October 21, 2018
Human soles with painted faces

Common Foot Problems (and What to Do About Them)

by Berkeley Wellness

According to a survey from the American Podiatric Medical Association, nearly 8 out of 10 people have experienced foot pain, with half of them reporting that it has restricted everyday activities like walking, exercising, working, and even playing with their children and grandchildren. Many common foot problems develop over time as a result of abnormalities (such as flat feet or idiosyncrasies of gait and stance) that are often inherited. Medical conditions such as obesity, osteoarthritis, and diabetes, all of which are on the rise in the U.S., can cause or worsen foot disorders.

In addition, foot problems may be caused or aggravated by ill-fitting shoes, which may be why women, who often wear high heels, are more likely to experience them than men.

The good news is that much foot pain is preventable. And many problems that do develop can be corrected, either on your own or with the help of a qualified health care provider.

The following is a rundown of the most common foot and toe conditions. Many people have more than one. As you’ll note as you read through them, the first line of treatment for many of them includes ice, rest, and, if needed, over-the-counter pain relievers (naproxen, ibuprofen, acetaminophen, or aspirin). And wearing proper footwear is usually a key to both prevention and treatment. Insoles are also frequently helpful. But if you have something that persists and interferes with walking or exercise or causes ongoing pain, seek medical care. Your doctor may refer you to a specialist, who can address biomechanical issues and, depending on the condition, may utilize other treatments.

Fun Facts About Feet

Did you know that your two feet together contain 52 bones—more than one-quarter of your body's total bones? Learn more interesting tidbits about your hardest working body part.

Note: If you have diabetes or poor circulation in your legs and feet, you should have your feet medically evaluated on a regular basis and see a doctor for any foot ailment, no matter how minor you may think it is, since these conditions increase the risk of foot infections and other complications.

Common foot and toe woes

Bunion (hallux valgus)

What it is: A deformity of the big toe, characterized by a bony outgrowth at the end of the metatarsal bone at the base of the joint. The big toe angles toward (or even over or under) the second toe, putting pressure on the joint and causing swelling and pain when you walk—though during flare-ups there can be pain even while at rest. (Smaller bunions, called bunionettes, may appear on the fifth metatarsal, at the base of the little toe.)

What causes it: The cause of bunions, which run in families and are more common in women, is not known but is thought to be related to the anatomy and biomechanics of the foot and toes. For example, having flat feet and overpronating (your foot rolls inward when you walk) may play a role.

There’s insufficient evidence to assess whether wearing high heels or tight, narrow shoes—which put excessive weight on the front of the foot—causes bunions, but in parts of the world where people go barefoot or wear broad-toed shoes, there is a lower prevalence of them. A paper from France that looked at foot bones in a necropolis containing remains from the 5th to 17th century found an increased prevalence of bunions over time, which the authors attributed to the influence of changes in footwear.

What to do: Rest, icing, pain relievers, and cortisone shots (on occasion) can help manage bunions, along with orthotics, toe straighteners, pads that reduce friction, and wide shoes made of soft material (you may have to experiment with different shoes to find ones that are most comfortable). A last resort is surgery, which reduces pain in most cases but involves weeks of recovery, plus it doesn't necessarily prevent bunion recurrence, especially if contributing factors are not addressed.

Hammertoes

What they are: Toes that are bent at the middle joint. They usually occur in one of the three middle toes, which curve into a hammer-shaped position and can eventually become painful and interfere with walking.

What causes them: Hammertoes often occur because of muscle imbalance in the foot resulting from wearing high heels or shoes with a narrow or short toe box for long periods of time. People with Morton’s toe and more rigid toe joints may be more prone to developing them. You may also be more susceptible if you have certain structural issues (such as very flat feet or very high arches) or other foot conditions (such as arthritis or bunions). Regularly putting your toes into a grip position, as happens when wearing flip-flops, may contribute too.

What to do: Switch to low-heeled shoes that have a soft, roomy toe area; wear sandals (but not flip-flops) when possible. Insoles may also provide some comfort. A physical therapist can provide recommendations and devices to help retrain the toes that still have some flexibility to flatten them out more; in some cases, the toes may be splinted. For hammertoes that cause extreme discomfort, surgery is an option, though it may involve a long recuperation during which you have to avoid most physical activity, and it is not a guarantee that the hammertoe won’t return.

Morton’s entrapment

What it is: A nerve compression at the base of the toes, often the third and fourth ones—similar to carpal tunnel syndrome (a nerve entrapment in the wrist). It's commonly but incorrectly called Morton’s neuroma. First described by Thomas George Morton in the 1870s, the condition is more common in women (especially those who wear high heels) and causes burning and pain in the ball of the foot and possible numbness in the toes. It’s associated with many activities, including ballet, jogging, and tennis.

What to do: Ice, massage, pain relievers, and orthotics are all part of conservative treatment; cortisone injections may also be an option. Putting an adhesive tear-drop-shaped pad under the forefoot may reduce pressure on the nerve. Traditional surgery—involving nerve decompression through a small incision—can be done if other remedies don’t work. Less-invasive procedures, such as radiofrequency ablation, may pose a lower risk of scar formation and return of symptoms.

Turf toe

What it is: A sprain that occurs when a toe, usually the big toe, is forcefully bent up beyond its normal range of motion (a hyperextension injury). It’s common in sports, like football, that are played on artificial turf (hence the name), when your shoe grips and sticks to the surface while your body continues moving forward. But it can happen in other settings, such as in martial arts or from wearing overly flexible shoes with poor support. Like all sprains, turf toe can range in degree, from mild (soft tissues are overstretched) to severe (ligament and associated joint capsule are completely torn).

What to do: As soon as the injury occurs, you should ice, rest, and elevate your foot to reduce swelling; in some cases, the toe can be taped. Once swelling is no longer increasing, you can do stretching exercises to increase range of motion in the toe. Because the injury may easily become chronic, it’s best to seek treatment for all but the mildest cases.

Sesamoiditis

What it is: An inflammation of the tendons associated with the two tiny bones on the bottom of the foot below the big toe, called sesamoids, which assist in weight bearing and stabilization of the big toe. A type of tendinitis, it results in dull pain in the ball of the foot when you put weight on it, especially when you jump or push off on it, but may progress to intense throbbing or sharp, even severe, pain. Sometimes the bones may fracture.

What causes it: Common in runners, baseball catchers, and ballet dancers, sesamoiditis can occur from repeated pressure on the forefoot during high-impact activities. Biomechanical problems, high arches, inflexible feet or bony feet (meaning there’s less padding around the bones), playing on a hard surface, and wearing poorly cushioned shoes or high heels may all contribute.

What to do: Rest or limit activities initially; ice the area and take pain relievers if needed. With instruction from your doctor or physical therapist, you may be advised to tape your big toe in a neutral or slightly bent-down position. Wear low-heeled soft-soled shoes or ones with stiff soles like clogs—whichever is more comfortable. Also helpful is a shoe with a slightly rolling curve to the sole, combined with a soft orthotic. A cushioned metatarsal pad placed away from the joint helps redistribute your weight, taking pressure off the inflamed area. When you increase activities, avoid those that put extra stress on the ball of your foot. If symptoms persist, diagnostic tests can be performed to help identify the problem and rule out other foot issues, such as a fracture. If sesamoiditis is confirmed, your doctor may recommend a removable short-leg fracture brace to wear for a month or, on rare occasions, a steroid shot. In extreme cases, the sesamoid bones may be surgically removed.

Do You Have Greek Feet?

If your second toe appears longer than your big toe, you have what's called Morton's toe—also known as Greek foot, because the ancient Greeks found it aesthetically appealing and incorporated it into much of their art.

Stress fractures

What they are: Hairline fractures, typically in the long bones of the feet (metatarsals)—notably in those associated with the second and third toes—but sometimes in the heel bone and the bone on top of the midfoot, as well as in the ankle. They're also known as “march fractures.”Pain from stress fractures typically increases gradually, worsens with activity, and lessens after rest. There may not be much swelling, but the area will be tender and may feel warm.

What causes them: Common in runners, stress fractures can occur from repetitive activity or if you rapidly change the intensity of your workout or abruptly switch to a different workout surface (for example, from running on pavement to running on a treadmill). You may be more prone to stress fractures if you have an underlying biomechanical issue, wear poorly cushioned shoes, play sports on hard surfaces, have flat feet, or have low bone density (due to aging, long-term steroid use, or an eating disorder, for instance).

What to do: Stress fractures often heal on their own in six to eight weeks (with rest, ice, pain relievers, and elevating the foot). Your doctor may recommend protective footwear such as a stiff-soled shoe or removable short-leg fracture brace, but, depending on the fracture, a cast or surgery may be needed. During recovery, you should refrain from high-impact activities to avoid a complete fracture (swimming and cycling are good alternatives). Note that X-rays may not reveal anything until several weeks (or even a few months) after symptoms start. And up to 50 percent of stress fractures never show up on X-rays, so an MRI may be needed if symptoms persist.

Subungual hematoma (“black toenail”)

What it is: The accumulatation of blood under a toenail, with resulting pain and tenderness.

What causes it: The problem can occur when the toe repeatedly hits against the inside of your shoe—as when running, hiking (especially downhill), or skiing, for example. Or it can result from a single strike, such as kicking a ball, or if something falls on the toe. It may also be a sign that your shoes don’t fit properly.

What to do: If the pain is severe, your doctor can pierce the nail to release the fluid for quick relief. If the nail is partly separated from the nail bed, it can be secured in place—or the nail may be removed, or it may fall off on its own. The trauma may cause the new nail to grow back thicker (see next section) or deformed.

Thick toenails (onychauxis)

What causes it: Thick toenails are associated with a number of conditions, including fungal infections, eczema, psoriasis, diabetes, and thyroid problems. You may also have a genetic predisposition. Or if you injure your toenail, it may grow back thicker. A thick toenail can make it uncomfortable to wear shoes because the nail presses upwards in the shoe—and it can be unsightly.

What to do: If you’re otherwise healthy, you can regularly file the nail down using an emery board (after soaking the nail in warm water and drying it), taking care not to file so much that you hit the nail bed. Your regular health care provider or a podiatrist can rule out a fungal infection or other potentially treatable causes and can also file the nail down when needed.

Corns

What they are: Thick hard growths of dead skin around a core, whose apex points inward and presses on nearby nerves,which can cause pain when walking. Hard corns typically develop on the outer toes and top of toes, “soft” corns between toes. (Often confused with corns, calluses are diffuse areas of skin thickening with no central core. Unlike corns, which have no useful function, calluses are protective and even desirable in some cases. They are usually painless and best left in place.)

What causes them: Corns form in response to pressure and chafing, usually from ill-fitting shoes, though having flat feet, an uneven gait, a toe deformity (such as a hammertoe), or a problem in foot mechanics increases susceptibility.

What to do: If a corn is bothering you, a podiatrist can pare it down and remove the core using a surgical blade (painlessly, since the skin is dead). Over-the-counter corn remedies containing salicylic acid must be used with care to avoid burns. To prevent corns, wear shoes and socks that fit properly; avoid high heels, pointed or narrow shoes, and any shoes that hurt. Various pads and cushions, as well as toe wraps or separators, can be used to protect more vulnerable parts of your feet, such as on the outside of your foot and between outer toes.

Webbed toes (syndactyly)

What they are: Webbed toes occur when toes, which normally separate by about the eighth week of human embryological development, remain fused. They are estimated to occur in one in every 2,000 to 3,000 humans (and 100 percent of all ducks, frogs, and kangaroos), with more males than females affected. The webbing may be partial or complete and may occur between just two toes (often the second and third) or between several toes. Whether webbed toes help people swim faster has yet to be determined.

What to do: This is mostly a cosmetic issue, but sometimes it causes discomfort. Surgery can be done to separate the toes.

Finding a foot professional

If you need to see a specialist for foot pain, there are several types of providers. These include orthopedists (MDs or DOs) who are trained to treat all types of bone and joint disorders, including fractures and torn ligaments; some undergo further training to become foot and ankle specialists. Podiatrists (doctors of podiatric medicine, DPMs) are specially trained and licensed to treat feet (from toenail fungus and plantar warts to bunions and hammertoes) and can, like orthopedists, prescribe medication and perform foot (and sometimes ankle) surgery.

Dermatologists, specialists in skin disorders, also commonly see people with such foot ailments as plantar warts and various nail conditions. Or you may be referred to a physical therapist for foot problems related to biomechanical or postural issues. Of course, your general physician can also tackle some foot conditions and should be your primary resource for diagnosing and treating any underlying medical conditions.

For more about your feet and to get further information about specific ailments, visit the website of the American Podiatric Medical Association.

Also see What to Do for Heel Pain.