(Photo shown is for illustrative purpose) 

A bunion is a painful bump on the inner side of the big toe joint. As the big toe is drifting towards the other toes, it may cause pain over the second toe or push it towards the third, closing the gaps between the toes. Discomfort may also arise on the underside of the toes – a condition commonly known as metatarsalgia due to uneven contact pressure  with the ground.  

While not all bunions need to be surgically corrected, if there is pain in the big toe, a foot specialist should be consulted.  Non-operative measures are usually first taken to alleviate symptoms. 

These include:

• Wearing shoes with a wider toe box

• Placing a toe spacer between the first and second toes, or a metatarsal gel pad under the forefoot 

• Avoid wearing heels or activities that require tip-toeing as this worsens the deformity and pain 

Bunions, unfortunately, are permanent. If the discomfort limits daily activities, or the deformity progressively worsens, a foot surgeon should be consulted to determine the next course of action. 

Bunions can be corrected using surgery, but a careful evaluation by our foot and ankle doctors to determine the most appropriate surgical option is required. Depending on the severity of the deformity and other conditions, the surgeon can help to recommend the best option. For suitable patients, minimally invasive (keyhole) surgery can be offered. The benefits of minimally invasive bunion surgery include smaller scars, better healing, and faster recovery. 

For the past two months, upon waking up, Tom* has been experiencing pain in the soles near his heel when setting foot onto the floor. The pain subsides when he moves but is more painful upon waking up and after he gets up from prolonged sitting.

  (Photo shown is for illustrative purpose) 

These symptoms are typically associated with plantar fasciitis (pronounced fash-ee-eye-tus), a foot condition where pain is commonly felt at the underside of the heel bone or around the heel cup. The discomfort usually occurs with the first few steps in the morning, or after prolonged sitting, and improves upon moving.  

Most patients recover with non-operative treatment. Calf and plantar fascia stretching exercises should help. Here are some to try:

• Keep a towel by the bedside. Upon awakening in the morning,  wrap the towel around the foot to stretch it before getting up. 

• Massage the plantar fascia, or the band of muscle located under the foot, while stretching your toes  

• Place a tennis ball under the sole and roll over it 
  

As this is a chronic condition, it may take six to 12 months of stretching before seeing improvement.

If these measures do not work, surgical intervention such as debridement to “clean up” the unhealthy tissue within the plantar fascia, partial release of fascia and bone spur excision may be recommended. 

Persistent pain that shows no improvement may also point to other underlying conditions. Should the pain be unbearable despite conservative measures, consult a foot surgeon to obtain an accurate diagnosis so that a personalised treatment plan can be drawn up.

Mr Kok* is 60 years old and exercises regularly. Recently, while climbing down the stairs, he started to feel a dull ache where his left ankle meets his foot as his heel lands on the steps. It doesn’t happen all the time but when it does, it would stop him from walking.

 

 (Photo shown is for illustrative purpose) 

Pain in the back of the heel may be due to achilles tendinitis and a prominent bump can sometimes be visible. While other conditions such as plantar fasciitis, nerve entrapment and inflammation may present in a similar way, a consultation with a foot doctor is advisable to determine the exact cause of discomfort. 

Meanwhile, the following  measures can be taken to manage the problem:

• Continue to maintain an active lifestyle

• Avoid high-impact activities such as running and over-exertion 

• Wear proper shoes with good insole support and comfort

• Place heel gel pads or heel lift insoles if pain is felt over the back of your heel

• Do calf stretches
  

If there is persistent pain despite stretching and shoe wear modification, surgery may be required. You will have to discuss this with a foot surgeon to better understand the available treatment options. 

*Names have been changed