Corns and calluses are something that most people will develop at sometime or another. They are the result of thickening of the top layer of skin, or stratum corneum, usually in response to repeated physical trauma. For many people, corns and calluses cause some degree of pain and discomfort. For some they are a cosmetic concern, especially larger calluses that develop on the heel.
If a corn or callus is painful or you see any blood in it, you should have it treated by a podiatrist. Pain or bleeding means the corn or callus is irritating the deeper layers of skin that contain nerves and blood vessels. Treatment will involve debriding, or paring the corn or callus so as to remove it without damaging nearby healthy skin. Even if a corn or callus is not painful, you may still opt to have it treated by a podiatist.
If you have a corn or callus that is not painful or very thick, you could have it treated at a salon pedicure or treat it yourself at home.
To help protect toes from friction that causes corns, try an elastic toe sleeve. Calluses on the bottom of the feet and heels may also benefit from gel insoles or heel cups. These products can be purchased where foot-health products are sold.
If you have a medical condition such as diabetes, peripheral arterial disease or any condition that causes peripheral neuropathy, it is always advisable to have corns and calluses treated by a podiatrist to minimize the chance they will develop into a wound.
If you have flat feet, your arches are low or maybe even absent. The condition is also known by the medical terms "pes planus" or "pes valgus."
Flat feet are often associated with excessive pronation, which is the action that causes the foot's arch to descend down and inward (flattening) as the foot strikes the ground. Pronation is a normal and necessary foot motion. Overpronation, however, means that feet pronate to an excessive degree while standing, walking or running.
Because of their tendency to overpronate, flat feet are less able to absorb shock. And this impaired shock-absorption can mean increased stress on the feet, ankles and knees.
You can sometimes identify overpronation in a person with flat feet by observing them from behind. You may see something called the "too-many-toes" sign, where the individual's toes and forefeet splay outward.
Normal Developmental Changes -- As children grow, their legs will experience developmental changes that can result in excess flattening of the arches with weight bearing. One example is genu valgum, or knock-knees, a usually normal, temporary condition in children at different stages of growth. A tight calf muscle or Achilles tendon can also contribute to a flat foot. Many children will experience tight calf muscles as they go through growth spurts.
Congenital Foot Abnormalities -- Conditions that are present at birth and are often diagnosed early include: metatarsus adductus, calcaneovalgus and congenital vertical talus.
Tarsal Coalitions -- Tarsal coalitions are congenitally fused foot bones that cause a rigid flat foot often associated with painful muscle spasms. This type of flat foot is usually diagnosed later in childhood or in adulthood.
Loose Ligaments -- Any condition that causes loose ligaments can result in a flat foot or lower-than-normal arch. Ligaments are bands of tissue that connect bones to each other and have an important role in giving form to foot arches. An example of a condition that causes loosening of ligaments is pregnancy, where normal hormonal changes relax the ligaments. Diseases that cause loose ligaments include Ehlers-Danlos syndrome, Marfan's syndrome and rheumatoid arthritis.
Leg Length Inequality -- If one leg is longer than the other, one foot may be flat in relation to the other to compensate. Usually the foot on the longer limb will have a flatter arch in an effort to shorten that limb, balancing-out the unevenness. Leg length inequality can be caused by spinal abnormalities such as scoliosis. It can also be due to an actual difference in length of one leg bone compared to the other.
If you have flat feet you may not necessarily need treatment -- sometimes a child or even an adult will have low arches and have no problems. It's normal for a baby's or young child's feet to appear flat until the structure of their feet is more fully developed.
If flat feet are contributing to secondary problems, especially leg or foot pain, treatment may be necessary. Flat feet can sometimes cause difficulty walking or running and interfere with athletic activities. A visit to a podiatrist will involve an evaluation of foot structure and function. Besides a foot exam, a visit may include foot X-rays and an analysis of your feet while walking.
Your podiatrist may prescribe arch supports or orthotics to control the pronation. While orthotics and arch supports don't permanently correct the shape of the arch, they do help control excess pronation that may be causing wear-and-tear on your muscles and joints. Sneakers with a design called motion control are also helpful for overpronators. This style of sneaker has a design that creates more stability by limiting movement in the heel and arch area of the shoe. Additionally, physical therapy and stretching exercises may be in order, especially if tendonitis (tendon inflammation) is present.
Flat feet that are the result of congenital or developmental abnormalities may require further intervention, such as bracing, casting or surgical correction.
The sesamoid bones of the foot are two tiny bones found under the first metatarsal bone, near the big toe joint (first metatarsophalangeal joint). Even though they are small, they can cause a significant amount of pain when they are injured. Inflammation of the tissues surrounding the sesamoid bones or a fracture of either bone usually causes significant pain under the ball of the foot, in the area under the big toe joint. Pain is often felt with every step, as the big toe flexes and weight-bearing increases under the big toe joint.
It's hard to believe two tiny bones such as the sesamoids would serve any purpose, but they do have an important function. The two bones sit within the tendon of the flexor hallucis brevis muscle, which stabilizes the big toe as we flex and push-off during gait. The sesamoid bones give that muscle a mechanical advantage, helping to increase the power it needs to help the big toe joint function efficiently. If one or both sesamoids is removed, the big toe will likely develop structural problems, such as a hammertoe or bunion of the big toe joint.
In some people, a sesamoid bone may be split, or bipartite, which is a normal anatomical variant that makes it appear as though it is fractured on an X-ray. Another anatomical variant that is seen on some X-rays is two tiny sesamoids in the area of the 5th metatarsal bone, at the pinkie toe joint.
Sudden or chronic injury in this area of the foot can result in a sesamoid bone fracture or injury to the soft tissue surrounding the bones. Symptoms of a fractured sesamoid or torn ligament may include swelling, bruising, and pain while applying pressure to that area. Sesamoid fractures can occur acutely, such as after a fall from a height. Chronic injury to the ball of the foot can cause a sesamoid stress fracture, which has an increased incidence in activities that require a lot of weight-bearing on the toes, such as ballet dancing and basketball. Diagnostic tests to identify a sesamoid fracture include X-ray and less often, MRI or CT scan. MRI is also indicated for identifying soft tissue damage, such as a torn tendon or a ligament sprain.
A condition similar to sesamoiditis is turf toe, a sprain of the first metatarsophalangeal (MTPJ) joint. Turf toe refers to any degree of ligament injury to the first MTPJ, ranging from overstretching to tearing of the toe's ligament(s). The injury occurs when the toe endures excessive force while flexing, such as when an athlete pushes off from the big toe when cutting and running. Like sesamoiditis, pain and other symptoms are located on the underside of the first MTPJ, at the ball of the foot. Depending on the degree of injury, treatment for sesamoiditis and turf toe will often be similar, and center on decreasing stress on the first MTPJ in order to allow healing.
Sesamoiditis can be a stubborn condition because of the amount of weight-bearing pressure on the ball of the foot during gait. More severe cases of sesamoiditis, turf toe, or fracture of a sesamoid bone may require non-weight bearing with crutches or a cast. Sesamoid fractures and severe cases of turf toe may require surgery.
Sesamoiditis that is not associated with a fracture or soft tissue tear may be treated with rest from activity, padding around the ball of the foot, and shoe orthotics (arch supports) to relieve ground pressure from the ball of the foot. Shoe recommendations may be given, such as a hard-soled shoe or a rocker-bottom shoe. A rocker-bottom shoe is similar to a toning shoe, in that they both have a curved sole which decreases pressure on the bottom of the toes.
When it comes to foot health, most people are aware that flat feet can be a problem foot type. When describing foot structure or type, the opposite extreme from a flat foot is the high-arched foot. A high-arched foot lacks the needed flexibility for absorbing shock and tends to roll outward or supinate, which can increase the risk of ankle sprains. Also known as a pes cavus deformity or a cavus foot type, high-arched feet can be associated with foot health issues, such as:
How do you know if you have a high-arched foot? A podiatrist (foot specialist) can evaluate your foot structure and function while you are non-weight bearing and while you walk to assess whether you have a flat foot, neutral foot, or high-arched foot. You can also get an idea of your foot type by observing the impression your feet make in wet sand or on textured paper after stepping into water. A high arched foot leaves a very thin foot print because a large part of the arch area is not contacting the ground.
High arches can make shoe comfort a challenge. A person with high arches may find that shoes which are too shallow, such as certain dress shoe styles, are uncomfortable because their feet slip out. And because high-arch feet don't absorb shock well, hard-soled shoes or shoes with thin soles may cause foot and leg pain, especially at the knee. Another issue is nerve or tendon irritation across the top of the foot from tight shoes. This can be alleviated by adding a pad under the tongue of the shoe or skipping every-other hole when lacing shoes. Shoes with a thick but flexible sole usually feel the most comfortable on high-arched feet.
Ankle braces, arch supports, and ankle strengthening exercises can help prevent recurrent sprains that can sometimes affect those with high-arched feet. Daily stretching of the calf muscles can help resist some of the tightness that affects the Achilles tendon and can also help control heel pain.
In most cases, high-arched feet are a hereditary foot type and not a consequence of any other health condition. In some cases, though, a pes cavus deformity is secondary to congenital or neurological conditions such as, post-stroke paralysis, Charcot-Marie-Tooth disease, spina bifida, cerebral palsy, club foot, or muscular dystrophy.
For diabetics, a high-arch foot can be especially problematic because of the excess pressure that is created on the sole of the foot. This often creates callus build-up which can become a non-healing wound, putting a diabetic at an increased risk for limb amputation. The key to prevention is regular podiatric care to keep calluses trimmed and assess the need for prescription footwear and orthotics which decrease stress on the feet.
Hammertoe deformity affecting toes of both feet.
Morton's neuroma surgery-Cryosurgery for Morton's Neuroma at the London Podiatry Centre
A hammer toe is a very common foot problem that can affect one or more toes. A hammer toe has a characteristic appearance as being elevated at the middle part of the toe, while the end of the toe flexes downward. While most hammer toes occur on adult feet, they can sometimes affect children as well.
The lesser toes, rather than the big toe, are where we most often see hammer toes occur. Each of these toes typically has three bones (phalanges) and three joints. A hammer toe occurs when there is a flexion (downward) contracture of the proximal interphalangeal joint (PIPJ) and an extension (upward) contracture of the metatarsophalangeal joint (MTPJ).
For some people, hammer toes may be only a cosmetic concern and are not causing any secondary problems. But often, a hammer toe is associated with pain or other problems, which may require podiatric care. Potential problems or associated conditions include:
The large number of bones, muscles, and joints within the foot give it a complex, dynamic structure. Muscles in the lower leg and within the foot contribute to foot stability and function -- imbalances in the strength of these muscles can cause hammer toes to develop. These muscle imbalances are most often due to hereditary leg and foot structure, but can occur secondary to neurological damage, such as seen after a stroke or spinal injury. Diabetes, which can cause nerve damage affecting leg muscle strength, is an example of a condition where hammer toes can develop.
Hammer toes that are just starting to develop, such as with children or young adults, are usually flexible -- meaning the toe can be manually pulled straight. The longer a hammer toe has been present, the more likely it is to be rigid, or non-reducible. This is because bone and soft tissue changes have occurred over time.
There is controversy over how much of a role shoe wear plays in the development of hammer toes and other foot deformities, such as bunions. It is unlikely that shoes, such as high heels, are completely to blame for toe problems. This is evident because we see hammer toes affect people who wear even the most ergonomic shoes. Also, not everyone who routinely wears high heels will develop hammer toes. However, high heels or tight shoes do contribute to hammer toes and can aggravate them, especially if one has a foot type that is prone to toe deformities. Not only do high heels cramp toes and cause rubbing, but they also create muscle imbalances when worn, putting stress on the toes resulting in toe contractures.
Hammer toes that are flexible and can be manually pulled straight as described above may improve with specific exercises that counteract the muscle imbalances that contribute to the deformity. These exercises target the extensor muscles, which pull the foot upward. Exercises that involve pulling the foot upward against resistance will target the extensor muscles.
Custom-made orthotics, which are usually obtained from a podiatrist, can also help counteract the imbalances that lead to hammer toes and other toe deformities. These are arch supports that are custom-made to an individual's foot. Some podiatrists and other foot or orthotic specialists add heel or arch wedges to over-the-counter arch supports, which can help improve toe position while walking.
These methods can improve a hammer toe's appearance and related symptoms, but may not always stop them from getting worse. Heredity plays a strong role in the appearance of our feet, no matter how well we take care of them. Over-the-counter toe splints and other devices for hammer toes are easily available and are helpful for reducing shoe friction, which can lead to pain. Rigid hammer toes can be corrected surgically using procedures that remove bone and soft tissue to re-align toes. Surgical correction is usually reserved for cases where conservative measuresfail to relieve symptoms, or if the hammer toe is causing secondary problems, such as skin wounds.