Foot problems often cause pain inflammation or injury to the toes, sole, and heel of the foot resulting in a loss or limitation of movement and mobility. Many people have pain in their heels when they stand first thing in the morning and wonder about the cause. This is a common problem experienced by runners and overweight middle-aged people and is caused by plantar fasciitis. Foot pain is commonly caused by poor foot biomechanics, friction, muscle imbalances, poor training techniques, infections, and incorrect footwear.
One of the commonest foot problems is the bunion. A bunion is when the base of the big toe gets deformed and appears large and swollen due to misalignment or deviation of the joint. The big toe starts leaning inward towards the second toe, the skin along the bunion is irritated, there is pain while walking, redness in the joint, swelling, the foot is tender and painful with the wearing of footwear, and blisters may form more easily around the site of the bunion. All these conditions need careful supervision, especially in people with diabetes.
The causes include heredity; biomechanical abnormalities, which means that the tendons, ligaments, and supportive structure of the toe are positioned differently; neuromuscular disorders; inflammatory joint disease (arthritis); trauma; and congenital deformities. However, tight fitting shoes with pointed toes seem to be the most common cause of this foot problem. Padding, shielding, taping, and larger shoes are the common treatments for the relief of pain in this foot problem, and surgery is the last option.
Corns and Calluses
Corns or calluses are a buildup of toughened, thick, and hard skin that is formed in response to repeated friction and other irritation at points of pressure over bony prominences. Rubbing that is too frequent or forceful will cause blisters or abrasions rather than allow calluses to form. Abrasions are especially important to monitor in people with diabetes.
Calluses form on the bottom side of the foot, corns form on the top of the foot between the toes. Although they are not harmful, they can lead to other problems like skin ulceration, pain, and infection. The hard part at the center of the corn is funnel-shaped; this intensifies the pressure at the tip and can cause deep tissue damage, pain, and ulceration. Callus formation is seen in a high number of patients with diabetes.
Diabetes affects the skin capillaries; the thickening of the skin compounds this problem. This can proceed into ulceration and foot infections in the person with diabetes. Care of all foot problems is particularly important for people with diabetes.
Calluses and corns are caused by repeated friction and pressure from the skin rubbing against bony areas or against an irregularity in a shoe. Sometimes, they are hereditary as well. Trimming or padding and surgery are used to treat this common foot problem. Calluses may also be dissolved with keratolytic agents containing salicylic acid, sanded down with a pumice stone, or pared down by a podiatrist.
Plantar Fasciitis/Heel Pain
Plantar fasciitis is an inflammation of the long band of connective tissue running from the heel to the ball of the foot. Heel spur syndrome is a boney overgrowth on the heel bone. Plantar fasciitis and heel spur syndrome affect women more than men. The bottom of the foot, the heel, and the arch experience extreme pain. Classic presentation of plantar fasciitis is sharp pain exacerbated by bearing weight on the heel after prolonged periods of rest, either after getting out of bed in the morning or after sitting for a prolonged period. This pain improves with continued walking.
The causes of plantar fasciitis are the stretching of the long band of tissue from the toe to the heel, muscle imbalance, bone deformity, obesity, trauma, and tightness of the muscles on the back of the leg. Plantar fasciitis is treated with painkillers, orthotic devices, taping, injections, and surgery. Rest, heat, calf-strengthening exercises, stretching techniques, and reduction of weight are also prescribed.
Athlete’s foot is a common infection of the skin characterized by itching, scaling, and the formation of small blisters. These lesions start between the toes and can extend to the borders and the bottom of the foot and heel. The fungus has the potential to spread to the toenails causing them to become thickened, discolored, and painful. Fungus grows well in the warm, dark, and moist environment that the shoes provide. It can be picked up in dressing rooms, hotel and locker rooms, shower, and swimming pool locker rooms. Topical or antifungal medications are prescribed for this foot problem.
Ingrown toenails are caused by poor nail-cutting technique, abnormal nail shape, or poorly fitted footwear. One can prevent ingrown toenails by not cutting nails into the corners, which can leave a spike of nail that can embed itself and lead to irritation of flesh next to the nail. It is also important to make sure that shoes fit properly.
People with diabetes who have ingrown toenails must seek medical help. Treatment for ingrown toenails includes a minor surgery where the outer margins of the nail are removed. People with diabetes also have a greater risk of serious foot problems. They should check their feet daily for cuts, blisters, bruises, or signs of injury, since healing takes longer in conditions such as diabetes. They should also wear well-fitted shoes that protect their feet from injury.
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