Care & Treatment
A small bunion may stop bothering you if you wear wide shoes and comfortable socks or stockings that do not rub on the bunion area. Shoe inserts like orthotics (soles specially molded to your foot) may also help.
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, or corticosteroid (cortisone) injections may help to relieve pain.
Surgery: Even if your bunion is severe, outpatient surgery may be all you need. In this type of operation—usually an office procedure—the abnormal growth of the bunion is gently shaved away and tendons are adjusted. In more intensive surgery, other toe bones may have to be repositioned.
Corns and Calluses
Shoes that are properly fitted are the solution for corns and calluses. Open-toed sandals are very helpful if the weather is appropriate. Sometimes, a shoemaker can stretch your shoes to give you more room around your toes. Thick socks also help to absorb pressure.
Simple over-the-counter products available at any drug store can be very useful for softening and resolving corns and calluses. These include:
- Creams or petroleum jelly (Vaseline) – regular use can soften dead skin
- Donut-shaped pads that fit around the corn and reduce pressure and friction. (Avoid medicated pads, especially if you have diabetes or numbness in your feet.)
- Cotton or other soft material placed between your toes to prevent them from rubbing against each other
- Pumice stones – used to gently sand down the corn or callus after soaking in very warm water for at least five minutes. This will take several treatments.
If the condition is mild, you may only need to get roomier shoes. To prevent corns and calluses from rigid hammertoes rubbing against shoes, you should apply soft padding between the affected toes, and wear wide shoes or custom-made orthotic inserts or footwear. Exercises and splints may help. You may need surgery to release the tendon if the deformity is severe.
For ingrown toenails that are not infected, your podiatrist or other trained healthcare professional can simply trim the side of the nail or shave it down to resolve the pain. Wearing open-toed shoes or sandals may prevent painful friction.
Medications: If the nail is infected by a bacteria or fungus you will require antibiotics. You may have to take antibiotics both by mouth and also apply antibiotic cream or antifungal ointments on the toe. (Applying antibiotic cream or antifungal ointments to the nail may improve the fungal infection, but treatment is expensive, it may need to continue for 6 to 12 months, and cure occurs in fewer than half of cases. Oral antifungal therapy is effective, but treatment takes months, the medicines can have adverse effects, and the relapse rate is high.)
Sometimes, the podiatrist will prefer to use a chemical to remove the skin around an ingrown nail. The skin may also be removed with a laser or by cauterizing (burning it away).
Surgery: If the nail is completely ingrown, or if there is a significant infection, more of the nail—or all of it—may have to be removed. Your podiatrist will use a local anesthetic for these procedures. If the infection is causing swelling, the podiatrist may drill a hole in the nail to allow drainage, which will relieve the pain. Soaking or icing the area may also be prescribed.
Diabetic Foot Problems
Minor foot infections: Your podiatrist will clean the infected area and give you antibiotics to make sure the infection heals and does not spread. It may take a while so make sure to take all the pills prescribed and have your healthcare provider check your progress.
Serious foot infections: If you have diabetes, you have a greater risk of developing stubborn foot ulcers from a small initial cut or abrasion. The infection can then spread into your bones, through your foot, and even into your leg. To prevent this, foot ulcers must be treated carefully and your progress must be carefully monitored by trained specialists.
If the infection cannot be controlled, you will probably need surgery, either in the hospital or at a clinic, and intravenous (IV) antibiotics for at least a few days. After the surgery, you will need a professional to change your wound dressings regularly for a while and you will be followed up with regularly after returning home. Do not miss follow-up appointments, because infections can come back if not completely cured.
Arthritis Foot Problems
Depending upon the severity of the symptoms, you may be able to control your pain and disability with exercise, warm footbaths, massage, or heating pads (if you do not have nerve damage or numbness). Custom-made footwear is often helpful. Painkillers, including acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (aspirin, ibuprofen) may take care of more serious pain.
If the pain is severe and prevents you from walking securely and comfortably, your healthcare provider or podiatrist may suggest surgery. This will depend on your individual condition.
Plantar fasciitis/heel spurs: There are steps you can take to relieve pain from plantar fasciitis. These include exercise to stretch the plantar tendons, painkillers such as aspirin or ibuprofen, cold compresses, taping the foot, or shoe inserts (such as orthotics) to cushion the soles of your feet. The most important thing about healing from plantar fasciitis is the required commitment to doing regular foot stretches and icing. It may take several months or more to see full results. Moderate, gentle walking, swimming, or bicycling is beneficial, but do not overdo it. You may have some relief from slightly elevated heels if your symptoms are mild.
For more severe cases, night splints, leg supports, corticosteroids (cortisone shots) and local anesthesia may be needed for plantar fasciitis. However, these approaches are not used for heel spurs.
For stubborn, disabling heel pain that has been going on for many months, surgery may help. An operation called “instep plantar fasciotomy” removes tissue that has been pressing on irritated nerves.
Flat feet: Non-surgical approaches are always preferable, and include:
- Pain medications and anti-inflammatory pills (aspirin, ibuprofen)
- Taping the foot
- Shoes that fit well with low heels and arch support
- Calf stretches
- Massage and warm-water foot baths
- Icing the arch
- Over-the-counter or custom-made orthotic insoles.
Surgery to lengthen the Achilles tendon or reshape the foot is rarely done in older people, and then only in very severe cases.
Overly high arches: Depending on how severe the deformity and pain, your podiatrist or other healthcare provider will prescribe non-surgical treatments similar to those for flat feet, exercise, or surgery.
Tarsal Tunnel Syndrome
Non-drug approaches include special shoes and custom-made insoles (orthotics). Sometimes, cortisone shots help. If your doctor finds a cyst or tumor, surgical removal can cure the problem. If no cause has been found, surgery is less beneficial, and is only done if the problem has persisted for at least a year with no relief. Recovery takes several months.
Various approaches are used to treat Achilles tendonitis but scientists are still uncertain which work best.
Exercise: Keep the leg elevated as much as possible while there is swelling in the calf or heel. When swelling is gone, you may try gentle calf stretches, but stop if the pain increases.
Medications: NSAIDs (aspirin, ibuprofen) often lessen the pain and swelling. Cortisone injections may also help but are not used often because of the risk of tendon damage.
Non-drug approaches: Icing the area up to five times per day for about half an hour may bring some relief, but be careful not to overdo it. If the tendon ruptures, you will probably need a cast over the calf and foot.
Surgery: A surgical approach for a ruptured Achilles tendon is sometimes done. However, surgery is usually not recommended for older patients.
The following approaches, alone or combined, may help:
- Massage of the painful area
- Wider shoes
- Cushioning pads
- Corticosteroid (cortisone) injections
- Ultrasound-guided alcohol injections
Surgery: If your symptoms have not improved with these treatments, surgery to remove the painful area is usually effective.
Your podiatrist or other healthcare provider may prescribe orthotic inserts for you to wear at all times. These insoles are molded from a cast of your foot. They may be rigid, semi-rigid, or soft. Your healthcare provider will decide which type is right for you depending on your condition. They are often expensive. Cheaper over-the-counter insoles available at any drug store may be sufficient.
You should inspect your feet regularly, checking for changes in skin color or temperature, thickened or discolored nails, and any sign of a break in the skin or abrasion.
Older people with diabetes make up the greatest number of older adults with serious foot disorders. For these people, it is essential to get a thorough foot evaluation at least once a year. Many older people—particularly those with diabetes—have impaired vision. This can make it harder to find small changes or skin problems. If your vision is not adequate, find a podiatrist or other trained healthcare provider who can check your feet regularly. If you have diabetes and your circulation to your feet is impaired or you have foot problems, you will likely need to see a podiatrist approximately every 3 months.
Last Updated June 2020