“Many thanks for giving me back my straight feet , now hopefully I can get rid of my granny shoes.”
No-one really understands how you feel after being on your feet all day in shoes that hurt your feet.
But you don’t have to put up with it. Something can be done to help.
Painful feet can affect anyone, men and women, young and old. What starts out as a mild twinge at the end of a long day unchecked can turn into constant pain, with your shoes pressing in all the wrong places and making you shift your weight constantly from foot to foot. And bad posture and poor gait can go on to cause other problems.
Here at the Surrey Orthopaedic Clinic we have a dedicated team of consultants with particular expertise in treating foot problems.
Whether you are a high-flying career woman who wears high-healed shoes every day, an avid sportsman or simply have developed problems with your feet over the years, we can help.
There are very many causes of painful feet and toes, and the good news is that they are almost all straightforward to treat.
Some of the common cause of foot pain
A bunion is an abnormal bump that forms on the joint at the base of your big toe. It’s a bone deformity caused by your big toe pushing up against your other toes, which forces the big toe joint in the opposite direction. Bunions can be very painful, especially around the outside of the base of your big toe, and are best treated by a specialist surgeon or podiatrist performing bunion surgery.
Bunions are often caused by pointed shoes squashing the toes together
Before (left) and after (right) bunion surgery
The lady in the picture above had a lot of pain and difficulty with her footwear but the results after surgery speak for themselves.
Misalignment of the big toe gradually gets worse and can force the other toes out of alignment. Eventually the only solution may be an operation to break the bone and reposition the joint to straighten the toe and relieve the pain. It also means finding comfortable footwear is now much easier too!
Achilles tendonitis is caused by overuse and injury to the Achilles tendon, the band of tissue that connects the calf muscles at the back of the lower leg to the heel bone. The pain begins as a dull ache in the back of the leg or above the heel. Often, a lump can be felt over the tender area.
Side view of foot showing Achilles tendonitis
Constant friction and pressure injures the foot which tries to protect itself by developing thickened skin. These is how corns or calluses develop and they can be quite uncomfortable.
The patient has corns as well as a bunion
These are exactly what they sound like – an abnormal bend in the toe that causes the toe to resemble a hammer, mallet or claw. The pain or pressure caused by these conditions can often be felt just by moving your toe and is often related to improper footwear that causes your toes to be forced against the front of your shoe.
Here you can see how the toes become “clawed”
This lady has clawing of the toes of both feet
Heel pain is most commonly felt on the back of your heel, often caused by plantar fasciitis or Achilles tendonitis. Sometimes it is caused by a heel spur. Although painless itself, the heel spur is a calcium deposit on the underside of the heel bone. There could be many others causes of your heel pain that are best discussed with your Foot and Ankle Specialist at the Surrey Orthopaedic Clinic, especially when your pain begins to interfere with your normal activities.
Heel spur and plantar fasciitis
Metatarsalgia is pain and inflammation in the ball of your foot. It can feel like a sharp, aching or burning pain or numbness and tingling in your toes. The pain worsens when you flex your feet, stand, walk or run.
The red area shows where the pain is often felt
Morton’s neuroma also affects the ball of your foot and is caused by a thickening of the tissues around a nerve leading to your toes. Pain is most commonly felt between your third and fourth toes. The pain experienced is sometimes described as if feeling like you are standing on a pebble in your shoe or a burning sensation.
The foot bones press on the swollen nerve causing pain in the red area
The plantar fascia is a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes. When it becomes painful and inflamed it’s called plantar fasciitis. It’s a common cause of heel pain that feels like your heel is being stabbed. It usually occurs when you first step on your feet in the morning.
Inflammation of the plantar fascia causes pain in the sole of the foot
The posterior tibial tendon runs along the inside of the ankle and foot. Tib-Post tendonitis is experienced when this tendon becomes strained and doesn’t function properly to hold up the arch of your foot, resulting in flat feet. Pain can be felt in your heel, arch or plantar fascia.
Inflammation of the tibialis posterior tendon causes pain and a flat foot
Sesamoiditis affects the front of the foot and is an irritation of the sesamoid bones, the tiny bones in the tendons that run to the big toe. Pain usually begins as a mild ache and gradually increases as the bones become aggravated. It can build into an intense throbbing that may mean you need to decrease your activity.
The tiny bones at the base of the big toe become inflamed
Simply put, because discomfort in the feet can be very disabling, causing pain, difficulty in finding comfortable footwear, difficulty in walking, poor posture and poor gait. It is a condition that really does not get taken as seriously as it deserves to be.
If you are experiencing chronic foot pain that is keeping you from participating in your normal activities, or you’d like more information about one of the topics above, contact a Foot and Ankle Specialist at the Surrey Orthopaedic Clinic. We believe feet shouldn’t hurt and neither should their treatment.
First and foremost the most important thing is that you are seen and assessed by a doctor who is a recognised expert in problems with the feet. Here at Surrey Orthopaedic Clinic we have three experts on foot pain who will see you personally. This is because the foot is actually quite complex and reaching the correct diagnosis is vital in planning the correct treatment. As you can see we have talked about some of the causes of foot pain but there are many others too which we haven’t even touched on.
Your GP may be right – it may be a simple ligament tear or sprain that will settle on its own. The trouble is that to really know what has happened you need to be seen by an expert, a specialist who has been specifically trained to assess and treat problems like this.
The first thing you can expect is your doctor to listen to your story about what has been happening – to take a detailed “history” of your symptoms. He will also ask about any history of injury as well as any other health problems you may have.
He or she will then examine you thoroughly to see exactly what the problem is.
At this stage, although your consultant will have a pretty good idea what is the problem with your foot, he may want to arrange further tests to confirm the diagnosis and to make sure there are no other problems which could be the cause. The tests he is likely to consider will include:
An X-ray is a simple test that gives much information about the bones of the feet and may be all that is needed to make a diagnosis.
Ultrasound is another useful way of diagnosing tendon, ligament and nerve disorders. Ultrasound guided injections are often used to treat conditions such as Morton’s Neuroma, which is a painful condition when the nerves between the long bones of the forefoot becomes swollen and tender due to repetitive crush injury due to tight footwear.
This is an advanced series of X-rays which are turned into three- dimensional images by computer. The CT scan is very good at showing “hard” structures such as bone.
An MRI (“Magnetic Resonance Imaging”) scan. This is a special scan that does not use X-rays but is especially useful at showing soft tissues and fluid. It is good for looking at the muscles and ligaments in the foot and ankle.
There is strong evidence to show that a delay in diagnosis and treatment for these conditions results in a worse outcome. If you have any doubt, it is better to see an expert who can reassure you or even prevent arthritis from setting in instead of wishing you had treatment earlier.
This is true for both acute injuries and painful foot conditions. Earlier treatment usually results in a better outcome and may prevent the need for further surgery later in life.
People who have had a foot surgery who were afraid or worried about surgery and delayed it for as long as possible often wish they had gone ahead earlier as this had such a major improvement in their quality of life and pain relief.
With correct treatment early on the chances of a full recovery with pain free movement and avoiding future complications such as arthritis are greatly increased.
As you might expect, it depends very much on what is causing the problem, which is why it is so important to be assessed by an expert.
For many conditions of the feet conservative measures (in other words there is no need for surgery) work well. Conservative treatments include:
On the other hand, some conditions require surgery to treat the problem. These include:
Obviously the exact treatment or operation you need depends upon exactly what the diagnosis is – many foot problems do not need surgery, after all – but in general terms you can expect to have a detailed discussion with your consultant who will go through precisely what he proposes to do to treat your condition. If you do need an operation most foot surgery is done as a day-case procedure under a general anaesthetic.
Unlike the NHS, where your consultant will supervise but may not perform every operation on every patient, privately you will be seen and assessed by your consultant personally. If surgery is required that consultant will perform the operation personally for you. This is one of the reasons that private healthcare at the Surrey Orthopaedic Clinic is so attractive of course.
On the day of your operation you will be met at reception by hospital staff and taken to your own room. Here the nurse looking will greet you and you will be seen shortly afterwards by the anaesthetist and the consultant surgeon looking after you.
After your operation you will feel drowsy but will feel little or no pain. Your consultant will see that you are well in the recovery suite of the operating theatre and in your room later. If required he will be happy to telephone your partner or other relative to let them know that all went well.
Most Foot and Ankle surgery is done as a Day Case. That means you come in for the operation and go home the same day.
You will be seen by your surgeon and a physiotherapist who will teach you how to walk using crutches and how to use the surgical boot or shoe that may be necessary after your operation.
After surgery, you may need crutches or other support which we will tailor to your needs with the assistance of our expert physiotherapy staff. You will be followed up in outpatients to ensure your recovery is proceeding rapidly and smoothly. It is important to us that you feel as little discomfort as possible after the operation and make a rapid recovery.
This varies depending on your occupation. For desk based jobs, it is possible to perform some work from home one week after surgery. Ideally you should take two weeks off from work to minimise swelling and maximise rehabilitation time with the physiotherapists.
Generally between 8-12 months depending on which sports. Higher level athletes with more intensive rehabilitation may get back closer to 6 months.
This is generally a day case procedure and there is no need to stay the night unless the surgery is performed later in the afternoon or early evening when we would advise an overnight stay to allow time to be spent with the physiotherapist before discharge.
Rehabilitation programmes are tailor-made for each individual based on the patients needs. Typically rehabilitation with physiotherapists lasts 6-12 months.
Driving may be resumed a few weeks after surgery, usually you are given the go ahead once seen at the clinic around the 6 week mark. If the surgery was performed on your right side, your surgeon may ask you to wait longer than if you had surgery on the left side, assuming you drive a car with automatic transmission. In any case you must be able to move the leg easily from the accelerator to the brake, and make a safe emergency stop before driving, that time typically varies from 4 to 8 weeks depending on multiple factors. Always inform your insurance company before going back to driving once given the all clear by your surgeon.
You will progress during your physical therapy program to walk normally as soon as possible.
OK, so you’ve been getting symptoms from your feet and would like to be seen by an expert. What should you do now?
To be referred to see either Mr. Dean Michael, Mr. Rishi Chana or Mr. Nick Masucci in our NHS practices please make an appointment with your GP and ask him to be referred to see us at Ashford & St Peters NHS Trust
We also see patients privately at our State-of-the–Art facilities at the Surrey Orthopaedic Clinic. If you have private medical insurance cover consult your provider about their policy for seeking an expert opinion. If you are self-funding simply contact our secretary Cassie Valenti on (020) 3130 4058 and she will make an appointment at a time that suits you.
I hope you have found the information here useful but I think it is important to stress that no-one can reliably self-diagnose their own medial problems or injuries. Even doctors see other doctors and try not to diagnose themselves.
One of the reasons for this is that even if the problem seems obvious there are occasionally serious causes of pain in the feet that can only be diagnosed by an expert.
Also the temptation with any symptom is to wait and see if it gets better on its own. Whilst in general terms this is a good idea it is always wise to be cautious and seek advice sooner rather than later if things aren’t settling in order to get diagnosed and treated early and prevent later problems.
As always, seek professional advice for any health problem you may have – and sooner rather than later.
We hope this page has been useful and we very much look forward to welcoming you to the Surrey Orthopaedic Clinic.