A bunion (also known as hallux valgus) is a visible bump or prominence on the joint of the big toe, where it touches the inside of your shoe or shoe strap.

If your shoe or strap rubs against the bunion, this can cause irritation and inflammation. This is associated with local redness(erythema) and pain or, more worryingly, cause swelling (bursitis), a blister or an infection.

What to do if you have a bunion

Most bunions are painless. To avoid irritation, it’s really important to choose your footwear carefully. Delicate sleeve dressings or stockings can protect your toe. If it’s painful, you can help settle inflammation by applying an anti-inflammatory ointment.

You can also wear a corrective device or splint at night to try to stretch the toe and slow the progress of the condition.

If your bunion is severe (large and painful), you may consider surgery to restore the alignment of the big toe.

How can Doctor Greene’s help you

Our specialist products can help you address big toe pain and irritation associated with bunions.

• Bunion Sleeve
• Big Toe Bunion Gel
• Big Toe Separator

The big toe is the most common area for arthritis in the foot and ankle. In fact, big toe arthritis affects 1 in 40 people.

Pain on moving the big toe is usually associated with joint stiffness. Osteoarthritis of the big toe is also commonly called hallux rigidus, derived from Latin terminology; hallux (big toe) and rigidus (stiff).

If you have big toe arthritis, you can develop swelling or even a solid bump over the top of the big toe. This can rub against the inside of your shoe.

Pain usually affects the top of the toe, but any part of the big toe joint may hurt. Pain is aggravated by the rolling motion of the foot when you walk. Standing on tiptoes can generate symptoms, making it hard to wear high heels.

What to do if you have big toe arthritis

Choose your shoes carefully and avoid flexible, thin soles and higher heels. You might find you can tolerate a wedge heel beter. You could also try:

• Shoes with a stiff sole or rocker sole, which can reduce joint irritation
• Orthotics or shoe inserts that limit motion at the big toe joint
• Anti-inflammatories, as a tablet or topical rub
• Physiotherapy to gently encourage mobility and strengthen surrounding muscles

With severe big toe arthritis you may consider steroid injections. Surgery is also an option, but is generally reserved for persistent pain and severe disability.

How can Doctor Greene’s help you

Our specialist products can help you address big toe pain associated with arthritis.

• Bunion Sleeve
• Gel Heel Cushion

This is one of the most common inflammatory foot conditions. It typically affects the big toe joint, but it can affect all foot joints. It arises from the local accumulation of uric acid crystals.

Gout tends to run in families. Food and drinks rich in a chemical called purine can cause gout. These include red meat, shellfish, sardines, red wine and beer, while some medications can also cause gout to flare.

Episodes of gouty inflammation occur suddenly and can be intense. Symptoms include severe, unremitting pain, often worse at night, with local heat, redness and swelling, and extreme sensitivity to even light touch.

Your doctors will usually diagnose gout based on a your symptoms and can confirm suspicions with a blood test that demonstrates an elevated uric acid level.

What to do if you have gout

Treatment includes rest, elevation, drinking plenty of fluids(water) and taking oral anti-inflammatories. You may find it hard to wear a shoe on the affected foot due to local irritation, so slides, sandals, slippers or even barefoot may be preferable for a period.

You can also seek dietary advice on specific gout associated foods to prevent flares in inflammation. Some people with gout need medication specifically designed to reduce blood uric acid levels. It is important to realise that repeated flare or inflammatory episodes can cause irreversible joint damage over time.

How can Doctor Greene’s help you

Our specialist products can help address big toe pain and irritation associated with gout.

• Bunion Sleeve

Ingrown toenails are one of the most common foot conditions. Typically, they develop on one or both big toes. An ingrown toenail can be painful, causing local swelling and redness, and sometimes infection.

Our nails usually grow in a uniform, straight direction, curving slightly at the skin fold edge. If the nail curves too much however, it can grow into the skin fold, causing irritation and pain. This irritation can create an entry point for bacterial infection.

What causes ingrown toenails?

Risk factors for ingrown toenails include:

• Aggressive nail trimming
• Irritation from shoes
• Shoes that are too tight
• Poor foot aeration and hygiene
• Excessive sweating
• Family history
• Diabetes
• Fungal nail infection.

The warm, moist environment of the foot, the presence of normal skin bacteria and a break in the skin due to local irritation increases the risk of infection.

Prevention is always best – keep your feet clean and trim your toenails straight, rather than cutting into the corners.

What to do if you have an ingrown toenail

Your chiropodist or podiatrist can advise on the correct treatment for you. If you have an infection, you may need antibiotics. In severe persistent cases or recurrent infection, nail removal or nail bed surgery may be required.

Toenails may be discoloured for a number of reasons. Most commonly this results from local injury or bruising under the nail or fungal infection. A rare cancer called subungal melanoma can also cause discolouration, so it is important to seek medical advice if the dark area does not grow out over time.

Do you have a fungal infection (rusty toe)?

Fungal toenail infection is extremely common, as the warm, dark, moist environment of our feet and toes in footwear encourages fungal growth. It spreads through contact with contaminated surfaces such as shower areas or pools, or even shared nail scissors or clippers.

This type of infection doesn’t usually cause significant discomfort, but the nail can discolour, turning yellow or brown. It can become thickened and friable (or crumbly). The diagnosis is usually based on visual inspection however if needed, your clippings can be analysed to confirm infection.

What to do if you have a fungal nail infection

Good toenail and foot hygiene is essential. Trim your nails to contour the toe, leaving the toenail corners intact, then bathe and moisturise your feet.

If it’s hard to cut your toenail, ask your chiropodist or podiatrist for help.

Other treatment options include:

• Topical antifungal creams, usually for three months
• Prescriptive oral medication(again antifungals), taken for three months, in cases of resistant infection
• Nail removal, if the tissue is extremely thickened and painful

Athlete’s foot is a fungal skin infection that can affect people of all ages. It thrives in moist, dark, warm environments.

It is highly contagious and spreads easily through contact with contaminated floors (pool areas, shower areas and changing rooms), towels and clothes. While sandals or flip-flops help protect your feet, they don’t make you immune to athlete’s foot.

It usually begins between the toes, with an extremely itchy, scaling red-rimmed rash, sometimes with blistering or ulceration.

Athlete’s foot can also affect the ball of the foot. Another variety, called moccasin athlete’s foot, can cause chronic cracking, peeling and dryness on the soles and side of the foot. It looks like eczema. This scaly inflamed skin can also be an entry point for bacterial infection.

What to do if you have athlete’s foot

Treating athlete’s foot involves changing the environment to discourage fungal growth. Make sure to:

• Keep your feet clean, cool, dry or ventilated and open to the light.
• Apply topical antifungal agents (powders or creams). These are generally effective.
• Use ‘saline soaks’ before you apply antifungals.
• Try topical tea tree oil solutions. These can relieve local symptoms, they also have an antifungal affect.
• Change your socks frequently to keep your feet dry.
• Treat any footwear or insoles you have worn in the previous two weeks with antifungal powder
• Wear waterproof sandals or shoes around pool areas, showers and lockers rooms to prevent reinfection.

Verrucae are plantar warts, which are usually found on the soles of the feet. They’re caused by infection with a human papilloma virus (HPV). Up to a third of primary school children get verrucae, of which two thirds resolve within two years. They are often confused with calluses.

Verrucae develop at sites of increased pressure, such as the heel or the ball of the foot, where the skin is damaged and acts as an entry point for the virus. The virus can then penetrate the skin cells, replicate and shed more viral particles.

Verrucae appear as single areas or clusters of thickened skin. There may be no symptoms or they can cause pain. Sometimes, they create the sensation of walking on a pebble.

A key feature of verrucae is the presence of small black dots, which you can see after the hard skin is removed. These are small veins and distinguish verrucae from true calluses or corns.

Verrucae can be very hard to eradicate, as the thick skin on the sole of the foot allows deep penetration and can prevent topical medications reaching the virus.

What to do if you have a verruca

There are numerous treatment options, but they all require patience, persistence and the understanding that verrucae often recur. There is no single guaranteed solution

If you have no symptoms from your verruca, you can adopt a ‘wait and see’ approach as most resolve within two years.

The two most common treatments are

• topical salicylic acid (burning the wart)
• cryotherapy with liquid nitrogen (freezing the wart).

Those with diabetes or poor circulation should be careful when trying these treatments.

More serious cases may require surgical removal, chemical cautery, phototherapy, laser treatment, immunotherapy or antiviral medications.

Stress-overuse injuries, bone bruising or fractures, all occur due to repetitive loading. They can involve any bone in the foot or ankle. They are an extremely common cause of foot pain, often under-appreciated, with delays in diagnosis and timely management. Therefore they are associated with prolonged recoveries.

Causes can include increased activity, a change in footwear or a change in the terrain on which you walk or run, but often there is no obvious cause.

If you notice gradual onset pain, without any obvious injury and it gets worse when you walk or engage in other weightbearing activity, suspect a stress injury. Any bone (of the 30) in the foot and ankle can be affected.

Diagnosing the problem

X-rays may reveal obvious fractures, but don’t detect bone bruising, which is best visualised on MRI.

What to do if you have a stress fracture or overuse injury

Treatment essentially involves reducing your activity so your bone can heal. You may need to choose specific footwear to cushion and protect your foot, or to use a surgical boot or shoe. Physiotherapy can help to maintain flexibility and address muscle imbalance.

Contributory factors can include suboptimal bone density(osteopenia or osteoporosis), or deficiencies in calcium, vitamin D or vitamin C , so consult your GP if you are concerned.

How can Doctor Greene’s help you

Our specialist products can help address the pain associated with stress injuries to your foot.

• Ball of Foot Cushion