1. Question by Mr Ng

Dear Sir,

I am 72yes old. I walk more than 10k steps every day. Sometimes, I feel pain in my left ankle, especially when I get up in the morning. However, after applying muscle rub and walking slowly for half an hour, it improves

Do I have to see a GP for this? Please advise. Thank you. 

Answer by Dr Eric Cher

Dear Mr Ng,

Thank you for your question.

It’s wonderful to hear that you are keeping yourself active by exercising regularly. Walking is an excellent way to keep fit and you are certainly on the right path towards healthier SG.

While aches and pain may be common in your age group, it should not be something you should overlook. There are many causes of ankle pain, and it is important for us to identify the exact location of the pain so that we can recommend the appropriate treatment to target the affected site.

From your description of morning pain around the ankle, it is likely that you may be having plantar fasciitis, a condition that commonly occurs with the first few steps in the morning and improves after moving. At the same time, other conditions that may present as morning ankle pain includes joint stiffness due to Arthritis, Achilles tendinitis and Inflammation to the joint, just to name a few.

I have written a post on “Plantar Fasciitis” (see above) and you will find some useful information and recommendations there. However, should your discomfort persist or if it affects your daily activities, do consult a foot doctor for a more thorough evaluation to determine the underlying cause of your pain.

Meanwhile, do continue to keep yourself active and monitor the intensity of your activities to prevent over straining yourself.

2. Question by George

Dear Dr Eric,

I have left foot heel pain issue since long time ago (around 10 years). It will be pan like prickling there when I,

1. Long time sitting and not stand up

2. Get up from bed and get off to walk on the floor

3. Long time sports then walk (I am badminton player and almost play once every 1-2 weeks, I feel better)

4. If I rest well,

5. If long time sitting and walk for a while

I went to clinic and consult with doctors, and they also answer cannot be fully recovery like normal person. 

Could you please advise on it, it is appreciated! Thanks.

Answer by Dr Eric Cher

Dear Mr George

Thank you for your question. Indeed, heel pain can be quite disabling and may take a long period of time before you see some improvement.

Based on your symptoms, it’s likely that you have plantar fasciitis. However, to recommend you the appropriate treatment, it is important that we isolate the exact location of pain, whether it is over the back or the underside of the heel.

Being of the most common foot pain condition, I have written a post on “Heel Pain” and “Plantar Fasciitis” (both above). You will find some useful information and recommendations there.

While majority of the patients improves after a period of non-operative treatment such as stretching, some of them see a plateau in their progress and continues to have frequent bouts of pain that limits their daily activities. To this group of individuals, I would recommend them to consult a foot doctor for a thorough evaluation and discuss the available treatments to help alleviate the discomfort.

Meanwhile, may I suggest that you continue to keep an active lifestyle and focus on stretching exercises.

3. Question by Mr Ying

Dear Dr Eric Cher,

I’m past 60 and exercise regularly – swimming, walking on treadmill, on a cross-trainer etc. Recently, when walking down stairs, I sometimes feel a dull aching pain within the area where my right ankle meets my foot as my heel lands on the steps – it doesn’t happen all the time but getting a little too frequently. Sometimes, I can shake it off and sometimes it’ll persist so that I have to walk gingerly down. There is no pain when I walk on flat surfaces.

Can I do anything, like exercising or stretching or massaging to alleviate the pain?

Answer by Dr Eric Cher

Dear Mr Ying

I’m glad that you are keeping yourself active by exercising regularly. There may be different causes to your described pain, especially the area where your ankle meets the foot, commonly known as the ankle joint. It would be important to pinpoint the exact location of your discomfort to determine the next cause of action. Pain over the back of your heel may be due to Achilles Tendinitis, while pain over the base of the foot near to the back may be caused by Plantar Fasciitis. Based on your description, your discomfort may also be from the ankle joint, especially when you are walking up and down steps.

If you find yourself getting more troubled with the frequency of pain, I advise for a thorough consultation to determine the exact cause of your discomfort.

Meanwhile, I would suggest the following:

• Continue to keep an active lifestyle

• Avoid impact activities such as running and over-exertion that may aggravate your pain

• Proper shoe wear with good support and comfort

• Calf stretching exercises

4. Question by Paul

Hi Dr,

I would like to know what is defined as a high arch foot and how is it treated? Thank you.

Answer by Dr Eric Cher

Dear Paul,

Thank you for your question.

Foot arch is the area that runs from your toes to the heel and high foot arch is defined as a foot arch that is raised more than normal. Visually, you may notice that the space between the floor and your arch is higher than a normal person.

In majority of the cases, a high foot arch may not cause you discomfort or disability. However, if you find yourselves having symptoms such as painful arch, recurrent ankle sprains, difficulty with shoe wear, painful callus due to excessive contact pressure, muscle weakness or altered sensations, etc, I would advise to consult a foot doctor to make sure there is no other underlying conditions and also to recommend treatments that may help you with your symptoms. Some patients may benefit from surgical correction to reduce the arch.

Meanwhile, I would suggest the following:

• Appropriate foot wear with good arch support. You may require customized insoles to accommodate the extra depth.

• Activity modification to avoid activities that aggravates your discomfort

5. Question by Yi Ting

Dear Dr Eric Cher,

I am 71 years old, a diabetic. Now having calf muscles and foot tightness and aches. Furthermore my shins are cold too.

Besides massaging on my own, also take paracetamol both of which give some relief.

Need to trouble you to advice what should be done to rid these.

Answer by Dr Eric Cher

Dear Yi Ting

There are many factors that may contribute to aches and muscle tightness in someone with diabetes. A few common reasons why you may be feeling these discomfort includes.

• Reduced physical activities causing stiffness

• Diabetic neuropathy resulting in altered sensation and muscle weakness

• Reduced blood circulation leading to cramps, aches and cold limbs

• Effects of diabetes such as dehydration

• Medication side effects

It will be important for you to work closely with your family doctor to ensure good control of your sugars. Meanwhile, I would encourage you to

• Adopt an active lifestyle

• Stretching exercises to loosen up the tight muscles

• Watch out for foot related ulcers that you may not realise due to altered sensations and numbness

6. Question by Patrick

Dear Doctor,

Lately I’ve been experiencing acute pain in my heel after sitting down for about fifteen minutes or so. The pain comes when I get up to walk, but after moving awhile, it subsides.

I walk about 6000 steps every other day and have been doing so for more than a year. I wear proper sports shoes for walking. Thanks for your help and reply.

Answer by Dr Eric Cher

Dear Mr Chow

Thank you for your question.

Firstly, it is important that we isolate the exact location of pain, whether it is over the back or the underside of the heel. However, from your description of pain after sitting and improves upon moving, it is very likely that you have plantar fasciitis, a condition where pain is commonly felt at the underside of the heel bone or around the heel cup region.

I have written a short post on “Plantar Fasciitis” (see above) and you may refer to that for more information. There are some recommended stretching exercises that may improve your current condition.

However, if the pain troubles you significantly and affects your daily activities despite trying out all the conservative measures, I recommend a consultation with a foot doctor to obtain an accurate diagnosis so that an appropriate treatment plan can be tailored to help you.   

Meanwhile, it is great that you are keeping yourself active by walking, and I will encourage you to continue doing so.

7. Question by Ms Tay

Hi Dr,

I’d like to know what are the medical options for managing bunions?

They are causing my toes to cramp and slight pain when I walk. Thank you.

Answer by Dr Eric Cher

Dear Ms Tay

Thank you for your question.

Bunions, also known as Hallux Valgus, is a common foot condition affecting many individuals. While not all bunions need to be surgically corrected, those who are experiencing pain over the big toe may need to consider surgery to improve their symptoms. If you are having slight pain during walking, you may want to consider trying some of the conservative treatment first to see if they help you with your discomfort.

I have written a short post on “Bunions/Hallux Valgus” (see above), and I hope you can find some useful information on the causes of pain and recommended medical options.
May I recommend that you speak to a foot surgeon regarding your bunions should you experience the following.

• Progressive worsening of deformity

• Painful bunion despite changing shoes wear

• Pain even when walking without shoes

• Unable to find a comfortable pair of shoes due to widen forefoot

8. Question by Herwani

Dear Dr,

My 15 year old daughter sprained her right ankle when she was 5. We just rested and iced her ankle when it happened, and after a week she was fine.

However she still feels ankle pain sometimes when she does some dance moves. Should I bring her in for an x-ray?

Answer by Dr Eric Cher

Dear Herwani

Thank you for your question.

It is unusually uncommon for your daughter’s ankle injury at 5 years old to affect her permanently unless there are some injuries to her growth plates that may affect her overall bone growth. Most sprains heal well after a period of rest, more so in a young child.

It’s good that your daughter enjoys dancing, but if she frequently feels pain when she dances, it would be important to find out if there are any underlying conditions causing the discomfort. For example, if she finds herself having difficult with dance moves that requires her to tip toe like a ballet dancer, she may have posterior ankle impingement.

As such, depending on location and foot position that reproduces the pain, different treatment plans can be tailored to help her.

9. Question by Grace

Hi Dr Eric,

I have heel pain on my left leg for the past few months. Initially the pain will go off after a while but recently it has become more persistent. May I ask if there are some ways to ease the pain?

Answer by Dr Eric Cher

Dear Grace

Thank you for your question.

Heel pain is a very common foot condition that may be quite disabling. The current discomfort that you are experiencing seems to be affecting your daily activities. While majority of the heel pain resolves after some period, persistent discomfort requires a more thorough evaluation so that an appropriate treatment can be tailored to your needs.

There are various underlying causes to heel pain, and I would recommend you read the short post I have written on “Heel Pain” (see above). You will find some useful information and treatment options there.

However, should the pain troubles you significantly despite trying out all the conservative measures, do consider seeking a consultation with a foot surgeon to discuss the available treatment options that may be beneficial to you.

10. Question by Ian

Dear Dr Eric,

For the past 2 months, when I wake up, I feel some pain near the heel on the soles of my feet when I step on the floor. It gets better as I move but more painful when I wake up and after I get up from sitting. Please advise.

Answer by Dr Eric Cher

Dear Ian,

Thank you for your question.

Based on your description, it is very likely that you have plantar fasciitis, a foot condition where pain is commonly felt at the underside of the heel bone or around the heel cup region. The discomfort usually occurs with the first few steps in the morning or after prolonged sitting and improves upon moving.  

I have written a short post on “Plantar Fasciitis” (see above) and you may refer to that for more information. There are some recommended stretching exercises that may improve your current condition.

It is also important to recognize that persistent pain that shows no improvement may also point to other underlying conditions. Should the pain troubles you significantly despite conservative measures, do consider seeking a consultation with a foot surgeon to obtain an accurate diagnosis so that a personalised treatment plan can be tailored to help you.

11. Question by Clairo

Hi Dr Cher,

I will be reaching 57 by November 2023, female.

I would like to stay active, doing much walking and hiking since 5-6 years ago (especially after I have crossed my 50).

I have gotten plantar fasciitis like 3 years back. I have visited KTPH sports doctor, seen the physiotherapy then. Have adjusted and moderated my walking distance, got better lined soles and shoes. I have learnt to do warm up and stretching before and after my long-distance walks or hikes. Usually on the weekend, depending on the group hike occasion 6-18km. I work on weekdays.

My plantar fascilities is better and under control, though not totally gone. My questions are:

1. I would like to continue to stay active in my aging years, what do I have to take note of and what natural food to consume more?

2. I hear some “cracking sound” on my knee and ankle when I stretch. Apart from glucosamine or supplements, I would like to know what natural food to consume in place of that?

My BMI is within range of 22-23, recent lab test is in healthy form. June done my scope recently, it’s clear. Thanks!

Answer by Dr Eric Cher

Dear Clairo

Thank you for your questions.

I’m glad to hear that you are keeping yourself active through walking and hiking. Both activities are excellent choices to maintain a healthy metabolism and activity level.

Given that your plantar fasciitis is getting better and under control, you should continue to stay active, maintain a healthy and balanced diet. You may want to consult a trained dietitian or nutritionist to seek more advise on the variety of food to consume.

Cracking sounds on the knee and ankle are mostly harmless and you need not be alarmed or worried. There are several reasons to explain the phenomena and most of them are benign. The popping sound is usually caused by the bursting of air or gas bubbles around the joint. In some cases, early arthritis or tendon/ligament moving across bony structures may also present as a cracking sound.

If the cracking sound is associated with pain, swelling or instability, it is advisable that you seek a professional consult to diagnose the underlying cause of your symptoms.

12. Question by Philip

Hi Dr,

I have been getting pain in my foot from walking about 5-6km about 4-5 times a week.

The pain is in the left forefoot where it flexes (around where the metatarsals meets the phalanges).

I also have a number of orthopaedic issues:

Flat left foot

My left leg is about 2mm shorter (and hence I have 11 degree scoliosis).

What can I do to minimise the pain?

Are there specific shoes or insoles that I should use?

Answer by Dr Eric Cher

Dear Philip,

Thank you for your questions. I'm glad to hear that you are keeping yourself active by doing low intensity cardio such as walking.

Based on what you have described, it is likely that you have metatarsalgia, a condition where the ball of your feel becomes painful and inflamed. Although many causes of metatarsalgia remains unclear, some of the known contributing factors may include ill fitted shoes, frequent runners, tight calf muscles, etc.

Other conditions such as Flat Foot and Uneven Limb Length can also cause altered biomechanics and uneven pressure distribution during walking due to foot over pronation and excessive loading when you walk.

To alleviate your pain, I would suggest the following:

• Appropriate foot wear with insole support.

• Metatarsal gel pads to cushion the balls of your feet

• Avoid activities such as planks, tip toes or positions that puts excessive pressure over the painful region

• Calf stretching exercises

If the discomfort persists despites the above measures, it would be useful to have a consultation with a foot surgeon to determine the cause of your pain. In some circumstances, surgical correction may be required to improve your condition.

13. Question by Christine

Dear Dr Cher,

I have been having this middle sole pain for a few months and sometimes the pain can be very obvious when I wake up in the morning and I can feel a lump when I press on the pain area.

Appreciate your advice. Thank you.

Answer by Dr Eric Cher

Dear Christine

Thank you for your question.

Based on your description, your two main troubling symptoms are the palpable lump over the sole and the morning foot pain. While both signs may originate from the same condition, let me explain each of them first.

Morning pain over the sole of your foot is a very common symptoms seen in plantar fasciitis, a condition caused by degeneration to the plantar fascia. Most individuals will describe it as pain with the first few steps in the morning and improves after walking. I have written a short post on “Plantar Fasciitis” (see above) and you may refer to that for more information.

Secondly, it is important for me to know the exact location of the lump to determine if both symptoms are caused by the same underlying condition.

• If the lump is felt at the base of your heel where the plantar fascia inserts into, it may be due to inflammation or bone spurs forming at the underside of the heel.

• If the lump is felt at the middle part of the sole and away from the insertion, it may be due to conditions such as thickening of the plantar fascia, fibroma, cysts or callus.

As such, should you notice an increase in size, discomfort or other symptoms that affects your daily activities, it would be wise to arrange for a consult with a foot doctor for further evaluation.

14. Question by Shirley

Dear Dr,

May I know what are the likely causes of heel pain and what physio exercises can eliminate it?

Answer by Dr Eric Cher

Dear Shirley

Thank you for your question.

Heel pain is a very common foot condition that may be quite disabling. I would recommend you read the short post I have written on “Heel Pain” (see above) for more information.

However, if the pain troubles you significantly and affects your daily activities despite conservative measures, I recommend a consultation with a foot surgeon to obtain an accurate diagnosis so that a personalized treatment plan can be tailored to help you.

15. Question by June

Hi Dr,

I have bunions and hammer toes. I only had problems with getting comfortable shoes. As I’m very old, should I consider surgery?

Answer by Dr Eric Cher

Dear June,

Thank you for your question.

Besides having problem with getting a comfortable pair of shoes, do you have other symptoms such as pain on walking or frequent painful flare of your bunions?

Let me address your bunions and hammer toes separately.

While not all bunions need to be surgically corrected, those who are experiencing pain over the big toe may need to consider surgery to improve their symptoms. Besides, your hammer toes may also be associated with your bunions. Due to the big toe deviating towards your lesser toes, it may over or under-ride your second toes causing discomfort and progressive deformities to the other toes.

I have written a short post on “Bunions/Hallux Valgus” (see above) and I hope you can find some useful information on the causes of pain and recommended treatment options.

Hammer toes may result in pain and stiffness over the affected toes. In many cases, individuals may find it difficult to find a comfortable pair of shoes because of the bony prominence.

You may want to consider looking for a high and wide toe box shoes or a footwear with an extra depth to accommodate to the hammer deformity. However, should the pain affect you significantly, surgical correction or fusion may be required to alleviate your discomfort.

If the deformity causes your undue discomfort and pain, I recommend you speak with your foot surgeon to discuss a feasible treatment option. 

16. Question by JT

Hi Dr,

I’ve been having swelling in the area surrounding my left big toe for a month now. The swelling has subsided 90-95% after taking Arcoxia and Colcitex for 1.5-2 weeks as prescribed by my GP.

My GP initially diagnosed it was gout. A blood test was ordered. The blood test result came back with a 477 umol/L of uric acid and was told that my uric acid level is not high (i.e. within acceptable range) and my GP wasn’t sure if it’s really gout attack that’s causing the swelling in the area surrounding my left big toe. An X-ray was also done for my left foot and there’s no abnormality too.

My question – is 447 umol/L of uric acid considered high? I’m a 39-year-old male. What could be causing swelling of the area surrounding my toe (other than gout attack)?

Thanks for answering my question.

Answer by Dr Eric Cher

Dear JT

Thank you for your questions.

Gout is a form of inflammatory arthritis that often affects the big toe, also known as Podagra. During an attack, the joint is acutely swollen and painful, with accompanying redness and warmth. You may also find that it is triggered by certain food intake, especially those that are purine-rich such as red meat, beer and seafood such as anchovies, sardines and mussels.

Uric level of 447umol/L is within the normal range but the presence of high or normal uric acid concentration may not accurately confirm or rule out the possibility that you have a gout attack. Your GP can only make a presumptive diagnosis based on your clinical history as the definitive investigation for gout is through joint fluid aspiration to look for the presence of urate crystals.

Having said that, I would still recommend that you look into your dietary habits to see if there are certain food/drinks that often triggers an acutely painful joint.

There are many other conditions that can cause big toe swelling. These include.

• Degenerative arthritis to the joint

• Deformities such as hallux valgus

• Ligamentous injury such as turf toe

• Seasmoiditis, Inflammation, etc

If you have frequent bouts of painful attacks, or persistent pain that does not resolve with medication and rest, I suggest a more thorough evaluation to determine if there are any other underlying causes of your big toe pain. If it is truly gout, there are treatment options to prevent recurrent attacks.

Meanwhile, may I suggest the following.

• Keep a diet diary to record any food intake that may triggers an attack

• Take a short course of anti-inflammatory medication during a painful episode

• Keep your big toe mobile by stretching

• Maintain a healthy lifestyle and weight 

17. Question by Leong

Hi Dr, my question is:

May I check if baxter nerve compression can heal on its own, and what are the stretches or massages that could help in healing? The likely cause is acupuncture damage (needling done at an acupoint near the ankle for a non-foot related ailment). Thank you.

Answer by Dr Eric Cher

Dear Leong

Thank you for your question.

Baxter nerve, also known as the first branch of the lateral plantar nerve runs along the inner part of the heel. When irritated or entrapped, it may cause symptoms such as pain around inside of the heel, burning sensation or discomfort during walking. As there are many other conditions that may present the same way including plantar fasciitis and heel bursitis, it is important to know the exact underlying cause of your current symptoms before an appropriate treatment can be recommended. If it is truly a baxter nerve related pathology such as entrapment, surgical procedures to release the compression can help to “free up” the nerve.

Meanwhile, I do have some suggestions for you to conservatively manage your current symptoms.

• Appropriate foot wear with good arch support

• Avoid tight shoes that places excessive pressure at the heel

• Calf stretching exercises

• Plantar fasciitis specific stretching exercises (kindly see my post on “Plantar Fasciitis” for more information)

If you continue to have persistent symptoms despite conservative therapy, do consider speaking to a foot doctor to discuss the next course of action.

18. Question by Karin

Hi Dr,

I recently suffered from heel pain doing some leg exercises without wearing shoes.

The sharp pain usually occurs when I first step off the bed. Other than this, the pain can go unnoticed unless I stand for a long time.

I have been using patches and oil cream but recovery seems rather slow. I also wear slippers in the house. It has been 4 weeks.

Everyone who suffered from heel pain before told me full recovery process can take 12 weeks to a year.

Can you recommend if anything can be done to expedite my recovery?

Answer by Dr Eric Cher

Dear Karin

Thank you for your question.

Indeed, heel pain can be quite disabling and may take a long period of time before you see some improvement. Based on your description of symptoms and the location of pain, it’s likely that you have plantar fasciitis.

You are not alone as plantar fasciitis is a very common foot condition and many individuals, regardless of age and gender may be affected by it.

I have written a post on “Plantar Fasciitis” and you may refer to that for more information.

However, if the pain troubles you significantly and affects your daily activities despite conservative measures, I recommend a consultation with a foot surgeon to obtain an accurate diagnosis so that a personalized treatment plan can be tailored to help you

19. Question by Dorothy

Dear Dr Cher,

Have been having pain near the ankle and also on the heel while walking. Have tried insoles which helps a little but pain still persists.

Would appreciate your guidance how to relieve the pain and best to have a remedy to this problem.

Thanks for your help.

Answer by Dr Eric Cher

Dear Dorothy

Thank you for your question.

Your foot seems to be troubling you quite a bit, especially when it’s around the ankle and heel. First and foremost, it is important for us to identify the exact location of the pain so that we can recommend the appropriate treatment to target the affected site.

There are many possibilities that may explain your discomfort. Some of the causes to ankle pain while walking includes.

• Degeneration to the ankle joint

• Cartilage injury

• Ligamentous strains / injuries

• Tendinopathies

• Deformities resulting in altered biomechanics of the foot

• Inflammation, Nerve impingement, etc

As for heel pain, you are not alone. Being of the most common symptoms of foot pain, I have written a post on “Heel Pain” and you may refer to that for more information.

However, please consider getting your condition evaluated so that we can pinpoint the underlying cause of your pain.

20. Question by Muneira

Dear Dr,

I have had a pain at the back of my right ankle since December last year. The pain is around my Archilles heel but does not extend to the base of my foot.

When I get up from a sitting or lying position to walk, the pain is worse but it goes away once I have taken about 20 to 30 steps. I can walk normally after that.

There is a spot on the left back of the ankle that is painful if I press it, and feels like the pain in a bruise, but it is not red or swollen. Please advise. Thank you.

Answer by Dr Eric Cher

Dear Muneira

Thank you for your questions.

Based on the description of your symptoms, it is likely that your heel discomfort is caused by Achilles Tendinitis. The painful spot at the back of the ankle is most probably the location where the achilles tendon inserts into the heel bone. Due to chronic degeneration, insertional calcific tendinopathy develops resulting in calcification of the achilles tendon at its attachment point. This results in a palpable prominent bump, that often causes pain with shoe wear and during walking. You may be most symptomatic during the first few steps after prolonged sitting or lying.

Achilles tendinitis is a very common foot condition that affects many individuals. I have written a post on “Heel Pain” (see above) and you will find some useful information there. I recommend that you try out some of the conservative measures suggested, but if you continue to have persistent pain that affects your active lifestyle, do consult a foot doctor to discuss the available treatment options to help you with your pain.

21. Question by Shamina

Hi Dr,

Past six month I am working as a childcare teacher. My job is I need to walk a lot with my bare foot. I started to have foot pain for past two months.

What could be the cause? My school floor is wooden. Thanks in advance.

Answer by Dr Eric Cher

Dear Shamina,

Thank you for your question.

First and foremost, is important for us to localize the exact region of the foot that is causing you discomfort, and the factors that aggravates it. As your work requires you to be barefooted, I was wondering if you also have the similar pain with shoes on?

Although one of the most common causes of foot pain is plantar fasciitis, you will need a more thorough evaluation to determine the underlying cause of your symptoms. For example, individuals with flat foot deformity often have pain that improves with arch support, while those with posterior tibial tendinitis improves with specific strengthening exercises.

I have written a post on “Plantar Fasciitis” (see above) and you will find some useful stretching advice there.

Meanwhile, may I suggest the following.

• Appropriate indoor foot wear with good arch support

• Calf stretching and plantar fasciitis specific exercises

• Avoid aggravating activities such as prolonged standing

Should your discomfort persist or if it affects your daily activities, do consult a foot doctor for a more thorough evaluation to determine the underlying cause of your pain.

22. Question by Patrick

Dear Dr Eric Cher,

I am currently experiencing slight pain on my left foot/ankle region when I climbed starts more consistently for the past 1.5 weeks.

This time round the pain doesn’t really go away after massaging the foot area with Chinese medical oil, but maybe reduce the pain. However it is not consistent.

The pain started about two months ago. I cannot think of specific incident or injury. It did go away at times after massaging my foot area then.

Last month, I played table tennis and couple of days later felt the pain was slightly more obvious which I though could be due to aggravation when playing table tennis.

I cannot locate the pain while pressure area around the affected left foot. As the pain is not excruciating or does not interfere in my daily course of work or routine, I have not consulted any doctor yet.

I hope you can provide some insights and advice. Thank you very much.

Answer by Dr Eric Cher

Dear Patrick,

Thank you for your questions.

It is not uncommon for individuals to experience slight aches and pain of the foot, but if it gets too frequent or persistent, it would be advisable to consult a foot doctor to accurately diagnose the underlying cause of your condition.

I could think of a few possibilities, but without a clinical evaluation, it would be difficult to recommend a definitive solution for you. If you are unable to locate the pain while exerting pressure around the affected foot, it may suggest a deeper source such as intra-articular lesions that is not palpable from the surface.

Meanwhile, may I suggest the following to help alleviate your discomfort slightly.

• Appropriate foot wear with good arch support

• Avoid aggravative activities that triggers the discomfort. This includes impact sports such as table tennis and running

• Consider low impact activities such as swimming and aqua-aerobics

Do consider speaking to a foot doctor if you find yourselves having difficulty coping with the discomfort or experiencing limitations to your activities.

23. Question by Richard

Hi Dr Eric Cher,

I have this burning sensation on both feet sometime in Dec 2022. My GP offered me Gabapentin 300mg to be taken every night before bed. I was fine after 2 weeks.

However, in May 2023, I have similar issues again. I took 2 months of Gabapentin 300mg it didn’t go away. In the third month, I stopped taking it. The burning sensation is very mild and I am able to sleep without the medication till today.

However, both my legs muscle seems weak and have mild pain at times while walking. What should I do? Please advise.

Answer by Dr Eric Cher

Dear Richard

Thank you for your questions.

The burning sensation on both your feet can be caused by various conditions. While most of them are mild and goes away after a period of rest, others may point towards a more serious underlying condition. Medical conditions such as diabetes, peripheral neuropathy, vitamins and hormonal deficiencies, and long-term medication use can all lead to altered sensations to the extremities. Orthopedics related issues may include nerve entrapments, hyperesthesia from previous injuries and poor footwear choices.

While I’m glad to hear that your symptoms of burning sensation is mild and doesn’t affect your sleep, I am however concern over the weakness of your legs. Muscle weakness may improve with strength building and exercises, but if you notice wasting of your muscles, or progressive worsening of your strength, it would be advisable that you consult your doctor for a more thorough evaluation.

Meanwhile, I would encourage you to

• Maintain a healthy and active lifestyle.

• Monitor your symptoms and seek help if its worsening

• Appropriate shoe wear that is not too tight or restrictive

24. Question by Maureen

Hi Dr Eric Cher,

I have a bunion on my right foot and recently I have been having pain in the area where my 3rd toe tends to draw close to the 2nd toe.

How can I relieve the pain my foot especially after walking even for a short distance? Or should I seek medical help from a specialist?

Answer by Dr Eric Cher

Dear Maureen

Thank you for your question.

Bunions, also known as Hallux Valgus, is a common foot condition affecting many individuals. While not all bunions need to be surgically corrected, those who are experiencing pain over the big toe may need to consider surgery to improve their symptoms.

Due to the big toe drifting towards the lesser toes, it may sometimes cause pain over the 2nd toe or pushing it towards the 3rd toe, closing the gaps between your lesser toes. Discomfort may also arise on the underside of your lesser toes, commonly known as metatarsalgia due to uneven pressure at the metatarsal heads.

If you are having pain during walking, you may want to consider trying out some of the conservative treatment first to see if they help you with your discomfort. Wearing a toe spacer between your 1st and 2nd toes or placing a metatarsal gel pad under your forefoot may also help you with your symptoms. 

I have written a short post on “Bunions/Hallux Valgus” (see above) and I hope you can find some useful information on the causes of pain and recommended medical options.

May I recommend that you speak to a foot surgeon regarding your bunions should you experience the following.

• Progressive worsening of big toe and lesser toes deformity

• Painful bunion despite changing footwear

• Pain even when walking without shoes

• Unable to find a comfortable pair of shoes due to widen forefoot

25. Question by Jacqueline

Hi Dr Eric,

I am 59 years old this year. I have this sharp pain in the ball of my left heel especially when I wake up in the morning. Sometimes the pain goes away but other times it will persist throughout the day.

I also have a pain in my left knee, it’s at a particular spot when I kneel down.

Could you advise what I can do to help alleviate this? Thank you!

Answer by Dr Eric Cher

Dear Jacqueline

Thank you for your question.

Based on the description of your foot pain, it’s likely that you have plantar fasciitis, a condition where pain is commonly felt at the underside of the heel bone or around the heel cup region. I have written a short post on “Plantar Fasciitis” (see above) and you may refer to that for more information.

As to your left knee pain, it would be important to localize the exact location of discomfort before an appropriate treatment can be recommended. Some of the common cause of knee pain during kneeling may include.

• Patella tendinitis, an inflammation to the patella tendon at its insertion into the tibia bone

• Patellofemoral syndrome
  

• Degenerative changes to the knee joint

• Bursitis, Meniscus tear, etc

To alleviate your knee pain, I would suggest the following:

• Avoid kneeling or placing pressure onto the place where it’s painful

• Place a cushion or gel padding between the knee and floor

• Quadriceps strengthening exercises

I would recommend a consultation with an orthopedic surgeon to diagnose the underlying cause of your knee pain.

26. Question by Brenda

Hello Dr,

I have pain on my left heel, usually in the morning and when standing up. What could be the cause of it? Your advice is appreciated.

Answer by Dr Eric Cher

Dear Brenda

Thank you for your question.

Heel pain is a very common foot condition and it’s likely that you have plantar fasciitis.

I have written a post on “Plantar Fasciitis” (see above) and you may refer to that.

As there are many other conditions that may mimic plantar fasciitis and presents as heel pain, I would encourage you to read the post on “Heel Pain” also. You will find some useful information and treatment options there.

If the pain troubles you significantly and affects your daily activities despite trying out the conservative measures, I strongly recommend a consultation with a foot surgeon to obtain an accurate diagnosis so that a personalized treatment plan can be tailored to help you.

27. Question by Mdm Ngoh

Hi Dr,

What is the reason that causes heel bone pain? Any solution for it? I had heel bone pain for months. When I get up from the seat, I feel the pain and after walking a few steps, it is not so painful.

Answer by Dr Eric Cher

Dear Mdm Ngoh

Thank you for your question.

Heel pain is a very common foot condition and it’s likely that you have plantar fasciitis. This condition usually presents with pain over the base of the heel after prolonged inactivity such as sitting and after sleep. 

I have written a post on “Plantar Fasciitis” (see above) and you may refer to that for more information.

As there are many other conditions that may mimic plantar fasciitis and presents as heel pain, I would encourage you to also read the post on “Heel Pain” (also above). You will find some useful information and treatment options there.

If the pain troubles you significantly and affects your daily activities, I strongly recommend a consultation with a foot surgeon discuss an appropriate treatment plan tailored to help you.

28. Question by Tian Hui

Hello Dr,

The pain in my feet started flaring up more frequently when I started being more active. For some context, I try to run 5km around 3 times a week and for at least a 1hr walk every week.

Suspecting the pain is due to intensity of pressure placed on my feet. I reduced the frequency in which I run/walk and only begin exercising when the pain is gone.

While this generally worked well in managing the pain, lately it seems like the pain is triggered more easily with more surface flaring up, and with higher pain intensity resulting in longer recovery time needed. Previously 3 days would be more than sufficient for a full recovery (no pain), recently I feel the pain sensation at day 3.

I realised that the pain usually starts when I wake up and hurts when pressure is exerted (i.e when I touch it or when that area comes into contact with the floor)

For additional context, I am a 23-year-old female with no serious medical health illness/history. Thank you so much and I look forward to hearing your opinions on this matter.

Answer by Dr Eric Cher

Dear Tian Hui

Thank you for your question.

It is great to hear that you are keeping yourself active and healthy by doing regular runs and walks. It’s good to recognize that aches and pain may surface if you overexert yourself or exercise excessively without proper warm up and stretching.

From your description of morning pain when your sole comes into contact with the floor, it’s likely that you have plantar fasciitis. While most of it recovers non-operatively, persistent pain that limits your daily activities may need to be evaluated and treated properly. I have written a short post on “Plantar Fasciitis” (see above) and you may refer to that for more information.

You may want to consider trying out some of the stretching exercises as written in the post. In addition, I would also recommend that you reduce on your running activities for a short period of time and progressively increase over the next few months.

If your discomfort persists despite conservative measures, you may want to consult a foot surgeon to discuss available treatment options to help alleviate your pain.

29. Question by Naroshinii

Hi Dr,

I am an overweight women, 35 years old with a very high BMI. I am trying to lose weight and understand this will likely solve most of my leg pain.

In the past, I have got my achilles torn and have gone for physio, it has slightly recovered than what it used to be unable to tiptoe. Due to my overweight, I can feel my ankle protruding out.

My question is can I reverse the bone structure deformation to normal around my feet if I lose weight and do you think there is any severe foot damage caused due to my overweight?

Thank you very much Dr Cher!

Answer by Dr Eric Cher

Dear Naroshinli,

Thank you for your question.

I’m glad to hear that you are improving from your achilles tendon rupture.  

To answer your queries on whether you can reverse the “ankle protruding out” feeling, it is important for me to first ascertain if there is truly a structural deformity to your ankle. In cases such as flat foot where your medial arch collapses, it is not uncommon to have swelling and bony prominence over the inner aspect of your foot. Other conditions including ankle arthritis can also result in your ankle tilting inwards, making it look abnormal.

It is also important for me to identify the location where you feel that your ankle bone is deformed. Achilles tendon rupture does not typically result in structural changes to your ankle bones, and both conditions are likely separate entities. 

Overweight is one of the risk factors causing ankle pain and arthritis. The fact that your feet carry your entire body weight throughout your daily activities makes it important that you control your weight. In addition, any deformity or mal alignment to the foot and ankle can significantly worsen the underlying condition due to abnormal weight distribution when you stand.  

May I recommend that you approach your condition in 2 ways.

• Seek a consultant with a weight management physician to determine the next course of action.

• Should your ankle pain cause you significant discomfort, speaking with a foot doctor to evaluate any underlying problems might be useful.

Meanwhile, I will encourage you to.

Keep an active lifestyle

Choose low impact activities such as walking, swimming and aqua aerobics to improve your overall cardiovascular health

Wear an appropriate pair of shoes with good insole support

30. Question by Cheryl

Dear Dr Cher,

I started getting heel tenderness recently. It comes and goes but particularly after a hike or using the elliptical machine.

It goes away sometimes on its own or after a foot rub. Should I be concerned? I’m 53 years old. Thanks.

Answer by Dr Eric Cher

Dear Cheryl

Thank you for your question.

Heel pain is a very common foot condition that may be quite disabling. While I’m glad that you are keeping yourself active by doing regular hikes and cardio exercises with the elliptical machine, it’s certainly not a good feeling to have heel pain after every exercises.

Do not worry as you are not the only one with heel pain. Many individuals are troubled by it. While most goes away after some rest, some of them like yourself continues to have frequent discomfort. There are many conditions that may cause heel tenderness, and it is important for us to identify the exact location of the pain so that we can recommend the appropriate treatment to target the affected site.

I have written a post on “Heel Pain” (see above) and you will find some useful information there. I would recommend that you try out some of the conservative measures suggested, but if you continue to have persistent pain that affects your active lifestyle, do consult a foot surgeon to discuss available treatment options to help you with your pain.

31. Question by Daphne

Hi Dr,

I would like to understand more about what are the causes of foot (sole) pain. Is it true frequent pain means certain part of body organ is not functioning well? Or is it simply the cold and flat floor that is the cause? Appreciate your advice.

Answer by Dr Eric Cher

Dear Daphne

Thank you for your question.

There are many causes of foot pain over the sole. Depending on the location of pain, type of activities that aggravate the discomfort and overall structural alignment of your foot, you will require a proper consult with a foot doctor to determine the underlying cause of your symptoms.

One of the most common causes of sole pain is plantar fasciitis where pain is often felt at the underside of the heel bone or around the heel cup region. I have written a post on “Plantar fasciitis” (see above) and you will find some useful information there.

I would recommend that you try some of the conservative measures such as stretching and proper footwear first. If your symptoms persist or worsen despite those treatments, do get an orthopedic referral for a more thorough evaluation so that a personalized treatment plan can be recommended.

32. Question by Poh Chin

Hi Dr Eric,

What causes ankle pain and what treatment is available? Likewise for heel pain? Thank you in advance for your time.

Answer by Dr Eric Cher

Dear Poh Chin

Thank you for your questions.

First and foremost, it is important for us to identify the exact location of the pain so that we can recommend the appropriate treatment to target the affected site.

There are many possibilities that may explain your ankle pain and some of the causes include.

• Degeneration to the ankle joint

• Cartilage injury

• Ligamentous strains / injuries

• Tendinopathies  

• Deformities resulting in altered biomechanics of the foot

• Inflammation, Nerve impingement and etc

While most of the above conditions can be treated non-operatively with analgesia and physiotherapy, I would strongly recommend that you obtain a thorough evaluation by a foot doctor to treat the underlying ailment.

As for heel pain, you are not alone. It is also one of the most common foot complaints affecting many individuals. Likewise, there are many underlying causes that may account for your discomfort. I have written a post on “Heel Pain” and you may refer to that for more information.

Meanwhile, may I suggest the following.

• Maintain an active lifestyle

• Avoid aggravating activities such as impact sports and excessive running

• Calf stretching exercises

• Appropriate foot wear with good insole support.

33. Question by Heaven

Hi Dr Cher,

I have bunion on my left foot. Is it true that aging will worsen the condition? I do not have any pain nor my toes are overlapping. Should I wear a corrector to prevent it from worsening

Also my big toe (same left foot) has pins and needles when I first step out of my bed every morning. It goes away after some more steps. Is this something of concern?

Thank you.

Answer by Dr Eric Cher

Dear Heaven

Thank you for your questions.

Bunions, also known as Hallux Valgus, is a common foot condition affecting many individuals. If you are not having pain over the bunion, I would encourage you to treat it conservatively with appropriate choice of shoe wear and avoid activities that may worsen the drifting of your big toe. Wearing a corrector will only temporarily correct the deformity and may not have a lasting change.

As to whether the bunion will worsen as you age, it is not uncommon for patients to find that their deformity becomes more significant over time. I would encourage you to take a picture of your foot today and then yearly to monitor if there is any progression. Some of the indications for surgical intervention include painful bunion, progressive worsening and discomfort that limits your daily activities.

The pins and needles sensation around your big toe may also be attributed by the bunion deformity due to nerve compression caused by joint misalignment. If it goes away after a few steps in the morning, I will consider observing it first.

However, if you find yourself having more trouble with your bunions with pins and needles sensation becoming more frequent and persistent, I recommend that you speak with a foot doctor to evaluate if you will benefit from a bunion surgery.

I have written a short post on “Bunions/Hallux Valgus” (see above), and I hope you can find some useful information on the causes of pain and recommended medical options.

34. Question by Sharon

Dear Dr Eric Cher,

I am 65 years old. I have an op done to stitch up a torn tendon in my right ankle in Dec 2015.

Two months ago, I started to have pain and inflammation at this exact spot as I did a slow walk. What is the next best thing I can do for treatment? Thank you so much.

Answer by Dr Eric Cher

Dear Sharon

Thank you for your question.

I would need more information pertaining to the tendon that was injured in 2015 and what exactly was done to repair the tendon. Was the repair performed to stitch up an acute rupture or was it done to reconstruct a chronic injury such as ankle instability.

From your question, I’m assuming that you had a good 8 years being symptoms-free but the same discomfort has recurred recently. The pain and inflammation at the exact spots likely suggest a recurrence of your initial problem, but I’ll need a thorough evaluation for a more definitive diagnosis before recommending you a treatment plan.

Meanwhile, I would suggest the following.

• Avoid aggravating activities such as impact sports and excessive walking

• Stretching exercises

• Appropriate foot wear with good insole support.

35. Question by Mdm Nellie

Hello Dr Eric Cher,

I am suffering from foot discomfort (nerve pain around the first web of my right foot). It was created from an earlier fracture near the last toe of the right foot.

The fracture has healed however I stared to experience nerve related kind of discomfort soon after the cast was removed. It has gone on for more than 6 months now. I was sent for an MRI and results indicated Morton’s Neuroma of the first web.

I was advised to wait out a few months with a hope of self-recovery, it may have improved a little. However, the discomfort largely remains.

Is there any other treatment I can take to improve or cure this problem beyond surgery? Thank you for your time.

Answer by Dr Eric Cher

Dear Mdm Nellie

Thank you for your question.

Morton Neuroma is an entrapment neuropathy condition of the interdigital nerve that causes pain, numbness, and tingling sensation around the affected area.

Besides waiting it out for a few months, there are some conservative measures you can adopt to help with your discomfort. These include.

• Appropriate shoe wear with a wide toe box

• Use of metatarsal gel pads under the forefoot

• Stretching of the toes to maintain its flexibility

• Corticosteroid injection for symptomatic relief

The aim of non-operative treatment is to relieve the compression around the affected nerve and to manage the symptoms caused by nerve irritation. However, should your symptoms persist, surgical excision of the neuroma can be considered.

36. Question by KH Chiam

Dear Dr Eric,

I am 56 years old male and walk on my treadmill at 5km/hr, 3 times weekly.

My problem is that when I wake up in the morning, the base of both my feet would be painful. The pain will go away after 20mins of my normal morning routine. Can you advise if I need to seek medical treatment and if this will get worst? Thank you.

Answer by Dr Eric Cher

Dear KH Chiam

Thank you for your question.

It’s wonderful to hear that you are keeping yourself active by exercising regularly. Walking on the treadmill is a great way to keep fit, yet not over stressing your joints. Other exercise alternatives may include swimming and aqua aerobics.

From your description of morning pain over the sole of both feet, it is likely that you have plantar fasciitis, a condition that commonly occurs with the first few steps in the morning and improves after moving. I have written a post on “Plantar Fasciitis” (see above) and you will find some useful information and recommendations there.

As to whether you need to seek medical treatment, it really depends on how the pain is affecting your daily activities. While majority of the patients improves with non-operative treatments, some of them requires surgical intervention to help with their pain. If your discomfort persists despite stretching and shoe wear modifications, do arrange a time to speak with a foot doctor to discuss other treatment options that may be beneficial to you.

37. Question by Rebecca

Dear Dr Eric, good day to you.

I’m an avid dancer who loves to dance practically every day from 30mins to 1.5 hours except Mon that I’ll be dancing more than 3 hours.

I guess due to my above activities, I have foot and ankle pains occasionally. So please advise what kind of treatment is available to address my issue?

I am 60 years old, weigh around 44kg and my height is 156cm. Thanks.

Answer by Dr Eric Cher

Dear Rebecca,

Thank you for your question.

It’s always wonderful to see patients like yourself engaging in social activities that promotes an active lifestyle. I’m glad you are enjoying dancing and do keep it up.

It is not uncommon for individuals to experience slight aches and pain of the foot, but if it gets too frequent or persistent, it would be advisable to consult a foot doctor to accurately diagnose the underlying cause of your condition. Occasional discomfort may arise from over-exertion, ligament strain, tendinitis, or underlying causes such as mild degeneration of the joints. Without a thorough evaluation, it would be hard for me to give you an accurate diagnosis and the appropriate treatment plan.

Do continue to monitor your discomfort and should it worsen or significant impact your dancing, do get it checked.

Meanwhile, may I suggest the following.

• Continue to maintain an active lifestyle

• Avoid impact activities such as jumping or hip hop dance

• Ensure an appropriate foot wear with good support, especially during dance

• Calf stretching exercises

38. Question by Terrence

Hi Dr Cher,

I have tender areas in my sole towards the base of my small toe, which are aggravated by walking barefoot on hard surfaces.

As my right foot is wider than my left, the tenderness was more pronounced there and I was advised that it could be partly due to a thickening of the sole. My remedy – use an abrasive instrument to remove the horny top thick layer.

However the situation has now aggravated and has spread to the left as well.

Do you have any recommendations please? Relief is felt when using padded insoles or wearing slipper on heard surfaces.

Answer by Dr Eric Cher

Dear Terence,

Thank you for your question.

There are various causes to pain over the little toe. However, based on your description, it is likely that you have bunionette deformity, also known as Tailor Bunion. Like the more commonly seen bunions which affects the big toe, a bony bump may also form at the little toe causing discomfort.

The thickening of the sole over the same area is due to uneven pressure distribution leading to callus formation. The use of abrasive instrument to remove the thickened layer is only temporary as the underlying cause is not resolved. You may also find that the foot is wider than the other side. This is due to the bony prominence resulting in a visually broader foot.

The use of padded insoles helps to relieve the pressures over the painful area and wearing slippers also reduces compression over the prominence. If the discomfort troubles you significantly and affects your daily activity, you may want to consider surgical intervention to correct the deformity.

39. Question by Paul

Hi Dr,

I’ve been experiencing aching pain for over a year on my right foot sole, just below the toes. May I know what are the possible problems? And what should I do?

Answer by Dr Eric Cher

Dear Paul

Thank you for your question.

Aching pain just below the toes may be due to metatarsalgia, a condition where the ball of your feel becomes painful and inflamed. Although many causes of metatarsalgia remains unclear, some of the known contributing factors may include ill fitted shoes, frequent runners, tight calf muscles, etc. Deformities such as flat foot, high arch and hallux valgus may also contribute to pain due to uneven load distribution.

If the discomfort persists and affects your daily activities, it would be useful to have a consultation with a foot surgeon to determine the cause of your pain. In some circumstances, surgical correction may be required to improve your condition.

Meanwhile, I would suggest the following:

• Appropriate foot wear with sole support.

• Metatarsal gel pads to cushion the balls of your feet

• Avoid activities such as planks, tip toes or positions that puts excessive pressure over the painful region
  

• Calf stretching exercises

Ref: I23