass through each foot. Do that in the wrong shoes, over the years, and it will catch up with you.

Just today, I must have given footwear advice to half my patients. Lots have had issues returning to work after lockdown. Working from home, they were wearing soft shoes, allowing their feet to take natural positions. Then, returning to the office, they had to squeeze them back into tight, formal shoes.

If you want shoes that are good for you, it means looking for the ones that fit best, not flatter most. The ideal shoe is foot shaped, so relatively square-toed. It should be a centimetre longer than your longest toe. If your foot is shifting around inside once it is laced up, then it’s not the right shoe for you. Ditto if your foot is squeezed. Better shoes cannot cure arthritis, but they can significantly reduce the pain you suffer as a result of it.

It is important to alternate your shoes. The sweat from your foot will take longer than one night to dry out. Wear the same pair on two days running, and you are sliding your foot into a damp, warm environment – the ideal breeding ground for the bugs behind conditions such as athletes’ foot.

Quit cigarettes and alcohol

One of the consequences of smoking is peripheral artery disease – narrowing arteries in the legs, decreasing the flow of blood to your feet and causing pain or numbness. Alcohol, on the other hand, can cause neurological problems – chronic alcoholics can end up with neuropathy (a type of nerve damage) in their feet.

Exercise outside – but build it up slowly

One major impact of our modern, sedentary lifestyles is increased BMI, which puts more load on the feet, increasing the likelihood of problems developing. Regular exercise loads the bones and builds their strength, so sitting at a desk not moving enough can seriously contribute to poor bone health.

Being indoors can also deprive you of sunlight which can lead to a lack of Vitamin D. If someone comes in with a stress fracture in their foot, we will check their bone density, their Vitamin D and calcium levels. These factors are becoming more common.

The feet are fantastically adaptive, but the muscles, ligaments, and tendons need time to build strength. Go from zero to hero and you may end up with injuries such as Achilles tendonitis (tendinopathy) or plantar fasciitis. The “Couch to 5K” programme is great for steadily building your runs, just don’t take the same route each time.

What are the most common foot conditions?

Bunions

A bunion is a deformity where the metatarsal head at the joint of the base of the big toe becomes prominent – that’s the lump you see on the side of the foot.

We do not yet know how to prevent them but you can ease the pain and prevent them from worsening by wearing well-fitting shoes (ones that do not squeeze or put pressure on your toes). Surgery is the only permanent solution.

Corns and calluses

These patches of hard, thick skin on your toes or soles are caused by repeated pressure or rubbing on the skin. So again, well-fitting shoes are key to prevention. Soak feet and then use a file or pumice stone to remove them gradually, then moisturise well.

Plantar fasciitis

The plantar fascia is a strong band of tissue that runs along the sole of the foot from the heel to the toes. When the fascia is strained or torn, commonly beneath the heel, the classic symptom is pain first thing in the morning, or on your first steps after a rest.

Common causes include obesity, over-exercise and unsupportive shoes. Rest and ice, calf stretches and shoes with good cushioning are the best home treatments, and it should ease on its own after a fortnight. If not, see a podiatrist.

Ingrown toenails

These occur when the nail penetrates the skin at the side of the nail plate, causing a wound that can become infected. Take care when cutting your nails, (if a spike of nail is left it can cause the problem). 

If you are suffering, soak your foot in warm, salty water then dry thoroughly and wear wide shoes. If they are recurrent, then relatively straightforward surgery can resolve the problem.

Verrucas

A verruca is a viral infection of the superficial layer of skin, much the same as a wart. Classically, you will see little black dots which are blood vessels that have been pushed towards the surface and standing on them can hurt. 

These can disappear of their own accord but some take several years so see your pharmacist if you want to use over the counter treatments.

Athlete’s foot

This fungal infection often shows up as white and red sore itchy patches between the toes or as a type of rash, sometimes with very small blisters. This can happen if your feet are either very dry or sweaty.
If your feet are sweaty, make sure you dry them well. You can apply surgical spirit with cotton wool, especially between the toes. If your feet are very dry, you may require an antifungal cream or ointment.

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