Most foot problems will be helped by finding footwear that has more room and is more comfortable, and by losing weight if you're overweight. A number of specific treatments can also help.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs can help to relieve painful inflammation, for example in the arch or heel area. Like all drugs, NSAIDs can sometimes have side-effects, but your doctor will take precautions to reduce the risk - for example, by prescribing the lowest effective dose for the shortest possible period of time.
NSAIDs can cause digestive problems (stomach upsets, indigestion or damage to the lining of the stomach) so in most cases they will be prescribed along with a drug called a proton-pump inhibitor, which will help to protect the stomach by reducing the secretion of gastric acid.
NSAIDs also carry an increased risk of heart attack or stroke. Although the increased risk is small, your doctor will be cautious about prescribing them if there are other factors that may increase your overall risk, for example, smoking, circulation problems, high blood pressure, high cholesterol or diabetes.
Insoles, which are sometimes used with special shoes, can relieve arch pain or tiredness and can help to correct less severe cases of valgus heel.
A steroid injection may be recommended if just one or two joints are inflamed and painful, and it might help inflamed tendons and bursae, neuromas and plantar fasciitis. You'll need to rest the foot for up to 48 hours after the injection to get the best result.
Disease-modifying anti-rheumatic drugs (DMARDs)
DMARDs are prescribed for some people with inflammatory arthritis. They act by altering the underlying disease rather than treating the symptoms. They're not painkillers, though they'll reduce pain, swelling and stiffness over a period of weeks or months by slowing down the disease and its effects on the joints. A common example is methotrexate.
There are a few foot-specific points to consider in relation to biologic drugs used to treat inflammatory arthritis. First, if you have persisting foot involvement while on other disease modifying anti-rheumatic drugs (DMARDs) you should discuss with your rheumatologist or nurse the options for starting a biologic. Often the feet are inadvertently overlooked.
If you're already on a biologic there are a few other considerations you'll need to bear in mind. Because biologics suppress the immune system, you need to be aware of the effect of biologics on infection. We don't think biologics make a difference to the overall risk of infections in your feet, but biologic use does seem to make infections take hold more quickly and cause greater trouble.
If you're on biologics do not use corn plasters or skin scrapers and if you do have an ulcer or infection it is very important to make sure you let your rheumatologist know as soon as possible.
In some people starting a biologic drug can result in a big improvement in joints in the upper body but problems can persist in the leg joints - we think this is because these weight-bearing joints may have already been damaged. If you do have ongoing aches and pains in your feet, ankles and knees after starting biologics, again let your rheumatologist or nurse specialist know. There are often additional treatments that can help.
Surgery is sometimes recommended to improve the structure of your feet. If other treatments haven’t helped, surgery may be suggested to:
- correct valgus heel or hammer toes
- remove a neuroma or rheumatoid nodule
- remove part of the bone from a bunion and reshape your toes
- relieve pain.
Joint replacements for the ankle and foot aren't yet as successful as replacement knees and hips. Most foot surgery is aimed at correcting the positions of the joints by resetting the bones or fusing the joint in the corrected position. Your surgeon will discuss the potential pros and cons of all the available options before you decide to go ahead with surgery.
Complementary and alternative therapies and medicines
Therapeutic massage can help to reduce pain or tiredness in the feet. Massage can be combined with a relaxing warm-water footbath, and both of these are fine as long as you don't have any open wounds or sores on your feet.
The effectiveness of treatments such as accupressure sandals and magnetic insoles isn't supported by evidence.
Generally speaking, complementary and alternative therapies are relatively well tolerated, although you should always discuss their use with your doctor before starting treatment. There are some risks associated with specific therapies. In many cases the risks associated with complementary and alternative therapies are more to do with the therapist than the therapy. This is why it's important to go to a legally registered therapist, or one who has a set ethical code and is fully insured.
If you decide to try therapies or supplements, you should be critical of what they're doing for you, and base your decision to continue on whether you notice any improvement.