Foot health - from bunions to corns to ankle injury

PUBLISHED : Tuesday, 28 August, 2012, 12:00am
UPDATED : Tuesday, 28 August, 2012, 6:11pm

Summer may be the season for flip-flops but not for Allison Ho who, like many other women in Hong Kong, suffers from foot disorders. Ho (not her real name) wears wide-boxed flat shoes all year round to conceal bunions, a condition that affects about 37 per cent of Chinese women in Hong Kong, according to research published in the
Foot and Ankle Online Journal in 2010.

"Hongkongers like to look good. I'd be treated differently if clients saw my feet, so I buy funky designer flat shoes to hide them," says Ho, a brand consultant.

A bunion (
hallux valgus) is where the big toe is bent towards the midline of the foot such that it often overlaps with the second toe, explains Douglas Horne, a founding partner of Douglas Horne Podiatry. "Traditionally, it was thought that bunions are caused by ill-fitting footwear, but I have seen too many women in ridiculous footwear with no bunions, and women who have worn flip-flops almost exclusively for years with serious deformity.

"Bunions are caused by biomechanical instability in the foot and can be hereditary. Caught early enough, it can be corrected by exercise, correct footwear advice,
hallux valgus splints and orthotics."

For severe bunions, Dr Kong Siu-wah, specialist in orthopaedics and traumatology at Matilda International Hospital on The Peak, recommends surgery to correct the deformity and rebalance the toe - an option that Ho is considering. Left untreated, bunions can cause "lesser toes deformity" resulting in pressure ulcers or deep and painful calluses known as "intractable plantar keratoses", also a commonly experienced foot disorder.

In a 2004 study published in the
American Journal of
Epidemiology, 60 per cent of 784 adults tested as part of the research had corns and calluses. These conditions were more common in women and were primarily due to ill-fitting shoes. Plantar keratoses, in particular, can be very painful and can affect walking. "Chronic keratotic lesion may ulcerate and become infected. In the worst case, osteomyelitis [bone infection] may result and if unable to control, amputation of foot or leg may be required," Kong warns.

The most common cause of non-traumatic lower limb amputation is diabetic foot ulcers, a condition that Alexandra Duff, podiatrist at PhysioMotion, treats on a regular basis. According to the
American Family Physician journal in 1998, diabetes contributed to about 80 per cent of 120,000 non-traumatic amputations performed yearly in the United States. In 2006, Britain's National Diabetes Support Team advised that more than one in 10 foot ulcers resulted in the amputation of a foot or a leg.

Duff says diabetic foot ulcers can "easily be prevented by daily inspection of the feet, good footwear, good management of a person's diabetes, and no smoking". Left untreated, patients are at risk of gangrene, septicaemia, amputation and death.

"Treatment consists of tight blood-glucose control, excellent wound management, pressure relief for the wound and antibiotics," she says. "Once the wound is healed, the patient should inspect his feet daily and attend regular reviews with the podiatrist. We also recommend appropriate footwear and orthotics for the individual."

According to Duff, Horne and Kong, ingrowing toenails are also on the list of commonly seen foot disorders. Ho has experienced ingrowing toenails, which Horne says could have been caused by the abnormal position of her toenails due to bunions.

"I tried soaking my feet in water three times a day but the pain and swelling in my big toe became unbearable. In the end, I had surgery. I had to wear open-toed sandals, as wearing shoes hurt too much," Ho says.

Inappropriate nail trimming, shoes with a narrow toe box, tight stockings as well as obesity, diabetes, thyroid disease, cardiac and renal diseases, can also increase the risk of ingrowing toenails, says Kong. "If an ingrowing toenail is left untreated, there will be persistent infection that may eventually cause [bone infection] of the great toe."

Duff advises: "Cutting back the offending part can cause temporary relief. The more permanent treatment is to have the offending section of the nail removed along with the nail root to prevent it coming back."

The most commonly experienced foot complaint for athletes is ankle injury. About 25,000 ankle sprains occur daily in the US, while a survey conducted among Hong Kong Chinese athletes in 1994 found that 73 per cent experienced recurrent ankle sprain.

"The average person walks 10,000 paces a day. If you're a runner or very active, it's three to five times that amount so it's important to have the right technique. People need to learn to walk and run effectively," says Dr David Cosman, a sports injury specialist.

Cosman, a medical adviser for the Hong Kong Basketball Association, advises athletes to warm up properly and wear supportive footwear. "In the event of a sprain, ice, rest, compression and support for the sprained ankle are recommended. Elevate feet to reduce swelling. Once activity resumes, taping by an experienced practitioner is advisable and expect severe ankle sprains not to fully heal for one whole year," he says.

All four practitioners said heel pain was common, which Cosman attributes to biomechanical foot deviations, collapsed arches (flat feet) and tight calf muscles. He suggests custom-made corrective foot orthotics, foot and calf massage, and hydration to prevent tight muscles. Kong explains that heel pain can also be caused by plantar fasciitis, a painful inflammation of the connective tissue on the sole of the foot. "Maintain a healthy weight; choose supportive shoes; don't go barefoot and avoid prolonged standing or walking," he advises.

Cosman reminds people to address walking and running technique. Horne advises: "For most people in Hong Kong, especially sporty types, wear appropriate footwear with the correct amount of stability and support." As for flip-flops, he recommends them only for the beach.