Specific foot conditions

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Problems in your ankles and heels

Pain in your ankles and heels can come from your joints or the muscles and tendons around your joint. Osteoarthritis isn’t very common in the ankle but can be the result of previous damage from an injury or inflammatory arthritis. When inflammatory arthritis affects your ankle, the joint may be especially sore or stiff first thing in the morning or after sitting for a while.

Valgus heel

If you have rheumatoid arthritis it’s fairly common for your heel to drift outwards. This is known as valgus heel. It may not cause any problems if it doesn’t drift too far, but it can be troublesome if your arch flattens as a result. Early treatment of rheumatoid arthritis may slow the development of valgus heel.

Valgus heel 

Plantar fasciitis

Plantar fasciitis is inflammation at the site where fascia attach under your heel bone (plantar fasciitis or enthesopathy). It used to be known as policeman’s heel and is the most common cause of discomfort in this area. It frequently affects people with inflammatory arthritis but it can also occur in people without arthritis.

Plantar fasciitis is sometimes caused by your Achilles tendon becoming shorter. Ask your doctor or physiotherapist about exercises to help you lengthen it.

Achilles tendinitis

Achilles tendinitis is an inflammation of your Achilles tendon. It’s quite common in people who have psoriatic arthritisreactive arthritis or ankylosing spondylitis. It can also occur as an over-use injury in people who take part in excessive exercise or exercise that they’re not used to.

Arch pain and tiredness

The arches of your feet allow your weight to be spread over many bones and joints. The structure of your arch can change when it’s affected by arthritis, and the areas nearby can be strained. In mild cases this feels like tiredness around your arch, but it can become more painful if your muscles or tendons are very overworked.

Having higher arches may increase your chances of developing other problems such as hammer toes, bunions, corns or calluses. Lower arches are sometimes linked to problems in your legs, especially knee pain.

Pain in the ball of the foot

Pain can be caused by arthritis in the joints at the ball of your foot, especially if you have arthritis elsewhere in your body. However, most pain here comes from minor damage to the soft tissues – your tendons, bursae, fat pads, nerves and skin.

The most common causes of discomfort under the balls of your feet are calluses (a build-up of hard skin) and corns. Calluses form at areas of high pressure or friction and typically cause a burning pain. If the pressure on the callus is extremely high, small areas of skin within the callused area produce an abnormal type of skin tissue, leading to the formation of a corn. You can ease discomfort by scraping away the excess skin with a pumice stone or an abrasive board, not with an open blade. You shouldn’t do this yourself without advice from an HPC-registered podiatrist – if your tissue is weak or your skin takes longer to heal, for example if you have diabetes, you may do more harm than good.

Remember that the callus will grow back in four to six weeks unless the pressure or friction that caused it is removed by changing to softer or roomier footwear or by inserting cushioning pads.

Other problems that can occur in the ball of the foot include:

Bursae

People with rheumatoid arthritis often develop bursae (fluid-filled sacs) under the ball of their foot. Bursae can grow and shrink as the level of inflammation varies. They occur next to large bunions or other irritated joints. Treatment for an inflamed bursa starts with reducing the pressure on the area, although if it’s large, especially inflamed or you’ve had it for a long time it may help to have fluid drained and a steroid injection.

Neuroma

A neuroma is a thickening of a nerve which occurs when it rubs against other internal tissues. It’s most common at the base of your toes, often between your third and fourth toes. The symptoms are pain or tingling.

A neuroma should settle down with roomier footwear, but special insoles or pads under the area may help. These may be available through an HPC-registered podiatrist.

Rheumatoid nodules

In rheumatoid arthritis, firm, pea-sized lumps can occur at pressure points such as your big toe joints, the back of your heels or on your toes. Nodules on the soles of your feet can be particularly uncomfortable. Padding can ease the discomfort but, in some cases, the nodules may need to be removed surgically.

Bursae and rheumatoid nodules under the ball of the foot

Problems in your toes

Bunions

Bunions are bony lumps that develop on the side of your foot and at the base of your big toe. They often run in families or are caused by rheumatoid arthritis. They’re the result of a condition called hallux valgus, which causes your big toe joint to bend towards your other toes and become deformed.You may also develop a bursa here too, especially if your shoes press against the bunion. The bursa may become inflamed and painful.

Sometimes swellings or bursae on the joints in your feet are also called bunions, but these aren’t the same as bunions caused by hallux valgus.

Hallux valgus is different to hallux rigidus, which is osteoarthritis of the big toe joint. Hallux rigidus causes your big toe to become stiff and its range of movement is reduced.

Symptoms of a bunion can be controlled by choosing shoes with a soft, wide upper to reduce pressure and rubbing on your joint. You can buy bunion pads from chemists if you have a flare-up of a bunion or bursa, but these should only be used on the advice of an HPC-registered podiatrist.

Hammer toes

Hammer toes (also known as claw toes, mallet toes or retracted toes) are toes that are permanently bent. Hammer toes are caused by hallux valgus or because your toes are squashed by poorly fitting shoes and/or socks. Hammer toes are most common in people who have bunions or high-arched feet.

Discomfort from hammer toes is usually due to a build-up of hard skin over the raised joints, which causes corns and calluses. There’s also a risk of ulceration, but this isn’t common.

Mild cases may be helped by rubber, leather or silicone splints. You can ease pain from corns and calluses by choosing shoes with a more generous fit or softer uppers, or by using a protective pad over the painful area. The only way to correct hammer toes is with surgery.

Hallux valgus, a bunion and hammer toes

Ulcers

If you have scleroderma and your circulation is affected by Raynaud’s phenomenon you may have problems with ulcers on your toes and feet. Speak to your specialist team if you develop an ulcer because it’s important to treat it as soon as possible. If these ulcers can become infected you may also need antibiotics to treat them. Medications to improve your blood flow can help.

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