What we treat

Causes

• Common in running, jumping, dancing and tennis, but can occur in any sport
• A sudden increase in activity or intensity
• Poor running technique, or excessive pronation of the foot (fallen arches / flat footed)
• Inadequate, poorly fitting or worn-out footwear
• In cyclists, a low saddle causing extra dorsiflexion of the ankle when pedalling
• Certain medications can cause inflammation of tendons

Symptoms

• Gradual onset of pain and stiffness over the tendon, which may improve with heat or walking and worsen with strenuous activity
• Often worse first thing in the morning, warming up through the day
• Tenderness of the tendon on palpation
• Pain on active movement of the ankle joint

Treatment options

We aim to treat the cause of your injury and not just the injury itself. To determine the cause, a biomechanical assessment is recommended: we discuss a full history of your symptoms and any lifestyle changes contributing to your pain, assess the joints and muscles of the lower limb, and analyse your posture and foot pressure. A programme is then tailored to suit your needs, and in some cases bespoke orthotic insoles may be necessary. We have invested in state of the art equipment to make orthotic insoles — these can be made at your assessment for you to walk out wearing them.

• Training modifications
• Rest and ice therapy
• Stretching and strengthening certain muscles and tendons in the leg and foot
• Footwear advice
• Orthotic insoles
• Kinesiology taping
• Lifestyle modifications
• A diet including anti-inflammatory foods such as whole foods, berries, nuts, fruit and veg
• Surgery in some extreme cases

Symptoms

• Swelling, tenderness and bruising
• Pain and stiffness
• Inability to put weight on the affected ankle
• Skin discolouration

Imaging such as X-rays may also be ordered to rule out a fracture.

Treatment options

• Elastic bandages or a brace to wrap and support the ankle
• Crutches, if needed
• Elevating your foot with pillows while resting or sleeping to reduce swelling
• Medication
• Ice therapy as often as needed in the early stages
• Plenty of rest, without putting weight on the ankle
• Stretching and strengthening once inflammation has reduced
• Strapping after injury to assist ankle stability

Common issues

• Excessive inward rolling of the foot (pronation)
• Excessive outward rolling of the foot (supination)
• Internal rotation of the lower leg and knee
• Excessive rotation or tilting at the hip
• Strain on the lower back

Associated injuries

Low back pain · hip pain · knee pain · ankle pain · bunions · IT band syndrome · shin splints · plantar fasciitis (heel pain) · metatarsalgia · Morton’s neuroma

Treatment options

We believe in treating the root problem of any injury. If an arch disorder is contributing, it is important to address this to complement your recovery programme — stretching and strengthening in the lower limb and foot, footwear modifications and, in some cases, orthotic insoles to realign the rear foot and support the arch. We can provide off-the-shelf insoles, and make and fit high performance bespoke orthotic insoles to any footwear, for any sport, the same day. If the arch disorder is not corrected then it is likely injuries will return at some point in the future.

Osteoarthritis

Often develops in adults in their late 40s or older, and is more common in women and in people with a family history. It initially affects the smooth cartilage lining of the joint, making movement more difficult and leading to pain and stiffness. Once the cartilage roughens and thins, tendons and ligaments have to work harder, which leads to swelling and the formation of bony spurs called osteophytes.

Rheumatoid arthritis

Affects more than 400,000 people in the UK, often starting between 40 and 50 years old and affecting women more than men. It occurs when the body’s immune system targets affected joints, leading to pain and swelling. The synovium is the first place affected; this can spread across the joint, changing its shape and causing bone and cartilage to break down.

Symptoms

• Joint pain, tenderness and stiffness
• Inflammation in and around the joints
• Restricted movement of the joints
• Warm, red skin over the affected joint
• Weakness and muscle wasting

Signs and symptoms

• Dry, red, scaly and flaky skin
• White, soggy and cracked skin
• Itchy or sore areas
• Small blisters

The infection can spread around your foot and to your toenails. In severe cases skin damaged by athlete’s foot can become infected with bacteria, which can lead to cellulitis.

Treatment options

Athlete’s foot is unlikely to get better on its own, but can usually be treated with antifungal treatments without needing to see a GP. We sell a range of antifungal products — creams, sprays, liquids and powders — which stop the fungus growing.

• Wash and dry the affected skin before applying treatment, and clean your hands afterwards
• Apply treatment directly to the affected skin and surrounding area
• Continue treatment after the rash has cleared, including spraying inside shoes every couple of weeks to reduce the risk of reoccurrence

Prevention

• Good foot hygiene, drying gently but thoroughly between the toes
• Cotton socks and roomy shoes of natural materials such as leather, so feet can breathe
• A fresh pair of socks, tights or stockings every day
• Change your shoes every couple of days so they dry out between uses
• Don’t walk barefoot in public showers and locker rooms
• Don’t share towels, socks or shoes
• Talcum powder to stop feet getting sweaty (but not between the toes)
• Don’t use moisturiser between the toes — this can help fungi multiply

Treatment options

Most blisters heal naturally after three to seven days and don’t require medical attention. Avoid bursting the blister, as this could lead to infection or slow healing. If it does burst, don’t peel off the dead skin — allow the fluid to drain and cover the area with a dry, sterile dressing. We may release the fluid using a sterile blade and then dress it to reduce the possibility of infection and speed healing. We also stock a range of blister prevention plasters and pads.

Signs of infection — contact your GP

• Increased pain
• Recurrence
• Yellow or green pus present
• Increased heat

Prevention

• Wear comfortable, well-fitting shoes
• Keep your feet dry with thicker socks or talcum powder
• Break footwear in gently over a number of days
• Don’t ignore any signs of pain
• Use a small amount of Vaseline on areas of increased pressure

Symptoms

• A swollen, bony bump on the outside edge of your foot
• Pain and swelling over the big toe joint, made worse by pressure from shoes
• Hard, callused and red skin where the big toe and second toe overlap
• Sore skin over the top of the bunion
• Changes to the shape of your foot, making shoes difficult to fit

Treatment options

Non-surgical treatments are usually tried first, including painkillers, orthotic insoles and bunion pads. These reduce symptoms such as pain but do not reverse the shape of the foot. Surgery may be considered if symptoms are severe and don’t respond to non-surgical treatment, though this can lead to reduced motion in the joint and altered gait. The best way to reduce your chances of developing bunions is to wear shoes that fit properly — shoes that are too tight or have high heels force the toes together.

Callus

Hard, rough areas of skin, often yellowish in colour, larger than corns and without a well-defined edge. They can develop anywhere pressure increases — most commonly the balls of the foot, under the metatarsals, the sides of the foot, the toes and around the heel. Other causes include excessively dry skin and reduced fatty padding under the feet.

A sterile blade is used to debride (shave) away the thickened skin, or it is filed using a water spray drill. As with corns, the prime objective is to remove the cause of pressure and reduce the chance of reoccurrence.

Corns

Small circles of thick skin that usually develop on the tops and sides of toes or on the sole of the foot, caused by increased pressure or friction. They differ from callus as the nucleus is still present, which makes it feel like walking on a stone and is usually more painful. Often caused by shoes that fit poorly, or designs that place excessive pressure on an area of the foot.

Corns won’t get better unless the cause of the pressure is removed. We enucleate (remove) the corn with a sterile blade and/or water spraying drill, and offer advice on how to prevent them in future. We do not recommend corn plasters due to the damage they can do to surrounding tissues.

Prevention

• Dry your feet thoroughly after washing and apply a good quality moisturising foot cream (not body lotion)
• Use a pumice stone or foot file regularly to gently remove hard skin, making sure it dries fully between uses
• Wear comfortable footwear that fits properly — shop for shoes in the afternoon, as feet swell as the day goes on

Causes

• Walking barefoot, or in flip flops and open backed sandals, which dries out the feet
• Long periods standing at work or home, especially on hard floors
• Increased weight, which increases pressure on the heels
• Poorly fitting shoes or sandals
• Poor foot hygiene
• Dry, scaly skin caused by climate — low humidity in dry summers or cold winters
• Poor nutritional diet, or circulation problems
• Other health conditions such as diabetes, thyroid problems, psoriasis and eczema
• The ageing process, with less supple skin and reduced circulation

Treatment options

In addition to cleaning the dead dry skin from your heels, we treat the underlying causes and give you the right advice on how to keep your heels in great condition.

• Use a heel balm or oil based moisturiser twice daily — a balm in the morning increases the elasticity of the skin before you get moving
• A pumice stone or foot file to reduce the thickness of hard skin
• Wear closed-in shoes and good socks when you can
• Drink plenty of water to keep your skin hydrated
• Essential fatty acids in your diet, such as omega 3, may assist
• If cracks start to bleed, apply an antiseptic to prevent infection and keep clean with a dressing

Nerve damage

• Sensory nerves — inability to feel pain, extremes of temperature and vibration
• Motor nerves — affects muscles in your feet, causing toe joints and bones to change shape
• Autonomic nerves — reduces sweat, making skin very dry and increasing the risk of callus, corns and pressure ulcers

Sensations you may feel if nerves are damaged

Tingling or pins and needles · numbness · pain · sweating less · red feet that feel hot to the touch · changes in the shape of your feet · hard skin · losing the sense of the position of your feet and legs

Sensations you may feel if blood supply is affected

Cramp in your calves · shiny, smooth skin · losing hair on your feet and legs · thickened toenails · cold, pale feet · change in skin colour · wounds or sores · pain in your feet

Preventing foot complications

Preventing foot problems is about being positive and active now, rather than acting only when there is a problem. It starts with managing your diabetes well, leading a healthy lifestyle and keeping blood glucose levels well controlled. It is advisable to have a diabetic foot assessment annually with the NHS; we conduct diabetic foot assessments and can tailor them to fit around your NHS appointments, meaning your feet can be assessed twice a year — changes in the foot can happen quickly.

Washing and moisturising your feet every day keeps the skin supple and healthy, and checking them daily helps you spot injury or skin damage quickly. Make sure your footwear is suitable and clean, and never walk around barefoot. If you have diabetes it’s important to try to stop smoking, as smoking impairs blood circulation and increases healing time.

Causes

• Poor foot hygiene, or poor footwear
• Damage to nails from dropping objects on them
• Contagious — sharing towels or shoes with family members can spread the infection
• Poor diet and lifestyle, poor circulation, smoking
• Being immunosuppressed

Symptoms

At the start there are usually no symptoms. Later, nails may become so thick that they hurt when they press on the inside of a shoe. The infection can spread across the whole nail or just part of it; infected areas turn white or yellowish and become thickened and crumbly. Not all discoloured nails have a fungal infection. Fungal nails are sometimes difficult to trim without professional equipment — we use water spraying drills to reduce the thickness of the nail, allowing it to be trimmed pain free and more effectively, and ensuring treatment can penetrate the nail bed where the infection lies.

Diagnosis

Many nail problems can look like a fungal nail infection — psoriasis, a bacterial infection or an old injury. The diagnosis should be confirmed before treatment starts. In most cases your GP will send a piece of nail to the laboratory; as this can take time and be costly, in some cases your GP or podiatrist will prescribe treatment based on the appearance of the nail and their clinical knowledge.

Treatment options

• Research suggests the most effective treatment is a tablet (such as Terbinafine) from your GP — usually 250mg once a day for three to six months for toenails, alongside a lacquer. Success rates are between 60–80{3bb1c0711227dd3c40bd97632c4ee03991d4aa8599de56ecf693fd4f5b060147}
• Natural products such as tea tree oil or certain vinegars are sometimes effective
• Nail surgery may be necessary if the nail is painful and a continuing problem. We can perform total or partial nail surgery under local anaesthetic and apply phenol to prevent regrowth (97{3bb1c0711227dd3c40bd97632c4ee03991d4aa8599de56ecf693fd4f5b060147} success rate), working with you through the whole process including dressing appointments
• Lead a healthy lifestyle — exercise, good hygiene and a healthy diet
• Newer products including laser therapy and clearanail show positive results, though it is too early to tell if they are more effective than traditional methods