The term athlete's foot is a highly misleading word, as this condition does not only occur in athletes. Athlete's foot is a common name given to a fungus infection of the skin that predominately occurs in between toes but can occur anywhere on the foot. If left untreated the condition can spread to other parts of the foot, hands and can even affect the face.

This condition can cause a great deal of discomfort and can affect an individual's quality of life. The skin involved may be red, swollen and may contain sticky fluid. Patients may also experience a scaly dry rash on the bottom and sides of feet. This type of athlete's foot is called a "moccasin" pattern. Cracks or "fissures" can occur between the toes, sometimes with a accompanied soft white scale

Symptoms include dry and itchy lesions. Patients often report a burning or stinging sensation. A common associated condition with athletes foot is a fungal nail infection. If athletes foot is not treated the lesion can become infected and extremely painful.

ANKLE SPRAINS

An ankle sprain is a common walking and sporting injury. It can be a very painful experience and can significantly affect a patient’s lifestyle. It occurs due to the ankle twisting and causing damage to the soft tissues and ligaments. A ligament consists of several strands of tissue all compacted together to form a strong structure, similar to a rope. An ankle sprain may result in a partial or complete tear of a ligament, which stabilizes the ankle joint. Once the ligament is torn, it becomes weak which in turn affects ankle stability.

The degree in which the ankle stability is affected is dependent upon the level of the tear. When an ankle sprain occurs, the usual scenario involves the athlete "rolling" his or her ankle while landing from a jump or running followed by a sharp pain on the outside of the ankle. An audible "pop" or "snap" may accompany the injury, which sometimes signals ligamentous rupture. If the athlete can walk on the injured ankle, the likelihood of a serious injury is less, but athletic participation should be discontinued. Shoes should be kept on until examination and treatment. Symptoms include a swollen, painful ankle with possible bruising due to ruptured blood vessels.

ARCH PAINS

The term arch pain (often referred to as arch strain) refers to an inflammation and/or burning sensation at the arch of the foot. The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot, that runs from the heel to the forefoot. The planter fascia can become inflammed due to over pronation (flat feet) which causes the arch pain.

SYMPTOMS OF ARCH PAIN

Pain and tenderness in the arch region of the foot.

CAUSES OF ARCH PAIN

The major cause of arch pain is plantar fascitis (inflammation of the muscle that runs along the bottom of the foot). Plantar fascitis is caused by excessive stretching of the plantar fascia, usually due to over-pronation (flat feet).The inflammation caused by the plantar fascia being stretched away from the heel, often leads to pain in the heel and arch areas.

BUNIONS

Bunions are one of the most common forefoot deformities. A displacement of the bone under the 1st toe occurs. This causes the big toe to move towards the smaller toes. This shifting of the bones causes a bony prominence on the side of the patients foot (the bunion joint). Over a period of time the big toe may come to rest under (occasionally over) the 2nd toe.

A bunion is more common in women than men due to women wearing tighter fitting shoes. This condition can cause a variety of different soft tissue and bony complaints which may result in severe pain.

Symptoms include redness, swelling and pain which may be present along the inside margin of the foot. The patients feet may become too wide to fit into their normal size shoe and may experience moderate to severe discomfort may occur when the patient is wearing tight shoes. A "hammer toe" may occur at the 2nd toe. This is when the toe contracts and presses on the shoe. Subsequently, this may cause a corn on top of the 2nd toe.

Corns and calluses may occur on the soles of the feet, in between toes and on the bunion joint. Stiffness can occur at the big toe due to secondary arthritis, this is known as Hallux Rigidus. Other foot conditions can occur such as in growing toe nails and in severe cases the bunion joint may have a fluid filled sack called a BURSITIS. This can be very painful and can become infected.

CAUSES OF BUNIONS

• The most important causative factor is poor fitting footwear. This accounts for an higher incidence among women then men.
• Family history of bunions
• Abnormal foot function, excessive pronation. If a chiropodist/ podiatrist uses this term he is referring to excessive rolling in of the foot at the ankle joint while you are walking.
• Rheumatoid or osteoarthritis.
• Genetic and neuromuscular diseases which can result in a muscular imbalance such as Down's syndrome.
• If one leg is longer then the other, the longer leg is more inclined to develop a bunion.
• If the ligaments in the feet are very weak.
• In some cases, bunions can occur due to trauma or injury to the feet.

BURNING FEET

Burning feet is a common foot complaint among many groups, most commonly in the older group over 50 years of age. There are many different causes of this condition. Diabetics are often affected with burning feet due to impaired neuropathy (nerves). There may be redness and swelling present, however, often there is no physical sign of this condition.

CAUSES OF BURNING FEET

• Dampness, together with friction, leads to the sensation of burning, so its important to buy shoes that let perspiration evaporate.
• Inappropriate socks. Wear socks made of cotton rather than synthetic fabrics.
• Athletes foot can sometimes spread to cause burning sensation on the sole of the foot.
• Allergic reaction to shoe material or socks.
• Alcohol is also contributing factor. Long term use can affect the nervous activity of the feet.
• Diabetes
• Smoking
• Neuroma. A trapped nerve can lead to a hot burning sensation.
• Gout can cause a burning sensation on the side of the foot.

COLD FEET

Cold feet is a common condition that affects many patients from all walks of life. The body responds to cold temperatures by reducing the blood flow to the extremities leaving the feet vulnerable. Chronic cold feet are often a result of impaired circulation (peripheral neuropathy) and lack of mobility. Patients with Muscular Dystrophy, Multiple Sclerosis, Diabetes, Raynauld Diaseasm Arthritis and Cerebral Palsy are at risk of this condition. One of the major causes of cold feet is peripheral neuropathy which can effect the feet and hands trying to protect core temperature.

PVD (Peripheral vascular disease) is a medical term given to a group of conditions that cause poor circulation to the legs and feet. Poor circulation can result in cold feet. Diabetes is the most common cause of PVD. Depending on the severity of symptoms, treatment may include lifestyle changes, medications and procedures designed to open clogged blood vessels.

Peripheral Neuropathy

The most common type of peripheral neuropathy damages the nerves of the limbs, especially the feet. Nerves on both sides of the body are affected. Common symptoms of this kind of neuropathy are:

1.Numbness or insensitivity to pain or temperature
2.Tingling, burning, or prickling
3.Sharp pains or cramps
4.Extreme sensitivity to touch, even light touch
5.Extremely hot or COLD feet

These symptoms are often worse at night.

CORNS

A corn is a localized thickening of the skin due to pressure. Corns often occur on the top of the toes where there is pressure from the shoes. However, they also occur at the sole of the foot and in between toes. Certain corns may become entwined with the nerves of the skin, these corns are particularly painful. Often corns develop a core which is often referred to as the "root" by patients. Corns can be very painful, especially if there is inflammation and swelling around the corn.

This condition is more prevalent in females as a result of wearing tight or ill-fitting shoes. Corns appear as white/ gray or yellow/ brown in colour depending on your skin type. Symptoms include pain and swelling around the corn and discomfort with direct pressure.

CAUSES OF CORNS

• Tight shoes
• Deformed toes (Hammer toes)
• Seam or stitch inside the shoe which rubs against the toe
• Abnormality of gait (walking)
• Surgery to the lower extremities
• Bunions

CRACKED HEELS

Cracked heels are often referred to as fissures and are usually caused by dry skin. For most people this is a nuisance and a cosmetic problem but when the fissures are deep, the skin bleeds easily and is can be very painful. The heels appear yellow or dark brown depending on the skin type and are normally accompanied by dry skin. Symptoms include a hard growth of skin, usually on the outer edge of the heel. Patients may experience pain while walking and increased discomfort in thin soles or open back shoes.

CAUSES OF CRACKED HEELS

• Inactive sweat glands
• Dry skin
• Prolonged standing
• Obesity
• Open backed shoes can be a contributing factor
• Surgery to the lower extremities
• Heel Spurs
• Mal-aligment of the metatarsal bones (the bone structure of the sole of the foot)
• Flat feet and high arched feet
• Abnormalities of gait (walking)
• Using excessively hot water is a contributing factor
• Eczema and psoriases can also be contributing factors

SMELLY SWEATY FEET AND DRY SKIN

Sweaty Feet. Throughout the average day, the body naturally perspires to regulate heat in the body. In some individuals, natural perspiration is excessive in the feet which results in sweaty feet. This condition is known as Hyperhidrosis and is defined as the production of perspiration beyond what is necessary to cool the body. Sweaty feet can result in very smelly feet! This condition can be very embarrassing for the affected patient. Patients often experience patches of skin that tend to peel and become very painful. Athletes foot is also a common associated condition with sweaty feet.

Dry Feet. If the body is unable to perspire to regulate heat flow in the body, a patient will suffer from dry skin. This is known as hypohidrosis. Dry skin can lead to other skin related complaints such as fissures are cracks in the skin which can be very painful. They can also provide a port of entry for bacteria to cause infections.

FUNGUS NAILS

Fungus nails is a unsightly condition which can be difficult to treat. Many patients become very conscious about a fungus nail condition and refuse to wear sandals and have their feet seen in public. It is caused by microscopic organisms called Dermatophytes. Dermatophytes grow in the nail bed, beneath the nail and live off keratin, the protein in the nail. The condition usually begins towards the far end of the nail and may start with patches of white or yellow discoloration. If the condition is left untreated, it will proceed to the base of the nail. It will attack the nail root (matrix) and cause the nail to grow very thick and deformed. The big toe is usually the first nail to be affected with the condition spreading to adjacent nails. In rare cases this condition can also affect the skin surrounding the nails.

APPEARANCE

• At an early stage, the nail may have white or yellow patches of discoloration. There may also be yellow horizontal streaks in the nail.
• At a later stage, the nail will grow thick, deformed, discoloured and have a foul odour (musty smell). It may also split and start to crumble.

SYMPTOMS

• The nail may become brittle and split in to several pieces.
• The actual condition is not painful. However, if the nail becomes thick and deformed it may grow into the skin at an angle and become an ingrowing toe nail.
• In severe cases, inflammation may arise from an ingrowing toe nail which may result in a secondary infection.
• It will affect a patients day to day activities as the pressure from the nails against the shoes causes discomfort.
• If the condition is left untreated for along period of time, the nail will become very brittle and the patient may experience episodes of total removal of the nail followed by re-growth.

FLAT FEET

Flat feet is a condition in which the foot doesn't have a normal arch. It may affect one foot or both feet. Most people have a gap between in the inner side of the foot and the ground when they are standing. This is referred to as an "arch". Feet that have a low arch or no arch at all are referred to as flat feet or fallen arches. On standing the patient will have a flat arch and the foot may roll over to the inner aspect.

The symptoms vary depending on the severity of the condition. Individuals may experience corns and hard skin under the sole of the foot. The arch area may be tender and shoes will tend to wear out quickly. In severe cases the patient may experience calf, knee, hip and back pain.

CAUSES OF FLAT FEET

• It may be hereditary, i.e passed on through generations.
• In most cases it is caused through a biomechanical complaint (abnormal walking) such as Fore Foot Varus. This is a condition in which the subtaler joint in the foot over pronates (rolls in too much).
• A ruptured tendon (tibilias posterior) can lead to a flat foot.
• Cerebral palsy, spins bifida and muscular dystrophy can also lead to a flat foot condition.

FOOT BLISTERS

Blisters occur when feet get hot & sweaty, making socks stick to the feet. The sock and foot then rub against each other and the inside of the shoe. Fluid fills up a space between layers of skin to protect the area, like a small balloon. That's how a blister forms. People with diabetes may not be able recognize the painful event due to a condition called neuropathy. A doctor should attend to their blisters and burns.

APPEARANCE OF FOOT BLISTERS

Sometimes these blisters "pop" by themselves and can become infected. Watch out for redness or leaking yellow liquid, and for red lines near the blister. These are symptoms that require medical attention. If the blister has not "popped," then leave it alone. Most of the time it will reabsorb and heal on its own.

CAUSES OF FOOT BLISTERS

• Form as a result of heat, moisture and friction.
• Friction forces caused by inappropriate footwear.
• Form as a result of fungal infections of the skin, allergic reactions or burns.
• Excessive foot perspiration.

HEEL PAIN

The most common cause of heel pain is plantar fascitis which is commonly referred to as a heel spur. Plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot, from the heel to the. Plantar fascitis is a condition in which the plantar fascia is inflamed. This condition can be very painful and cause considerable amount of suffering.

Long standing inflammation causes the deposition of calcium at the point where the plantar fascia inserts into the heel. This results in the appearance of a sharp thorn like heel spur on x-ray. The heel spur is a-symtomatic (not painful), the pain arises from the inflammation of the plantar fascia. Symptoms include a dull ache which is felt most of the time with episodes of a sharp pain in the centre of the heel or on the inside margin of the heel.

Often the pain is worse on first rising in the morning and after rest and is aggravated by prolonged weight bearing & thin soled shoes.

CAUSES OF HEEL PAIN

• Excessive load on the foot from obesity is a major cause of plantar fascitis. Which is why this condition is common in middle aged and over weight adults.
• A sudden increase in weight, such as pregnancy can also lead to plantar fascitis.
• A sudden increase in walking or a sporting activity can also be a contributing factor. A classical example is a post man who has returned to work after a period away from the job can develop this condition.
• Tight plantar fascia (this is often caused by tight calf muscles).
• Excessive flattening of the arch on weight bearing.
• Biomechanical problems (walking abnormalities) is a major cause of plantar fascitis.
• Different types of arthritis can also lead to this condition such as osteoarthritus and rheumatoid arthritis.

HIGH ARCH

Most people have a gap between in the inner side of the foot and the ground when they are standing. This is referred to as an "arch". Small children do not have an arch, the arch begins to form between the ages of 3 and 10. Feet that have a high arch are sometimes referred to as cavus type feet.

APPEARANCE

• On standing the person will have a high arch.
• The heel may be drawn towards the inner side and the toes may be drawn inwards.
• Some people with pes cavus have clawed toes.
• The front of the foot may appeared to be dropped or drawn downwards. The results in the 1st Ray (1st toe Joint) and the 5th Ray (5th toe joint) to be dropped.

SYMPTOMS

• The symptoms vary depending on the severity of the condition.
• The patient may experience corns or hard skin under the sole of the foot, especially under the 1st and 5th toes.
• Shoes may wear out quickly.
• Pain or tenderness along the arch.
• Shoes may be very difficult to fit, especially around the ankle.
• Stiffness of the feet.
• With severe pes cavus, problems such as calf pain, knee pain and hip pain may be present.
• Some patients may suffer from ankle sprains very easily.

HARD SKIN (CALLUS)

Callus occurs due to hyperkeratosis. Hyperkeratosis is the thickening of the skin due to pressure. Callus can occur over bony prominence, on the ball of the foot or on the heel. Callus often occur due to prolonged standing and may result in chronic pain. A callus appears as yellow or dark brown discoloured skin.

SYMPTOMS

• Pain on weight bearing, relieved by rest.
• A hard growth of skin, usually on the ball of the foot.
• Increase discomfort in thin soled shoes or high heeled shoes.

CAUSES

• Prolonged standing
• Obesity
• High heeled shoes
• Surgery to the lower extremities.
• Bunions
• Mal-aligment of the metatarsal bones (the bone structure of the sole of the foot)
• Flat feet and high arched feet
• Abnormalities of gait (walking)

IN GROWING TOE NAILS

In growing toe nails are one of the most common foot complaints treated by a chiropodist. This condition can be very painful and patients may often be very reluctant to have the condition treated. However, we can assure you that this condition will not resolve itself and requires specialist care. An In growing toe nail is caused by a splinter of nail or the whole nail causing pressure into the skin. Some In growing toe nails are acute which means that they have occurred due to a injury to the toe. Others are chronic, which means the patient has had the problem for a long period of time. The large toe is usually affected, however, it can also affect the lesser toes.

APPEARANCE OF IN GROWING TOE NAILS

• In an acute condition the toe will be very red, swollen, painful to touch and there may be a discharge of pus or a watery discharge with a hint of blood.
• In a chronic condition the toe will appear slightly inflamed at the corner of the nail.

SYMPTOMS OF IN GROWING TOE NAILS

• The condition may be aggravated by wearing tight shoes or shoes with a inadequate depth.
• In a acute condition the toe will be very painful to touch and there may be presence of a infection.
• In a chronic condition the toe will only be painful when the patient is walking with shoes on.

CAUSES OF IN GROWING TOE NAILS

• Trauma to the nail
• Improper cutting of toe nails.
• Tight shoes or hosiery
• Abnormal shape of nail plate
• Abnormal thickness of nail

METATARSALGIA

(Pain in the ball of the foot)

Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball of the foot). This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia (ball of foot pain) is often located under the 2nd, 3rd, and 4th metatarsal heads, or more isolated at the first metatarsal head (near the big toe).

With this condition one or more of the metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent, or chronic pain with this common foot condition. Ball of foot pain is often caused due to improper fitting footwear, most frequently in women’s dress shoes and other restrictive footwear. Footwear with a narrow toe box (toe area) causes the ball of foot area to be forced into a minimal amount of space. This can inhibit the walking process and lead to extreme discomfort in the forefoot.

Other factors can cause excessive pressure in the ball of foot area that can result in metatarsalgia. These include shoes with heels that are too high or participating in high impact activities without proper footwear and/or orthotics. Also as we get older, the fat pad in our foot tends to thin out, making us much more susceptible to pain in the ball of the foot.

NEUROMA

The term neuroma refers to a swelling of a nerve. The nerve commonly affected is a small nerve that connects the 3^rd and 4^th toes, counting from the big toe. The patient will complain of pain in the sole of the foot.

SYMPTOMS OF A NEUROMA

• Begins with numbness or tenderness in the foot, just behind the 3^rd and 4^th toes
• At a later stage, pain, numbness, burning and tingling sensations can radiate around the foot.
• The symptoms may appear and disappear spontaneously.
• Severe pain may be present at weight bearing.
• The patient may experience spontaneous shooting pains, which is often referred to as an "electric shock". This can affect patients when are sleeping at night.

CAUSES OF A NEUROMA

• The pulling of the ligaments under the foot irritates the nerve.
• High heels can damage the nerve.
• A tight toe box will squeeze the toes in the foot and therefore put pressure on the nerve.
• Mechanical problems with the feet such as "over pronation". Over pronation can be simply described as a condition, which causes your arches to flatten out when you stand up. This causes your ankles to roll in towards each other and disturbs your normal walking pattern. If a foot over pronates the structures of the foot are put under stress, which increases the likelihood of a neuroma occurring.

EXCESS/ OVER PRONATION

One of the most common causes of foot and leg discomfort is a condition known as excessive/ over pronation. Normal pronation, or "turning inward" of the foot is necessary as the foot adapts to the ground. With excessive pronation/ over pronation, the arch flattens, collapses, and soft tissues stretch. This causes the joint surfaces to function at unnatural angles to each other. When this happens, joints that should be stable now become very loose and flexible.

At first, excess pronation may cause fatigue. As the problem gets worse, strain on the muscles, tendons, and ligaments of the foot and lower leg can cause permanent problems and deformities.

APPEARANCE OF EXCESS/ OVER PRONATION

1. When standing, your heels lean inward.

2. When standing, one or both of your knee caps turn inward.

3. Conditions such as a flat feet or bunions may occur.

4. You develop knee pain when you are active or involved in athletics. The knee pain slowly goes away when you rest.

5. You abnormally wear out the soles and heels of your shoes very quickly.

SYMPTOMS OF EXCESS PRONATION

Symptoms can manifest in many different ways. The associated conditions depend on the individual lifestyle of each patient. Here is a list of some of the conditions associated with Excess Pronation:

1. Hallux Abducto Valgus (bunions)
2. Hallux Rigidus (stiff 1st toe)
3. Arch Pain
4. Heel Pain (plantar Facsitus)
5. Metatarsalgia (ball of the foot pain)
6. Ankle Sprains
7. Shin Splints
8. Achilles Tendonitis
9. Osteochondrosis
10. Knee Pain
11. Corns & Calluses
12. Flat Feet
13. Hammer Toes

CAUSES OF EXCESS/ OVER PRONATION

Over pronation occurs due to a biomechanical dysfunction (walking abnormality). This can be controlled via Insoles and Orthotics.

SHIN SPLINTS

A shin splint is the most common cause of exercise-induced leg pain encountered by athletes of all levels. This condition can also affect non-athletic people who are on their feet all day. In the past the term shin splint has been used to describe all forms of pain in the lower leg. Misleading terms such as compartment syndrome and stress fractures have all been used to describe a shin splint. However, a shin splint is a very specific problem. It is essentially an inflammatory reaction involving the deep tissues of the lower leg and may involve tendons & muscles.

The inflammatory reaction occurs at the point where the deep tissues insert into the inside (medial) or front (anterior) aspect of the leg bone (tibia), tenderness is usually present between 3-16 cm above the foot.

When a patient is suffering from a medial shin splint the pain and the tenderness will be present on the inner aspect of the leg. In an anterior shin splint, pain and tenderness is present on the front and outer aspect of the leg, in both cases, running and walking may be extremely painful. In severe cases, even light weight bearing may be painful.

CAUSES

• Over training.
• Mechanical problems with the feet such as "over pronation". Over pronation can be simply described as a condition which causes your arches to flatten out when you stand up. This causes your ankles to roll in towards each other and disturbs your normal walking pattern. If a foot over pronates the structures of the leg are stretched and put under stress, which increases the likelihood of that structure being injured.
• Tight calve muscles.
• A young novice runner training for long periods on hard roads and in poor physical condition.
• Training on hard surfaces such as concrete.
• Improper shoes, inadequate shock absorption.
• Excessive rotation of the hip.

 


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