Tired of nagging foot and ankle pains that just won't go away?

Take this opportunity to ask our specialist as he helps to shed light on common foot and ankle conditions. 

Learn about the latest treatments and preventive measures to keep your feet happy and healthy.

In this Q&A, feel free to ask about:

• Common foot and ankle ailments: From plantar fasciitis to bunions, Dr Li can help you to unravel the mysteries behind these conditions.

• Latest treatment options: Learn about non-surgical and surgical interventions to alleviate pain and restore function.

• Preventive care tips: Find out what you can do to protect your feet and ankles from injury and discomfort.

Don't let foot pain hold you back. Learn how to care for your feet and take the first step towards a healthier you!

About Dr Li Zongxian

Dr Li Zongxian is a Consultant Foot and Ankle Surgeon with the Department of Orthopaedic Surgery at the Singapore General Hospital (SGH). 

He obtained his medical degree (MBBS) from the National University of Singapore (NUS) and completed his Singhealth Orthopaedic Surgery Residency Programme. 

Following which he underwent a trauma surgery fellowship with Queen Mary Hospital, Hong Kong, as well as a foot and ankle fellowship with Royal London Hospital and Wrightingon Hospital, United Kingdom. 

Dr Li is a strong advocate for the advancement of orthopaedic surgery and has been actively involved in research and teaching. He has published numerous peer-reviewed articles and presented at multiple international conferences. He is passionate about providing high-quality orthopaedic as well as foot and ankle care to his patients.

Questions and answers on managing knee and ankle pains

1. Question by Agnes

Hi Dr Li Zongxian,

I’ve been experiencing pain in my second toe, and I suspect it might be related to my bunions (present in both feet).

Recently, I travelled to Shanghai and walked extensively. The pain started after that and, while it has improved, it hasn’t fully subsided. Could this be a result of overuse, or might it indicate something like capsulitis?

Any insights or advice on managing this discomfort would be greatly appreciated. Thank you!

Answer by Dr Li Zongxian

Hi Agnes,

It seems like you really made full use of your time in Shanghai. Hope you enjoyed your trip there!

Most patients with bunions do not experience too much discomfort but like you mentioned, periods of excessive walking may bring about some pain about the bunion bump as well as the lesser toes due to something called transfer metatarsalgia.

If the symptoms are largely improving after a period of rest and supportive footwear then all is good and well, but it may recur in future after similar exertions.

If it does persist, feel free to visit your local foot and ankle doctor or podiatrist for further assessment and management.

2. Question by swanee

Dear doctor,

Are there non-surgical ways to help minimise or re-adjust the big toe alignment? 

Other than avoiding pointed shoes, will wearing special insoles to elevate or support the middle part of foot help? 

Thank you for your advice.

Answer by Dr Li Zongxian

Dear Swanee,

Thank you for your question.

Unfortunately, there are no lasting non-surgical methods to realign the big toe. However, it is known that having a flat foot or tight calf muscles may contribute to development and progression of a bunion.

As such, calf stretching exercises, wide toe box shoes and corrective insoles may help in delaying or preventing progression of your bunion.

3. Question by Yen Goh

Hi Dr Li,

For bone spur causing bottom of foot pain:

a) What is the best treatment? What causes bone spur at bottom of foot and can we prevent it?

b) Besides physiotherapy are there other non-surgical option if the condition does not improve after physiotherapy?

c) If surgery is last resort, what is the healing period and risk?

Answer by Dr Li Zongxian

Hi Yen,

I believe you are referring to plantar fasciitis symptoms with pain at the bottom of your heel which usually strikes you when you take your first step coming out of bed or after sitting for a long period of time?

Ironically the spur has no direct relation to the symptoms of plantar fasciitis. There are many patients no spurs but no pain, similarly many patients with such pain do not have spurs either.

The spur in itself requires no treatment, but if you do experience plantar fasciitis symptoms, calf and plantar fascia stretching exercises, direct pressure and massage, supportive foot wear both outdoors as well as at home, and silicon heel pad inserts are some things which might help.

Other treatments like shockwave therapy, platelet rich plasma (PRP) injections, or minimally invasive endoscopic surgeries do exist as well. If your symptoms are unbearable and persistent, feel free to drop by your local foot and ankle surgeon for further assessment and discussion.

4. Question by Gio

Hi Dr Li,

Can a stroke patient do orthopaedic surgery on his knee? Thanks!

Answer by Dr Li Zongxian

Hi Gio,

We do perform orthopaedic surgeries on patients with previous history of stroke. However, when as well as how extensive the stroke was does have an impact on the safety of anaesthesia pertaining to the surgery.

If you are concerned regarding the increased risk of surgery relating to the previous stroke, there are various non-surgical treatment modalities that may alleviate the knee symptoms as well, depending on the condition involved.

Feel free to drop by for a more detailed assessment and discussion.

5. Question by Chelva

Greetings Dr Li,

I am raising this query on behalf by my wife. She faced “intermittent pull” with both her feet, at times affecting her toes.

This last about a few seconds to a couple of minutes. During this time, she is in pain.

What could be the likely cause for this and is there any treatment? Thank you.

Answer by Dr Li Zongxian

Hi Chelva,

It sounds like the symptoms your wife has been experiencing can range from tightness of muscle and tendons of her feet, to nerve or spine related problems.

Do visit your local primary care physician for further assessment and treatment. A referral to the relevant local specialist may be required if initial treatment does not provide adequate relief.

6. Question by John

Dear Doctor,

I have this persistent pain at the inner side of my right ankle especially when I do brisk walking exercise in the morning. The pain is lesser when walking normally.

This has lingered on for 2-3 years but in recent time the pain intensity has increased. The pain is like needle poking, and I would rate 6-7 on the scale of 10.

I have seen an orthopaedic doctor in Dec 24 and the doctor has taken x-ray of the foot but no news to date. The doctor has also referred me to physiotherapy and podiatry and still pending to see them.

I would like to know whether physiotherapy and podiatry can resolve my pain and if not, can you advise me what else can to do?

Thank you for your advice.

Answer by Dr Li Zongxian

Dear John,

Glad to hear that you have been seen by a doctor for your condition. Most foot and ankle conditions do benefit from a trial of physiotherapy and podiatry. If symptoms persist, more invasive treatment methods like injections or surgery may be discussed.

It seems that your visit was about a month ago. Please do give your care team some time to arrange for your follow up physiotherapy and podiatry appointment. 

You can check your HealthHub or SingHealth Health Buddy app for upcoming scheduled appointments as well. 

Alternatively you can call up the hospital appointment hotline to enquire about your physiotherapy and podiatry appointment dates.

7. Question by Peter

Dear Dr,

I have a right foot problem. After long walks, my foot will feel painful at the heel.

Podiatric doctor diagnosed it as plantar fasciitis and now undergoing shockwave treatment.

After 4 sessions, don't seem to help. Should I go for PRP injection instead. Fyi, I don't rest my foot much as I still play golf or walk about twice a week.

Now I am trying infrared treatment. My friend asked me to go for acupuncture. What would you recommend?

Answer by Dr Li Zongxian

Hi Peter,

It is good to hear that you are still able to enjoy a good game of golf and your weekly walks despite your plantar fasciitis.

Unfortunately, plantar fasciitis can be a very stubborn and recalcitrant condition to treat.

Shockwave is a good initial treatment for plantar fasciitis along with supportive footwear, calf and plantar fascia stretching exercise. PRP (platelet rich plasma) injections can offer relief by decreasing inflammation and aiding in healing.

There may be other underlying factors that may contribute to your persistent symptoms like excessive activity, inappropriate footwear, tight calf muscles, or flat feet.

Acupuncture may be able to provide you some relief as with the other mentioned treatment modalities.

Do drop by for a friendly conversation if further assessment and discussion if necessary.

8. Question by Des

Dear Dr Li,

I had a fall last December (13months ago). It happened very suddenly, but I believe it was my left ankle that gave way, and I landed on my right knee.

The ache in my left ankle still persists even though it has "healed". I go for weekly foot reflex and my sifu helps to alleviate the tightness in the ankle, but it comes back after a day.

I have taken to wearing socks at night to keep my left ankle warm. It helps a bit but is there a better solution for me? Are there exercises I should do, or acupuncture or...?

I am 52, female. Thank you for your advice.

Answer by Dr Li Zongxian

Dear Des,

I’m sorry to hear about your accident. It sounds like you had quite a bad sprain and it is still giving you persistent symptoms. Usually, a trial of ankle bracing and physiotherapy should help but in severe cases, more invasive treatment like injections or surgery may be necessary.

Further evaluation or even an MRI scan may be necessary to determine the root of your problem such that effective treatment can be provided.

9. Question by Hwee Lan

Dear Dr,

The muscles in both of my legs tighten, making it difficult to walk. Also, I feel a painful ache especially in my right knee and have difficulty of walking. Please advise what should l do to get better? Thank you.

Answer by Dr Li Zongxian

Dear Hwee Lan,

It sounds like you may benefit from a good course of physiotherapy and stretching exercises. Most polyclinics offer in house physiotherapy treatments.

That would be a good place to start from.

10. Question by Katrina

Hi Dr,

Is the calcium provided by the polyclinic able to ease the pain in the kneecap? Thanks.

Answer by Dr Li Zongxian

Hi Katrina,

Calcium supplements can help patients with low bone mineral density, especially if dietary calcium is lacking.

Depending on your knee condition, they do often require other forms of medication and treatment to ease the pain.

11. Question by Eileen

Dear Dr,

My leg is only painful when I get up from a sitting position or get up after lying in bed. I can walk without pain after the first few steps of unsteadiness.

However, I have pain when trying to squat or if I bend my knee to a large angle.

All this happens only to my right leg. What is wrong? Do I have to undergo surgery or physiotherapy? Thanks Doctor.

Answer by Dr Li Zongxian

Hi Eileen,

I’m sorry to hear that you’re being troubled by such symptoms.

Your symptoms seem to describe conditions ranging from plantar fasciitis to knee osteoarthritis.

Do visit your local primary care physician for an assessment and suggestion on initial treatment methods.

12. Question by Nawawi

Hi Dr,

I've recently encountered that my heel will hurt for no reason at times. I will apply counter pain and it will be fine for some time and then it will start to ache again. It does not seem to be gout and also, I did not have any injuries to the heel.

So wondering what could be causing it or it could be some form of rheumatism?

Answer by Dr Li Zongxian

Hi Nawawi,

Your symptoms seem to describe an ongoing plantar fasciitis. However you are right in saying that rheumatoid arthritis amongst other forms of inflammatory arthritis can cause spontaneous joint pains as well.

Do visit your local GP or polyclinic for assessment if your condition does not improve with rest.

13. Question by George

Hi Doctor,

Kindly provide your professional advice, which are the devices or modalities proven to be effective in non-surgical treatment for persons suffering from Plantar Fasciitis.

Can it be cured? If so, what preventive measures must be taken to avoid recurrence? Thank you.

Answer by Dr Li Zongxian

Dear George,

Plantar fasciitis is a very stubborn and recalcitrant condition. Though harmless, the pain experienced can be debilitating.

Non-surgical treatment methods include reducing activity levels, supportive footwear, direct pressure massage, silicon heel cups, calf and plantar fascia stretching, shockwave therapy and injections amongst others.

If such initial treatment methods do not provide sufficient relief, surgical modalities may be explored.

14. Question by Stacey

Dear Dr Li,

I feel tight and occasional pain on my both ankles, please advise what exercises I should do to lighten. Thank you.

Answer by Dr Li Zongxian

Hi Stacey,

Depending on your condition, different treatments do exist. However, most foot and ankle conditions do benefit from a course of physiotherapy, stretching and strengthening exercises.

Exercises like heel raises and toe lifts, or calf stretches are an easy way to start.

15. Question by Michelle

Dear Dr Li Zongxian,

My child has an os navicular and os trigonum and swims competitively. Will this affect the fusing of the bone to her feet in the long term? If the pain worsens, does it mean the bone is getting bigger? What can we do to help her?

Answer by Dr Li Zongxian

Dear Michelle,

Good to hear that your daughter leads an active and healthy lifestyle!

Os navicular and os trigonum are benign conditions that you may be born with. Most do not cause pain or affect the development of the feet, and many people go about their daily lives without ever knowing they had them.

Some may become painful when the tendons and ligaments around them become inflamed either through injury or excessive activity. An initial trial of rest, icing and physiotherapy often resolves the symptoms without too much fuss.

16. Question by Anyonymous

Dear Dr Li,

Why do I have a daily ache in my ankles even when I walk with sneakers with good support? The ache is felt when I get home.

Answer by Dr Li Zongxian

Dear Anonymous,

I’m sorry to hear that you are suffering from such symptoms. Many conditions may give you the symptoms you describe, ranging from tendon inflammation to cartilage conditions, to ankle osteoarthritis.

Do see your local primary care physician or specialist for further assessment and treatment if you find the symptoms affecting you.

17. Question by Theresa

Hi Dr,

I had a right foot injury due to being run over by a trolley. After 3 months, I can feel the small bump around the side of the foot despite X-ray showing no fracture. What should I do?

My toes are numb every night and I don't feel anything when I touch it. Could it be caused by the injury?

Appreciate your advice on this, thanks.

Answer by Dr Li Zongxian

Dear Theresa,

I’m sorry to hear that you are still suffering from your injury.

It seems like you may benefit from a further assessment and closer examination to determine the cause of your troubles and provide an effective treatment plan.

18. Question by Marsita

Hi Dr,

I sprained my ankle back in 2013. I step into a hole while carrying my son and fell, sprained my ankle badly. Went to the A&E the following day and found no fracture. From then, my ankle have been aching every time after long walks especially with extra weight.

What would be my next step to check my ankle? Thank you for your advice.

Answer by Dr Li Zongxian

Dear Marsita,

I’m sorry to hear that you have been suffering for the past 10 years since your ankle injury in 2013.

Severe or frequent sprains can result in tendon, ligamentous or cartilage injuries that may not be apparently on initial XRs.

A visit to your local foot and ankle specialist for further assessment or even an MRI scan may be useful in your context.

19. Question by Faith

Hi Dr,

Every morning, when I wake up, I would experience tightness at the back of my heels in both feet and ache in my right inner sole.

But once I start to walk on the floor, the tightness would go away after a while but the ache remains. Is there a reason for this?

Answer by Dr Li Zongxian

Dear Faith,

It sounds like you are experiencing symptoms of plantar fasciitis.

Activity modification, supportive footwear, direct massage, calf and plantar fascia stretching and silicon heel cups amongst other modalities are a good way to start initial therapy.

20. Question by Tracy

Hi Dr,

I’ve been experiencing ball of right foot pain, is it due to wrong shoe or walking gait?

Answer by Dr Li Zongxian

Hi Tracy,

It seems like you may be experiencing symptoms of plantar fasciitis.

This can often result from excessive activity or inappropriate footwear.

Activity modification, supportive footwear, direct massage, calf and plantar fascia stretching and silicon heel cups amongst other modalities are a good way to start initial therapy.

21. Question by Quirks

Hi Dr,

I would like to know if there is a bone spur (findings from x-ray) at the back of the heel (along bone leading up to the ankle) which will hurt when start to walk after prolonged leg rests, is there any care plan / treatment / can stop / change spur growth?

What about occasional foot spasms - could there be any underlying conditions to take note of and care for?

Lastly, are flat feet reversible? Feet still hurts when wearing arc support shoes. Thank you for your advice.

Answer by Dr Li Zongxian

Hi Quirks,

You seem to be describing symptoms of achilles tendinitis. There are effective treatment plans for such a condition and most doctors are happy to discuss them with you.

Flat feet are unfortunately not reversible, however symptoms are definitely treatable. If arc support shoes are ineffective, you may need to see a podiatrist for personalised assessment and customised insoles.

22. Question by Christina

Hi Dr Li,

I had plantar fasciitis on both legs. Started with left leg, then the right leg. It’s been 2 years. I have been doing stretching & exercises for strengthen.

Will there be full recovery? How long will this take? What else can I do to expedite recovery. Thank you.

Answer by Dr Li Zongxian

Hi Christina,

I’m sorry to hear that you have been suffering so long from your plantar fasciitis. Stretching and strengthening are good ways to help you feet but if the symptoms do persist, more invasive methods like shockwave, injections or minimally invasive endoscopic surgeries can be considered as well.

Most foot and ankle surgeons or podiatrist are happy to discuss further treatment plans for your troubles.

23. Question by Ivan

Hi Dr Li Zongxian,

I have experiencing pain at the bottom of my left foot for almost a year now. The pain usually come and go. Lately, I begin to experience similar pain on the right foot too.

I used to go for long walks (more than 5 km) but have stopped. Now I workout in the gym and feel pain when doing leg press or leg extension exercises. Should I continue with these exercises? What are my treatment options? Thanks.

Answer by Dr Li Zongxian

Hi Ivan,

It seems like you may be experiencing symptoms of plantar fasciitis.

This can often result from excessive loading or inadequate footwear.

Activity modification, supportive footwear, direct massage, calf and plantar fascia stretching and silicon heel cups amongst other modalities are a good way to start initial therapy.

Low impact exercises tend to aggravate plantar fasciitis less but if certain activities do trigger or worsen your pain, then it is advisable to cut down or stop them.

24. Question by Jemima

Hi Dr Li,

I am a 43-year-old female, in menopause already and suffer with severe pain in my left foot. Pain radiates from somewhere below small toe all the way until the ankle.

What are the remedies that can help relieve the pain apart from pain killers. I don’t believe in pain relief without addressing the main issue. But due to time constraints defer going to the ortho.

Your advice would be very helpful.

Answer by Dr Li Zongxian

Hi Jemima,

I’m sorry to hear that you’re suffering from such debilitating pain.

I totally agree with you that pain killing without addressing the main issue is not the way to go. Most often if the inciting factor like a recent injury or temporary increase in activity has passed, pain killers do offer a humane solution to tide you through the initial suffering while the body heals up.

Your symptoms may be structural due to foot biomechanical imbalance or relating to the nerves. It would be good to get specialist assessment if your symptoms are persist and unbearable.

25. Question by Christopher

Dear Doctor Li,

I have ankle pain at times but mostly on my right lower shin which as I understand is due to Lumbar Spondylolisthesis L4-L5. I am taking Pregabalin as prescribed.

I go for acupuncture now and then to try to relieve pain but it was done mainly on my lower back and right leg. Do you think acupuncture can be done on the ankles to relieve pain.

I also have bunions and need to wear shoes which are wide to accommodate the bunions which are not bothering me as there is no pain. However, is there any way to reduce the bunions whether through exercise or surgery?

Answer by Dr Li Zongxian

Hi Christopher,

If your condition has been assessed and found to be due to the lumbar spondylosis, then the medication, physiotherapy and acupuncture prescribed seems like the best cause of action. There is no harm to having acupuncture around the ankle but may not provide as much relief if the problem lies in the spine not the ankles.

Toe spacers or bunion splints may provide temporary correction to the bunion deformity while they are worn. However they do not offer lasting corrections. Surgery can be considered if they are giving you issues, as a more long term solution.

26. Question by Chris

Dear Dr Li,

How does one prevent getting a bone spur at the heel? Is it due to diet? Or 'improper' walking style/ shoes? Grateful if you can advise. Thank you.

Answer by Dr Li Zongxian

Hi Chris,

Very often such spurs in the heel are due to chronic tension and traction of tendinous connections to the heel bone. Adequate and frequent stretching would go a long way in reducing tightness and excessive tension in such cases.

27. Question by Yvonne

Dear Dr,

I had triple arthrodesis done on my left foot in mid 2020. 4 years later i still experience pain at mid foot, big toe joint, moderate swelling (lymphedema) and great discomfort at the ankle and exacerbate knee pains (due to changes to my gait). I hobble and limp when walking.

I have gone for physiotherapy but my and pain never goes away.

How can I reduce the constant swelling at my ankle and pain at mid foot (dorsal) and also big toe joint? Appreciate your advice.

Answer by Dr Li Zongxian

Hi Yvonne,

Triple arthrodesis is often performed for patients with severe flat feet with a background of arthritis.

The symptoms you describe may or may not be related to your initial flat foot and surgery. Or it may signify progression of arthritis amongst the other joints of the foot.

Activity modification, supportive footwear and elevation of the foot while sleeping may provide some relief. But it seems like you will greatly benefit from further assessment by your foot and ankle specialist.

28. Question by Paulyn

Hi Dr,

I would like to know what are the potential side effects if we undergo a bunion ops to correct the born alignment? Would it result in nerves and tendon tear if the doctor also additionally loses the calf muscles to deter future bone misalignment after the ops?

Secondly, would a small tendon tear at the ankle self-repair? What are the ways to help the tear repair faster and better? Do we have to stop movement as much as possible?

Lastly will nerves damaged during the bunion ops self-recover?  Or are nerves damages permanent? Thank you for your advice.

Answer by Dr Li Zongxian

Hi Paulyn,

Any surgery will involve potential risks, complications and side effects. Nerve and tendon injuries are part of the risks involved. Calf muscle loosening (gastrocnemius recession) may be offered in the same setting if you have a tight calf that does not improve with stretching as it is known to be associated with bunion progression and recurrence.

Secondly, small tears of the tendon and ligaments of the ankle do heal and recover with time but more severe ones may not heal entirely. Avoiding excessive strain and activity will naturally help in its recovery. However we do not advice for prolong immobilisation in most cases as this would result in stiffness and weakness of the ankle in the long run.

To answer your last question, most nerve injuries do recover with time, but depending on the extent of injury, some may be more persistent than others.

29. Question by Lim

Dear Dr Li,

I am a Stage 4 Kidney cancer patient and received Immunotherapy (Nivolumab injection) and Target Therapy (oral drug Cabozantinib) combination.

Two weeks after I suffered the side effect of Cabozantinib drug, i.e. soles of both feet near the last toe area seems a bit sensitive. While walking, I can feel slight pain (pain level 2 out of 10). The area below my right small toe has had calluses for many years. Yes, this is the painful area, about 1.5 cm in diameter. When I squeeze it hard, the pain level is about 4. Now both feet top 1/3 area feel pain while walking.

Is there any drug or exercise to eliminate the side effects/pain?

Answer by Dr Li Zongxian

Hi Lim,

I’m sorry to hear about your cancer diagnosis. Many cancer therapies are known to have side effects affecting the nerves.

It sounds like you will benefit from assessment by a podiatrist for treatment of your painful calluses and possibly customised insoles to help off load the pain areas.

30. Question by Mdm Heng

Hi Dr, kindly address my questions:

a) As we age (near 50 years old), is it true that our feet arch will become weak and therefore need special foot arch for shoes to support us ?

b) To protect our feet, we should wear covered shoes and not sandals or slippers?

c) We need special supplements to prevent arthritis and knee problems because healthy diet is not enough to provide necessary nutrients?

d) What type of exercises for age 50 is good for feet, knee, hip? Thank you.

Answer by Dr Li Zongxian

Hi Mdm Heng,

Flat foot can be something that happens early or later in life. Arch supports are always helpful in realigning the foot to avoid subsequent symptoms relating to foot imbalances. The type of supports are largely dependent on the extent and type of malalignment you have. This can be assessed by your foot and ankle doctor or podiatrist.

Sports shoes do often provide more cushioning and support compared to slippers or sandals and are advisable if you have foot and ankle ailments.

Special supplements are not necessary in the prevention of arthritis or knee problems if you have a healthy diet and lead a healthy lifestyle with adequate and appropriate levels of exercise.

Generally low impact dynamic exercises are a good start in maintaining flexibility and balance. Resistance exercises can also be beneficial in avoiding sarcopenia (low muscle mass).

31. Question by Kristin

Dear Dr,

I have a question on recovery of ankle following a surgery due to remove implants after a fracture.

It has been months since the surgery, and I am still feeling pain surrounding the incisions. Can I ask - how long generally do we recover from any form of bone surgery, and what are the preventive tips to prevent and improve the recovery process?

Also, my mom has been complaining about pain on the feet and under feet. Wearing a slippers at home help, but would like to understand what are the causes and what can be done to improve the condition?

Thank you for your advice.

Answer by Dr Li Zongxian

Dear Kristin,

I’m sorry to hear of your injury and current symptoms.

Generally skin wounds heal in about 2 weeks while bony healing requires months. Generally, limb elevation, range of motion exercises and stretching as well as early physiotherapy tend to aid in recovery.

It seems like your mom may be experiencing symptoms of plantar fasciitis.

This can often result from excessive activity or inappropriate footwear.

Activity modification, supportive footwear, direct massage, calf and plantar fascia stretching and silicon heel cups amongst other modalities are a good way to start initial therapy.

32. Question by Wing Yee

Hi Dr,

I have this constant pain at my R dorsum foot with slight swelling. There's also a raised bump due to degeneration which I have to take Arcoxia tab to reduce swelling and pain.

Is there any other non-surgical intervention to help improve my condition without having to take long term painkillers? It affects my walking.

Hope to hear some good news.

Answer by Dr Li Zongxian

Hi Wing Yee,

It sounds like you may be experiencing symptoms of mid foot arthritis amongst other possible diagnoses.

Physiotherapy, calf stretching and supportive footwear tend to help improve symptoms. Failing which, injections or surgery may be considered.

33. Question by Ah Chai

Hi Dr,

My wife has been suffering from bunion deformities for many years and has consulted some orthopaedics and searched on YouTube podcasts on bunion surgery. 

As the bunion conditions are getting worse, she is now seriously considering surgery but still worried about the outcome of the surgery as she believes that it is a very complicated surgery and may not be able to performed by a surgeon who is experienced in performing bunion surgery.

Would really appreciate advice on how she could better ensure successful surgery. Thanks.

Answer by Dr Li Zongxian

Hi Ah Chai,

I’m sorry to hear that your wife has been suffering from her bunions for such a long time. It is true that all surgeries big and small, even relatively straight forward ones like bunion correction, has their own risks and side effects.

It seems like she will benefit from a frank discussion with her foot and ankle surgeon on the benefits, potential risks and post operative rehabilitation process to align her expectations and alleviate unfounded fears and concerns before a decision for surgery is made.

34. Question by Irene

Dear Dr Li,

1) About plantar fasciitis

I have plantar fasciitis and although I take extra care with footwear and select those which suits me, it has never really gone away. 

What else can I do to manage this condition such that I can prolong the gaps between painful mornings? What about home remedies?

2) About high arches

My 14 year old has high arches. Other than orthotics, will putting on a foot brace at night help to correct his arches over time at least to flatten out a little? I’ve seen many models online, are these suitable for teens?  What must he watch out for on a daily basis?

I appreciate your replies.

Answer by Dr Li Zongxian

Dear Irene,

It seems that you are well aware of your condition and have taken the first steps towards getting better.

This can often result from excessive activity or inappropriate footwear.

Activity modification, supportive footwear, direct massage, calf and plantar fascia stretching and silicon heel cups amongst other modalities are a good way to start initial therapy.

Failing which, further therapy like shockwave, injections or surgery can be considered.

Your child appears to have pes cavus (high arch). People may be born with them, or it may be the result of other underlying conditions. Most patients with high arches do not have any symptoms and do not require treatment. Treatment really depends on the symptoms that’s bothering them.

Unfortunately, there are no effective ways to flatten out the high arch, though stretching exercises may help reduce or prevent symptoms.

35. Question by Meg

Dear Dr,

May I know if you have any suggestion on preventive care for foot of elderly woman with sarcopenia? Thank you for your advice.

Answer by Dr Li Zongxian

Hi Meg,

Generally, well fitting, supportive and stable shoes tend to be the most useful. Hope this helps!

36. Question by Amy

Dear Dr,

I am 70 years and have been putting up with my left foot pain for more than 5 years. The pain is somewhere between the 2nd and 3rd toes and I can only wear sports shoes or sandals with thick paddings with minimal discomfort.

I am asking if laser treatment is suitable for me. Thank you.

Answer by Dr Li Zongxian

Hi Amy,

I’m sorry to hear of your suffering. The symptoms describe suggest a range of possibilities including Morton’s neuroma to transfer metatarsalgia.

Depending on the condition, various treatment options are available. I am not certain whether laser treatment may be of help.

Do seek medical attention if your symptoms persist or are affecting you.

37. Question by Mdm Ang

Dear Dr,

I am 69 years old and a diabetic. I have bunions & slight flat foot since young and my ankle is not strong as I've sprained several times before. I also have lower back pains.

Being diabetic, I have to do regular exercises. How to improve my pain conditions?

Will using Bixeps machine as mentioned by SGH Dr Tay Boon Keng in this article help? How do I go about it? Thank you for your advice.

Answer by Dr Li Zongxian

Hi Mdm Ang,

Given your conditions, supportive shoes with wide toe box should be most appropriate for you. Podiatric assessment and customised insoles may be beneficial if your symptoms persist.

Bixeps machine has been shown to benefit patients with sarcopenia and muscle weakness. It is available commercially or at various care centres around Singapore.

38. Question by Suraindran

Good day Dr Li Zongxian,

I am having this excruciating pain just above my left side of my ankle. The pain is also spreads to the back of the heel.

I feel that is a swelling/growth on the area of the pain.

I have iced and used a heat pack but the pain returns once I start walking.

What do I need to do as this pain has been there for 3 months?

I do my regular walks 5 times a week even with the pain as after a while of walking, the pain reduces and returns. Thank you for your advice.

Answer by Dr Li Zongxian

Hi Suraindran,

I’m sorry to hear that your ankle has been bothering you as much. It appears that the condition mainly involves your ankle joint.

Unfortunately, I am unable to offer you any effective advice without further assessment.

I would advice you to seek medical attention as it appears your symptoms are severely debilitating.

39. Question by Christine

Hi Dr,

Can a person opt out for total foot reconstruction surgery if the torn ligaments and worn out cartilage are due to deformed foot structure which causes one to twist and sprain?

In this case the injured can still can walk and stand with a brace and regular physiotherapy also helps with the relief of occasional pain. Thank you.

Answer by Dr Li Zongxian

Hi Christine,

Generally, foot deformity resulting from or resulting in ligamental injury and cartilage degeneration can benefit from bracing or specialised shoes.

If symptoms of pain or instability remain unbearable or if the injured is unable to tolerate long term use of the brace then surgery may be necessary, depending on the condition involved.

Hope this answers your question.

40. Question by Irene

Hi Dr Li,

Recently I noticed that my left big toe joint (base of foot) appears to be enlarged as compared to my right big toe joint.

Although it is not causing any pain at the moment, I am perplexed as to the cause of it being enlarged. Am wondering if it could be a sign of an emerging bunion?

Would appreciate very much your advice on this.

Answer by Dr Li Zongxian

Hi Irene,

It might very well be the case, but a proper assessment by a medical professional would surely be beneficial.

41. Question by Katt

Dear Dr,

Is it possible to completely heal plantar fasciitis? I have a nagging pain for my heels and side of the foot. Have gone for physiotherapy but still the pain comes back on and off. How to totally heal it? Thank you.

Answer by Dr Li Zongxian

Hi Katt,

Plantar fasciitis can be a very stubborn and persistent condition, but it is no doubt treatable!

Activity modification, supportive footwear, direct massage, calf and plantar fascia stretching and silicon heel cups amongst other modalities are a good way to start initial therapy.

Failing which, further treatment with shockwave, injections or surgery can be discussed.

42. Question by Jasmine

Dear Dr Li Zongxian,

I started having foot & ankle pains on both feet since six months’ ago, with needle-like pains rising towards knee level; often times woken up in the middle of the night and able to sleep for the most about 2-1/2 hours. It usually ends up with sitting up although desperately needing sleep.in sleep daze.  It plunges me into depression. I feel shooting pain throughout the whole body especially on the right.

As recent as yesterday when I was shown my recent X-ray for body length, whereby the upper body shows a big somewhat flowing curve – the x-ray was taken when I stood upright without slanting as it was done under supervisory of the radiology staff.

I haven’t been able to sleep flat facing the ceiling due to severe pain around my sacro-iliac area for over 20 years after a bus accident -, where I can sense shooting pains throughout the whole of my right body – right up to my head/eye area. 

I was hurt in a bus accident when a bus always waiting to pick up office workers suddenly lunged forward when I was in front of it. I was thrown off and landed on my buttock area resulting in tailbone fracture/crack. The pain never recovered over the years and I had been taking strong painkillers for the past number of years since the accident.  I suffered from sacroiliac joint dysfunction with severe pain on my right buttock area whenever in sitting position so always sit-slanting towards the left seat, lifting up the right buttock area from the seat.

Over time, the pain appeared to spread all over the body and I then learned about the term “fibromyalgia”… while searching for information from the internet…..and it was confirmed by the pain management specialist who treated me for past 20 years since the bus accident. I have never recovered and it’s 6 months’ ago I start to develop the intolerable foot and ankle pains.

Can you kindly advise what could be done and how could I receive the necessary treatment as needed? 

I am impressed that this space is created for those suffering from foot and angle pains to share our plight. Thank you very much indeed.

Answer by Dr Li Zongxian

Hi Jasmine,

I’m most sorry to hear of your unfortunate accident and your 20 years of suffering.

It sounds like your symptoms are related to conditions pertaining to your spine and nerves and that your pain specialist is actively on board with your recovery.

I am unable to advice whether your current foot and ankle pains might be a separate issue or an extension of your previous injury. A proper assessment by your local foot and ankle specialist would be most beneficial currently.

43. Question by Richard

Hi Dr,

I sprained my ankle slightly more than 2 years back and until now, I still have pain in my ankle. The MRI only shows a very old, recovered ankle fracture and nothing serious that is causing this lingering pain. 

I have been trying to strengthen my ankle with calf raises and balancing on one foot. But still the pain lingers. Any advice what I should do? Thanks.

Answer by Dr Li Zongxian

Hi Richard,

Most ankle sprains benefit from early physiotherapy to prevent stiffness and weakness and subsequent aid in recovery and return to sports.

If your symptoms remain persistent and affect you, a further assessment or repeat MRI may be beneficial. Occasional a diagnostic ankle arthroscope may be helpful as well.

44. Question by Sonal

Dear Dr Li,

I have been diagnosed with FHL tendosynovitis while on a visit to India. What is the prognosis and how can I care for my foot? What further treatment should be initiated? Thank you for your advice.

Answer by Dr Li Zongxian

Hi Sonal,

Most often FHL (flexor hallucis longus) tendinosis can be treated with physiotherapy, anti-inflammatory medications, bracing and stretching exercises.

Failing which injections or shockwave can be considered. Most patients do not end up requiring surgery.

Ref: G25