For this week’s ‘Ask an Expert’ edition of our Wellness Matters blog, we spoke to Ryan Twist, a podiatrist from Bayswater Foot and Ankle Clinic, and asked him all your questions about foot health.
What is the most common cause of foot pain? – Rachel
Poor footwear is the most common cause.
Generally, people who spend a lot of time on their feet will need supportive shoes that are long enough, broad enough, wide enough and supportive enough.
A lot of people buy cheap shoes – these generally won’t have enough cushioning or support, and they also don’t tend to last very long.
Is there any particular shoe that you recommend for people with an active lifestyle? – Ben
It is highly individual when choosing a shoe. Every shoe is made differently, and choosing the right shoe is really important.
It’s hard to recommend the best type of shoe, because one shoe might be good for one person, but might be bad for another person. It really depends on your foot type, the activity you are doing, how strong you are and how conditioned you are. If you’ve been running for 20 years, you’re far more conditioned to running then someone who has just taken it up for enjoyment.
Do you need a referral to see a podiatrist? – Sam
No, referrals are not required. You can get these from GPs; however, you are able to just book appointments yourself.
What causes tenderness on the foot at the base of the toes? Only one foot and only in one spot, a recent occurrence. – Ann
This could be a number of things. The feet are very complex structures and pain can be caused by a number of pathologies. In terms of pain in the ball of the foot, this could include a number of common injuries/conditions such as:
- Morton’s neuroma – generally speaking, this is the most common forefoot injury in women;
- Turf toe – this is very common, particularly in athletes; however, it can happen to the general population, in particular those who wear high heels;
- Stress fracture; however, this is very unlikely if the patient is not very active.
I have high arched feet and when I do a lot of walking after some time I get a burning sensation in my foot, in particular the ball and arch of my feet. Do you have any tips of how I can stop the burning sensation? – Narelle
This is very common in people with high arched feet. This is highly likely to be due your footwear not being appropriate.
People with high arched feet need a shoe that is quite cushioned and flexible. They typically have very rigid feet and there’s not much shock absorption going on.
If you have a shoe that’s quite supportive, it’s going to work against your foot. What you need is a shoe that’s very soft and flexible to promote a bit more natural motion through the foot. That way, shock absorption will be much better through your feet.
I have flat feet – they have less arch when compared to others. Do I have to get orthotics for my arch support, or can I just continue as normal as long as I don’t have any pain in my feet?
I am concerned about this because most people say I will have feet issues in future since I have small arch. Is that true?
I stopped wearing heels and my feet did not like it. – Vasantha
This is a very good question that podiatrists get a lot. The answer is that flat feet are not bad, they’re fine.
If you’re not in pain and you don’t have any noticeable issues, there is absolutely no need for orthotics.
It’s common for people wearing high heels to have muscles in their feet contract; so their calf, Achilles and plantar fascia contract and get used to that position. When these people wear flat shoes, these muscles that have been contracted for so long have to stretch and elongate, which can cause a lot of discomfort and pain as the muscles aren’t used to the positioning.
People who have worn high heels for a long period of time will often say they find flat shoes very uncomfortable, and if that’s the case, they need to be doing a lot of calf stretches, massage and plantar fascia stretching, because this is not a good problem to have.
What do you believe are the most important elements of foot care? – Sophie
Good question. First and foremost, investing in good shoes is very important. Other important aspects of foot care include:
- Boring answer, but generally, a healthy lifestyle with sufficient exercise is crucial. Exercise improves the blood flow and circulation to the feet (and other parts of the body, of course);
- If you begin to notice any pain or discomfort, then you need to get onto it as soon as possible. Foot pain can become very tricky to manage if it has been present for a long period of time;
- Moisturising the feet each day to help protect the skin;
- It is extremely important to apply sunscreen to your feet during summer as the skin on the top of our feet is very thin and is susceptible to burns and possible skin cancers.
My toes and ankles are always cracking. Is this normal? – Michelle
It’s nothing to worry about. Some people are just susceptible to cracking – studies have shown that it doesn’t cause early onset arthritis, injury or other pathologies.
In terms of causation, there are a few different things that could be responsible for cracking. Usually, it will occur due to a build-up of nitrogen gas within the joint, inflammation or swelling i.e. tendinitis, or it can be caused by a condition where people have excessive synovial fluid in the joint.
In most instances (99.9% of the time), the cracking is caused by the gas build-up. The gas gets trapped in the joint, and the ‘popping’ sound is just the release of this.
I have bunions – do I need to do anything about them? – Michelle
The bad news with bunions is that they are irreversible. In terms of what a podiatrist can do, there are two main courses of action that can be taken.
Firstly, we can prevent them from getting worse, and secondly, we can manage the pain associated with the condition. As mentioned above though, we can’t reverse the process; bunions are there forever unless surgery is undertaken.
Bunions are often caused by genetics – females are four times more likely than males to develop bunions. Poor footwear is also a common cause of bunions. Generally speaking, females are more likely than males to wear high heels, and wearing shoes like that predisposes people to bunions.
There are other hormonal influences that predispose women to foot conditions; for example, oestrogen can cause a joint to break down faster than it would in men.
I often feel as if I need to ‘warm up’ my big toes before I go for a walk (i.e. rise on my tip toes) because I have bunions – any other exercises I can do? Walking is quite painful first thing in the morning if I don’t do this. – Michelle
Wiggling or ‘clawing’ your toes (a similar motion to the one you make with your hand when picking something up) is a good exercise to free up the big toe joint. Calf stretches are also a good idea, as is rubbing the soles of your feet with a tennis ball or spiky ball – the best way to do this is to place the ball on the ground and roll your foot from heel to toe over it.
What is the best way to avoid ingrown toenails? – Elisa
The best way to avoid ingrown toenails is to cut them properly! This might sound ridiculous, but everyone has different toenails. As you were growing up, your Mum probably told you to cut your toenails straight across – whilst this may work for some, others may develop ingrown toenails as a result. It all depends on the shape of the person’s toenail. Cutting your toenails properly is definitely the first step to avoiding ingrowns, so this means never bite, rip or peel your toenails as this causes rough edges. It’s also good practice to file your nails after cutting them.
Another way to avoid ingrown toenails is to, again, ensure you’re wearing appropriate footwear. If your shoes are too tight or too short, your toes can bang into the end of the shoes, causing ingrowns. This is particularly common in adolescents as their feet are constantly growing, and playing sport can also increase this susceptibility.
Most people need to wear certain footwear to look professional, but at all other times i.e. not at work, a meeting or going out for dinner, you should really make a point of wearing suitable, supportive footwear.
How often should I see a podiatrist for general foot care? – Jeremy
How often you should see a podiatrist definitely depends on the person or the issue at hand. For example, people with diabetes or ingrown toenails may need to see a podiatrist every month, whereas some people don’t need to see one at all if they’re not experiencing any pain.
Best practice would be to have check-ups every now and then. Your podiatrist is trained to recognise any susceptibilities you may have and is able to give you advice on how to prevent, delay or manage the condition.
Generally speaking, if you run or play sport, it’s a good idea to get an assessment to check your footwear, posture and strength. Podiatrists with a sport-focus can recognise any inherent weakness in hamstrings, calves or other areas and help you prevent potential injury.
If you have another health profession you would like us to explore in a future Wellness Matters blog, please email email@example.com.