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The misery of painful feetLast updated at 23:52 26 November 2007They're at the end of our bodies - and the bottom of our list of priorities. Symptoms: Stabbing, cramping or burning pains that run across the ball of the foot and up the toes, most commonly the third and fourth toes. Symptoms: Throbbing pain in the ankle or the sole, often worse in the morning, and heel spurs - painless bony lumps.
Symptoms: Sharp pain or numbness in the ball of the foot (pain is concentrated, unlike Morton's neuroma where it spreads up the toes).
It’s easy and pretty for women to ink a foot tattoo because feet have enough space for any designs you love. But while most people don't give their feet a second thought, when something goes wrong with them, it can be literally disabling. Cause: Inflammation or tearing of the Achilles tendon, which attaches to the heel bone and controls the calf muscle.
Cause: Damage to the plantar fascia, the taut band of tissue which runs from the heel bone to the toes and helps keep the middle of the foot arched.
Cause: Damage to the metatarsals, the small bones that run from the base of the toes down the foot - this is usually because the fat pad on the ball of the foot is worn out through repeated high impact (such as through sport), or through age, leaving the bones exposed. This means people often endure painful conditions for far too long, and the problem can get worse. Cause: Bone misalignment - the big toe pushes towards its neighbouring toes while one of the bones in the middle of the foot pushes in the opposite direction, towards the other foot.
Cause: The metatarsals - the small bones running from the base of the toes to the middle of the foot - become crushed together, pinching the nerve. Problems can occur when the plantar fascia is put under excess pressure, such as through weight gain or sporting activity or if you are immobile (this causes the arches to droop leaving the plantar vulnerable).
Treatment: Orthotic insoles to protect the bones can reduce pain, antiinflammatory injections can reduce swelling. During the average lifetime our feet cover over 70,000 miles, the equivalent of walking four times around the world., so it's not surprising that problems can occur.
This friction causes the nerve to thicken and eventually a lump (or neuroma) forms at the site of the pressure. Sometimes surgery is required to alleviate the strain on the metatarsals - the bones will be trimmed to stop them slanting towards the ground.
Indeed around three-quarters of all adults will experience some sort of problem with their feet at some time. The most common cause is flat feet - the foot rolls inwards putting excess pressure on the metatarsals. Insoles or heel pads can be used to prevent the tendon from having to stretch fully with each step as normally happens.


Flat feet are another common cause - the lack of an arch causes the plantar to stretch excessively. Tight-fitting shoes can be to blame, especially in those prone to the condition (bunions tend to run in families).
High heels or tight shoes are another cause (the condition is much more common in women, affecting thousands). The patient wears a special insole which sends messages to a computer about where the most intense areas of pressure are. Arthritis, weak ligaments in the foot which usually hold the bones tight, and a tendency to roll the foot when walking can also cause them.
Occasionally surgery is needed to repair or replace the tendon with another from elsewhere in the body. Treatment: Tears and inflammation will often heal with rest, a change of exercise regime or weight loss. Bunions leave the joint vulnerable to arthritis, Treatment: Padded inserts or broadfitting shoes can alleviate pressure on the joint and stop pain and ulceration. For advanced cases - where the pain is persistent - surgery to remove the neuromas is normally recommended.
SOPHIE DHENIN, 50, is a physiotherapist at Scorpio Clinics in Virginia Water, Surrey, and is married to Chris.
If you have flat feet, wearing a splint at night (available from podiatrists and chiropodists) can stretch the plantar and prevent morning pain; special insoles which keep the arch of the foot raised and pressure off the plantar can also help with flat feet. Ice packs and anti-inflammatory medication, such as ibuprofen, help to bring down swelling. Your GP may offer anti-inflammatory injections into the sole of the foot or suggest shock-wave therapy - where low-frequency sound waves are used to stimulate the healing process - although exactly how it helps is still not fully understood.
She says: On a skiing trip, I developed stabbing pains that went from the ball of my feet up to my knees. Initially, it was only after sport, but gradually even a slight touch against a chair would be agonising.
There are now 130 types of surgery for bunions - many techniques have not been overly successful, so new ones are constantly being developed. My surgeon said there were mini tears in both tendons; he put tiny holes into them to encourage the growth of blood vessels to heal the tears. She says: Last year I suddenly felt an excruciating pain in my heels, as if someone was shoving a knife in.
For over three years, the bottom of my foot was so tender it felt as if I was walking on bare bone. One of the latest, the scarf technique, involves rotating the bones back into place; this has a 90 per cent success rate compared with 70 per cent for older versions such as the Keller method, which involved removing a large part of the big toe and creating a new toe joint.


When it got worse during my next skiing trip and my feet felt numb, I bought some heated skiing boots. My doctor thought that I had pulled something and would get better with rest, but it didn't. Whereas the Morton's neuroma had only hurt when I wore tight shoes, I was now in permanent agony, limped and had to wear shoes with a spongy sole.
Physiotherapy didn't work and I began getting stabbing sensations in my foot, like broken glass. This involved injecting local anaesthetic between the tendon and its surrounding sheath, having 15 holes jabbed in my tendon. I had to quit my job as a mobile hairdresser because it meant driving and standing for long periods - and the pain was too much.
I was diagnosed with metatarsalgia - the mechanics of my left foot had changed so that the ball of my foot was taking the full force of each step. I was diagnosed with plantar fasciitis and referred to a podiatrist, who said my feet rolled inwards when I walked, which put too much pressure on a section of my plantar at the front of the foot. My big toes pointed at 45-degree angles and were so prominent they would soon push a hole through my shoe leather.
I was measured for a pair of orthotics - tailor-made insoles - to go in my shoes, which would hold my feet in place when I took a step.
I was in constant pain so the surgeon operated on two of my toes to redistribute the weight of my foot.
As a teenager I hated having to wear sensible shoes and my bunions would ache after exercise.
Back home, my GP referred me to Jason, who works out of the Harley Street Clinic in London. I had Morton's neuromas in both feet but decided to have just my right foot done so I could hobble around during my recovery (I'll have the other done next year). Two operations later, using a tendon from my big toe to replace the damaged one, I can finally lead an active life again. Shocked, I agreed to surgery but just on the worst one so I could be mobile during my recovery. I have to wear them all the time and if I don't, I am in in pain again within half an hour. The surgeon took a triangular piece of bone out of my big toe and realigned it to the rest of my foot.



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