Podiatry and foot health

If you have diabetes your feet should be checked at your annual diabetes review offered by your GP practice.

The foot screen is important as it reviews the health of your feet, advises you on how to maintain or improve the health of your feet and most importantly makes you aware of your Risk Status. It is important to understand your risk status so you can appropriately care for your feet. An individual's foot risk status tells us how likely they are to develop a non-healing foot wound, often referred to as 'ulcer'.  A person's risk can change over time so it's important to have a regular foot assessment.

Podiatry only provides an annual diabetic foot screen for those patients seen routinely for other concerns with their feet. Occasionally, your GP or practice nurse will request we examine your feet if they have identified any concerns requiring further investigations.

Please see the links and publications for advice on ways you can care for your feet according to your risk status. Speak to your Podiatrist, Practice nurse or GP for further individualised information.

The Diabetes Foot Team also treat acute foot problems such as:

• Ulceration
• Infection
• Suspected osteomyelitis (bone infection)
• Suspected Charcot Foot

Care of these conditions is provided by a specialist diabetes foot care team either in a community health centre or hospital setting. Please see the links and publications opposite for further details.

You may also find some useful information at Diabetes UK.

What is Podiatry?

Our team of Podiatrists provide assessment, diagnosis and treatment of conditions affecting the lower limbs and feet.

What can I expect?

You will be invited to attend an assessment clinic for the initial consultation. During this consultation, your medical status is assessed, risk of developing foot complications determined and you will be categorised as low, increased or high risk, and if you have urgent or non-urgent foot problems.

Initial advice and education specific to your foot health needs will be provided at this stage. In line with our service criteria and treatment pathways you will be:

• Discharged with education and advice on how you or your carers can manage your condition
• Offered further assessment/advice by remote consultation (video or telephone)
• Where remote consultation is not appropriate, offered a face to face appointment at one of our local podiatry clinics, or specialist care clinics.

If you have an urgent problem, you may be asked to travel to any one of our County-wide clinics to allow you to be seen as soon as possible.

Examples of urgent foot conditions include:

• Open wounds or ulcers on the foot
• Problems with wound healing
• A serious infection

If you have diabetes and have developed:

• New swelling, heat, pain or unusual odour.
• Change in colour (becomes blacker, bluer, redder or whiter than usual).
• Open wound  or discharge (oozing) onto your socks or stockings

please follow this link Diabetic Foot Emergency

Packages of care may be offered for less urgent foot problems such as:

• Ingrowing/infected toenails
• Painful problematic hard skin (callus) or corns
• Severe foot deformities (eg club foot or hammer toes) that cause significant pain, high pressure or risk of complication such as ulcers
• Painful nail conditions/deformities

Ongoing treatment will be provided on the basis of your medical and foot health needs.

Note: If you are classed as low risk and/or have minor foot problems such as normal toenails and minor hard skin, you are unlikely to receive ongoing NHS podiatry care. You will be provided with advice on how you or your family/carers can look after your minor foot problems. Please see the links and publications opposite for advice on ways you or your carers can care for your feet.

If you have any additional needs, for example you require an interpreter, please make this clear to you referring health care professional or you can contact the Podiatry Admin Team directly. Please see Get in Touch for details.

If you are bed bound or completely house bound a home visit can be arranged if we are informed in advance.

What is the CDDFT Musculoskeletal Podiatry and Biomechanics service and what do we offer?

CDDFT Musculoskeletal Podiatry and Biomechanics is a community based service providing assessment and treatment for Biomechanical problems, musculoskeletal (MSK) conditions, including injuries, involving the bones, joints, muscles and nerves of the foot, ankle and lower limb.  The service is comprised of Advanced MSK Podiatrists, Specialist Podiatrists and Podiatry Assistants.

Our Advanced MSK and Specialist Podiatrists have extensive knowledge in foot/ankle conditions and assessing lower limb biomechanics. Our Podiatrists offer of a comprehensive range of foot and ankle therapy, which may include prescription of individualised function foot orthoses (corrective shoe inserts), physical therapies and exercises as well as footwear and lifestyle advice. The Advanced MSK Podiatrists also assess for and deliver corticosteroid injections.

The team of MSK Podiatrists liaise with referring GPs and Healthcare professionals to request diagnostic investigations including x-rays, ultrasound, MRI, EMG & bloods tests, or to arrange referral to secondary care if required.

We support patients to self-manage and empower them to maximise any advice or treatment prescribed for the best possible outcomes. Please see our common conditions page for further advice on your symptoms and their management.

We implement Shared Decision Making at all stages of the pathway to ensure patients are fully engaged in their treatment plan, and take ownership of their condition, as early as possible.

Who is this for?

CDDFT Musculoskeletal Podiatry and Biomechanics accept musculoskeletal referrals for all patients (adults and children) with a Co Durham or Durham Dales, Easington or Sedgefield (DDES) GP.

How can you access this service?

The service accepts referrals from your GP, Consultant or other qualified Health Care Professionals. Self referral is also accepted to access this service. See podiatry self referral form on the podiatry home page.

When and where do we offer this service?

You will be invited to attend an initial clinical assessment appointment.

Clinic Sites

• Hundens Lane Clinic Darlington
• Bishop Auckland General Hospital
• Chester-le Street Community Hospital
• Green Lane (University Health Centre) Durham
• Stanley Primary Care Centre
• Sedgefield Community Hospital
• Seaham Primary Care Centre

The service is offered Monday to Friday, with appointments available from 8.30am to 4.00pm.

Please contact our central booking service for further information on when the clinics are available at the above sites.

Please note Musculoskeletal Podiatry and Biomechanics do not provide a home visiting service

You can contact our service by:

Phone:  01388 455 200

Post:
AHP Central Appointments
1st Floor Education Building
Bishop Auckland Hospital
Cockton hill
DL14 6AD

What Is Nail Surgery?

Nail surgery involves removing a piece or all of a problematic toenail under a local anaesthetic and, in most cases, preventing the problematic nail from growing back.

Referral

Referral for podiatry assessment can be made by your G.P. or other qualified health care professional.

What will happen at my assessment consultation?

Your Podiatrist will discuss your nail condition and general health and it would be helpful to have the following information at hand:

• List of current medication and medical conditions.
• If you have ever suffered an allergic reaction to medications or local anaesthetic injection.
• If you have diabetes we advise having your HbA1c (long term blood sugars) checked beforehand, this will need to be done at your GP surgery. Ideally this needs to be 75mmols or below otherwise we will not be able to carry out the procedure.
• If you have hypertension (high blood pressure) it would be helpful to know you current readings.

Having this information will allow you both to agree on what procedure you are best suited for, or if it would be better to try non-surgical treatments first. Please note it is not advisable to have nail surgery under local anaesthetic in the first trimester of pregnancy. If you are breast feeding you will need to express milk & have enough for 24 hours after the procedure.

Your Podiatrist will explain the procedure, answer any questions you may have and give you a nail surgery information booklet which should be brought to your surgery appointment.

Preparing for the appointment

• Ensure you have breakfast/light 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. An ambulance cannot be provided.
• Ensure you are able to rest the foot for the remainder of the day.

What will happen at my Nail Surgery Appointment?

When you arrive for your surgery appointment, your Podiatrist will check for changes in medical history, explain the procedure again and answer any questions you may have. They will check you are still happy for the procedure to go ahead (give consent). The procedure will require your toe(s) to be numb which is achieved using a local anaesthetic injection.

During the procedure a tight elastic band (tourniquet) is applied to the toe to prevent bleeding during the procedure. The toe nail is then either partially or totally removed. After removal of the nail, a chemical (phenol) is applied to the nail to prevent the nail growing back. Finally, a sterile dressing is applied.

The procedure usually takes about an hour and the local anaesthetic usually wears off in 2-3 hours. You will normally be able to return to work or school etc. the next day.

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

Normally, you will be required to attend an appointment within the week following surgery, to check and re-dress your wound.

After this appointment, unless advised otherwise by your podiatrist, 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 dressing (you will be provided with some at your surgery appointment).
• You will need to do this daily. It is important to avoid foot baths, prolonged soaking and any type of scrubbing of the area.

Healing times may vary from 4 to 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.

Please see the links and publications for further information.

WARNING - THE INFORMATION VIDEO CONTAINS IMAGES OF THE SURGICAL PROCEDURE BEING PERFORMED.

Childrens Feet

A baby is born with 26 bones which are made of soft cartilage and are easily deformed. The bones in young people's feet are not fully developed until they are 18-20 years old. Most of us are born with trouble free feet, but 3 out of 4 adults have foot problems or deformity.

Small children go through different phases of development from being flat footed to knock-kneed. Normal walking patterns do not develop properly until the age of about 6 or 7 years.

If you are concerned about your child's foot development, contact a podiatrist (Health and Care Professions Council Registered) or another health professional.

Please see the links and publications opposite for further details of common paediatric foot and lower limb problems.

Footwear

Chosing the correct footwear for your child is very important for normal foot development and avoiding foot problems in the future. Here are some tips:

• Always have children's feet measured when buying shoes.
• Children's feet should be measured every 3-4 months.
• The shoe should be the correct length, width and depth for your child's foot.
• There should be 1 cm or 0.5 inches between the end of your longest toe and the end of your shoe.
• The upper should be soft with no hard seams or ridges and made from a natural fibre such as leather which allows moisture to evaporate.
• The shoe needs to hold the foot firmly in place with an adjustable fastening, i.e. laces, straps with buckles or Velcro.
• The toe box should be round and deep to give the toes room to move.
• The heel should be less than 4 cm or 1.5 inches high, broad and stable.
• The shoe needs a firm heel counter that fits snugly around the back of the heel and helps to maintain and stabilise the heel in place as the shoe makes contact with the ground.
• Ideally the shoe will have a thick, lightweight, rubber sole of a non-slip material that flexes at the toes but does not bend in the middle of the sole.
• Socks should be checked to ensure they are not too tight and ideally made of cotton or other natural fibres.
• For small babies, 'baby-grows' with closed in feet can deform feet if they are too tight. Check them for fit or cut the toes out to prevent pressure.

Hygiene

Feet should be washed and socks changed daily to prevent poor hygiene and risk of infection such as athletes foot (fungal infection). Fungal infections can cause sogginess and peeling skin between the toes or redness, scaling over the soles of the feet or vesicles (small blisters) can form.

Poor hygiene can also cause smelly feet.

Sweaty feet

This is a common problem associated with teenagers and usually improves by the mid-twenties. The use of natural fibres and leather footwear, daily sock changes and the use of a charcoal based insole will help. Soggy white skin between the toes will improve with the daily application of surgical spirit. Do not use surgical spirits if it 'stings'.

Verrucae

Verrucae are a common viral infection of the feet. They normally disappear within two years of their own accord. By leaving them alone and letting nature run its course, immunity will be built up and prevent further infections. Should a verruca cause pain or spread rapidly, seek medical advice.

Nails

Always cut or file nails straight across following the contours of the toe. Never pick at them or cut down the sides. Incorrect cutting of toe nails and wearing tight footwear can lead to involuted (curved in) or ingrowing toenails. If a child has an infected or very painful in growing toe nail, this condition can be treated with a simple operation to remove the offending side of nail. See minor surgery.

Please see the links and publications opposite for further details of common paediatric foot and lower limb problems.

Athlete's foot is a common fungal infection that affects the feet. You can usually treat it with creams, sprays or powders from a pharmacy, but it can keep coming back.

Check if you have athlete's foot

Symptoms of athlete's foot include:

• Itchy white patches between your toes.
• Red, sore and flaky patches on your feet.
• Skin that may crack and bleed.
• It can also affect your soles or sides of your feet. If it's not treated, it can spread to your toenails and cause a fungal nail infection.
• Athlete's foot sometimes causes fluid-filled blisters.

A pharmacist can help with athlete's foot

Athlete's foot is unlikely to get better on its own, but you can buy antifungal medicines for it from a pharmacy. They usually take a few weeks to work.

Athlete's foot treatments are available as:

• creams
• sprays
• powders

They're not all suitable for everyone - for example, some are only for adults. Always check the packet or ask a pharmacist.

You might need to try a few treatments to find one that works best for you.

How you can help treat and prevent athlete's foot yourself

You can keep using some pharmacy treatments to stop athlete's foot coming back.

It's also important to keep your feet clean and dry. You don't need to stay off work or school.

Do

• dry your feet after washing them, particularly between your toes - dab them dry rather than rubbing them
• use a separate towel for your feet and wash it regularly
• take your shoes off when at home
• wear clean socks every day - cotton socks are best

Don't

• do not scratch affected skin - this can spread it to other parts of your body
• do not walk around barefoot - wear flip-flops in places like changing rooms and showers
• do not share towels, socks or shoes with other people
• do not wear the same pair of shoes for more than 2 days in a row
• do not wear shoes that make your feet hot and sweaty

Important
Keep following this advice after finishing treatment to help stop athlete's foot coming back.

See a GP if:

• treatments from a pharmacy do not work
• you're in a lot of discomfort
• your foot is red, hot and painful - this could be a more serious infection
• you have diabetes - foot problems can be more serious if you have diabetes
• you have a weakened immune system - for example, you have had an organ transplant or are having chemotherapy

Acknowledgement. The content in this section has been adapted from original information published by NHS.uk

Blisters should heal on their own within a week. They can be painful while they heal, but you shouldn't need to see a Podiatrist or GP.

How you can treat a blister yourself

To relieve any pain, use an ice pack (or a bag of frozen vegetables wrapped in a towel) on the blister for up to 30 minutes.

To protect the blister and help prevent infection:

Do

• cover blisters that are likely to burst with a soft plaster or dressing
• wash your hands before touching a burst blister
• allow the fluid in a burst blister to drain before covering it with a plaster or dressing

Don't

• do not burst a blister yourself
• do not peel the skin off a burst blister
• do not pick at the edges of the remaining skin
• do not wear the shoes or use the equipment that caused your blister until it heals

A pharmacist can help with blisters

To protect your blister from becoming infected, a pharmacist can recommend a plaster or dressing to cover it while it heals.

A hydrocolloid dressing can help reduce pain and speed up healing.

Check if you have a blister

• Blisters are small pockets of clear fluid under a layer of skin.
• Blood blisters are red or black and filled with blood instead of clear fluid.
• If the blister is infected it can be red, hot and filled with green or yellow pus.

Important
Don't ignore an infected blister. Without treatment it could lead to a skin or blood infection.

See a GP if:

• a blister is very painful or keeps coming back
• the skin looks infected - it's red, hot and the blister is filled with green or yellow pus
• a blister is in an unusual place - such as your eyelids, mouth or genitals
• several blisters have appeared for no reason
• a blister was caused by a burn or scald, sunburn, or an allergic reaction

Acknowledgement. The content in this section has been adapted from original information published by NHS.uk

Corns and calluses are hard or thick areas of skin that can be painful. They're not often serious. There are things you can try to ease them yourself.

Check if you have a corn or callus

You mostly get corns and calluses on your feet, toes and hands.

• Corns are small lumps of hard skin.
• Calluses are larger patches of rough, thick skin.
• Corns and calluses can also be tender or painful.

What you can do about corns and calluses

Important
If you have diabetes, heart disease or problems with your circulation, do not try to treat corns and calluses yourself.

These conditions can make foot problems more serious. See a GP or Podiatrist.

Corns and calluses are not often serious and there are things you can try to:

• get rid of them yourself
• stop them coming back
   

Things to do

• regularly use a pumice stone or foot file to remove hard skin
• moisturise to help keep skin soft
• wear thick, cushioned socks
• wear wide, comfortable shoes with a low heel and soft sole that do not rub
• use soft insoles or heel pads in your shoes
• use non medicated felt padding to cushion and deflect pressure
• various toe/foot pads are available from pharmacies and health care retail stores

Your Podiatrist can advise on the most appropriate measures to take in individual cases

Acknowledgement. The content in this section has been adapted from original information published by NHS.uk

Fungal nail infections are common. They're not serious but they can take a long time to treat.

Check if it's a fungal nail infection

Fungal nail infections usually affect your toenails, but you can get them on your fingernails, too.

• Fungal nail infections usually start at the edge of the nail.
• They often then spread to the middle. The nail becomes discoloured and lifts off.
• The nail becomes brittle and pieces can break off. It can cause pain and swelling in the skin around the nail.

A pharmacist can help with fungal nail infections

Speak to a pharmacist if the look of your nail bothers you or it's painful.

They may suggest:

• antifungal nail cream - it can take up to 12 months to cure the infection and does not always work
• nail-softening cream - used for 2 weeks to soften the nail so the infection can be scraped off

The infection is cured when you see healthy nail growing back at the base.

See a GP or Podiatrist if your fungal nail infection:

• is severe and treatment has not worked
• has spread to other nails

Treatment for a fungal nail infection

Your GP can prescribe antifungal tablets. You'll need to take these every day for up to 6 months.

Tablets can have side effects, including:

• headaches
• itching
• loss of taste
• diarrhoea

You cannot take antifungal tablets if you're pregnant or have certain conditions. They can damage your liver.

Badly infected nails sometimes need to be removed. It's a small procedure done while the area is numbed (under local anaesthetic). See Minor Surgery

Other treatment

Laser treatment uses laser to destroy the fungus.

You'll have to pay for it as it's not covered by the NHS. It can be expensive.

There's little evidence to show it's a long-term cure as most studies only follow patients for 3 months.

Preventing fungal nail infections

Fungal nail infections develop when your feet are constantly warm and damp.

You're more likely to get an infection if you wear shoes for a long time and have hot, sweaty feet.

To prevent fungal nail infections

Do

• treat athlete's foot as soon as possible to avoid it spreading to nails
• keep your feet clean and dry
• wear clean socks every day
• wear flip-flops in showers at the gym or pool
• throw out old shoes

Don't

• do not wear shoes that make your feet hot and sweaty
• do not share towels
• do not wear other people's shoes
• do not share nail clippers or scissors

Acknowledgement. The content in this section has been adapted from original information published by NHS.uk

An ingrown toenail is a common problem where the nail grows into the toe. It can be painful, but there are things you can do to ease the pain.

Check if you have an ingrown toenail

You usually get an ingrown toenail on your big toe. But you can get them on any toe.

• Your toe may be red, painful and swollen.
• Your toenail may curve into your toe.
• Your toe can also get infected.

Signs of an infected toe include:

• pus coming out of it
• you feel hot or shivery

How to treat an ingrown toenail at home

If you go to a GP, they'll usually suggest you try these things first.

Do

• soak your foot in warm water 3 to 4 times a day for a few days - this softens the skin around your toe and stops the nail growing into it
• keep your foot dry for the rest of the day
• wear wide, comfortable shoes or sandals
• take paracetamol or ibuprofen to ease the pain

Don't

• do not cut your toenail - leave it to grow out
• do not pick at your toe or toenail
• do not wear tight, pointy shoes

Non-urgent advice: See a GP if:

• treating it at home is not helping
• your toe is very painful and swollen with pus coming out of it
• your temperature is very high or you feel hot or shivery
• you have diabetes - foot problems can be more serious if you have diabetes

Treatments for an ingrown toenail

A GP can:

• check your toe to see if it's an ingrown toenail
• give you antibiotics if your toenail is infected

If you have a badly ingrown toenail, they may refer you to a Podiatrist.

Treatment from a Podiatrist

A Podiatrist may offer further treatments, such as:

• cutting away part of the nail
• removing the whole nail

You'll have an injection of local anaesthetic to numb your toe when this is done. See Minor Surgery

How to prevent ingrown toenails

To help stop ingrown toenails:

• do not cut your toenails too short
• cut straight across the nail, not the edges
• do not wear shoes that are too tight or do not fit properly

Acknowledgement. The content in this section has been adapted from original information published by NHS.uk

What is a verruca?

A verruca is a wart on the foot caused by a virus which can be caught and spread very easily.

What is the difference between a verruca and a corn?

A corn is usually painful when directly pressed, whereas a verruca is often painful when pinched.

What are the symptoms?

Sometimes verrucae are painful particularly when on the weight bearing part of your foot. More often than not, you will not feel them and they will not really inconvenience you.

How can you get rid of a verruca?

There are no treatments that guarantee to cure a verruca. Most disappear within 2 years even if left alone without treatment. Some do persist for longer periods and may spread. The older you are the longer they tend to take to disappear.

Advice on self-management

It is a good idea to keep verrucae covered to prevent spread, especially in communal changing areas.

If the verruca becomes thick and painful, you could remove some of the surface hardness with a pumice stone. Keep this pumice stone for your personal use only to prevent spreading the virus.

You could pad around the verruca with a non-medicated felt ring if walking on it is painful.

There are some treatments available from pharmacies, but these must be applied with caution as they may contain acids which can damage ordinary skin.

DO NOT USE THESE TREATMENTS IF HAVE DIABETES OR POOR CIRCUALTION.

It is always best to consult your pharmacist if you are unsure if the treatments are suitable for you.

The best treatment is to cover your verruca with a plaster and let nature take its course. Remember, most will go away on their own and especially if you are young.

Acknowledgement. The content in this section has been adapted from original information published by NHS.uk

Bunions are bony lumps that form on the side of the feet. Surgery is the only way to get rid of them, but there are things you can do to ease any pain they cause.

Check if you have bunions

Symptoms of bunions include:

• Hard lumps on the sides of your feet, by your big toes.
• Your big toe pointing towards your other toes.
• Hard, red or swollen skin over the lump.

You may also have pain along the side or bottom of your feet. Associated pain in the ball of your foot is called transfer metatarsalgia as more weight is transferred to the 2nd-4th when walking. See Metatarsalgia

How to ease bunion pain yourself

You cannot get rid of bunions or stop them getting worse yourself, but there are things you can do to relieve any pain:

Do

• wear wide shoes with a low heel a fastening retainer such as a lace to hold the foot in position and prevent the foot from sliding in the shoe causing more pressure at the forefoot and toes
• hold an ice pack (or a bag of frozen peas wrapped in a tea towel) to the bunion for up to 5 minutes at a time
• try bunion pads (soft pads you put in shoes to stop them rubbing on a bunion) - you can buy these from pharmacies
• take paracetamol or ibuprofen
• try to lose weight if you're overweight

Don't

• do not wear high heels or tight, pointy shoes

Acknowledgement. The content in this section has been adapted from original information published by NHS.uk

Smelly feet aren't fun for anyone, so good personal hygiene and changing your shoes regularly should keep your feet fresh and sweet smelling.

Medically known as bromodosis, stinky feet are a common year-round problem.

The main cause is sweaty feet combined with wearing the same shoes every day.

Why feet sweat

Anyone can get sweaty feet, at any temperature or time of year.

But teenagers and pregnant women are more likely to get them because hormonal changes make them sweat more.

You're also more likely to have sweaty feet if you're on your feet all day, wear shoes that are too tight, are under a lot of stress, or have a medical condition called hyperhidrosis, which makes you sweat more than usual.

Feet often become smelly if sweat soaks into your shoes and they don't dry before you wear them again.

How to treat and prevent smelly feet

The good news is that smelly feet are usually easy to treat by keeping your feet clean and dry, and changing your shoes regularly.

To treat sweaty or smelly feet yourself, try to:

• wash your feet with an antibacterial soap once a day (a pharmacist can advise you about different products)
• dry your feet well after they have been wet, especially between your toes
• try not to wear the same pair of shoes 2 days in a row so they have at least 24 hours to dry out
• change your socks (ideally wool or cotton, not nylon) at least once a day
• keep your toenails short and clean, and remove any hard skin with a foot file (it can become soggy when damp, which provides an ideal home for bacteria)

If you often get sweaty feet, you might want to try:

• using a spray deodorant or antiperspirant on your feet - a normal underarm deodorant or antiperspirant works just as well as a specialist foot product and will cost you less
• putting medicated insoles, which have a deodorising effect, in your shoes
• using a foot powder to absorb sweat (a pharmacist can advise you about foot powders)
• trying socks for sweaty feet - some sports socks are designed to keep feet dry, and you can get special antibacterial socks
• wearing leather or canvas shoes, as they let your feet breathe, unlike plastic ones
• always wearing socks with closed-toe shoes

When to see a doctor

Smelly feet are a harmless problem that generally clears up. Sometimes, however, it can be a sign of a medical condition.

See your GP if simple measures to reduce your foot odour don't help, or if you're worried that your level of sweating is abnormally high.

Your doctor can offer you a strong prescription antiperspirant or refer you for a treatment called iontophoresis, which delivers a mild electric current through water to your feet to combat excessive sweating.

Acknowledgement. The content in this section has been adapted from original information published by NHS.uk

Chilblains are small, itchy, red patches that can appear after you have been in the cold. They usually clear up on their own. You may need to see a health care professional if they do not go away.

Check if you have chilblains

Chilblains usually appear a few hours after you have been in the cold.

You mostly get them on your fingers and toes. But you can get them on your face and legs, too.

• Your skin can feel itchy or like it's burning
• Your fingers or toes may become red or swollen

Causes of chilblains

You can get chilblains when it's cold. The cold makes the tiny blood vessels in your fingers and toes get smaller. This stops blood moving around as easily.

If you warm up too quickly, the blood vessels get bigger again and blood rushes to your fingers and toes. This can cause pain, redness and swelling.

What you can do about chilblains

Chilblains usually go away on their own in 2 to 3 weeks.

There are things you can try to:

• get rid of them yourself
• stop them coming back

Do

• take paracetamol or ibuprofen to ease the pain (see below)
• avoid being outside when it's cold or damp
• wear warm, waterproof clothing, gloves and thick socks if you do go out when it's cold or damp

Don't

• do not put your feet or hands on a radiator or under hot water to warm them up
• do not smoke or have drinks that have caffeine in them - this can affect the flow of blood in your fingers and toes
• do not scratch or pick at your skin

You can ask a pharmacist about:

• the best painkiller to take
• creams that can help to soothe the itching
• whether you need to see a GP

See a GP if:

• your skin has not got any better after 2 to 3 weeks
• there is pus coming out of your skin
• your temperature is very high or you feel hot or shivery
• you keep getting chilblains
• you have diabetes - foot problems can be more serious if you have diabetes

Acknowledgement. The content in this section has been adapted from original information published by NHS.uk

Bunions

What are bunions?

A bunion, also known as 'hallux valgus', is a deformity of the big toe in which the big toe excessively angles towards the second toe and leads to a bony lump on the side of the foot. This can also form a large sac of fluid, known as a bursa, which can then become inflamed and sore.

What causes them?

They are most often caused by a defective mechanical structure of the foot, which is genetic, and these certain foot types make a person prone to development of a bunion. Poorly fitting footwear tends to aggravate the problem as tight or narrow footwear can squeeze the forefoot, crowding the toes together and exacerbate the underlying condition, causing pain and deformity of the joint.

Bunions can also be caused by the big toe pushing over on to the second, causing crossover of the toes, which makes it difficult to walk due to pressure on the toes from footwear. Once the big toe leans toward the second toe, the tendons no longer pull the toe in a straight line, so the problem tends to get progressively worse. This condition can also lead to corns and calluses developing.

Bunions can also be caused by age, arthritis or playing sport.

Who gets them?

Although anyone can get a bunion, they tend to be more common in women, possibly due to some of the more restrictive footwear typically worn (more than 15% of women in the UK suffer from bunions). Women also tend to have looser ligaments. If your parents or grandparents have them, you may also be more prone to developing them.

Are they serious?

Some people have large bunions that cause no pain but do cause difficulties with footwear, while others have relatively small bunions that can be very painful. Although some treatments can ease the pain of bunions, only surgery can correct the defect.

In some cases, pressure from the big toe joint can lead to a deformity in the joint of the second toe, pushing it toward the third toe and so on. However, just because you have a bunion, does not mean you'll get a bursa as well.

What are the treatments?

Your podiatrist may recommend the following:

ExercisesOrthoses (special devices inserted into shoes)Shoe alterations or night splints which hold toes straight during sleep (helps to slow the progression of bunions in children)These are all conservative measures and, although they may help relieve symptoms, there is no evidence they can correct the underlying deformity. Your podiatrist will be able to identify any significant deformity and/or defect and may refer you for surgery, which can involve a combination of removing, realigning and pinning of the bone.

Once referred, your podiatric surgeon will evaluate the extent of the deformity. They can remove the bunion and realign the toe joint in a common operation known as a first metatarsal osteotomy ('bunionectomy').  However, there are more than 130 different types of operation that fall under this title, so each individual surgery is different.

The aim of surgery is to address the underlying deformity to prevent recurrence. As with all surgery, there are risks and complications, so it is not usually advised unless your bunions are causing pain - or are starting to deform your other toes.

How can I prevent them?

Wearing sensible shoes that fit well is a good preventative measure. If you notice a bump developing where your big toe joins the foot, it may be time to switch your footwear. Try to opt for wider shoes that provide your toes with room to move and keep your heel height to no more than 4cm for maximum comfort.  The following also serves as a useful guide:

• Wear backless, high-heeled shoes in moderation. Backless shoes force your toes to claw as you walk, straining the muscles if worn over a long period.
• Vary your heel heights from day to day, one day wearing low heels and the next day slightly higher heels.
• If you want to wear a heel every day, keep heel heights to 4cm or less.
• Wearing a shoe with a strap or lace over the instep holds the foot secure and helps stop your foot sliding forward.
• Calf stretches to counteract the shortening of the calf can help to keep feet supple.

When should I see a podiatrist?

If you experience any foot care issues that do not resolve themselves naturally or through routine foot care within three weeks, it is recommended that you seek the help of a healthcare professional.

Acknowledgement. The content in this section has been adapted from original information published by The College of Podiatry

Arthirits of the Big Toe (Hallux Limitus/Rigidus) 

The big toe joint is the most common site for osteoarthritis in the foot. This can occur from late teens onwards, though it is more common with increased aged. It is thought to affect about 20% of people over the age of forty. 'Hallux' is the medical term for the big toe. 'Limitus' means there is reduced movement at the big toe joint which is an indication of osteoarthritis. 'Rigidus' means that the condition is so advance that the joint will no longer move. Full upward motion at the big toe joint is about 90°. Recent studies have shown that we use no more than 45° of upward movement at the big toe joint during normal walking. It is therefore typical that the osteoarthritic changes can progress to quite an extent before people start experiencing a level of pain and swelling that requires them to seek medical attention.

Hallux rigidus

What causes osteoarthritis of the big toe?

In most cases, these changes are due to a specific injury or repetitive minor trauma. Certain recreational and occupational activities can lead to degenerative changes over time. You are more likely to develop osteoarthritis in the big toe if you have a flat arched (pronated) foot, if you already have a bunion, if there is a family history of osteoarthritis in the big toe and with the wearing of shoes that are too flexible or if the heel is too high.

There are some conditions such as rheumatoid arthritis and gout that can lead to changes within the joint which results in degeneration and subsequent osteoarthritic changes. These conditions normally affect more than one joint. Other rare causes of big toe joint pain include infection or a piece of bone within the joint space.

How is osteoarthritis of the big toe diagnosed?

These osteoarthritic changes have quite a characteristic appearance. The joint will normally be enlarge. There can be a bony lump 'Osteophyte' over the top or the side of the big toe joint. Pain can typically be experienced by bending the big toe joint upwards with your hand, most commonly at the end of this range of motion.

These signs and symptoms will normally be sufficient for your clinician to make the diagnoses. Sometimes investigations such as x-ray may be used to help decide the best way to treat the condition. Blood tests may be ordered if there are any reasons to suggest that the symptoms may be due to conditions such as gout of rheumatoid arthritis.

Will the pain get worse?

Arthritis is a progressive condition and typically will get worse through time though this is usually very gradual over a number of years. As a result, the joint will become more stiff and prominent / enlarged. Although the degree of pain is generally related to the extent of arthritic change, it does not necessarily get more painful through time. The joint can continue to stiffen until the point that it stops moving altogether. Often, at this stage, there can be a reduction in pain.

It is common for people to experience other symptoms away from the big toe joint due to changes in the way that they walk to compensate for the loss of big toe joint movement. There can be discomfort over the outside of the foot as you 'push off' away from the big toe joint. Pain over the outside of the ankle and lower back pain can also occur.

Will I require any treatment?

Usually the symptoms associated with this condition can be self-managed.

Pain relief

You can take simple pain killers if the pain is significant and interfering with your daily activities. Try paracetamol first as side-effects are rare if you stick to the correct dosage. Sometimes anti-inflammatory medicines such as ibuprofen are useful. If you have never taken this type of medication before, or have not done so for a long time, you should first check with a pharmacist, or your GP to make sure there is no reason why you should not take these. These are painkillers but they also reduce inflammation and may work more effectively than ordinary painkillers. Some people find that rubbing a cream or gel that contains an anti-inflammatory medication, onto the joint can also be helpful.

Ice

This can help to reduce the pain and inflammation associated with the condition. This can be very effective at the end of a busy day. Place some ice cubes or a bag of frozen peas in a tea towel. Place on the joint for 10-15 minutes. This can be repeated on the same day though not within 2 hours of the last application.

Footwear

Rather than treating the symptoms, it is better to try and prevent this happening in the first place. The pain and inflammation occurs in the big toe joint because the joint is being forced to bend when your foot pushes off from the ground when walking and running. Footwear such as high heels, or footwear that is overly flexible, increase this demand on the big toe joint to bend and will lead to pain and inflammation.

It is generally found that the best type of footwear are those that are hard to bend or even completely stiff at the front of the shoe. The front of the shoe should also have a roll or a rocker. These properties in a shoe will act to splint the joint and reduce the demands on the joint to bend. Shoes may also need to be quite deep at the front of the shoe to accommodate the enlarged joint. Many people find that they can control the pain well if they wear this type of footwear most of the time.

Foot orthoses

This intervention can offer benefit though it is likely to only be considered at an early stage, with the aim of improving the motion at the big toe joint during walking/sporting activities. This is unlike to help much in the more advanced stages where the joint is quite stiff.

Steroid injections

A steroid (cortisone) injection, which usually includes a local anaesthetic, can sometimes be used. As with any osteoarthritic condition, there are, however, no guarantees on how long any benefit will last. The symptoms may recur quite soon, within days or weeks, although there might not be a recurrence of pain for over a year. Adherence to footwear advice should prolong any benefit experienced from a steroid injection. It is not advisable to have too many steroid injections to the same joint, over a short period of time, as there are concerns that this may accelerate further osteoarthritic change.

Surgery

A referral can be made for you to be assessed in a surgical department where it can be decided if it is appropriate for you to have an operation. In some cases people may benefit from having surgery for this condition, however, as with all operations, there are risks and complications that can occur and these will be discussed with you by your specialist. It is also important to be aware that, following surgery, you may be left with some pain and stiffness and the deformity can recur again in the future. It is therefore not advisable to have surgery if the deformity is not painful and does not limit your daily activities.

Acknowledgement. The content in this section has been adapted from original information published by Leeds Community Healthcare NHS Trust.

Metatarsalgia

Pain within the ball of the foot or forefoot, is known as Metatarsalgia. Pain may radiate into the toes (see also Morton's neuroma below).

As the forefoot supports our bodyweight during standing or exercise, metatarsalgia is common. It can be caused by injury, badly fitting shoes, excessive exercise or foot conditions such as bunions. Pain symptoms may feel mild to severe and affect daily activities, work or exercise. Treatment is simple and starts at home by making changes to your lifestyle, performing exercises, using different shoes or insoles all without the need to see a GP or a specialist.

Symptoms of Metatarsalgia

Discomfort can be mild to severe and described as:

• Pain felt underneath the toe joints, under the forefoot and into the smaller toes.
• Burning
• Shooting
• Pins and needles with numbness
• Sharp or aching pain
• A rucked up sock or pebble sensation beneath the foot.
• One or both feet may be affected

Causes of Metatarsalgia

• High-heeled narrow shoes increase pressure under the forefoot and stop toes from supporting bodyweight during standing or activity.
• Sudden changes in exercise increase strain upon bones, tendons and muscles.
• High arched, flat feet or stiff ankles may increase the risk of metatarsalgia.
• Arthritis, gout, bunions, bursitis, Morton's neuroma, hammer toes and occasionally stress fractures may result in metatarsalgia.
• Diabetes, weight gain and age related changes may increase the risk of metatarsalgia

Treatment of Metatarsalgia

Lifestyle

Keep active and eat a healthy diet to help reduce unwanted weight gain. Sleep 7-8 hrs+ each night as pain is worse without adequate sleep. Swap high impact activities such as running for low impact exercise like swimming or cycling. Increase exercise gradually to allow your body to adapt and become stronger. Take rest breaks if you stand a lot.

Pain relief (Always ask your pharmacist before taking medication)

Paracetamol can help mild to moderate pain. Ibuprofen is for severe pain and swelling, avoid taking if you have diabetes, stomach complaints or cardiovascular problems. Ice the painful area for 10 minute periods. Place a towel between the skin and ice to prevent ice burns and skin damage.

Footwear

Shoes should be well cushioned, have low heels and be wide enough for all toes to move. A stiff soled shoe can reduce metatarsalgia, but experiment to find your preferred comfortable option. Walking shoes and trainers can be good options.

Insoles / pads

Insoles are a cheap and effective way to change how feet absorb pressure. Insoles with arch and metatarsal support (metatarsal dome pads) can be effective for metatarsalgia. These can be bought cheaply online, from chemists or sports shops.

Acknowledgement. The content in this section has been adapted from original information published by East Sussex Healthcare NHS Trust

Morton's neuroma

The pain of Morton's neuroma occurs when the nerve connecting the toe bones (metatarsal bones) becomes irritated or compressed. The exact cause of the irritation is unknown, but it may be the metatarsal bones pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken.

Some experts believe that a number of other foot problems, including flat feet, high foot arches, bunions and hammer toes, may also play a role in Morton's neuroma.

People with Morton's neuroma usually complain of pain that can start in the ball of the foot and shoot into the affected toes. However, some people just have toe pain. There may also be burning and tingling of the toes. The symptoms are usually felt up the sides of the space between two toes. For example, if the nerve between the third and fourth long bones (metatarsals) of the right foot is affected, the symptoms will usually be felt up the right-hand side of the fourth toe and up the left-hand side of the third toe. Some people describe the pain that they feel as being like walking on a stone or a marble.

Treating Morton's neuroma

If you have Morton's neuroma, shoes with a wider toe area may be recommended. You can also take painkillers to help ease the pain.

Insoles are a cheap and effective way to change how feet absorb pressure. Insoles with arch and metatarsal support (metatarsal dome pads) can help. These can be bought cheaply online, from chemists or sports shops.

Steroid/local anaesthesia injections may also be given to treat the affected nerve if more conservative measures fail. In rare cases, surgery may be needed. This involves removing the thickened tissue around the nerve (and sometimes the nerve itself) to release the pressure.

Acknowledgement. The content in this section has been adapted from original information published by East Sussex Healthcare NHS Trust

Plantar Fasciitis (or fasciopathy)

This is the most common caused by damage to the fascia 'band' (similar to a ligament) which connects the heel bone to the base of the toes. This condition can be caused in various ways including extensive running, walking or standing for long periods of time, especially when you have a sedentary lifestyle. In particular, a change of surface (e.g. road to track), poor shoe support, being overweight, overuse or sudden stretching of your sole, as well as a tight Achilles tendon, can lead to this condition.

Who gets it?

Heel pain can affect everyone, whatever your age, but those more commonly affected include those in middle age (over 40s age group), those who are overweight or stand for long periods of time, as well as athletes.

How do I know I have it?

With plantar fasciitis, there are often no visible features on the heel but deep localised painful spots found in or around the middle of the sole of the heel, and pain is usually worse on standing after long periods of rest, particularly first thing in the morning.

Is it serious?

Plantar fasciitis is a common condition and in most cases will diminish following some routine self-care measures. If the pain persists longer than three weeks, it is best to seek professional advice from a podiatrist, as there are many types of heel pain, each with their own different causes and separate forms of treatment.

What are the treatments?

If you experience heel pain, some simple self-care measures include:

• Avoid wearing ill-fitting or uncomfortable shoes
• Wear shoes with good heel cushioning and effective arch support
• Minimise walking or exercising on hard ground
• Rest regularly and try not to walk or run too fast
• Wear a raised heel (no more than 6-10 mm higher than normal)
• Lose weight if you are overweight

More specialist treatments include:

Plantar fasciitis (or fasciopathy):

Treatment can take many forms, from resting your foot as much as possible, stretching exercises and deep-heat therapy to steroid injections and even medication or surgery to release the tight tissue 'band'. In the acute stage, use ice compresses for 10 minutes twice a day, and ibuprofen (always check with your GP or pharmacist before taking any new medication). In some cases, padding and strapping is applied to alter the direction of stretch of the ligament to alleviate symptoms in the short term. However, for the long term, special insoles (orthoses) may be prescribed to help the feet to function more effectively and help to make any possible recurrence less likely.

Painful Flat foot

A painful flat foot will often involve a muscle called tibialis posterior. This can be called several names including posterior tibial tendon dysfunction (PTTD) and it can be the result of a sudden change in activity levels, or it could be a gradual increase in discomfort due to increased demand on the muscle.

The main purpose of this muscle is to help stabilise the arch of the foot and, more often than not, it happens because the muscle/tendon is not strong enough to cope with the demand that is being placed on it. The picture below shows the area where the musclen and tendon run around the inside of the ankle.  Its main insertion point is the inside of the arch, however it has multiple insertions so the pain may spread around the arch of the foot.

You might notice some swelling or pain around the inside of your ankle bone and into the arch of your foot, or that the arch of the affected foot is flattening. A reasonably reliable way of telling if this muscle is involved, is to try multiple heel raises on the unaffected leg - and then seeing if you can do the same on the affected leg without any discomfort.

Spending long periods standing or walking, especially a sudden increase in these activities is often the reason we see problems around this area. Also, if you are overweight, this will increase the stress through the muscle and tendon.

If you think you have this problem, it is important to seek advice from your GP or Podiatrist as the condition can be progressive.

Footwear is a very important aspect of first-line treatment. Good quality walking shoes or boots that offer support both to the arch of the foot and around the ankle are recommended.

Acknowledgement. The content in this section has been adapted from original information published by NHS Greater Glasgow and Clyde

Rearfoot and Heel Pain

What is heel pain?

The heel is a specialised part of the body designed to absorb the impact of your body weight when walking, running or undertaking any other form of physical exertion or weight-bearing exercise. When pain does develop, it can be very disabling, making every step a problem, which in turn affects your overall posture.

What causes the problem?

Heel pain is a common occurrence and in most cases the pain is caused by some form of mechanical injury caused by small repetitive injuries that occur at a rate faster than the body can heal them.

Heel pain can also be caused by lower back problems or inflammatory joint conditions.

The following types of heel pain are not exhaustive but may help you appreciate the complexity of heel pain and why specialist advice can be helpful.

Plantar Fasciitis (fasciopathy)

This is the most common caused by damage to the fascia 'band' (similar to a ligament) which connects the heel bone to the base of the toes. This condition can be caused in various ways including extensive running, walking or standing for long periods of time, especially when you have a sedentary lifestyle. In particular, a change of surface (e.g. road to track), poor shoe support, being overweight, overuse or sudden stretching of your sole, as well as a tight Achilles tendon, can lead to this condition.

Other causes Heel Pain

Heel bursitis (subcalcaneal bursitis):

This is an inflammation of a bursa (a fluid-filled fibrous sac) under the heel bone where the pain is typically more in the centre of the heel than that experienced with plantar fasciitis and significantly worsens during the day. This condition can be caused following a fall from a height on to the heel.

Heel bumps:

These are firm bumps on the back of the heel, usually caused by excessive shoe rubbing in the heel area, or the thickening of the tissues associated with a tight Achilles tendon.

Tarsal tunnel syndrome:

This can feel like a burning or tingling sensation under the heel within the arch of the foot with occasional loss of sensation on the bottom of the foot. This is caused by compression of the tibial nerve as it passes the inside of the ankle. Tapping of the nerve just behind the ankle bone (known as Tinel's test) will stimulate the symptoms of the condition.

Chronic inflammation of the heel pad:

This is caused by a heavy heel strike or sometimes a reduction in the thickness of the heel pad which can give rise to a dull ache in the heel which increases during the day.

Fracture:

Often caused following injuries such as falling from a height or landing on an uneven surface.

Sever's disease (calcaneal apophysitis):

This painful condition affects young children, usually between the ages of 8 and 12, especially those who are physically active or undergoing a growth spurt. It results from inflammation of the Achilles tendon where it attaches to the heel.

Achilles tendinosis:

This condition occurs when the Achilles tendon is placed under more pressure than it can cope with and small tears develop along with inflammation and in some cases can lead to tendon rupture. These tears become a source of further injury, which can lead to swelling within the tendon.

Who gets it?

Heel pain can affect everyone, whatever your age, but those more commonly affected include those in middle age (over 40s age group), those who are overweight or stand for long periods of time, as well as athletes.

How do I know I have it?

With plantar fasciitis, there are often no visible features on the heel but deep localised painful spots found in or around the middle of the sole of the heel, and pain is usually worse on standing after long periods of rest, particularly first thing in the morning.

With bursitis, pain can be felt at the back of the heel when the ankle joint is moved and there may be a swelling on both sides of the Achilles tendon. Or you may feel pain deep inside the heel when it makes contact with the ground.

Is it serious?

Heel pain is a common condition and in most cases will diminish following some routine self-care measures. If the pain persists longer than three weeks, it is best to seek professional advice from a podiatrist, as there are many types of heel pain, each with their own different causes and separate forms of treatment.

What are the treatments?

If you experience heel pain, some simple self-care measures include:

• Avoid wearing ill-fitting or uncomfortable shoes
• Wear shoes with good heel cushioning and effective arch support
• Minimise walking or exercising on hard ground
• Rest regularly and try not to walk or run too fast
• Wear a raised heel (no more than 6-10 mm higher than normal)
• Lose weight if you are overweight

More specialist treatments include:

Plantar fasciitis (or fasciopathy):

Treatment can take many forms, from resting your foot as much as possible, stretching exercises and deep-heat therapy to steroid injections and even medication or surgery to release the tight tissue 'band'. In the acute stage, use ice compresses for 10 minutes twice a day, and ibuprofen (always check with your GP or pharmacist before taking any new medication). In some cases, padding and strapping is applied to alter the direction of stretch of the ligament to alleviate symptoms in the short term. However, for the long term, special insoles (orthoses) may be prescribed to help the feet to function more effectively and help to make any possible recurrence less likely.

Heel bursitis (calcaneal bursitis):

Medication and ultrasound can give relief but for the long term, a shoe insert may be necessary. In addition, attention to the cause of any rubbing and appropriate padding and strapping will allow inflammation to settle.

Heel bumps:

Adjustments to footwear is usually enough to make them comfortable, although a leather heel counter and wearing boots may help. In more serious, recurring cases, surgery may be necessary.

Tarsal tunnel syndrome:

Special shoe inserts can reduce the pressures on the nerve and may be appropriate for certain foot types whereas, on other occasions, local injections of medication to the area where the tibial nerve is inflamed may be necessary.

Chronic inflammation of the heel pad:

A soft heel cushion can help this condition.

Fracture:

If this is suspected, an X-ray is required to confirm final diagnosis and to determine the extent of the injury and a follow-on treatment plan.

Sever's disease (calcaneal apophysitis):

This condition is temporary and self-limiting but can be painful at the time. Rest and stretching exercises may help.

Achilles tendinosis:

Treatment involves special exercises that strengthen the tendon and increasing the height of the heel with an insole on a temporary basis.

Acknowledgement. The content in this section has been adapted from original information published by The College of Podiatry

Chronic ankle pain

The ankle joint is formed by the lower end of the tibia (shin bone) and the talus (ankle bone). Chronic ankle pain is often the result of 'wear and tear' or osteoarthritis in this joint or the joint immediately below called the sub-talar joint. The ankle joint works mainly in an up and down motion and the sub-talar joint provides more of a tilting and rotating motion associated with rising and flattening of the foot arch.

In a normal healthy joint, there is a layer of cartilage which acts as a shock absorber and allows a smooth gliding motion. In osteoarthritis the cartilage is worn which can cause pain. Sometimes extra bone can form osteophytes which together with scarring of the joint lining can be responsible for joint stiffness. Pain and stiffness are the two main symptoms of ankle arthritis.

Ankle arthritis: what is subtalar arthritis

Treatment options

Many patients respond well to non-surgical treatments. There are many options, and these should be tried first before considering surgery.

These include:

Diet: Losing weight will reduce the strain on your feet and ankles.

Medication: Taking sufficient and regular pain relief is an important part of managing this problem. It is advised that you speak to your GP or pharmacist about this.

Cold and Elevation: Use a cold pack wrapped in a damp towel and apply for 10-15 minutes. In addition, elevating the foot so that it is higher than your hip can help reduce the swelling.

Heat: Can help reduce the pain. Use a heat pack or hot water bottle; wrap it in a towel to ensure it does not burn the skin, and apply for 10-15 minutes.

Footwear: Wearing supportive and shock absorbing footwear (e.g. trainers or boots that come up above the ankle) can help provide your ankle with more support. In addition, wearing a small heel can help.

Ankle supports and insoles: There are many different types available that can help to support your ankle/foot. Basic arch supports can be purchased from many chemists or sports shops. Your podiatrist or physiotherapist may recommend you are assessed for custom supports in severe cases.

Walking Aids: A walking stick or an elbow crutch held in the opposite hand to the arthritic ankle will help to offload your weight. Seek advice from your physiotherapist.

Activity modification: Avoid running, squatting and carrying heavy loads. Non-weight bearing cardiovascular exercise (e.g. swimming or cycling) would be best to prevent irritation.

Exercise: Your podiatrist or physiotherapist may show you some exercises to try and prevent your ankle becoming stiffer

Ankle Sprain

How can you treat an ankle sprain?

RICE - Rest, Ice and Elevation. It is helpful to apply an ice pack as soon as possible to the site of pain. Use a cold compress or a bag of frozen peas wrapped in a tea towel for 10-15 minutes every two to three hours. Do not apply ice directly to your skin, as this can cause skin damage.

Try to rest the ankle from long periods of standing or activity and elevating may also help with swelling. It is important to protect the ankle from further injury (an appropriate ankle splint may be beneficial for severe injuries). The use of crutches may be necessary, but it is good to try and take as much weight as is comfortable through the foot and ankle.

If your sprain is mild, your ankle should begin to feel a bit better after two to three days. It is important to gradually reintroduce movement and encourage gentle walking. Move the ankle through all movements as pain allows. Writing an imaginary alphabet with your foot and ankle is a good starting exercise.

If your sprain is more severe and not settling, it is important to seek professional advice.

Acknowledgement. The content in this section has been adapted from original information published by North Devon NHS Trust

Shin splints

How To Treat Shin Splints | Causes, Treatment, Recovery, and ...

Shin splints is a type of shin pain, usually caused by exercise. It's not serious and there are things you can do to help get better.

Check if you have shin splints

Shin splints usually happen when you do exercise like running.

You will have pain and tenderness along the front of your lower leg (shin).

Things you can do to help

Shin splints usually get better within a few weeks. There are things you can do to get better quicker.

• take paracetamol or ibuprofen to ease the pain (you should always consult your GP or pharmacist before taking any medication)
• put an ice pack (or bag of frozen vegetables) in a towel on your shin for up to 20 minutes every 2 to 3 hours
• switch to gentle exercise such as yoga or swimming while healing
• exercise on soft ground, if you can, when you're feeling better
• warm up before exercise and cool down afterwards
• make sure your trainers or shoes support your feet properly - find out more about choosing the right shoes

Acknowledgement. The content in this section has been adapted from original information published by NHS.uk

Patellofemoral Pain Syndrome

What is patellofemoral pain syndrome?

Patellofemoral pain syndrome is often caused by imbalances in the muscles surrounding the knee, which affect the kneecap (patella) and cartilage within the joint. As many as 1 in 3 young adults experience this type of knee pain at some time or other.

Symptoms

The main symptoms of patellofemoral pain syndrome are:

• Pain
  You may feel pain in the front of your knee and around and behind your kneecap. It can sometimes be quite severe and everyday movements like walking up and down stairs can make it worse. You may also feel a dull ache, for example after you've been sitting for a long time. The pain often makes it difficult to kneel or squat. It's often aggravated by running, so it frequently occurs during or after you've played sport.
• Crepitus
  Changes in the surface of your cartilage can cause a scratching or grating sensation from the kneecap, which you may be able to hear when you bend or straighten your knee. Crepitus doesn't often cause pain.

The effect of these symptoms on your everyday life can vary from time to time.

Causes

We don't yet fully understand all the causes of patellofemoral pain syndrome, but it's most likely a combination of factors. Some factors that could lead to it are:

• weakness or imbalance in your thigh or buttock muscles
• tight hamstrings (the muscles at the backs of your thighs)
• short ligaments around your kneecap
• problems with weight bearing and alignment through your feet
• An imbalance in the muscles surrounding your knee can put too much pressure on your kneecap and the cartilage in your joint. This pressure can lead to changes in a small area of cartilage where your kneecap meets your femur, which can lead to knee pain.

Treatment

Patellofemoral pain syndrome sometimes gets better on its own without any treatment, though you may have symptoms for several years. However, painkillers and exercises can help to reduce your pain.

Exercise

It's important to exercise your thigh muscles (quadriceps) to stop them from becoming weak. Swimming is an excellent form of exercise, and front and back crawl will put less strain on your knees. You should avoid sports that put a lot of pressure on your knees, like football, rugby or cross-country running, if they make the pain worse, although it should be possible to start these again once symptoms have eased.

Wall squats will be helpful if you do them regularly.

• Stand with your back against a wall, feet together or apart at a 30° angle.
• Slide down the wall by bending your knees, until you can no longer see your toes.
• Hold this position and clench your buttocks for 5-10 seconds.
• Relax and repeat the whole exercise as many times as possible.
• Your physiotherapist or podiatrist may recommend additional exercises.

Support your feet

Arch supports often help if you have flattened arches (over-pronation). Choosing the correct type of footwear is also important - find out more about choosing the right shoes

Acknowledgement. The content in this section has been adapted from original information published by versusarthritis.org

Please click the links to access condition specific advice leaflets and educational videos

The leaflets and information found on this page are intended for use under the guidance of your podiatrist and may not intended for use prior to being assessed by a therapist.

What do I do if I haven't been assessed by a clinician?

IF you haven't been assessed by a podiatrist yet and would like general advice to help you manage your symptoms, please return to our Common Foot Problems - self help advice page and follow the links that best describe your symptoms or query.

Please click the links to access condition specific advice leaflets and educational videos

The leaflets and information found on this page are intended for use under the guidance of your podiatrist and may not intended for use prior to being assessed by a therapist.

What do I do if I haven't been assessed by a clinician?

IF you haven't been assessed by a podiatrist yet and would like general advice to help you manage your symptoms, please return to our Common Foot Problems - self help advice page and follow the links that best describe your symptoms or query.

Please click the links to access condition specific advice leaf

Please click the links to access condition specific advice leaflets and educational videos

The leaflets and information are intended for use under the guidance of your podiatrist and may not intended for use prior to being assessed by a therapist.

What do I do if I haven't been assessed by a clinician?

IF you haven't been assessed by a podiatrist yet and would like general advice to help you manage your symptoms, please return to our Common Foot Problems - self help advice page and follow the links that best describe your symptoms or query.