Common foot conditions: When to see a foot specialist

24th-30th April is Foot Health Week. In this blog post, Mr Ewan Kannegieter, Consultant Podiatric Surgeon based at Phoenix Hospital Chelmsford discusses some common foot conditions that he sees, and advises on when you should see a foot specialist. The three conditions are:

• Foot arthritis
• Morton’s neuroma
• Ingrown toenails

Foot arthritis

What is foot arthritis?

The term arthritis is a general term that covers over 100 joint and musculoskeletal conditions.

Each foot has 33 joints, 26 bones, and over a hundred tendons, muscles and ligaments.  These all work together to allow us to walk, run, jump, bear weight and move from A to B. Arthritis in the foot can occur for many reasons; injuries and accidents, overuse, family genetics, and inflammatory conditions.

In the foot the most common site affected by arthritis is the 1st metatarso-phalangeal joint (MTPJ). Arthritis here is often called hallux limits or hallux rigidus.

Symptoms of foot arthritis

Symptoms of arthritis vary but can include:

• Aching and throbbing pain
• Loss of movement/joint stiffness
• Pain at rest and at night
• Avoidance of the area
• Swelling or enlargement of the joint

How is foot arthritis diagnosed?

To diagnose foot arthritis, you would need to see a specialist and have some diagnostic tests. X-rays are used as a baseline investigation to help review the stage of arthritic change within the food, as well as bone quality. Other investigations that may also be helpful include MRI or CT scans, as well as bloods to review inflammatory markers.

Treatment of foot arthritis

Treatments for foot arthritis can vary, and depend on the severity of the condition. Conservative treatments to help relieve pain and discomfort will be the first step, such as:

• Changing shoes
• Over the counter pain medications
• Injections (cortisone, steroid, hyaluronic acid, PRGF)

Most patients do well with conservative treatments, however arthritis is usually a progressive problem that will require self-management, repeat of the conservative options or surgery.

Surgical treatment will be recommended only if you are suffering from severe arthritis pain that conservative measures have failed to treat. Surgery will be specific to the joint(s) affected. As a general rule, a joint fusion for foot arthritis takes 6-8 weeks to recover from.

When to see a specialist

You should see a foot specialist if you think you may have foot arthritis, or have a diagnosis and would like help managing your symptoms. Some signs that you need to make an appointment with a foot surgeon include:

• Pain or discomfort that affects your daily activites
• You have exhausted at home conservative measures

Morton’s Neuroma

What is Morton’s neuroma?

A neuroma is a swelling and thickening of the nerve under your foot just before the toe web-space. When you walk the nerve is compressed and causes pain which usually is felt as a burning sensation which can radiate into the toes. There is usually involvement of a swollen bursa (bursitis) at the same site. Often this combination is termed a neuroma/bursal complex. Some patients describe the feeling of walking on a pebble, or socks being rucked up underneath the toes.

Conservative and surgical treatment options are available and around 80% of patients are managed without surgery

What causes Morton’s neuroma?

Morton’s neuroma is a fairly common condition, especially in women, and is the most common nerve complaint in the foot. The condition has been linked to:

• Wearing tight fitting shoes
• Some sports (particularly running or sports that involve placing high loads on the forefoot)
• Other foot issues and deformities such as flat feet, bunion or hammer toes can increase the risk of neuroma due to transfer of pressure to the ball of the foot.

Diagnosing neuroma

An ultrasound or MRI scan will be used initially to chart the location and size of the swollen tissue and confirm the diagnosis. A doctor will examine the area by compressing the forefoot; it may demonstrate an obvious pop or click.

Treatment options for neuroma

Initial treatments will include:

• Changing shoes
• Over the counter pain medication
• Course of injections for pain relief

Around 80% of patients do well with conservative treatment. Surgical treatment is recommended if you’re suffering from severe pain from Morton’s Neuroma and simple measures have failed to improve your symptoms. The operation takes about 20 minutes and usually involves making an incision on top of the foot via which the nerve and bursa is removed.

The recovery process following neuroma surgery will vary from patient to patient. Generally speaking, patients should expect to wear a post-op shoe for 2 weeks with immediate heel weight bearing being allowed after the operation. Although patients often transfer into a sneaker/trainer shoe at around 2 weeks post-op, the forefoot may be tender for around 6 weeks. The pros, risks and recovery of any surgery will be discussed with you at your visits to the hospital.

When to see a specialist

If you’re experiencing any of the following symptoms, it’s time to make an appointment with us:

• Pain or discomfort that affects your daily activities
• You have exhausted at home conservative measures

Ingrown toenails

What are ingrown toenails?

Ingrown are a common problem typically caused by a nail edge cutting or burying itself into the soft flesh around the nail. Ingrown toenails can be extremely painful. They can become infected and easily develop into a chronic condition.

What causes ingrown toenails?

Ingrown nails usually occur in young people. However, thickened, misshapen and painful nails can occur at any age. A number of factors can lead to painful toenails:

• Poorly cut toenails
• Wearing tight-fitting footwear
• Sweaty feet
• Injury such as stubbing your toe

How to treat ingrown toenails

Conservative care can help prevent pain or further infection but often won’t cure the problem. In order to successfully treat the condition, you may require a minor procedure which we would recommend if you have a significant problem or frequent episodes of infection.

The procedure to resolve an ingrowing toenail involves removing the sliver of nail that is pressing into the flesh causing your pain. Once the nail portion is removed, the wound can be cauterised with a chemical called Phenol. This prevents this part of the nail bed regrowing the nail. The rest of the nail is usually unaffected. The procedure takes about 10 minutes. You will have a bulky dressing on your toe and you should only wear flipflops or slippers for the first day or two.

Risks of surgery

As with any medical procedure, there are risks which will always be explained to you prior to your treatment. The main risks following surgery are:

• Pain
• Infection
• The remaining nail will be narrower and can be thickened
• Occasionally the entire nail will shed and a new one will grow in its place
• The nail may re-grow and cause a further ingrown toenail, however this is uncommon

When to see a podiatrist

If you’re experiencing any of the following symptoms, it’s time to make an appointment:

• Pain or discomfort that affects your daily activities
• Recurrent infections
• Needing repeated courses of antibiotics
• Exhausted self-care options

To learn more please visit www.kannfootsurgery.com

To book an appointment with Mr Ewan Kannegieter, please call Nikki Freeman on 07808 643950