Forefoot pain is very common and it is estimated that around 80% of people will suffer from forefoot pain at some point in their life.
Females are more likely than males to suffer from forefoot pain mostly due to footwear choices. Being overweight can also contribute foot pain as can weakness or tightness in specific muscle groups.
It is important to think back to when the problem started and try to link it to a potential change in activity, or change in footwear to see if there is anything you can do to ease the discomfort. Symptoms can range from a burning sensation to a numbness, or it could just be that it is really painful to walk.
Exercise and support
Strengthening the muscles in the feet (known as the intrinsic muscles) can help, as can stretching out the calf muscles as this can reduce the pressure on the front of the foot when walking.
The video below will demonstrate a range of exercises that might help.There are 7 short videos. Numbers 1 and 2 are relating to calf stretching & Numbers 5 and 6 are relating to the intrinsic muscles, however, you may find the others useful too.
Don’t expect things to improve overnight though. It can take time for muscles and joints to adapt.
Please note: If you do not see any sign of improvement after 6 – 8 weeks of following the advice and exercises, please phone 0141 347 8909 for more advice and support.
Hallux valgus (also known as bunion) is a bony bump on the inside of the foot at the base of the big toe with the big toe tilting towards the second toe.
Many people who have bunions do not get any real problems with their feet and nothing needs to be done.
Some people will however get pain around the big toe or problems with their shoes
The bump can make foot wider and it can be difficult to find shoes which are comfortable
The bump can rub on shoes and become red and swollen and in some cases the skin can blister
Some people with bunions go on to have problems with their smaller toes too.
What causes bunions?
Inherited factors and the shape of the bones in feet can cause bunions. Footwear which does not fit well probably has a role in making bunions more uncomfortable and increasing problems in the future.
What tests may be done?
You do not need any x-rays or special tests to diagnose bunions, these are only used for planning surgery.
What can you do to help your bunion?
There are many non-surgical treatments that can help.
Footwear: One of the most important things you can do to help is to wear the right footwear. You should try to wear wide shoes with a low heel that fit you comfortably. Shoes with laces or an adjustable strap are best as they can be adjusted to the width of your foot. Do not wear high heeled, pointed or tight shoes as this will make your pain worse.
Diet: Losing weight will reduce the strain on your feet.
Medication: Painkillers such as paracetamol can reduce the pain. Follow the advice from your community pharmacist or other healthcare professional about taking medication. It is important to take medication regularly.
Exercise: Helps build the strength of the small muscles in your feet, which can take the strain off the toes and we think help to delay or stop problems getting worse.
What else can be done?
Most patients with bunions respond well to non-surgical treatments, especially changing their footwear. Where these have been tried and failed then there may be other options. If your pain does not start improving after a period of 3 months of following the advice above, please phone 0141 347 8909 to see a healthcare professional who can assess your foot.
Some patients may be referred on for Orthopaedic footwear or a surgical opinion.
Surgery
Surgery is considered in patients who have significant problems with their bunions and have tried non-surgical management which has not worked usually over at least 12 months.
An operation will not give you an entirely normal foot, but it will correct the shape of the big toe and narrow your foot back towards a more usual shape.
The aim of bunion surgery is to straighten the big toe and make it more comfortable. There are several procedures for bunion surgery and the best surgery for you depends on the size of your foot.
For most people the surgery is a bony surgery where the bones of your toe are cut and reset to straighten your big toe. This is called an osteotomy, some people who have developed arthritis in their big toe joint need a different type of operation where the big toe joint is surgically stiffened (fused). Very occasionally if your foot is more complicated an operation would be done further back in the middle of your foot to help straighten and support it.
Bunion surgery is largely very successful with around 85% of people happy with the outcome but as with any operation there are some risks.
It may take 3-6 months for you to be back to your normal level of activity where you will be able to work standing all day, however every person is different.
The leaflets below provide some added information, however, if you feel you would liketo talk to a podiatrist about your options, please phone 0141 347 8909 for more advice and support.
Pain is always made in the brain. No exception, the brain decides.
About 30-50% of people in the UK live with persistent pain. It is the leading cause of disability in the world. Pain is usually the result of a combination of different things but its impact can be significant and negatively affect our physical and mental health, our social and home lives and our ability to stay in work.
The links below with take you to information on the NHSGGC pain service, as well as some other fantastic online resources and information about pain which will help your understanding of pain and empower you to take back control and manage your pain.
The big toe joint (called the metatarsophalangeal joint or MPT joint) is an important joint that needs to be able to bend for the foot to work as efficiently as it should. Sometimes, for a variety of reasons, the joint can become stiff and make walking painful at this area – and sometimes it can become so bad that it results in a complete loss of movement.
Footwear is important in these cases. If the joint cannot bend, then a shoe with a stiff sole – or rocker sole like the examples pictured below- can be useful. A shoe with a decent heel height may make symptoms worse as this will ask more of the joint and so may be best avoided – or at least limited. It is also important to point out that themake and price of the shoe/trainer is not important, as long as it is fit for purpose.
If you do not see any sign of improvement after 6 – 8 weeks of following the advice and exercises in this leaflet, please phone 0141 347 8909 to see a healthcare professional who can assess your foot and potentially recommend further treatment.
As a portion of nail punctures the surrounding skin it can cause pain, inflammation and at times infection. This is known as an ingrown toenail and is a common complaint that can be treated effectively by a Podiatrist.
Further information on ingrown toenails
Why does this happen?
There are many reasons this can occur including:
Cutting nails too short
Cutting or trimming the sides of the nail where it meets the skin
Picking toenails
Tight or ill-fitting shoes or hosiery
Excessive moisture (sweat)
Damage to the nail or toe
Fungal infection
Increased curve of the nail.
How can I prevent this?
There are things you can do to prevent an ingrown toenail as part of your personal footcare routine. Further information and support available from our personal footcare site.
Important points to remember:
Ensure you are using the appropriate equipment and technique when cutting your nails.
Change socks regularly throughout the day to prevent increased moisture
If you have an ingrown toenail, and self-treatment has failed, you will require treatment by a qualified Podiatrist. To access podiatry treatment you can self-refer by contacting NHSGGC Podiatry Referral Management Centre:
At your initial appointment the Podiatrist will assess your concerns, treatment options and the risks and benefits of treatments. This will allow you to make an informed choice of your treatment plan. If there is infection present the podiatrist can arrange for antibiotics to treat the infection. Treatment may be performed on the day to remove the problematic portion of nail however, in some cases you may need further treatment which may require a local anaesthetic (nail surgery). Your Podiatrist will discuss all your treatment options and will refer you for nail surgery if deemed necessary.
Nail Surgery
What is nail surgery?
Nail surgery involves removing a piece or all of a problematic toenail. The option to have the nail permanently removed or allowing it to grow back will be discussed with your Podiatrist.
What will happen at my nail surgery appointment?
Your Podiatrist will discuss your general health and it may be helpful to bring a list of your medication. If you are diabetic we advise having your HBA1C (blood sugars) checked before your procedure date. Having this information will allow you both to agree on what procedure you are best suited for. The procedure will require your toe(s) to be numb which is achieved using a local anaesthetic injection. Your Podiatrist will explain the procedure and answer any questions you may have. A family member/friend may accompany you to your appointment for support if needed.
Preparing for the appointment
Ensure you have breakfast/lunch depending on the time of your appointment
Bring open toe shoes (sandals, flip flops etc.) to accommodate the dressing that will be applied
Ask of family member/friend to drive you or consider public transport. If this is not possible you may drive
Ensure you are able to rest the foot following the procedure. The Local anaesthetic will wear off in approximately 2-3 hours, take care not to damage it while it is numb.
After the procedure
You will be provided with information to help you manage your care at home. This will include:
Pain relief
Dressings
Footwear
Activity.
Aftercare and what to expect
You will be expected to change your own dressings while the wound is healing. This will normally involve:
Allow the dressing to get wet in the shower/bath
Remove dressing and allow the water to run down your body and over the toe – avoid direct water pressure on the toe
Allow the area to air dry, do not use a towel to dry the toe
Apply a breathable dressing available from local supermarkets or pharmacies. We advise you obtain these before your procedure date
It is important to avoid foot baths, prolonged soaking and any type of scrubbing of the area.
Healing times may vary from 4 – 12 weeks, depending on your medical history and the procedure undertaken. The application of the chemical (Phenolisation) to prevent the nail growing back will increase healing time. Normal healing from phenolisation may include:
Redness localised to the tissues around the nail bed
The nail bed may be moist and leak some fluid onto the dressing initially
A thin yellow film may form over the nail bed
Area may look slightly yellowish before getting better and looking more like a normal wound.
All of the above should reduce gradually and result in a dry scab forming with no fluid leaking onto the dressing.
Infection
It is important to monitor the area for signs and symptoms of infection and contact your local Podiatry department if you have concerns. If you follow the aftercare advice this should help prevent infection occurring. Signs that infection may be present include:
Significant increase in redness and swelling
Significant increase in pain and discomfort
A foul smell from the area
Flu like symptoms (Out of hours, contact NHS 24 on 111 if podiatry service not available).
What will it look like once healed?
If the nail has been allowed to re-grow this will normally take 3-6 months. If the aim is to prevent the nail growing back the area will heal over with normal skin that will toughen slightly over time. There is a chance the nail could grow back however this can often be managed with light regular filing or further treatment if causing significant issues.
Podiatry provide assessment, management and foot health education to individuals with conditions affecting the lower limb, enabling self-care where possible. We have highlighted some of the most common problems and created resources which you might find helpful in supporting your foot health concern below.
