Foot problems

Also called Bunions, Corns and calluses, Ingrown toenail, Morton's neuroma, Flat feet

Bunions, corns, ingrown nails and nerve pain. Mostly caused by footwear, and on a diabetic foot none of them are minor.

What it is

A group of common problems of the foot, gathered together because the advice, the footwear question and the referral route are the same.

**Bunions** are a bony deformity where the big toe drifts sideways. They are largely inherited, worsened by tight or pointed shoes, and are not caused by shoes alone. Splints and spacers relieve symptoms but do not straighten the toe; only surgery corrects the deformity, and it is worth doing for pain rather than appearance.

**Corns and calluses** are thickened skin from pressure or friction, and they are a symptom rather than a diagnosis. Removing them without changing the pressure guarantees their return.

**Ingrown toenails** occur when the nail edge grows into the skin, usually from cutting nails curved rather than straight across, or from tight shoes. Recurrent ones are cured by a minor procedure with phenol, which has a high success rate.

**Morton's neuroma** is a thickened nerve between the toes, causing burning pain and a feeling of a pebble in the shoe, and responds to wider shoes and metatarsal support.

**Flat feet** are usually normal and painless. Pain, or a foot that has become flat in adulthood, particularly in one foot, needs assessment.

For anybody with diabetes or peripheral arterial disease, none of these is minor. See podiatry.

Signs you might notice

Bunions: a bony bump at the base of the big toe, redness and soreness over it, and difficulty finding shoes that fit.

Corns and calluses: hard thickened skin, on the sole or over a toe joint, tender to press.

Ingrown toenail: pain, redness and swelling along the nail edge, sometimes with pus.

Morton's neuroma: burning or shooting pain between the third and fourth toes, numbness, and the sensation of a stone in the shoe, relieved by taking the shoe off.

Same-day assessment for anyone with diabetes: any break in the skin, redness, swelling, discharge, or a change in colour or temperature.

Also urgent: spreading redness with fever, which may be cellulitis; or a foot that is cold, pale or painful at rest, which may be poor circulation.

How it can affect day-to-day life

Footwear is the single biggest lever and the one people resist. Shoes need to be long enough, wide enough at the toes, deep enough, and fastened so the foot does not slide forward.

Feet change shape with age; most people are wearing the size they were measured for decades ago.

Painful feet are a major and under-recognised cause of falls and of reduced activity in older people. Sorting them out is a mobility intervention.

NHS podiatry is rationed by risk in most areas, so routine nail care often has to be arranged privately, and unregulated providers exist; check registration.

For older people who cannot reach or see their feet, this needs to be somebody's job within their care, not an assumption that they manage.

Bathroom surgery on corns and nails causes infections, particularly with poor eyesight or reduced sensation.

Supporting someone well

Get shoes measured, both length and width, and buy for the larger foot.

Cut toenails straight across, not curved, and not too short.

Do not use corn plasters or blades, particularly in diabetes or poor circulation.

Address the pressure, not just the callus: a wider shoe, a cushioned insole, or a metatarsal pad.

Look at the feet regularly; daily for anyone with diabetes.

For recurrent ingrown toenails, ask about the phenol procedure rather than repeated antibiotics.

Ask for podiatry referral for anybody at risk, and check any private practitioner is registered with the Health and Care Professions Council.

Consider bunion surgery for pain that limits walking, not for appearance.

Treat painful feet in an older person as a falls risk.

Where to get help

A pharmacist for simple advice and padding.

A GP practice or podiatry service for painful, infected or recurrent problems.

Same-day for any wound, redness or swelling on a diabetic foot.

Royal College of Podiatry hold a directory of registered practitioners.