Many common problems can occur in this complex structure. Your ankle bone is joined to your leg bones tibia and fibula at your ankle joint, which acts like a hinge. This allows your foot to bend up and down. These form the arch of your foot. Your tarsal bones are connected to the front and back of your foot by muscles and the arch ligament the plantar fascia.
The muscles in your lower leg are attached to bones in your feet by tendons, and they control movement that allows us to stand, walk, go on tiptoes and jump.
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These muscles move your toes and control the position of your foot as it hits the ground, allowing it to become flexible and cushioning the impact. They also make the arches of your feet more rigid to push your body forward when you move. Your heel bone is connected to the calf muscles in your lower leg by your Achilles tendon, which is the most important tendon for movement. The tibialis posterior tendon, which attaches the underside of your foot to your lower leg, helps supports the arch of your foot and allows you to turn it inward.
The main nerve of your foot controls the muscles in your sole and gives feeling here and to your toes. Other nerves give feeling to the top and outside edge of your foot. The decision whether to operate depends on a number of factors:. The decision to have foot and ankle surgery is usually based on lifestyle choices and the information given by surgeons rather than being essential in terms of life and death.
Conditions that may need surgery include bunions and hammer toes, ankle arthritis, Achilles tendon disorders and plantar fasciitis. Bunions are bony lumps that develop on the side of your foot and at the base of your big toe. If symptoms carry on over a long period, your toe may need to be surgically corrected. This involves straightening your big toe and metatarsals, a process called an osteotomy.
Most surgery can be performed as a day case and takes up to an hour. If your bunion has been caused by rheumatoid arthritis , you may also develop rheumatoid nodules. These firm, pea-sized lumps can occur at pressure points such as your big toe joints, the back of your heels or on your toes, but they can be surgically removed. If treated early, surgery can be used to remove painful osteophytes overgrowth of new bone that can develop and allow more joint movement to return.
As well as bunions, hallux valgus can also cause your other toes to become clawed or permanently bent. This condition is known as hammer toes. Damages caused by hammer toes can be eased by:.
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Both procedures are performed as day cases and last around an hour. The joints in your forefoot can be damaged by inflammation of the lining of your joint synovitis in some forms of arthritis, for example rheumatoid arthritis. These small joints are called the metatarsophalangeal joints MTPJs , and they can become dislocated when damaged by arthritis. Your surgeon will be able to give you more information before the operation.
Ankle arthritis is usually caused by osteoarthritis. This is where the cartilage covering the ends of your bones gradually roughens and becomes thin, and the bone underneath thickens. This leads to pain, swelling and occasional deformity of the joint. You may need surgery if your symptoms are severe.
Ankle fusion — Ankle fusion involves removing the damaged ankle joint and fusing your talus bone to your tibia to form a stiff but pain-free ankle. Your foot is fused at a right angle to your leg, in the position it would be if you were standing up. Your bones are held together using screws and new bone grows across, creating one bone where there were two.
It normally takes between 12—14 weeks for the fusion to be complete and your bone continues to become stronger after this. You should be able to wear normal shoes after the cast is removed, although some alterations are occasionally needed. It takes 12—14 weeks for the fusion to be complete. Ankle replacement — An ankle replacement involves taking out the worn-out ends of your tibia and talus bones and replacing them with a man-made artificial ends made out of plastic or metal.
Unlike an ankle fusion, a replacement allows you to move your joint after surgery. Fusion after a replacement is harder to do than a primary fusion and more bone may need to be removed. You may need a bone graft where bone is taken from elsewhere in your body, normally your pelvis to replace the removed bone. This is quite a common procedure, and ankle fusion following a replacement is usually very successful.
Your Achilles tendon is the largest tendon in your body, and the muscle in your lower leg puts a lot of force through it to make you move. As we get older it can start to wear, which can lead to painful swellings within the main tendon or where it attaches to your heel bone. Very occasionally surgery can be used as a method of treatment. It most commonly affects the nerve to your third and fourth toes. If your symptoms are bad, surgery to remove the painful nerve can be successful.
The tibialis posterior is a muscle that supports the shape of your instep arch. The tendon that connects this muscle to the bone can become inflamed, leading to pain and swelling on the inside of your ankle. Continual swelling can start to cause the tendon to weaken, which can lead to a flatfooted look.
Occasionally, bad cases need surgery to rebuild the instep arch. The plantar fascia is a tough band of fibrous tissue that starts at your heel bone and stretches across the sole of your foot to your toes. Plantar fasciitis is inflammation at the site where the fascia attaches under your heel. Very rarely, bad cases may need surgery to release the plantar fascia from the heel bone. This procedure is usually performed as a day case and it takes less than an hour. As with any surgery, results can vary from person to person and there can occasionally be complications.
Alternatives to foot and ankle surgery may include exercise, footcare, drug treatment and specially modified shoes. These may include:. Complications of foot and ankle surgery can include infections, swelling and stiffness, and wound haematoma bleeding. Every possible care is taken to prevent complications, but in a few cases these do happen.
A wound haematoma is when blood collects in a wound. But occasionally blood may collect under your skin, causing a swelling. This can cause a larger but temporary leakage from the wound usually a week or so after surgery, or it may require a smaller second operation to remove the blood collection. Drugs like aspirin and antibiotics can increase the risk of haematoma after surgery. Before your surgery, your doctor or nurse will check your general health and give you information about preparing for surgery.
Ask about any possible changes to your medication and any other questions you may have. This may include not eating or drinking for a few hours before your operation. You should also discuss with your surgeon, anaesthetist or nurse whether you should stop taking any of your medications or make any changes to the dosage or timings before you have your surgery. Most foot surgery is aimed at correcting the positions of the joints by resetting the bones or fusing the joint in the corrected position. Your surgeon will discuss the potential pros and cons of all the available options before you decide to go ahead with surgery.
Therapeutic massage can help to reduce pain or tiredness in the feet. Massage can be combined with a relaxing warm-water footbath, and both of these are fine as long as you don't have any open wounds or sores on your feet. The effectiveness of treatments such as accupressure sandals and magnetic insoles isn't supported by evidence. Generally speaking, complementary and alternative therapies are relatively well tolerated, although you should always discuss their use with your doctor before starting treatment. There are some risks associated with specific therapies.
In many cases the risks associated with complementary and alternative therapies are more to do with the therapist than the therapy. This is why it's important to go to a legally registered therapist, or one who has a set ethical code and is fully insured.
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If you decide to try therapies or supplements, you should be critical of what they're doing for you, and base your decision to continue on whether you notice any improvement. A regular footcare routine can help to keep problems to a minimum but seek advice from your doctor or a podiatrist first, especially if:.
The routine should include regular nail cutting, filing the skin and applying appropriate foot care cream.
Choosing the right footwear is important. Good footwear, which is supportive and comfortable, is essential to improve pain and discomfort in the feet. You may need to take special care of your feet if you have arthritis, either because of the condition itself or because of the medications you take. A good, regular footcare routine will usually keep problems to a minimum:. If you have rheumatoid arthritis, you should have your feet checked by a professional just after your diagnosis and then once a year. This can be done by your GP, rheumatologist or nurse , and if you have problems you should be referred to an HCPC-registered podiatrist.
Some people with rheumatoid arthritis have a burning sensation in their feet at night. Using a hot-water bottle filled with cold water can help but you should speak to your doctor about it, especially if this is a new symptom. Calluses can usually be scraped away using a pumice stone or abrasive board. You should never use an open blade such as a scalpel or razor blade. Special skin files and scrapers may be suitable as long as you and your skin are in good health, although these will not help much with corns where the nucleus goes deeper into the skin. Check with your doctor or an HCPC-registered podiatrist first, especially if:.
Pads and cushions available from the chemist may help with painful pressure points, but over-the-counter creams and medicated corn plasters aren't generally recommended. If you're on steroids or biologics, or if you have vasculitis or your skin heals slowly you should avoid these treatments altogether. If you can't care for your feet yourself, your GP or hospital consultant can refer you for professional care within the NHS. Podiatry services accept patients on a self-referral basis. An HCPC-registered podiatrist will help with troublesome nails, corns and calluses, and they'll provide advice on finding special shoes or orthoses.
Some centres have access to an orthotist who will be able to assess and provide ready-made or custom-made shoes as required. Pain in the ankles and heels can come from joints themselves, or from muscles and tendons around the joints. Osteoarthritis isn't very common in the ankle but can be the result of previous damage from an injury or due to inflammatory arthritis. When inflammatory arthritis affects the ankle, the joint may be sore or stiff first thing in the morning or after sitting for a while.
Valgus heel is commonly associated with tendon damage on the inside of the ankle and arch; this can cause the heel to drift outwards which is known as valgus heel. It may not cause problems if it doesn't drift too far, but it can be troublesome if the arch flattens. It's fairly common in people with rheumatoid arthritis and research has shown that early treatment of rheumatoid arthritis may slow the development of valgus heel. It used to be known as policeman's heel and is the most common cause of discomfort around the heel.
Plantar heel syndrome frequently affects people aged 40 to 50 with active occupations. It can be associated with inflammatory arthritis. Research has shown that plantar heel syndrome is sometimes caused by the shortening of the Achilles tendon. Ask your doctor or physiotherapist about exercises to help you lengthen it.
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Losing weight and wearing insoles to provide cushioning in your shoes may ease symptoms. A steroid injection can help but they're not recommended as a first resort. Achilles tendinopathy can cause pain, inflammation and stiffness of the Achilles tendon at the back of the ankle.
It can occur as an over-use injury in people who take part in excessive exercise or exercise they're not used to. For example it can affect marathon runners. It can also affect people who have psoriatic arthritis , reactive arthritis or ankylosing spondylitis. This condition can also be called Achilles tendonitis.
However, Achilles tendonitis is an older term and strictly it means that there is inflammation, which might not necessarily be the case. Symptoms of Achilles tendinopathy can get worse when standing and walking. The pain may start slowly and increase in intensity over a period of time.
It may be so severe that you have difficulty walking. There may be some swelling and heat but this may be caused by inflammation of the bursa sac of fluid that sits between the tendon and the heel bone. The arches of the feet allow the weight of the body to be spread over many bones and joints. The arch structure can change when it's affected by arthritis, and the structures nearby can be strained. In mild cases this feels like tiredness in the arch area, but it can be more painful if the muscles or tendons are overworked.
Losing weight if you're overweight can help ease symptoms because it reduces the stress on joints. Swimming is a good form of exercise if you find weight-bearing exercise difficult. Some people find arch supports or foot orthoses helpful for arch pain or tiredness. Non-steroidal anti-inflammatory drugs NSAIDs , such as ibuprofen, can help with arch pain, and a steroid injection may ease severe pain.
You may find an anti-inflammatory gel applied two to three times per day can help. You can buy this in chemists and supermarkets. Anti-inflammatory tablets should be taken when a number of joints are painful. Having higher arches pes cavus may increase your chances of developing other problems such as hammer toes, bunions, corns or calluses.
Lower arches pes planus are sometimes linked to leg problems, especially knee cap pain. Pain can be caused by arthritis in the joints at the ball of the foot, especially if you have arthritis elsewhere. However, most pain in the ball of the foot comes from minor damage to the soft tissues: tendons, bursae, fat pads, nerves and skin. The most common causes of discomfort under the ball of the foot are calluses a build-up of hard skin and corns. Calluses form at areas of high pressure or friction and typically cause a burning pain.
If the pressure on the callus is extremely high, small areas of skin within the callused area produce an abnormal type of skin tissue, leading to the formation of a corn. Calluses will grow back in four to six weeks unless the pressure or friction that caused it is removed by changing to softer or roomier footwear or by inserting cushioning pads. Bursae are pockets of fluid that cushion joints and tendons. They can become inflamed under the ball of the foot and cause pain, particularly if wearing high heels or tight shoes, or by doing too much weight-bearing exercise.
People with rheumatoid arthritis often develop new and large bursae under the ball of the foot. Bursae can grow and shrink as the level of inflammation varies. They also occur next to large bunions or other irritated joints. Treatment for an inflamed bursa starts with reducing the pressure on the area. If it's large, especially inflamed or you've had it for a long time it may help to have fluid drained and a steroid injection. A neuroma is a thickening of a nerve, which occurs when it rubs against other internal tissues. It's most common at the base of the toes, often between the third and fourth toes.
A neuroma should settle down with more roomy footwear, but special insoles or pads under the area may help. A local steroid injection may be recommended and, if symptoms are severe, the thickened nerve may be surgically removed. In rheumatoid arthritis, firm, pea-sized lumps can occur at pressure points such as the big toe joints, the back of the heels or on the toes. Nodules on the soles of the feet can be particularly uncomfortable.
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Padding can ease the discomfort but, in some cases, the nodules may need to be removed surgically. Bunions are bony lumps that develop on the side of the foot at the base of the big toe. A bursa may develop here too, especially if shoes press against the bunion. The bursa may become inflamed and painful. Sometimes as the bunion develops, the big toe may be pushed over towards the smaller toes. The big toe joint becomes stiff and its range of movement is reduced sometimes without the bony lump. This is called hallux rigidus. This can cause the other toes to become clawed or permanently bent known as hammer toes.
Symptoms of a bunion can be controlled by choosing shoes with a soft, wide upper to reduce pressure and rubbing on the joint. Insoles orthotics can help control the foot function to relieve pressure on a painful joint. Bunion pads are available from chemists if you have a flare-up of a bunion or bursa. If symptoms persist over a long period, the bunion may need to be surgically removed. Hammer toes also known as claw toes, mallet toes or retracted toes are toes that are permanently bent.
Hammer toes are most common in people who have bunions or high-arched feet. Discomfort from hammer toes is usually due to a build-up of hard skin over the raised joints, resulting in corns and calluses. There's a slight risk of ulceration. Mild cases may be helped by rubber, leather or silicone splints. Pain from corns and calluses may be eased by choosing shoes with a more generous fit or softer uppers, or by using a protective pad over the painful area. The only way to correct hammer toes is with surgery. Rheumatoid arthritis, lupus, scleroderma and diseases such as diabetes that affect the bones, circulation and nerves can cause ulcers delayed healing and foot sores.
Ulcers on the toes and feet can be problematic in people with rheumatoid arthritis and scleroderma, where the circulation is compromised due to Raynaud's phenomenon. If you discover an open sore that won't heal, speak to your specialist rheumatology team at the hospital, which may include a nurse specialist and an HCPC-registered podiatrist, or a GP. If you're on steroids or biologics, it's important to treat ulcers as soon as possible because your risk of infection is greater.
Ulcers which have become infected may require treatment with antibiotics. Medications to improve the blood flow can help. The foot can be affected by many different conditions. Two causes of foot pain are plantar fasciitis and Achilles tendinitis. Try the exercises suggested here to help ease pain and prevent future injuries. Your pain should ease within 2 weeks and you should recover over approximately a week period.
Sit down and cross one foot over your knee. Grab the base of your toes and pull them back towards your body until you feel a comfortable stretch. Hold for seconds. Repeat 3 times. Sit down and rest the arch of your foot on a round object e. Roll the arch in all directions for a few minutes. Repeat this exercise at least twice daily. The front foot should be approximately 30 cm 12 inches from the wall. With the front knee bent and the back knee straight, bend the front knee towards the wall until the calk in your back leg feels tight. Relax and repeat 10 times. Repeat the 10 times.
Sit down with a towel on the floor in front of you. Keeping your heel on the ground, pick up the towel by scrunching it between our toes. Repeat times. As you improve, add a small weight such as a tin of beans to the towel. Loop a towel around the ball of your foot and pull your toes towards your body, keeping you knee straight. Hold for 30 seconds. Repeat 3 times on each foot. Exercise is important to keep your joints moving and helps you keep to a healthy weight. Losing weight if you're overweight can be difficult, but will help ease the pressure on painful feet. Swimming and other non-weight-bearing exercises are best if painful feet make it difficult to exercise.
A Health and Care Professions HCPC -registered physiotherapist or podiatrist may be able to suggest exercises to help with particular foot problems. If your ankles feel stiff in the morning, allowing some time for your joints to loosen up will usually help. You might find that having a bath or shower helps because the warm water can ease stiffness.
During the day, alternate between sitting and standing activities to take the pressure off your feet. Resting for 10 minutes at a time throughout the day can be helpful, especially if you keep your feet raised. This is particularly useful if you have plantar fasciitis or swollen ankles. Getting the right footwear will make a difference for almost all foot problems and the importance of appropriate footwear should not be underestimated. A bit of trial-and-error to get the right footwear might remove the need to seek out professional help.
Changes to footwear will be part of most professional discussions about foot problems. Comfort should be the main consideration when choosing shoes. High-heeled shoes or shoes that pinch your feet can contribute to the development of deformities such as bunions or hammer toes. Your feet may change shape as you get older, especially if you have arthritis, so you may need to try a different size or width fitting.
If the footwear protects your feet against injuries, supports them and keeps them warm, dry and comfortable, it's doing its job. Leather uppers are usually the most comfortable if you have foot problems, although many modern materials offer breathability, flexibility and comfort. Look for a cushioning sole unless you've been advised by a doctor or podiatrist that rigid soles are better for your particular foot problem.
If you need special insoles or orthoses, make sure there's enough room to fit them, especially in the toe area. Around the house, slippers may feel the most comfortable for hammer toes and prominent joints, but make sure the soles provide adequate cushioning. Always wear shoes when you're outside to make sure your feet are properly supported.
Factors to consider when buying shoes. Have your feet measured if they've become wider over the years or have changed shape because of arthritis. Your feet may change shape when you stand up, so have them measured while standing. Many shops have experienced fitters. Try shopping later in the afternoon. If your feet tend to swell, they'll be at their largest at that time.
Judge a shoe by how it feels on your foot and not just by the size marked on the shoe. Size varies between shoe brands and style. Think about how the shoe fits around your toes, under the soles and at the back of the heels. Always buy your shoes to fit the larger foot; many people have one foot bigger than the other. An insole can be used in the other shoe. Try shoes on with the type of socks or stockings you normally wear or with any insoles or orthoses you normally use.
Some insoles may need extra depth, especially in the toe area. Don't buy shoes to break in later; the right shoes for you will be comfortable when you first try them on. Buy shoes that have both leather uppers and inners the inner lining , if possible. These are more breathable than inners made of synthetic materials and will help to avoid dampness and fungal infections. Look for dark colours and a suede finish if you're worried about the appearance of your feet, they'll help to disguise the problem. You may need insoles in your shoes for a number of reasons.
An insole, or orthosis, can help to support the arch of your foot. If you have arthritis in the joint across the middle of your foot the midtarsal joint , a rigid insole may help. If you have one foot bigger than the other, an insole can help to pad out the shoe of your smaller foot. Insoles will often take up half a shoe size, so take along your largest shoes when you go for an insole fitting. Sometimes you may need to purchase a larger shoe to accommodate an insole, although this is not always the case. Take your insoles along when you buy new shoes. If you need to wear a prescribed insole, don't try to wear the new insole all day when you first receive it.
Wear it for a short period at first and gradually build up to longer periods.
Don't use them for heavy duty activity or exercise. If you change your shoes indoors, either have a second pair of insoles for your indoor shoes or remember to swap the insoles over. Your feet will return to their old shape while indoors and will never be comfortable if you don't continue to wear your insoles.
Lace-up shoes can be difficult to fasten if you have arthritis in your hands. Here are a few alternatives:. Useful leaflets on this and other subjects related to the feet and footwear are available from the Disabled Living Foundation or through your local occupational therapist. People with permanently swollen feet, very narrow, long, or broad feet, or with hammer toes or bunions may find it difficult to find shoes that fit them well. A number of retailers are beginning to stock shoes with extra width and depth, which can help.
It may be possible to have high-street footwear adapted by an orthotist - ask them for advice. Some people may have footwear prescribed by their consultant, GP or by a Health and Care Professions HCPC -registered podiatrist, but they're usually provided by an orthotist. You can also opt to see an orthotist or orthopaedic shoemaker privately. Each NHS hospital trust will have its own arrangements for footwear referral and entitlements. Many people prefer to wear slippers around the house.
However, slippers aren't a good idea for those who have to wear special insoles. They also sometimes contribute to falls in the elderly. The uppers of slippers are often soft, so they're comfortable for hammer toes and prominent joints, but the soles may lack adequate cushioning and grip.