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Foot pain
Foot pain
This booklet provides
information and answers
to your questions about foot
conditions and footwear.
www.arthritisresearchuk.org
Arthritis Research UK
Foot pain
The foot has a complex structure and What causes foot pain?
most people take a million or so steps a
year, so it’s not surprising the feet can be The main causes of foot pain are:
prone to arthritis and related problems. • osteoarthritis
• inflammatory arthritis
hat typical foot problems
W
are there? • soft tissue aches and pains
• nerve damage
Ankles and heels • poor circulation
• valgus heel, or inrolling of the heel • ill-fitting footwear
• plantar fasciitis, or heel pain syndrome. • connective tissue diseases.
Arches
• changes in the structure of the arch Should I seek professional help?
• strain in muscles, ligaments or tendons. Seek help if you:
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Arthritis Research UK
Foot pain
Figure 1
Parts of
the foot
Forefoot
Midfoot
Hindfoot
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Arthritis Research UK
Foot pain
Figure 2
Low arches and
high arches
5
Inflammatory arthritis last one to two weeks. Without treatment,
There are various forms of inflammatory repeated attacks can cause permanent
arthritis, which can affect the feet in joint damage, leading to osteoarthritis.
different ways. Gout can usually be controlled with
medications.
Rheumatoid • affects many joints in
arthritis the foot. See Arthritis Research UK booklets
Reactive • usually affects the ankle
Ankylosing spondylitis; Gout;
arthritis or around the heel. Psoriatic arthritis; Reactive arthritis;
Rheumatoid arthritis.
• may affect the toes,
causing swelling (dactylitis).
Figure 3
Valgus heel
Arthritis in the
ankle can cause
the heel to drift
outwards.
7
The arches of the feet
allow the weight of the
body to be spread over
many bones and joints.
Having high or low
arches can increase your
chances of developing
foot problems.
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Arthritis Research UK
Foot pain
Figure 4
Bursae under
the ball of
the foot with
overlying
callus
Bursa with
overlying
callus
Photography used with kind permission of Elsevier. © Elsevier 2011. Taken from Rheumatology, fifth edition.
Edited by Marc C Hochberg, Alan J Silman, Josef S Smolen, Michael E Weinblatt and Michael H Weisman.
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Arthritis Research UK
Feet, footwear and arthritis
Sometimes, as a
bunion develops,
the big toe may
be pushed over pushed over towards the smaller toes. The
big toe joint becomes stiff and its range of
towards the movement is reduced sometimes without
smaller toes. the bony lump. This is called hallux
rigidus. This can cause the other toes to
become clawed or permanently bent
(known as hammer toes).
Symptoms of a bunion can be controlled
by choosing shoes with a soft, wide upper
to reduce pressure and rubbing on the
joint. Insoles (orthotics) can help control
the foot function to relieve pressure on
a painful joint. Bunion pads are available
Problems in the toes from chemists if you have a flare-up of a
Bunions bunion or bursa. If symptoms persist over
Bunions are bony lumps that develop on a long period, the bunion may need to be
the side of the foot at the base of the big surgically removed.
toe (see Figure 5). A bursa may develop
here too, especially if shoes press against Hammer toes
the bunion. The bursa may become Hammer toes (also known as claw toes,
inflamed and painful. Sometimes, as the mallet toes or retracted toes) are toes
bunion develops, the big toe may be that are permanently bent (see Figure 5).
Figure 5
Hallux valgus,
a bunion and
hammer toes
Hammer toes
Bunion
Hallux valgus
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Arthritis Research UK
Foot pain
Ulcers
Rheumatoid arthritis, lupus, scleroderma
and diseases such as diabetes that affect
the bones, circulation and nerves can
cause ulcers (delayed healing and
foot sores).
Ulcers on the toes and feet can be
problematic in people with rheumatoid
arthritis and scleroderma, where the
circulation is compromised due to
Raynaud’s phenomenon. If you discover
an open sore that won’t heal, speak
to your specialist rheumatology team
at the hospital, which may include a
nurse specialist and an HCPC-registered
Should I seek How are foot problems
professional help? diagnosed?
For most people foot problems can come In most cases a simple clinical
and go without any prescribed treatment, examination is all that is required. This
or can respond well to self-treatment. usually involves looking carefully for
However, if you have a known condition signs such as swelling, combined with a
such as rheumatoid arthritis, scleroderma short hands-on exam to work out which
or diabetes, you should discuss any new structures might be involved. Sometimes
foot problems with your rheumatologist, it is helpful to have the person walk up
your GP or a podiatrist. and down to see what happens during
weight-bearing and routine activities.
Even if you don’t have any significant It is less common for foot problems to
health conditions you should still seek require blood tests or imaging (e.g X-ray
help if your foot problem: or ultrasound) to reach a diagnosis.
• involves ulceration of the skin or
infection
What can I do to
• impairs the blood flow to the skin
help myself?
• has caused pain for more than three A regular footcare routine can help to
months
keep problems to a minimum but seek
• is getting noticeably worse advice from your doctor or a podiatrist
• is changing the colour of your skin – first, especially if you have conditions
especially if it is dark blue or black such as vasculitis or scleroderma, you’re
taking steroids or biologics, or your skin is
• is leading to progressive changes in the slow to heal. The routine should include
shape of your foot. regular nail cutting, filing the skin and
You should also seek help if you develop applying appropriate foot care cream.
foot problems and you have increased Choosing the right footwear is important.
swelling, you’re on drugs which supress
your immune system (including steroids Good footwear, which is supportive and
or biologics) or if you have a history of comfortable, is essential to improve pain
poor skin healing. and discomfort in the feet.
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Arthritis Research UK
Foot pain
A cream or powder from the chemist biologics, have vasculitis or your skin
will speed up the healing process. heals slowly you should avoid these
• Toenails can be affected by fungal treatments altogether.
infections. Topical application of If you can’t care for your feet yourself,
anti-fungal paints and/or oral anti- your GP or hospital consultant can refer
fungal therapy can be obtained on you for professional care within the NHS.
prescription from a GP. Podiatry services accept patients on a
If you have rheumatoid arthritis, you self-referral basis. An HCPC-registered
should have your feet checked by a podiatrist will help with troublesome
professional just after your diagnosis nails, corns and calluses, and they’ll
and then once a year. This can be done provide advice on finding special shoes
by your GP, rheumatologist or nurse, or orthoses. Some centres have access
and if you have problems you should be to an orthotist who will be able to assess
referred to an HCPC-registered podiatrist. and provide ready-made or custom-made
Some people with rheumatoid arthritis shoes as required.
have a burning sensation in their feet at
night. Using a hot water bottle filled with
cold water can help but you should speak
to your doctor about it, especially if this is
a new symptom.
Calluses can usually be scraped away
using a pumice stone or abrasive board.
You should never use an open blade such
as a scalpel or razor blade. Special skin
files and scrapers may be suitable as long
as you and your skin are in good health,
although these will not help much with
corns where the nucleus goes deeper into
the skin. Check with your doctor or an
HCPC-registered podiatrist first, especially
Good footwear,
if you have a history of skin ulcers or which is supportive
suffer with scleroderma, vasculitis, lupus
or Raynaud’s phenomenon.
and comfortable,
Pads and cushions available from the is essential to
chemist may help with painful pressure improve pain and
points, but over-the-counter creams and
medicated corn plasters aren’t generally discomfort in
recommended. If you’re on steroids or the feet.
17
What treatments are drug called a proton-pump inhibitor (PPI),
which will help to protect the stomach.
there for foot pain?
Most foot problems will be helped by NSAIDs also carry an increased risk of
finding footwear that has more room and heart attack or stroke. Although the
is more comfortable, and by losing weight increased risk is small, your doctor will
if you’re overweight. A number of specific be cautious about prescribing them if
treatments can also help: there are other factors that may increase
your overall risk, for example, smoking,
Non-steroidal anti-inflammatory drugs circulation problems, high blood pressure,
(NSAIDs) can help to relieve painful high cholesterol or diabetes.
inflammation, for example in the arch
or heel area. Like all drugs, NSAIDs can Insoles (orthoses), sometimes used with
sometimes have side-effects, but your special shoes, can relieve arch pain or
doctor will take precautions to reduce tiredness and help to correct less severe
the risk – for example, by prescribing the cases of valgus heel.
lowest effective dose for the shortest A steroid injection may be
possible period of time. recommended if just one or two joints are
NSAIDs can cause digestive problems inflamed and painful, and it might help
(stomach upsets, indigestion or damage inflamed tendons or bursae, neuromas
to the lining of the stomach) so in most and plantar fasciitis. You’ll need to rest the
cases they will be prescribed along with a foot for up to 48 hours after the injection
to get the best result.
Functional
orthoses can
The right heel support help relieve pain
can help correct some in the feet.
cases of valgus heel.
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Arthritis Research UK
Foot pain
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Arthritis Research UK
Foot pain
Comfort should
be the main
consideration
Footwear when choosing
Getting the right footwear will make a
difference for almost all foot problems shoes.
and the importance of appropriate
footwear should not be underestimated.
A bit of trial-and-error to get the right
footwear might remove the need to
seek out professional help. Changes to
footwear will be part of most professional
discussions about foot problems.
room in the shoes to fit them, especially
Comfort should be the main consideration
around the toe area.
when choosing shoes.
Around the house, slippers may feel the
High-heeled shoes or shoes that most comfortable for hammer toes and
pinch your feet can contribute to the prominent joints, but make sure the soles
development of deformities such as provide adequate cushioning. You should
bunions or hammer toes. also make sure that they are non-slip/trip.
Your feet may change shape as you get Always wear shoes when you’re outside
older, especially if you have arthritis, so to make sure your feet are properly
you may need to try a different size or supported.
width fitting. If the footwear protects your
Factors to consider when
feet against injuries, supports them and
keeps them warm, dry and comfortable, buying shoes
it’s doing its job. Have your feet measured if they’ve
become wider over the years or have
An adjustable fastening will improve fit changed shape because of arthritis.
generally and help if the feet swell. Your feet may change shape when you
Leather uppers are usually the most stand up, so have them measured while
comfortable if you have foot problems standing. Many shops have experienced
although many modern materials offer fitters.
breathability, flexibility and comfort. Look Try shopping later in the afternoon. If
for a cushioning sole unless you’ve been your feet tend to swell, they’ll be at their
advised by a doctor or podiatrist that largest at that time.
rigid soles are better for your particular
foot problem. If you have hammer toes or Judge a shoe by how it feels on your
prominent joints, look for a smooth lining foot and not just by the size marked
without seams. If you need special insoles on the shoe. Size varies between shoe
or orthoses, make sure there’s enough brands and style. Think about how the
21
shoe fits around your toes, under the Look for dark colours and a suede
soles and at the back of the heels. finish if you’re worried about the
Always buy your shoes to fit the larger appearance of your feet – they’ll help to
foot – many people have one foot bigger disguise the problem.
than the other. An insole can be used in
the other shoe. There should be at least
Insoles
You may need insoles in your shoes for a
1 cm (3/8 inch) of room at the front of the
number of reasons. An insole, or orthosis,
longest toe.
can help to support the arch of your foot.
Try shoes on with the type of socks or If you have arthritis in the joint across the
stockings you normally wear or with middle of your foot (the midtarsal joint), a
any insoles or orthoses you normally rigid insole may help. If you have one foot
use. Some insoles may need extra depth, bigger than the other, an insole can help
especially in the toe area. to pad out the shoe of your smaller foot.
Don’t buy shoes to break-in later – the Insoles will often take up half a shoe size,
right shoes for you will be comfortable so take along your largest shoes when
when you first try them on. you go for an insole fitting. Sometimes
Buy shoes that have both leather you may need to purchase a larger shoe
uppers and inners (the inner lining) if to accommodate an insole, although this
possible. These are more breathable than is not always the case. Take your insoles
inners made of synthetic materials and along when you buy new shoes.
will help to avoid dampness and fungal If you need to wear a prescribed insole,
infections. don’t try to wear the new insole all day
Upper Figure 7
Fastenings The main parts
of a shoe
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Insoles will often
when you first receive it. Wear it for a
take up half a shoe
short period at first and gradually build size, so take along
up to longer periods. Don’t use them
for heavy duty activity or exercise. If
your largest shoes
you change your shoes indoors, either when you go for
have a second pair of insoles for your
indoor shoes or remember to swap
an insole fitting.
the insoles over. Your feet will return
to their old shape while indoors and
will never be comfortable if you don’t
continue to wear your insoles.
• A zip fastening can be easier to manage Some people may have footwear
than laces or buckles, and a ring (such prescribed by their consultant, GP or by
as a keyring) added onto the zip pull an HCPC-registered podiatrist, but they’re
can make it easier to pull up. usually provided by an orthotist. You can
also opt to see an orthotist or orthopaedic
There are also a number of devices shoemaker privately. Each NHS hospital
available to help people with putting on trust will have its own arrangements for
socks, tights/stockings and shoes. Useful footwear referral and entitlements.
leaflets on this and other subjects related
to the feet and footwear are available Wearing slippers around
from the Disabled Living Foundation or the house
through your local occupational therapist. Many people prefer to wear slippers in
the house. However, slippers aren’t a
See Arthritis Research UK booklet good idea for those who have to wear
Occupational therapy and arthritis. special insoles. They also sometimes
contribute to falls in the elderly. The
uppers of slippers are often soft, so
23
they’re comfortable for hammer toes The Raynaud’s & Scleroderma Association
and prominent joints, but the soles produces a leaflet containing tips for
may lack adequate cushioning and grip. keeping warm.
Like outdoor shoes, slippers should fit
properly and shouldn’t be too loose.
Backless slippers and slippers with a What other help is
high heel really should be avoided. The available?
features of the ideal slipper are generally An HCPC-orthotist or podiatrist will
the same as for the ideal shoe. be able to advise on special insoles
and custom-made or adapted shoes.
Wearing safety footwear Rheumatology and general practice
If you need to wear safety boots for work, nurses are usually able to offer advice
they should display the British Kitemark or and assistance with routine foot care and
CE mark. If your existing safety footwear possibilities for onward referral.
is uncomfortable, you may need to talk to
your employer about getting alternatives.
Safety versions of extra-depth and
cushioned shoes are available. If you
suffer from toe or foot ulceration, make
sure that safety footwear is not causing
pressure or pain to the wounds.
The features of
the ideal slipper
are generally the
same as for the
ideal shoe.
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Glossary Inflammation – a normal reaction to
injury or infection of living tissues. The flow
Ankylosing spondylitis – an
of blood increases, resulting in heat and
inflammatory arthritis affecting mainly
redness in the affected tissues, and fluid and
the joints in the back, which can lead to
cells leak into the tissue, causing swelling.
stiffening of the spine. It can also affect
the heels and can be associated with Ligaments – tough, fibrous bands
inflammation in tendons and ligaments. anchoring the bones on either side of a
joint and holding the joint together. In the
Bursa (plural bursae) – a small pouch
spine they’re attached to the vertebrae
of fibrous tissue lined (like a joint) with
and restrict spinal movements, therefore
a synovial membrane. Bursae help to
giving stability to the back.
reduce friction; they occur where parts
move over one another, e.g. where Non-steroidal anti-inflammatory
tendons or ligaments pass over bones. drugs (NSAIDs) – a large family of drugs
Others, however, form in response to prescribed for different kinds of arthritis
unusual pressure or friction – for example, that reduce inflammation and control
with a bunion. pain, swelling and stiffness. Common
examples include ibuprofen, naproxen
Enthesopathy – pain or discomfort at the
and diclofenac.
point where a tendon or ligament inserts
into a bone (the enthesis). Occupational therapist – a therapist
who helps you to get on with your daily
Fascia – connective tissue that wraps
activities (e.g. dressing, eating, bathing)
around muscles, blood vessels and nerves
by giving practical advice on aids,
to bind them together.
appliances and altering your technique.
Gout – an inflammatory arthritis caused
Orthosis (plural orthoses) – a device to
by a reaction to the formation of urate
help part of the body to work better. An
crystals in the joint. Gout comes and
orthosis is used to provide support or to
goes in severe flare-ups at first, but if
adjust the mechanical function of a joint,
not treated it can eventually lead to joint
for example for the foot or ankle. Most
damage. It often affects the big toe.
foot orthoses are insoles worn inside the
Hallux rigidus – osteoarthritis of the big shoe. They may range from very rigid
toe joint with a stiff, often painful, big toe. to soft depending on their purpose.
Hallux valgus – a condition in which the Orthoses are also referred to as functional
big toe pushes across towards the other orthoses.
toes, often associated with osteoarthritis Orthotist – a trained specialist who
of the big toe joint. It’s often referred to prescribes and fits orthoses for any part
as a bunion, although in fact a bunion can of the body, including insoles and special
exist without hallux valgus. footwear. Check that your orthotist is
HCPC registered.
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Arthritis Research UK
Foot pain
27
Where can I find out more? Therapies
Arthritis Research UK is the charity leading • Occupational therapy and arthritis
the fight against arthritis. • Physiotherapy and arthritis
We fund scientific and medical Self-help and daily living
research into all types of arthritis and • Complementary and alternative
musculoskeletal conditions. medicine for arthritis
We work to take the pain away for • Keep moving
sufferers with all forms of arthritis, and • Looking after your joints
help people to remain active.
• Pain and arthritis
Everything we do is underpinned by
research. By funding high-quality research Drug leaflets
we can provide information to patients • Local steroid injections
and health professionals. • Non-steroidal anti-inflammatory drugs
We produce a range of more than 90
You can download all of our booklets
booklets to help people affected by
and leaflets from our website or order
arthritis to understand more about the
them by contacting:
condition, its treatment, therapies and how
to help yourself. We also produce a range Arthritis Research UK
of separate information leaflets on many Copeman House
of the drugs used for arthritis and related St Mary’s Gate
conditions. We recommend that you read Chesterfield
the relevant drug leaflet for more detailed S41 7TD
information about your medication. If Phone: 0300 790 0400
you’ve found this information useful you www.arthritisresearchuk.org
might be interested in these other titles
from our range: Related organisations
The following organisations may be
Conditions able to provide additional advice and
• Ankylosing spondylitis information:
• Gout Arthritis Care
• Osteoarthritis 18 Stephenson Way
• Raynaud’s phenomenon London NW1 2HD
Phone: 020 7380 6500
• Reactive arthritis Helpline: 0808 800 4050
• Rheumatoid arthritis www.arthritiscare.org.uk
• Scleroderma
• Vasculitis
28
British Association of Prosthetists
and Orthotists (BAPO)
Sir James Clark Building,
Abbey Mill Business Centre,
Paisley, PA1 1TJ
Tel: 0141 561 7217
www.bapo.com
Email: enquiries@bapo.com
Disabled Living Foundation
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Red Lion Square
191 Wandsworth High Street Tell us what you think of
London our booklet
SW18 4LS We hope that you have found our
Helpline: 0300 999 0004 information booklet useful. Your feedback
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Ground Floor Please send your views to
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SL6 7RJ
Phone: 0845 458 3969 or 01628 823524 A team of people contributed to this
Helpline: 0800 298 7650 booklet. The original text was written by
www.nras.org.uk Prof Tony Redmond and Prof Deborah
Turner who have expertise in the
Raynaud’s & Scleroderma Association subject. It was assessed at draft stage by
112 Crewe Road podiatrists Andrea Graham, Dr Michael
Alsager Backhouse, Dr Jill Halstead-Rastrick and
Cheshire ST7 2JA Serena Peirce, and the British Association
Phone: 01270 872776 or 0800 917 2494 of Prosthetists and Orthotists. An Arthritis
www.raynauds.org.uk Research UK editor revised the text to
Society of Chiropodists & Podiatrists make it easy to read, and a non-medical
1 Fellmonger’s Path panel checked it for understanding. An
Tower Bridge Road Arthritis Research UK medical advisor,
London SE1 3LY Dr Anita Williams, is responsible for the
Phone: 020 7234 8620 content overall.
www.feetforlife.org
29
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© Arthritis Research UK 2011
Published July 2015 2012/FEET/15-1