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If your feet hurt, everything can hurt; It is often only once your feet hurt that you realise quite how important they are, as foot expert Dr Sarah Curran explains.

OUR feet can be one of the most essential parts of our body, but often they are neglected when it comes to taking good care of them.

Health Check Wales looks at why issues with the feet can be a taboo for many people.

Philosopher Socrates once said: "To him whose feet hurt everything hurts."

Our feet are not only essential for getting us from A to B, but foot pain and symptoms can have a major affect on our function, mobility and quality of life.

Dr Sarah Curran is a senior lecturer at the Wales Centre for Podiatric Studies, Cardiff Metropolitan University, and is currently the editor-in-chief of Prosthetics and Orthotics International and chief editor of the Foot and Ankle Online Journal.

She says: "In essence, it is not until you have something wrong with your feet that you realise just how important they are.

"My opinion is probably a little biased here but our feet represent the foundational platform that provides the link between our body - lower limb - and the supporting surface, the ground we walk on.

"During weight bearing activities, our feet act to absorb shock, adapt to uneven surfaces and become strong and rigid enough to support and propel our body forward."

Dr Curran, who has been a podiatrist for the past 12 years, is a clinician who tends to see a lot of knee pain and many of her patients are runners who have picked up injuries.

But from a more general perspective, the department sees problems with plantar fasciitis, which is pain in the bottom of the heel and arch and patients with fungal infections of their nails and skin is also very common.

"Verracue are also common and we tend to advise no intervention since they are not very receptive to treatment," said Dr Curran.

"However, for patients where this approach is not suitable, a treatment plan can be implemented with regular debridement (of the verracue tissue) and the application of various medicaments, or by freezing (cryotherapy) or burning (electrocautary) the verracue tissue away."

To prevent cross-infection of verracue, Dr Curran advises patients to wear flip flops if they go to swimming pools or spas and not to share towels. She also advises the use of a verracue sock if a patient wishes to go swimming, but a less conspicuous method is to paint some clear nail varnish over the area.

Another common problem presented to podiatrists involve in-growing toe nail, which is known as onychocryptosis.

This can affect both men and women, but in particular teenagers - as their feet have a tendency to sweat more which makes the skin around the nail softer.

As you get older, more people are also prone to suffering with thickened and curved nails which can dig into the skin around the nail.

General foot care of cutting the nail straight across, reducing the thickness of the nail and wearing non-restrictive footwear can help reduce symptoms.

However, for some cases, the best option is to have part or all of the nail removed. This would be fully discussed with a podiatrist prior to this ever happening.

But what are the most important things you can do to take care of your feet? Dr Curran said: "Wear good fitting and supportive footwear, preferably one that is laced or has a buckle that goes across the foot.

"There should also be a good width and depth to the forefoot area. Dry between your toes after your shower or bath and apply a moisturiser cream daily to avoid dryness of the feet."

And it is very important to start good foot habits from an early age. Dr Curran said: "A child's foot is very supple and can adapt quite easily. Wearing too small footwear can create a deformity with the cramming of the toes and footwear that is too big can cause clawing of the toes. From an immediate point of view, too small or big footwear can increase the friction between the foot and the footwear and cause blisters which is not ideal.

"It is never too early to start looking after your feet. It is hoped that by adopting good basic principles of wearing sensible fitted footwear from an early age, it will continue throughout a person's lifespan.

"However, there are those everyday challenges of footwear and fashion, for example, high heeled footwear, which can challenge these principles.

"Our feet are mechanical marvels that help us get from A to B - sadly we only get one pair, so look after them."

Foot care amongst diabetics is incredibly important as foot ulcers affect as many as one out of 10 people with diabetes.

Even small ulcers on the foot can represent a serious risk as they may heal extremely slowly and need rigorous treatment to cure.

In turn, ulcers can develop into serious lower body infections, with the possibility of amputation at an advanced stage.

The presence of high blood glucose levels over a long period of time may result in damage to the body and to bodily functions.

Although it is uncertain how this process works, amongst diabetics it is relatively frequent. A condition called diabetic neuropathy sometimes occurs over time.

Commonly, this manifests itself as peripheral neuropathy and usually affects the sensory nerves in the legs.

If your nervous system is even slightly damaged, the extremities of the body can become numb.

For this reason, you may not be able to feel foot problems until they have developed. It is key to ensure you have regular foot examinations. As Dr Curran explained: "Diabetes mellulitis is linked with many complications but its relationship with the feet is due to the effects of neuropathy.

"This is where patients lose the ability to perceive sensation and presents as a stocking (sock like) effect. It can gradually occur without the patient realising and, as such, the loss of protective sensation puts them at risk of developing increased pressures underneath the feet that can cause ulceration and in some severe cases where infection and gangrene is present, amputation.

"The blood supply to the feet can also be affected along with an increased tendency to develop foot deformities due to an imbalance between the foot and lower leg muscles. These complications represent a significant risk to patients with diabetes mellitus and their health and quality of life in general."

So what can diabetic patients do to minimise feet problems? Check their feet daily, or ideally ask a family member to take a look.

Always check the inside of your footwear prior to putting them on and make sure they are the correct size and do the shoe laces up.

Attend the annual review appointments with a NHS podiatrist so that they can monitor signs of loss of protective sensation and foot health in general. There are a number of healthcare tips that should be adhered to in order to make sure your feet stay as healthy as possible, according to website

Examine you feet yourself Feet are somewhat like teeth. It is easy to ignore mild problems with them, hoping that they will go away.

However, the best course of action is to regularly examine your own feet for the slightest sign of ulcers or problems.

This can be particularly important if you are suffering from poor circulation and numbness. Treat any cut, graze, bruise or mark with suspicion: either treat it yourself or consult your doctor as soon as possible.

Also be aware of cracking from dry skin becoming ulcerated over time. Take extreme care of your feet, making sure that your socks and footwear are comfortable and fit well. If your eyesight has diminished due to diabetes, make sure that a professional is on hand to examine your feet and cut your nails.

Have your feet examined by a professional Making sure that you receive a regular check-up from a health professional is also a good idea. In this way, any problems will be detected at an early stage and treatment should be relatively simple and painless.

Manage your diabetes Strictly controlling your diabetes with an aggressive treatment regime, healthy diet and lifestyle and an appropriate amount of exercise means that you are less likely to suffer from foot complications, such as foot ulcers.

Bunions aren't just caused by pointed high heels Anthony Perera, a specialist foot an ankle orthopaedic surgeon at Spire Cardiff Hospital and the University Hospital of Wales, answers questions on the sometimes troublesome topic of bunions What is a bunion? A bunion is a bony swelling on the inside of the big toe joint. Typically it starts in people in their thirties and forties though it can start in some girls in their teenage years. It tends to progress, sometimes this can be quite rapid but generally it deteriorates slowly. As it does so, the swelling can become worse causing the forefoot to be quite wide. This is associated with a deviation of the big toe and, as things get worse, can affect the other toes causing them to become elevated or curled. It can also lead to pressure problems underneath the foot.

What causes a bunion? Traditional teaching suggests that bunions are a problem of women who wear narrow and pointed high heel shoes but in actual fact, the situation is more complicated than that. Recent editorials that I wrote for the Journal of Bone and Joint Surgery, an international leader in orthopaedic research, showed that bunions can be found in populations around the world who have never worn shoes which clearly shows that there is a genetic predisposition towards developing bunions. On the flip side, there are plenty of people who wear narrow, pointed high heels shoes who never develop bunions.

What can I do to help my bunions? Whilst there are numerous braces, straps and appliances available on the internet that suggest that they can treat your bunions or stop them from getting worse, unfortunately none of them are of any benefit. The basic issue with the bunion is that the forefoot becomes very wide whilst your heel stays the same width. Unfortunately, shoes come with set dimensions for the forefoot and heel and you will find that shoes that fit your heel will be too tight on the forefoot whilst ones that accommodate your forefoot will leave the heel loose at the back. There are 'bunion-type' shoes available, however, they are not usually very fashionable. The most straightforward advice is to ensure that your shoes fit you properly. Our feet do get flatter and bigger with time and it is important that you get these measured accurately.

So do all bunions need surgery - I heard it was really painful? Definitely not, in fact I would advise against bunion surgery for cosmetic reasons. The size of the bunion itself also does not matter. There are some people with very small bunions that have quite considerable trouble whilst others with large bunions are able to manage adequately. Think about bunion surgery if they are still giving pain on a regular basis and they are affecting your activities such as walking, sport and ability to wear the shoes of your choice despite simple measures.


Dr Sarah Curran
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Publication:Western Mail (Cardiff, Wales)
Date:Mar 18, 2013
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