Want to know more about your feet problems? Dr Lai Michael Yi Chang, Principal Podiatrist, Dr Lee Pei Yueng, Podiatrist, and Dr Ng Chee Hong, Senior Podiatrist, at Singapore General Hospital, give detailed answers to your questions.
Bunions, ingrown toe nails, plantar warts, corns and calluses... So many ailments can affect your foot health, you don't have enough of 10 toes to count them! Fortunately, most of these problems are easily treatable. Don’t let pain and embarrassment prevent you from going places.
Dr Lai Michael Yi Chang, Principal Podiatrist, Dr Lee Pei Yueng, Podiatrist, and Dr Ng Chee Hong, Senior Podiatrist, from the Department of Podiatry at Singapore General Hospital, give detailed answers to your questions.
Question by muffysg
Both my feets have quite serious pronation and bunions as well. Currently i am wearing orthopedic shoes that are wide in the toe box area and has support both at the arch and heel area. However, often at the end of the day, my feets still sore and so is my back. Sometimes, after long walks (running makes it worse), my feet area also feels tight and walking afterwards is often in awkward posture. Your advise is much appreciated.
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
If you have been correctly diagnosed as having chronic foot strain due to flat feet and bunions, then wearing orthopaedic shoes is a correct component of conservative management. However, you may need more than just the shoes. Depending on the diagnosis, a podiatrist may make a pair of customized insoles to further adjust your foot orientation inside your shoewear.
For home use, I recommend a pair of orthopaedic slippers with built-in arch support.
Question by kheesoon
I am 57. I have been diagnosed by an orthopaedic doctor to have osteoarthritis of the mid-foot joints. I experience stiffness, pain and discomfort after a long day on my feet or after walking a distance. There is sometimes a small "hill" on my foot. I rub anti-inflammatory, analgesic ointment which helps but is temporary. I was not told to try glucosamine. Is surgery the only solution? Is the way I walk contributing to the degeneration? Should I get a gait analysis done? If so, where to do it?
Answered by Lee Pei Yueng, Podiatrist, Dept of Podiatry, Singapore General Hospital
Osteoarthritis of the mid-foot joints can result in stiffness, discomfort and pain in the mid-foot regions of your feet. The loading of your foot joints and the way that your foot functions when you walk could be contributing to the foot pain.
Some studies have associated mid-foot osteoarthritis with increased loading in the mid-foot regions of the foot during walking.
Orthotic insoles may help to reduce the loading in the mid-foot. This can relieve foot pain when you walk, but it will not eliminate the pain. You can consult a podiatrist for a biomechanical assessment to find out if insoles could be suitable for you.
Question by sumarsi74
Hello and good day. I am having this pain for about past 6 months and i dont know what to do. I have been trying to ease the pain by going to foot reflexology and do ownself massage but the pain still there. It is at the side of my left feet. I also suspect if this is RLS (restless leg syndrome) ? Because the pain makes me cant sleep well as i will feel something like tingling or the urge to move my legy leg. Kindly help. Thanks a lot. Sincerely, Ms Su.
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
If you suspect you have RLS, you should consult a doctor for a definite diagnosis and proper treatment. RLS has many possible associated medical conditions, such as various nutritional deficiencies, venous disease, fibromyalgia, diabetes, thyroid disease, and various auto-immune disorders. Any of these would require treatment if diagnosed.
If you do not have RLS, then it sounds like you have nerve pain at the side of your left foot. Nerve pain can have many different causes. The first thing you can try is to change to wider more comfortable shoewear, in case the pain is due to nerve impingement from tight rigid shoes. If this does not help, consider seeing a podiatrist.
Question by wengkuen
I am suffering from heel pain after my weekly jogging and waking up in the morning. I tried all kinds of stretching, night splint and got a customised insole. However, it's not helping at all. Pls advise me what should I do to cure this pain. Thanks.
Answered by Ng Chee Hong, Senior Podiatrist, Dept of Podiatry, Singapore General Hospital
If after exhausting all kinds of conservative treatment and the pain still persists, it may be other aggravating factors that have not been addressed or a wrong diagnosis might have been made. Hence more detailed investigation such as medical resonance imaging MRI/diagnostic ultrasound might be warranted to ascertain the diagnosis.
Reducing your running frequency might be the next step to do. A review of solid and good running form would also be helpful through running form modifications and drills. A sports Podiatrist would be able to assist you in picking a pair of optimal running shoes that matches your body weight, running style, comfort and running distances.
Question by fpz81
Every morning when waking up, i will feel pain on my lower half of my feet. I read online that this could be Plantar fasciitis. How can i confirm without seeing a doctor?
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
If your foot appears swollen or bruised near the area of pain, then you may have a foot injury rather than plantar fasciitis. If you also have pain at other areas of your foot or the onset of pain is varied, then it may not be plantar fasciitis.
If the foot appears normal visually but you can elicit "aching" or "burning" pain by pressing at one specific spot at the bottom of your heel, then it may be classic plantar fasciitis.
Question by chanmfull
Hi Doc I am 64 yrs old and have just started a job which requires me to be on my feet for 6 hrs once a week. I bought a pair of walking shoes but always have lower back ache after standing for 6 hours.I can walk without any problems. Pls advise. Thank you. (Margaret)
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
While supportive shoewear may indirectly help with pain higher up in the body, you should still consult an orthopaedic doctor first for any complaints of low back pain.
After an evaluation, the orthopaedic doctor may then refer you to a podiatrist if he/she feels that you will benefit from shoewear modifications.
Question by taylk
After resting the feet in the evening pain occurs while standing and walking. Sometimes the pain at the plantar and heel region can be quite intense that I prefer to sit most of the time. Advise by the reflexology to put on magnetic belt on it. After a long night sleep , pain subsides. It is ok at work but the above episode happen again in the evening. Had changed many types of shoes to ensure it can get better but it doesnt helped. Kindly advise.
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
Based on this brief description, you may be suffering from plantar fasciitis. It is quite common among Singaporeans, i.e. city folks.
Conservative self-treatment for plantar fasciitis includes daily calf lunge-stretch (it forms a closed kinetic chain with the plantar fascia), daily self-massage of the plantar fascia (the painful areas of the bottom of your foot), and use of ice compress at the bottom of the foot when it is especially painful.
You may not have bought the correct shoes for your foot type, despite being motivated to wear shoes that are good for your feet. The easiest choice is to wear good supportive sports shoes, such as name-brand stability-category running shoes. Or you can purchase orthopaedic shoes. I also recommend wearing orthopaedic slippers at home, rather than being barefooted or wearing flat bedroom slippers.
Question by shirleyhowong
My last toe nails on right and left feet is rough and black. It is embarrassing and ugly. I have fear to see doctor as in case they suggest some surgery is required. I applied fungi cream but it did not help. Any suggestion ? Thanks.
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
If you have fungal toenails, ordinary antifungal cream application will not cure the problem. You would need to use antifungal nail lacquer as directed for a year or longer, without any lapses in treatment. Besides that, you would also need to trim and file the affected nails regularly, as the nail lacquer cannot penetrate a fungal nail that is thick and long.
The other option is to take oral antifungal medication. You would have to consult a dermatologist.
Alternatively, you may not actually have nail fungus. If you have worn tight shoewear all your life, the outermost nails could have become damaged from pressure. This would cause them to become naturally ridged and darkened.
Reposted by administrator
Hello Dr.,
I have thick skin formation in my feet genetically from my mother grand mother & so on.
That was not actually a problem but now I feel so difficult to walk. My mom, or others didn't face this problem in walking. But in my case my feet pains a lot. I cant carry myself. I'm just 27 yrs old and this problem is really not bearable. I have seen doctors in India also and here in National Skin Centre also, but it is no use Sir. They just recommended Gentamacin Cream or the Sallycilic Acid just to soften my skin. My last hope is asking for your advice.
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
The dermatologist may have given you a diagnosis (a medical name) for your condition, such as palmoplantar keratoderma. I’m not sure if this is what you have based on the limited information presented.
If you do have palmoplantar keratoderma or a similar condition, then the only treatment may be dedicated palliative self-treatment; you would have to scrub, exfoliate, and moisturize the soles as often as possible to keep the condition under control. Many patients with this condition keep themselves pain-free with daily self-care of the palms and soles as above.
Question by janey
What's the risk and benefit of getting a surgery to remove a bunion? If I wear proper shoes from then on, does this mean the bunion wil not grow back? Is it full surgery ( and full anaesthesia), or just local anaesthesia to the foot? How long does it take to recover? Thanks.
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
A bunion is an acquired bone-and-joint deformity of the foot. The benefit of corrective surgery is that you solve the problem in one go. With ideal results, your operated foot will look and function normally afterwards. The risks include severe post-operative wound infection, failure of the bone to heal correctly, prolonged pain and swelling, decreased range of motion of the big toe, and failure to fully correct the bunion deformity. A surgeon cannot and does not give guarantees on how well you will heal, or on whether the bunion can be fully corrected.
The same biomechanical forces that caused your foot to form a bunion will start to act on your operated foot again, after the surgery. That is why some patients experience a return of the deformity. This deforming process typically takes years. If you wear proper supportive shoes with wide toebox, it would significantly slow this deforming process.
The anesthesia method used for this same-day surgery depends on both patient and surgeon preferences. It is possible to perform this surgery with local anesthesia to the foot, and intravenous sedation for the patient. However, being awake when your foot is being operated on can be a stressful experience, so many patients and surgeons prefer full anesthesia.
With optimal healing, it takes 6 to 8 weeks to fully recover from this surgery for a healthy adult. During this time, you would be using crutches in order to keep weight off of the operated foot. You risk breaking and ruining the bones of your foot if you walk on it too soon.
Question by mkong
I have been experiencing swelling and pain on the whole bone of the right big toe for a year now. In the past, I experienced the pain only after walking for 2 -3 hours and once rested, the pain goes away. In the last 3 - 4 months, the pain is more intensed.
I also noticed now that the right big toe bone is larger in size than the left big toe; rendering a different shoe size of one size difference whenever I go to buy shoes. I have been buying new shoes to try to lessen the pain but it didn't help. Btw, I also have flat foot.
How can I manage the swelling and pain to prevent the bone from growing bigger and bigger ? What is your advise for me when buying shoes? Thank you.
Best Regards,
Mei Leng
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
It sounds like you may have a bunion, or hallux valgus deformity. It is an acquired deformity of the big toe joint from years of poor foot function. The bone seems larger to you because the deformity is becoming more severe, and the big toe joint is becoming more painful with motion because the cartilage is being damaged.
One option is foot surgery as it corrects the bunion in one go. The other option, non-surgical management, involves correcting your foot posture when you walk. But non-surgical management may not fully relieve the pain if your big toe joint cartilage is already damaged.
For all shoewear, you must look for wide toebox adequate to accommodate your forefoot without squeezing on the bunion. For women’s shoes, stay away from high heels as they put additional stress on the big toe joint. I recommend orthopaedic shoes as normal shoes are not specialized enough to accommodate a painful bunion. There are many orthopaedic shoe stores in Singapore with open-toe sandal and dress shoe selections, appropriate for office work or casual wear.
If your flatfeet is significant, just using orthopaedic shoes may not be adequate. You may require orthotic insoles to more fully support your flatfeet and shift the stress forces away from your big toe.
Question by zcfap13
The skin of my feet is always peeling off. This has been happening for many years now, ever since my teenage years. Is there any way to prevent skin from peeling off on its own?
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
In Singapore, chronic peeling skin can be most commonly due to eczema (allergic or hypersensitive skin condition), or a fungal skin infection.
If you have not done so already, you should consult a dermatologist. The skin doctor will be able to tell you what may be causing your skin condition, and prescribe oral or topical medication to address the problem. If your skin is simply dry and peeling, you can try a keratolytic skin cream.
They are strong moisturizing creams which contain lactic acid and/or urea as the active ingredient, and are available over the counter. For best effect on severely dry skin, apply the cream before bed and then enclose the feet in occlusive material such as plastic bags.
Reposted by administrator
I am 60 years old and have bunions on both legs, Can you tell me what the best treatment for them.Will I have a problem if I leave them untreated.
Thank you.
Mary Ding
Answered by Lai Michael Yi Chang, Principal Podiatrist, Dept of Podiatry, Singapore General Hospital
For mild or asymptomatic bunions, the key is to prevent them from becoming worse or becoming painful. This often involves a lifestyle change as it requires a person to re-evaluate her shoewear choices.
High heels should never be worn as they place additional stress on the big toe joint. Soft women’s flats may feel comfortable, but also exacerbate the bunion over time.
Optimal shoewear should have a heel counter and supportive arch, in order to prevent the foot arch from collapsing and causing further deformation of the big toe joint. Shoes should also have wide toebox, in order to not cramp the toes together and rub on the bunion prominence.
Some people never experience pain from their bunions, in which case it is only a cosmetic problem and a shoe-fitting problem. However, many people do end up experiencing joint pain because the big toe joint becomes damaged, or they develop secondary foot problems such as painful calluses on the ball of the foot because the big toe joint is no longer functioning correctly.
Ref: R14
