The Normal Foot
There are 26 bones and 33 joints in the human foot and ankle, and the height of arches and the shape of the toes vary from person to person. There are many things you can do to keep your feet healthy, but there are some times when it's important to see an orthopaedic foot and ankle specialist to diagnose your foot or ankle problem.
Sweaty feet can cause rashes and eczema. Wearing nylon socks in plastic shoes or tightly fitting shoes may not allow the feet to dry properly and can aggravate the problem. Changing socks every day and letting shoes dry out between wearings can help eliminate smelly feet. Wearing thick, soft cotton socks helps draw moisture away from the feet.
True athlete's foot
is a rash, often between the toes, caused by a fungus infection. Athlete's foot will usually respond to treatment with anti-fungal powders and lotions along with good foot hygiene.
Poorly fitting shoes cause most calluses, corns and blisters. Poor shoe fit can aggravate other foot problems and result in irritation which may require medical attention.
often result from trimming the nails too short, particularly at the sides. Trim your toenails straight across,
allowing adequate length to project beyond the skin at the toenail margins. Cuticles should be pushed back with an orange stick or hindu stone and rarely cut.
Nail Fungus Infection
An infection of the toenail is called onychomycosis (on-i-ko-my-ko-sis). The nail may look brownish, yellowish or have little white patches. The nail may be flaky, brittle, ragged and chipped, and debris may collect under it. The toenail may get so thick that wearing shoes can cause pain. Infected nails may also separate from the nail bed, a condition called onycholysis.
Nail fungus is more common among the older population. Factors that can increase the risk of developing nail fungus include walking barefoot in a damp environment, such as around a swimming pool; circulation problems; diabetes; and a weakened immunity system.
Nail fungus is difficult to treat. After proper diagnosis, your doctor may prescribe oral antifungal medications. It may take up to three months or longer to eliminate an infection. These medications may be contra indicated in patients with liver disease.
Fractures and Sprains
Stubbed toes can be more than just a minor nuisance. If you experience swelling, discoloration, or a persistence of some pain beyond two to three days, you may have a fracture. Neglected fractures, particularly of the large or great toe, can result in painful foot problems
Ankle sprains are common; foot sprains less so. If you experience persistent pain and swelling about the foot that interferes with walking, you may need X-rays to determine if you have a fracture.
, the common name for hallux valgus, is a prominent bump of the great toe at the outer edge where it joins the foot. This bump is sensitive to pressure caused from wearing shoes that fit too tightly. Shoes that are pointed and too narrow squeeze the great toe and cause it to drift toward the little toes.
Wearing sandals and accommodative shoes can help. Often wearing a pad, available from a drugstore foot counter, will relieve symptoms. If pain persists or shoe fitting is difficult, and the bump is quite noticeable, you should discuss this problem with your physician. Some bunions need surgical correction. Avoid having bunion surgery for cosmetic reasons.
There are many operations for bunions, often named for the orthopaedic surgeon who developed the procedure: McBride, Keller, Mitchell and Lapidus, to name a few. Most not only remove the bump but correct what causes the bunion so that it does not grow back. Your orthopaedic foot and ankle specialist will discuss with you which procedure, if any, is appropriate.
All swellings of the great toe are not bunions. For example, a swelling could be caused by gout, which strikes thousands of Americans. This special type of arthritis can be diagnosed only by medical examination and laboratory testing. Diet and special medications can treat gout.
Corns, Hammertoes and Clawing of Big Toe
result from pressure when the skin is squeezed between the bones and shoes. Corns can appear over almost any
bone of the foot but most commonly over misshapen hammertoes. Here the hammertoe causes continued pressure which results in skin irritation and corn formation. Sometimes you will need surgery to relieve the underlying pressure, but a toe pad from a drugstore can treat a mild problem. Also, as with bunions, wearing an accommodative shoe will often be all you need. If the problem persists, your physician can decide if you need surgery.
Small muscles in the foot help to stabilize the big toe. When those
muscles are weakened by disease, an imbalance occurs that leads to clawing. The
clawing results in abnormal pressure to the ball of the foot and can result in
the formation of an ulcer. In addition, clawing may lead to pressure on top of
the toe from shoewear. Clawing is associated with a variety of underlying
disorders, including Charcot-Marie-Tooth disease, diabetic neuropathy, head
injury, polio and stroke.
Warts can occur without pressure from shoes. Warts are the skin's reaction to
chronic viral infection. These raised and painful sores, often on the sole of
the foot, will sometimes respond to pads and over-the-counter ointment but often
need medical attention. Not all painful sores are warts. Reaction to
injury, hidden slivers, and old puncture wounds can also result in painful
sores. Dark brown or black warts can indicate a type of skin cancer and should
be immediately examined by your physician.
Rest, stretching the heel cord, heat and change of shoewear will often suffice. If the heel pain persists, your physician will probably prescribe medication, shoe modification and more specific stretching exercises. In a more serious case of heel pain, your physician will prescribe injections. Rarely is surgery necessary.
Irritation to a nerve can cause it to swell. This condition, known as a neuroma, can occur anywhere in the body. In the foot, walking and shoe pressure can lead to painful neuromas.
The most common neuroma, called Morton's neuroma
, occurs on the bottom of the foot between the toes. Here, a small nerve to the toe becomes pinched between the toe joints, toe knuckles, and the shoe. Neuromas can occur in other places on the foot, often from injury to skin nerves. Pressure from shoes may cause neuromas to become painful.
A change in shoewear to wider or more accommodative shoes, use of pads, and avoidance of irritating activity can help treat a neuroma. Your physician may also recommend medication and injections. If symptoms persist, you may need surgery to release or remove the nerve.
Diabetes and certain other medical conditions which similarly affect the nerves can cause special foot care problems. In some people, diabetes will result in nerve damage. When this happens, the nerves no longer perceive pain due to numbness and therefore do not warn of injury. This is particularly true in the foot.
With diabetes, the body's poor defense against infection and damage to blood circulation complicate the problem. Poorly protected from infection by weakened body defenses and loss of circulation, the feet and toes become more vulnerable to injury. Patients with diabetes must exercise extreme caution. Properly fitting shoes can help protect feet and avoid injury. Any injury, no matter how minor, deserves careful attention. You also must always exercise great caution in trimming toenails. Avoid trimming corns and calluses. Visit The Diabetic Foot page for tips on daily care and choosing diabetic shoes.
Orthopaedic foot and ankle specialists do not make shoes but occasionally advise you to wear special shoes or have minor shoe modifications made with pads or wedges.
Shoes should be comfortable and practical and fit well. It is very important that the shoe fits the shape of your foot. Narrow and tight shoes result in foot problems. Make sure your shoes fit comfortably at the time you buy them.
If new shoes need to be "broken in," it means either they were not properly designed or not properly fitted to your feet.
High-fashion shoes with pointed toes, shoes with thin soles, and shoes with high spike heels cause crowding of the toes and increased pressure. These can lead to corns, calluses and neuroma problems in the foot. Check out these tips
for safely wearing higher heels.
Checklist for Shoes
Good fit; comfortably loose when worn with soft, absorbent socks
Shaped like the foot; broad and spacious in the toe area
Shock-absorbent sole; a low wedge type is best; avoid high heels
Breathable material; canvas or leather, not plastic
Comfortable the moment you put them on
A good running or tennis shoe should have a wide, cushioned heel and sole. The toe box should be deep enough so the toes do not press against the top and long enough to allow free motion and gripping during running. There should be about a thumbnail-length between the longest toe and the toe of the shoe. If you don't allow enough space for the toes, you can injure the toenails.
Running shoes should have spring in the forefoot, meaning the forefoot of the shoe should tilt up off the ground when the shoe rests flat on the ground.
The running shoe should be flexible but not limp and the heel counter firm and padded to support the heel.
The sole of the shoe should be cushioned enough to absorb much of the shock of running. A sole that is EVA cushioned and semi-rigid is a great help in absorbing shock.
Most running shoes have a built-in arch support, which is desirable for avoiding excessive pronation.
Pay attention to cuts and bruises of the foot. Like any other injury they should be cleansed and dressed. Generally, minor wounds need little attention. If a wound starts to spread, particularly in lacerations of the sole of the foot, you should consider an emergency visit for stitches.
Puncture wounds are a serious matter and can be dangerous. Nails and the like do not have to be rusty to cause lockjaw (tetanus) or to cause an infection in the foot. You should wear foot protection when walking out-of-doors. Even at the beach, you may encounter hidden obstacles such as glass or shredded aluminum.
Lockjaw is best avoided with immunization protection before you injure your foot. A tetanus booster shot is recommended every three to seven years.
Need to See a Doctor?
If you are concerned about your feet, talk to your family physician. If you need more advice from an MD or DO dedicated to foot and ankle care, click here
to find members of the American Orthopaedic Foot & Ankle Society in your area.
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.