Wearing the wrong shoe can be a right pain

I have a very sore foot lately. The pain radiates across the bottom of my toes like a cramp. It has become so severe I can't wear high-heeled shoes. Is there something I can do?
Dr Nina Byrnes replies: The foot may seem like a simple structure but this isn't the case. It contains 26 bones, 33 joints, 126 muscles and multiple nerves. We are rarely born with foot problems. These are usually acquired as we age and, in the majority of cases, it is due to wearing ill-fitting shoes and not giving our feet the loving care that they deserve.

Pain in the foot can occur across the toes, in the forefoot (ball of the foot), middle of the foot, heel and arch.

Poor-fitting shoes are a common culprit. Shoes with a narrow toe push the toes together and over time can damage the structure of the toes. High-heeled shoes push a lot of weight and strain onto the ball of the foot and also cause alot of foot pain.

Obesity, poor posture or balance can alter the body's centre of gravity, leading to pressure through the feet and lastly high intensity exercise that involves jumping or running also put a strain on the foot.

Corns and callouses can also cause toe pain. These are thickened and irritated layers of skin that occur on the surface (corn) or base (callous) of the foot. They occur due to friction between toes or the foot and a shoe. Corns are sometimes removed using special ointments or the pressure can be relieved using special bandages.

Hammer toe or mallet toe occur when toes become bent or deformed. Hammer toe occurs when the joint in the middle of the toe becomes bent. Mallet toe is a bend in the furthest joint on a toe. The second toe is most commonly affected.

These occur mostly in women and are largely due to years of wearing narrow-toed, high-heeled shoes.

Bunions are a very common problem. They can run in families and 15pc are genetic. However, the other 85pc are once again due to ill-fitting shoes.

A bunion occurs when the base of the large toe moves away from the other joints of the foot at the same time as the top of the large toe moves towards the other toes. This creates an angle at the base of the toe and this joint can become inflamed and tender. The skin on the outside can become thickened and red creating the classic angled red appearance that we dread.

Pain across the ball of the foot may be due to arthritis, injury, irritation or inflammation of structures here but there are also a few quite specific causes.

Morton's Neuroma is a thickening of the fibrous tissue that surrounds the nerves in this area of the foot. It most commonly occurs between the third and fourth toes but can also occur between the second and third. Ill-fitting or high-heeled shoes, repeated stress to the foot from sports, or trauma to the foot form a fracture or sprain, can all cause this condition. The fibrous tissue builds up due to friction between bones, ligaments and nerves in this area. Morton's Neuroma is more common in women.

The pain in Morton's Neuroma can be quite severe and can cause cramping, burning or stinging that can shoot into the toes. It is sometimes relieved by massaging the foot.

Metatarsalgia is a general term used to describe pain across the ball of the foot. Pain can be severe cramping or aching. It is often worse if you stand, flex the foot or walk. Barefoot walking on a hard surface can be a particular trigger. Some people experience tingling or burning in the toes. Pain may start suddenly or build up more gradually.

Metatarsalgia is caused by ill-fitting shoes and high-intensity sports or running, but foot deformities such as high arches or other problems such as bunions or hammer and mallet toes also make this more likely.

Pain in other areas of the foot may be due to high arches, flat feet or deformities that cause the foot to turn out, changing the angle at which it hits the ground.

Problems in the heel can be due to Plantar Fasciitis or Achilles tendon pain.

When foot pain occurs, simple measures like applying ice, raising the foot and taking over-the-counter painkillers may help. Avoid wearing shoes that have a narrow toe or high-heel. These will exacerbate the problem. The dreaded sensible shoes do make a difference I'm afraid.

Seeing a chiropodist or physiotherapist who has an interest in foot pain can help. They may be able to prescribe orthotics - specially moulded insoles placed in shoes that may relieve the pressure across the ball of your foot. Losing weight if you are overweight will reduce the strain on your feet.

If simple measures aren't working, visit your doctor. They can organise X-ray and or scan for a more specific diagnosis. Referral to a specialist who can arrange injections into the area may be needed.

Bunions, hammer and mallet toes and Morton's Neuroma are also amenable to surgical treatment. This is usually only undertaken if the pain or disability is not relieved by more simple treatments or you are having difficulty wearing shoes.

There are various foot operations possible but they do require a general anaesthetic and you may be on crutches or off your feet for several weeks. Surgery doesn't always mean you can get back into your high-heels, either. Friction along the scar line may make these uncomfortable. Surgery for Morton's Neuroma may leave a permanent area of numbness on the foot surface.

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