Foot Health: Orthotics, Footwear and Common Problems

Plantar heel pain

Pain under the heel, characteristically worst on the first steps in the morning and after periods of sitting, is the most common presentation.

It is usually related to loading of the plantar fascia rather than inflammation, which is why the older terminology has shifted.

First-line management is calf and plantar fascia stretching, activity modification, supportive footwear, and progressive loading exercises. Evidence supports loading programmes over rest.

Recovery is measured in months rather than weeks, which is worth knowing because people abandon effective treatment too early.

Footwear

Fit matters more than brand. Feet change size with age and differ between left and right, so measuring both periodically is worthwhile.

Adequate toe box width prevents or reduces bunion and neuroma symptoms. Narrow pointed shoes are implicated in several forefoot problems.

Heel height shifts load forward and shortens the calf over time. Occasional wear is unremarkable; daily wear over years has effects.

Shoes lose cushioning and support with use. Running shoes in particular have a functional life measured in distance, and continuing beyond it contributes to injury.

Orthotics

Off-the-shelf insoles are inexpensive and perform comparably to custom devices for many common conditions in trial evidence, which surprises people who assume custom is necessarily better.

Custom orthotics are appropriate for specific structural problems, significant deformity, diabetes-related risk and some post-surgical situations.

Either way they are usually an adjunct to exercise and footwear change rather than a replacement for them.

A trial of an inexpensive supportive insole before committing to custom devices is a reasonable sequence.

Problems needing prompt assessment

Any foot problem in someone with diabetes, because reduced sensation and circulation mean minor injuries become serious quickly. Regular professional foot checks are part of standard diabetes care.

Numbness, tingling or weakness, which suggests nerve involvement.

Sudden severe pain, inability to weight bear, or deformity after injury.

Redness, warmth and swelling with fever, which may indicate infection.

Nail and skin problems

Ingrown toenails are frequently caused by cutting nails curved rather than straight across, and by tight footwear. Recurrent cases can be treated definitively by a podiatrist.

Fungal nail infection is common, slow to treat and frequently misdiagnosed. Confirming the diagnosis before months of treatment is worthwhile.

Corns and calluses indicate pressure. Removing them without addressing the cause guarantees recurrence.