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Pain down the outside of the foot in a child

There are many different causes of pain down the outside of the foot and one of those rare causes in children is a condition called Iselin’s disease. There is a growth plate at the base of the fifth metatarsal bone that the peroneal tendon from the leg attaches to. This means that this growth plate is subject to a lot of pressure from the tendon, especially if the child is active in sport. Overuse of this area can result in an inflammation or irritation of that growth plate, resulting in the Iselin’s disease. Age 13 years is the most common time for this and it affects bots just as much as it affects girls.

The pain of this usually starts slowly and gets worse with increased sports activity. There may be some swelling in the area and the pain may be making the child limp. Palpation of the base of the fifth metatarsal about midway down the outside of the foot is painful or tender. X-rays may need to be done to confirm the problem and rule out other potential causes of pain in the area.

The most effective treatment for Iselins disease is simply rest. This means reducing the amount of sport or total rest. This may need to be done in a moon boot if the pain is bad enough. It can take 4-6 weeks of this type of rest for it to improve enough for the levels of exercise to be gradually and slowly increased.

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What is a Tailor’s Bunion

A Tailor’s Bunion is the bunion that occurs at the base of the little toe. It is called a Tailor’s bunion because it used to be assumed that it was more common in the Tailor’s who used to sit cross legged while they did their work. This sitting position put a lot of pressure on the outside of the foot wear this small bunion occurs. It is also called a bunionette as it is widely considered to be the smaller cousin of the typical bunions that occur at the base of the big toe.

The cause of a Tailors bunion is most likely die to poorly fitting footwear causing pressure on the fifth toe in those who a hereditary predisposition. The symptoms are an enlargement of the bone at the base of the first toe that may become inflamed and be painful when wearing shoes that press on it.

To treat a Tailor’s bunion make sure you are wearing roomy, comfortable shoes with a wide toe box can alleviate pressure on the painful area and provide relief. Barefoot can be best or something like the Archies will allow you to walk around without any pressure on it. Any shoe that puts any pressure on the joint are best avoided. High heel shoes will also increase the pressure on the problem and are best avoided. There are protective pads and corrective pads can help reduce friction and protect the affected area. The pads can be placed on or around the enlarged joint to straighten the toe and protect the bunion for friction.

If these approaches with good shoes and different paddings are not helpful, then surgery is really the only other option to get rid of a Tailors bunion.

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Do you need toe straighteners?

Toe straighteners or toe correctors or toe spacers or toe braces or correct toes or whatever you want to call them are being used more often than in the past. They come in a variety of different designs and types with a lot of variation between them.

The purpose of these toe straighteners are to obviously straighten the toes! As you can see above, the left one tries to straighten them by pulling down on the toe from above whereas the one on the left tries to straighten and separate the toes to spread them. This spreading is particularly helpful if you spend all day in tight footwear. As to which toe straightener you should use, it could depend on the nature of the problem that we are trying to correct. The one on the left will also fit better into the shoes whereas the one on the right will only fit into shoes that have the room. It may be better to use the one on the right as more of a night splint.

The main use for these toe straighteners are to use on toes that are cramped into shoes all day. They are helpful for hammer toes and claw toes and the one on the right can be particularly useful for conditions like a Morton’s neuroma.

At the end of the day, if you wear shoes, you will probably benefit from one or both of these types of toe straighteners to counter some of the forces that the shoes apply to the foot to deform them. Get in touch with us if you want more advice on this.

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What is Sesamoiditis?

Under the big toe are two small bones called the sesamoid bone. These are embedded in tendon in the same way that the patella bone is in the from of the knee. The function of the sesamoid bones (and the patella) is to give the tendons are more efficient lever to move the joint. As these bones are under the big toe joint, they are subjected to a lot of force when walking and playing sport. Sports like tennis where you need to use the big toe joint to pivot on put an enormous amount of force on them. If these loads are too high, you can end up with a condition called sesamoiditis in which these small bones and the structures around them become inflamed. Wearing higher heels shoes also puts pressure on the sesamoid bone and so does having to stand all day at work, especially on hard floors.

The symptoms of sesamoiditis are gradually increasing levels of pain under the big toe joint. If you palpate where these bones are they can be quite painful. Sometime the bones are very prominent because there has been some atrophy of the fat pad. On occasion, especially if the onset of pain is acute there might be a fracture of one or both of the sesamoid bones. There are a number of conditions that can affect the big toe joint such as gout or osteoarthritis that also needs to be taken into account when assessing someone with pain in this area.

Once a sesamoiditis has been diagnosed then sesamoiditis treatment usually starts with some sort of reduction in activities or modifying them if that is possible. Getting into well padded and cushioned footwear is also a useful idea. There are adhesives felts that can be stuck on the foot to get pressure off the painful are. Pads an also be used on insoles in the shoes. Over the long term foot orthotics with pressure relieve are usually very helpful.

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Medical Conditions Affecting the Foot

When you first come to us we will be asking questions about your medical history and what medicines that you might be taking. Periodically when you come to see us, we will update this information. Sometimes you may wonder why this information is relevant and what it might have to do with your foot and what we do. It is relevant and important as it might impact on what is the cause of your foot problem and it may impact on how and what we do to treat your foot problem.

The obvious one is diabetes. Diabetes increases the risk for a lot of foot problems due to its effect on the nerves and blood vessels. Not only does diabetes increase the risk for foot problem, it also affects how problems with the foot heal up. We really do need to know if you have diabetes and how things are going with it so we can assess how it affects your feet.

It may not seem relevant, but thyroid disease is another one. Over and under activity of the thyroid glad can cause issues with the feet. For example, under-activity can lead to dryer skin that can lead to painful cracks around the heel.n

Coeliac disease is another one that you might well wonder what it would have to do with the foot when the disease is a problem with gluten damaging the villi in the gastrointestinal tract. Coeliac disease does affect the foot. There have been a number of case reports of chilblains in those with celiac disease and it can also cause an enthesopathy in the foot and affect the nerves to the foot. This means that something that may seem to be so unrelated to the foot and problems with the foot may need to be considered when assessing a foot problem.

When you get asked about your medical history and symptoms and the drugs or medicines that you might be taking, then there is a good reason why we might need that information. It may not seem relevant to you, but it could well be a factor in your foot problem and may be a factor that needs to be taken into account when we recommend the best approach to treat your problem.

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Arthritis of the midfoot

Pain in the midfoot, just in front of the ankle is a reasonably common problem. One of the more common causes of that pain is osteoarthritis, the so called ‘wear and tear’ arthritis. The symptoms typically start out with a mild ache in the midfoot. Often that can be helped with a some mild anti-inflammatory drugs and wearing more supportive footwear. Later as the osteoarthritis progresses the pain can become more constant and become a real problem. The pain is typically deep within the midfoot or arch area of the foot and is made worse after activity.

One of the biggest risk factors for osteoarthritis is obesity and that is true for midfoot osteoarthritis, so loosing weight is a good approach to dealing with the symptoms of osteoarthritis. You should raise this with your general medical practitioner about how to approach that.

The use of a cream like fisiocrem that give a deep heat feeling is often advised as well as mobilisation exercises. There are different exercises for both stretching and strengthening the muscles around the midfoot that can be helpful. Anti-inflammatory drugs are also more helpful as the pain gets worse.

Another approach can be to use the shoe stiffening inserts for midfoot osteoarthritis. These are thin and very rigid carbon fibre plates that help stiffen the footwear to make it more rigid. Some people find that wearing more rigid or less flexible shoes are more comfortable, so in these cases they will often benefit from these types of rigid plates.

Foot orthotics for midfoot osteoarthritis are most commonly used to give some support and stability to the midfoot and arch. This is usually very helpful at helping with the symptoms and increasing the ability to walk without any pain. Custom made foot orthotics are generally a better option for managing this.

If you have pain in your midfoot, then give us a call for an appointment and we can certainly help and discuss your options..

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What are those tiny holes or craters under the ball of the foot?

They are most likely a condition called pitted keratolysis. It is an infection by a bacteria (a Corynebacterium) in feet that sweat a lot. As sweat accumulate and is not allowed to evaporate it creates an environment that the bacteria like to grow in. All the multiple tiny holes or pits or craters come about because of an enzyme that the bacteria release to eat away at the keratin in the outer skin layer. The skin also tends to have a whitish colour which is due to the accumulation of moisture in the skin. The feet also commonly have a foul odor as well due to the bacteria causing sulfur to be released.

There are two approaches to get rid of pitted keratolysis: first there is to use a topical antibiotic that can usually quickly and easily deal with the infection. The second and more important is to get rid of the environment that the bacteria likes to grow in, so the pitted keratolysis can no longer be a problem. This means good foot hygiene habits. The feet need to be washed, cleaned and thoroughly dried every day. Go barefoot as much as possible so that the sweat can evaporate and the feet dry out. Wear socks and shoes that can help absorb moisture or at least wick it away from the foot. Change the socks during the day so they can help keep the feet dry. An absorbent powder in the socks can also help. Odour eating insoles can also help absorb moisture.

If you have pitted keratolysis and none of these measures are helping, then please call us and come in for a consultation and we can advise more clearly on what needs to be done.

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If your big toe hurts to move, then we need to find a way to stop it moving

Pain in the big toe that hurts when walking is most commonly due to osteoarthritis, a condition commonly known as hallux rigidus (if the joint is really stiff) or hallux limitus (if its not so stiff). If its really painful at rest, then it might more likely be gout than hallux rigidus. With the hallux rigidus, when we are walking and the heel starts to come off the ground, the big toe joint needs to move. If that movement is limited or there is osteoarthritis in the joint, then that is going to be painful to walk. It makes sense that if that joint hurts to walk, then a logical way to deal with it is to restrict how much the joint moves.

There are a number of ways to do this. One is felt padding that can be stuck on the foot under the big toe and ball of the foot or strapping could be used to tape the joint. Both of these are really good short term measures. If you need a foot orthotic for other reasons, there is an extension that can go on the front of the orthotic called a Morton’s extension that can be used to stiffen up the joint. Another way is to use a carbon fibre insole plate that usually are about 1-1.5mm thick and very rigid that fit inside the full length of your shoes. These carbon fibre plates are often used to treat hallux rigidus and other problems such as turf toe. The evidence is that they are pretty effective.

Another way to treat the pain from the hallux rigidus is to simply use shoes that are more rigid across the ball of the foot. The more flexible the sole of a shoe is, the more that the big toe joint is going to move and the more likely it is to be painful. The are some shoes, especially the Hoka running shoes, that have a rocker built into them. The effect of the rocker is that the big toe does not need to move as much. A pedorthist or shoe technician can add a rocker on the sole to many different types of shoes to achieve the same thing.

If you have pain in your big toe joint when you walk, come and see us and we can discuss what options may be the best for you.

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The thyroid gland and the foot

When we see a patient we always collect an initial detailed history of medical conditions, and not for no good reason. There is a good reason that we need that information. The medical condition may cause symptoms in the foot. The medical condition may affect the choices that we have to deal with your foot problem. The drug you are on may have side affects that show up in the lower limb. There is a good reason for asking all that information and plenty of things that can affect the foot and the treatment choices of foot problems.

The thyroid gland is in our neck and secretes some hormones that help control our body’s metabolism. At first glance is probably is not hard to wonder what that might have to do with the foot! It has plenty to do with the foot.

For those who are lacking some of the thyroid hormone (hypothyroidism), the skin can be dry and make heel fissures more common. There may be some symptoms in some of the joints that might feel like a common form of arthritis, but are an effect of the lack of the thyroid hormone. The nails my become easily ‘looser’. Some of the tendon reflexes do not work as well and do not relax well after you hit the Achilles tendon (this is called Woltman’s sign). There could be some nerve damage that can cause the feet to get some pins and needles and even go numb. If you are on treatment for hypothyroidism with the drugs, then these problems are less likely to occur, but we need to look out for them and consider them when there is a foot problem.

This is just the affects of a low thyroid hormone, but serves as a good illustration as to why we need to know about your medical history.

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Foot care for those with dementia

All types of dementia, of which Alzheimer’s disease is the most common and the most well known is a devastating condition. We certainly see it in many patients that we see drift away slowly and the impact that this has on their loved ones.

We sometimes get asked if is foot pain associated with dementia and Alzheimer’s disease? Generally, the answer to that is no. There is nothing that is inherent in the physiological processes that go on in those with Alzheimer’s disease that can cause foot pain. However, as those who tend to get Alzheimer’s are older and foot problems are more common in those are older, it stands to reason that they will get the usual and typical types of foot problems that those in that age group get. There are also issues with the ability of those with the Alzheimer’s to care for their own feet and the necessity for caregivers to check the feet on a regular basis for any problems. Also the general frailty associated with the condition does make the foot more vulnerable to damage.

Getting foot care for those with all forms of dementia is just as important as any other health service provided. The development of foot problems is going to affect the mobility and quality of life. Providing foot care can be a challenge at times, mostly due to them failing to understand and appreciate what is going on around them, perhaps even lashing out physically and verbally. Foot problems do develop in Alzheimer’s disease, so please check your loved one and bring them in if there are any problems.

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