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Common Foot Problems

Have you ever wondered why some mornings when you step out of bed an intense pain shoots through your heel? What are you going to do when your bunion starts hurting and none of your shoes seem to fit? Suddenly you realize you have a foot problem, now what?

Heel pain

Pain under the heel is caused by plantar fasciitis, and pain in the back of the heel is due to achilles tendonitis ("itis" comes from the Latin word meaning inflammation).

The plantar fascia is a band like structure that begins from your heel and spreads out, extending to each toe. Its purpose is to maintain the arch of your foot, acting like a spring each time you put weight through it. With incorrect foot wear and over training the band becomes thickened and inflamed. When you sleep at night your arch collapses and the plantar fascia begins to heal by scar tissue in this shortened position. In the morning as you stand up and put weight through the arch, the newly formed scar tissue is ripped from the plantar fascia at your heel causing intense pain.

Treatment consists of massaging and stretching out the arch of the foot, anti-inflammatory medication and a heel cushion in the shoe. Resistant cases may require physiotherapy or a corticosteroid injection into the heel (this is as painful as it sounds). In the very rare cases that the pain persists for more than six months surgery may be required.

Achilles tendonitis or "pump bump" ,named after pump shoes that rub against the back of the heel, causes a deep burning pain and causes the heel bone to actually grow a large bump. Again the cause of this is ill fitting shoes and over use or over training. The Achilles tendon is attached to the back of the heel bone (calcaneus), there is a small fluid filled sac behind the tendon which helps prevent friction as the tendon moves up and down against the heel.

When the tendon becomes inflamed it begins to rub against the heel bone causing small tears in the tendon and microscopic cracks in the heel bone. The tendon heals with scar tissue, thickens and becomes nodular (bumpy) and the heel bone forms new bone, creating an enlarged bump on the back of the heel. The two enlarged surfaces rub against one another causing friction, inflammation and pain.

Treatment consists of physiotherapy, massaging, anti-inflammatory medication and a heel raise within the shoe. Lifting the heel relaxes and takes the strain off the Achilles tendon allowing it time to heal and recover. If this conservative treatment has no effect after six months surgical treatment might then be indicated.

Bunions

Bunions are a painful inflamed red swelling on the inside of your big toe. They stop you from wearing tight fitting shoes, throb at night and unfortunately slowly worsen. Contrary to popular belief they do not only affect the elderly, but can even begin as a teenager. The most common cause is tight, ill fitting shoes and high heels.

The bump, or boney outgrowth on the side of the big toe is a result of bones in the foot being forced skew, with the big toe being forced over or under the second toe. This causes the big toe joint to become more prominent, rubbing on the side of the shoe, irritating the sac that surrounds the joint, creating pain, swelling and inflammation.

Treatment starts with wearing appropriate foot wear, bunion pads, silicone spacers between the toe and even a toe splint. When the bunion prevents you from wearing normal shoes and causes pain, surgery might then be indicated. Surgery is not as simple as cutting off the bump, but involves breaking and re-aligning the bones in the foot.

Corns

Corns are hyperkeratoses of the skin. This is a thickening of the surface layer of the skin of the toes in response to pressure. Corns are extremely painful and can even make walking unbearable.

There are many treatments available ranging from corn pads, acidic preparations to natural remedies. When the thickened buildup of skin is removed the pain diminishes, this can either be done at home with an abrasive sponge or brush or by a podiatrist who will remove the skin build up with a scalpel blade.

Corns can often be confused with plantars warts on the sole of the feet. A plantars wart usually has a black central pit "root" and is also treated with an acidic preparation.

Athlete's foot

Fungus (Tinea pedis) grows in warm, dark and moist places, where better than between your toes. The fungus is usually picked up from the showers in public sporting facilities, but despite its name it can affect anyone.

The fungus creates a burning, itchy sensation between the toes as well as causing the skin to flake off. Treatment is either an anti-fungal cream or a natural remedy. Fungal infections can be resilient and occasionally, a few weeks of treatment might be necessary.

As Summer really starts and our shoe wear patterns change, foot problems become more common. The earlier we identify and treat the problem, the quicker and more effective the treatment is.

DR JASON CRANE

As a full time orthopaedic surgeon at Mediclinic Cape Town, Doctor Jason Crane offers advanced orthopaedic care in a state-of-the-art medical facility on the slopes of Table Mountain.

CONTACT

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jason@capetownorthopaedic.co.za

Mediclinic Cape Town, Suite B105, 1st Floor (Doctors Block)
21 Hof Street, Oranjezicht, Cape Town, South Africa