Check your feet daily
if you have diabetes
Special Report
A supplement to Mayo Clinic Health Letter • August 2023
Foot health
Walk through common problems, find helpful solutions
Though they may be some of the
most pedestrian of body parts,
your feet are really something of
a biomechanical wonder.
Twenty-six bones, 33 joints, and
dozens of muscles, ligaments and
tendons in each foot function like the
spokes of a wheel, rolling with every
step to distribute your weight as you
walk. When you run, your foot must
bear forces equal to several times
your body weight with each stride.
Your feet may hit the ground more
than 200 million times over your
lifetime, carrying you more than
100,000 miles.
Like many complex systems,
this one sometimes breaks down,
especially with age and use. Cartilage
wears away, ligaments sag, and joints
become rigid or disengage. This
changes the shape of your feet, which
become wider and longer over time.
Bones
and joints
Inevitably, problems occur. An
estimated 80% of Americans will
have a painful foot condition at some
point, including bunions, flatfeet,
hammertoes and plantar fasciitis.
Hereditary factors, chronic diseases
and injuries all can play a part in the Ligaments
and tendons
development of foot problems. And so
can your lifestyle.
Feet take a lot of abuse. They may be
wedged into shoes shaped like arrows,
jacked up on high heels, stuffed into
socks that don’t breathe or ignored
when painful. Disregarding these Twenty-six bones, 33 joints, and
warning signs only allows conditions dozens of muscles, ligaments and
to grow worse. tendons in each foot help to distribute
With a better understanding of your your weight as you walk. Like many
foot problems, you can help prevent complex systems, though, this one
them from getting worse. Some foot sometimes breaks down, especially
problems require medical care. with age and use. It has been estimated
However, you also can take steps on that 80% of Americans will have a
your own to improve or prevent some painful foot condition at some time
foot problems. in their lives.
Bunions
If you have developed a bulge beside
the big toe over the years, it’s probably
a bunion. The bump may be painful,
and your big toe angled inward.
The characteristic bunion bulge on
the side of the big toe joint is not a
growth. This bulge is actually the head
of the first metatarsal bone, which has
shifted out of place. The shift occurs
from changes in the position or
function of the muscles, tendons and
ligaments that keep the bones and
joints of the foot aligned, creating a
wider forefoot. As that happens, the big
toe gets tethered toward the second
toe and can begin to rub. The normal
mechanics of the foot may become
disrupted as the big toe squeezes
against the smaller toes and the head of
the first metatarsal pushes against the
inside of the shoe. The friction inflames
the skin, and a thick callus can form.
Daily stress from walking and
standing stretches the ligaments and
tendons that connect the bones of the
foot. Pointed shoes, high heels and
ill-fitting footwear crowd toes together,
gradually shifting joints out of
alignment. Arthritis or gout inflames
joints. All can contribute to bunions.
Bunions also can be caused by the
shape of your foot or the mechanics of
your walk, traits that can be inherited.
Nearly 3 out of 4 people with bunions
have them in their family history. Some
people are even born with them.
Bunion
First
metatarsal
The characteristic bunion bulge on the
side of the big toe joint is not a growth.
This bulge is actually the head of the
first metatarsal bone, which has shifted
out of place.
2 MCPress.MayoClinic.org/HealthLetter
About 1 out of 4 people will develop
a bunion before age 65. After that, the
rate rises to 1 out of every 3 people.
Women are more than twice as likely
as men to develop bunions.
Bunions can disrupt your daily life.
They also can lead to serious health
concerns, including infection,
immobility, impaired balance and falls.
Treating a mild bunion
Basic steps can bring relief and slow or
stop a bunion’s progression. However,
these can’t reverse or reduce the
bunion’s bulge. Steps include:
• Improving shoes — You may find
that changing to wider shoes helps.
Your toes will be less crowded, and
the irritation on the outside of the
bunion will be reduced. Running
shoes can be a good choice because
they are typically designed wider
to accommodate the foot as it
broadens during each stride.
• Trying pads — Toe pads reduce
rubbing between crowded toes.
Other pads available at a pharmacy
can reduce the irritation between
the bunion and your shoe. You may
need to wear a wider shoe, as adding
pads to a tighter fitting shoe could
make the problem worse.
• Considering shoe inserts — These
alter the way your foot fits into your
shoe and potentially provide relief.
For some people, off-the-shelf
inserts will work, while others may
need custom-made orthotics.
• Selectively using pain medication
— Topical diclofenac sodium gel
(Voltaren), which is now available
without a prescription, can relieve
pain. Nonprescription oral pain
relievers such as acetaminophen
(Tylenol, others), ibuprofen (Advil,
Motrin IB, others) or naproxen
sodium (Aleve) also can be helpful.
Periodic use of these products to help
with pain flares is likely safe, but talk
to your health care team if you have
concerns or are using these long term.
• Applying ice to the bunion area
— Doing so for about 5 to 10
minutes at the end of the day can
relieve swelling and soreness.
Wrap ice packs in a towel to avoid
damaging skin and nerves.
Surgery
Surgery may be required if your
bunion has not responded to basic
treatment and is interfering with daily
activities. Options include:
• Osteotomy — In this common
procedure, the first metatarsal bone
is surgically broken, realigned and
put back together using pins or
screws. For mild to moderate
bunions, this can be done close to
the big toe — a procedure called a
distal osteotomy. For very prominent
bunions, a proximal osteotomy is
done at the base of the metatarsal.
• Arthrodesis — Your surgeon removes
parts of the joint with arthritis, then
joins the bones together with screws,
wires or plates until they fuse. This
may be done for severe bunions
associated with advanced arthritis in
the joint where the first metatarsal
and the big toe connect.
• Exostectomy — A surgeon shaves
off some of the bone forming the
bunion. Because this does not
correct the underlying cause, it’s
usually done in conjunction with
another surgical procedure.
• Resection arthroplasty — The
damaged joint is removed, leaving
the space between the bones to fill
in with scar tissue over time. This
procedure can affect walking, so it’s
not often recommended. However,
it is sometimes an option for those
who have undergone previous
bunion surgery without success or
for people who are sedentary.
Fungal nails
Your toenails are made of keratin, the
same tough protein found in animals’
hooves and horns. While their primary
function is to protect your toes, toenails
can become a particularly stubborn
problem when infected with fungus.
Also known as onychomycosis, this is
the most common toenail problem.
Toenails grow only about 1
millimeter each month, taking up to
12 months or more to fully replace
 ANTIFUNGAL MEDICATION EFFECTIVENESS
Cure rates after 48 weeks for prescription drugs used to treat toenail fungus.
Medication Type
Ciclopirox Topical
Efinaconazole Topical
Tavaborole Topical
Itraconazole Oral
Terbinafine Oral
themselves. So getting rid of fungus
is a year-long effort. Even when the
fungus is eliminated, the nail may not
return to its typical appearance.
Toenail infections are typically
caused by a skin fungus, such as the
one that causes athlete’s foot. Yeast is a
less common cause of these infections.
These organisms can be picked up
anywhere but are especially common
around pools, gyms and public showers.
When the fungi take up residence in the
nail, it becomes thickened, brittle and
yellow. Infection frequently begins at
the front of the big toenail, then spreads
through the nail and to other toenails.
Aging, going barefoot, wearing shoes
and socks that make your feet sweat —
all can promote fungal infection.
The nail’s toughness makes treating
a fungal infection difficult. While the
drugstore shelf is filled with topical
polishes or liquids, these have limited
success for most people. Many people
lose patience with daily applications
and quit doing them before completing
the necessary year of treatment.
Prescription medicines
Your health care team may prescribe a
topical or oral medicine to treat fungal
nail infection. Some have limited long-
term success and possible side effects.
Topical medicines include:
• Ciclopirox — This nail lacquer,
similar to a polish, is applied daily.
Then it is rubbed off with alcohol
after seven days. The course is
repeated every week. Results might
not be seen for six months or longer.
pain, the nail can be removed and
the root can be treated to prevent
nail regrowth.
Fungus-free Fungus-free, clear nail Ingrown nails
Nails don’t always grow in the direction
29%-36% 6%-9%
you want. If not properly trimmed, the
53%-55% 15%-18% nail can grow into the skin along its
31% 7% edges, causing pain, inflammation and
54% 14% sometimes infection. This is most
common in the big toe.
70% 38%
Ingrown nails can be caused by shoes
that crowd the toes. They also can result
from cutting your nails too short or not
trimming them straight across. When
• Efinaconazole (Jublia) — This is severe, an ingrown nail can become
brushed onto the entire toenail infected and affect your ability to walk.
surface daily for almost a year. Ingrown nails often can be cared
• Tavaborole (Kerydin) — This solution for at home. Soaking the foot in warm
is applied daily with a dropper for a water can soften the skin and the nail
year. Its low molecular weight allows for easier trimming. If the problem
it to penetrate the nail better. doesn’t respond well to home care,
your health care team might use one
Oral antifungal treatments work or more treatments, including:
throughout the entire body and can be • Lifting the nail — Tape, splints or
more effective than topical options. cotton can be used to lift the nail or
However, these carry the risk of side separate it from the skin.
effects, including possible harm to
your liver or heart. These medications
also can potentially create harmful
drug interactions.
The Food and Drug Administration
has approved two oral medicines for
treating toenail fungus:
• Itraconazole (Sporanox, Tolsura) —
This drug is taken daily for 12 weeks
as a capsule or oral solution. It
carries a warning about a risk of
developing congestive heart failure.
• Terbinafine — This tablet is taken
daily for 12 weeks. Terbinafine carries
a warning of possible liver problems,
including liver failure. For this reason,
periodic bloodwork is often
recommended while taking the drug
Other treatment options
In severe cases, a medical professional
might recommend removing the nail.
If the root structures are left intact,
the nail often regrows with fungal If an ingrown toenail doesn’t respond to
infection that must be treated with home care, your care team may use one
topical antifungal medicine as it or more treatments, including lifting the
regrows. If the infection does not nail. Tape, splints or cotton can be used
respond to treatment and is causing to lift the nail or separate it from the skin.
Special Report 3
• Wedge resection — This involves
trimming out a wedge of the ingrown
nail. But there is the potential that
the ingrown nail may redevelop.
• Nail removal — In some situations,
the nail may be partially or totally
removed and allowed to grow back.
For chronic or recurrent ingrown
toenails, a permanent partial or total
nail removal may be recommended.
Arthritis of the toe
As you walk, forces equal to almost
120% of your body weight come down
on the first metatarsophalangeal joint.
This joint, which connects the bones
of the big toe to the rest of the foot,
can stiffen over time. The cartilage
breaks down and bone growths, called
bone spurs (osteophytes), can form at
the top of the foot at that joint level.
If the cartilage eventually wears away,
the ends of the two bones begin to
rub until the joint loses its ability to
move. This form of arthritis was given
the name hallux rigidus, Latin for
“stiff big toe.”
Arthritis of the toe can be caused
by wear-and-tear arthritis, a past injury,
or problems that affect the dynamics
of the foot, including bunions and
flatfeet. Women are twice as likely as
men to develop hallux rigidus. Genetics
can play a role too.
Along with an inability to bend
the toe up or down, symptoms can
include joint pain and swelling while
walking. Pressure from shoes also can
cause pain.
Bone spur
(osteophyte)
One common approach for toe arthritis,
called cheilectomy, removes bone spurs
that have grown to hinder the motion of
the toe. This procedure can make the
joint more flexible and reduce pain.
4 MCPress.MayoClinic.org/HealthLetter
A NEW NONPRESCRIPTION OPTION
For more than a decade, diclofenac sodium topical gel (Voltaren) was
available only by prescription to treat arthritis pain. In 2020, the Food and
Drug Administration allowed the medication to be sold without a
prescription, making it more widely available.
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID), as are
ibuprofen and naproxen. These drugs interrupt the chemical processes in
your body that cause pain and inflammation.
While generally safe, NSAIDs carry risks, especially for older adults. These
risks increase when the drugs are taken orally, with the medicine reaching
most parts of the body. Topical gels do not deliver medicine throughout the
body, so they may be well suited to treat pain in joints near the skin, such as
the one involved in arthritis of the toe.
Studies of the effectiveness of diclofenac gel for relieving arthritis pain
have been mixed, and some have shown only a small difference between
the gel and placebo.
Consult your health care team or a pharmacist before using diclofenac gel
if you are using other pain relievers, including nonprescription options.
Treatments sometimes performed if the benefits
Treatment begins by changing your from cheilectomy decrease over time.
shoes. A supportive shoe with a sturdy Those who have this fusion surgery
outer sole reduces pressure on the will not be able to participate in
inflexible joint. A carbon-fiber plate high-impact activities, such as sports
fitted inside the shoe also can help. that include jumping.
Rocker bottom shoes have soles with
the profile of a rocking chair runner, Hammertoe
allowing the foot to roll more easily Your toes are held straight by muscles
with each step. Shoes that have a deep and tendons supplying a balance of
toe box with no seams reduce friction tension. When that balance is disturbed,
and pressure on swollen joints. the toe begins to bend instead of lying
Nonprescription medications, flat. This is called hammertoe when the
including NSAIDs such as ibuprofen, bend occurs in the middle toe joint. It
can reduce pain. A topical diclofenac is called mallet toe when it appears in
sodium gel (Voltaren) is available the joint closest to the end of the toe.
without a prescription. These changes typically affect one or
If discomfort becomes severe, your more of the three middle toes.
doctor might suggest an injection of High-heeled and narrow shoes are a
a corticosteroid, such as cortisone, frequent cause of hammertoe, which
which reduces inflammation. This can is much more common among women.
bring relief for several weeks to several Hammertoe also can be related to
months. Cortisone injections can cause a bunion or arthritis. It can be caused
further damage to cartilage, so you can by a past injury or by other health
get only a limited number each year. conditions, such as diabetes. Or you
Surgical treatment includes several may be predisposed to hammertoe
options. One common approach, called because of the structure of your foot
cheilectomy, removes bone spurs that and the length of your toes.
hinder the motion of the toe. This Moving an affected toe can be
procedure can make the joint more uncomfortable, and friction causes
flexible and reduce pain. The joint calluses or blisters. Walking, or even
also can be fused with a procedure wearing shoes, can be painful, and
called arthrodesis. This procedure is your gait may change because of pain.

Hammertoe
The toes are held straight by muscles and tendons supplying a balance of tension.
When that balance is disturbed, a toe begins to bend downward instead of lying flat.
This is called hammertoe when the bend occurs in the second joint from the end of
the toe. It is called mallet toe when it appears in the first joint from the end of the toe.
An exam for hammertoe includes an
evaluation of your foot while bearing
weight and not bearing weight. The
evaluation also may include imaging
with X-ray or MRI.
If the toe is still flexible, basic
treatments are often successful. This
might include retiring any high-heeled
shoes. Shoes with a wide toe box can
reduce rubbing. Orthotic inserts and
toe pads can help too. Exercises that
flex your toes — such as picking up a
marble or a towel with your toes — are
often recommended.
Surgery can be considered if
conservative care fails. If the toe is
still flexible, the surgeon may be able
to correct the problem with a tendon
procedure. A rigid toe might require
surgery on the bone. Procedures to
correct hammertoe are among the
most common foot surgeries and have
high success rates. However, the
condition sometimes returns.
Plantar fasciitis
Plantar fasciitis often greets you in the
morning with your first steps from
bed. Sharp pain radiates from the
center of your heel each time your foot
hits the floor and pushes off. In many
cases, the discomfort decreases after
your foot loosens up from walking.
Beneath the skin, the sole of your foot
has three sturdy bands of connective
tissue called the plantar fascia. This
tissue is made up of collagen and elastic
fibers. The fibers connect to a bump
on the heel bone called the calcaneal
Mallet toe
tuberosity. That’s where the trouble
usually starts. Repetitive strain
can cause tiny rips that result in
inflammation where these hard-
working tissues connect to the bone.
Plantar fasciitis often appears
between the ages of 45 and 64 and is
more common in women. You are more
likely to develop the condition if you
have flat or high arches, run long
distances, stand for long periods, or are
overweight. It has been estimated that 2
million people in the U.S. seek medical
care each year for plantar fasciitis.
If pressing into your heel produces
pain, that suggests plantar fasciitis.
Imaging is rarely needed, though
it may be required if the condition
doesn’t respond to treatment.
Treatment for plantar fasciitis
The good news is that this common
foot condition responds very well
to treatment, as long as you stick
with it. Up to 90% of people can be
successfully treated without surgery.
While some results come quickly, it
may take six months or longer to be
completely free of pain.
Steps you might consider include:
• Rest — Give your feet a break to
allow healing.
• Try specific exercises — Choose low-
impact activities such as biking or
swimming. Some stretches can help.
(See “Stretch the pain away,” page 6.)
• Pain relievers — Nonprescription
pain relievers such as ibuprofen and
naproxen sodium can help.
• Supportive shoes that fit properly —
Consider wearing cushioned athletic
shoes to support your feet all day.
Don’t go barefoot. Keep a supportive
pair of shoes next to your bed to
cushion your first morning steps.
• Orthotics — Try shoe inserts that
support the foot and cushion the heel.
• Splints — Plantar fasciitis sometimes
responds well to splints worn at
night. Night splints apply tension
to the plantar fascia, keeping it
stretched out as you sleep.
Procedures that may help
If those steps don’t provide relief, other
options may be recommended, such as:
• Shock wave therapy — High-energy
sound waves applied to the foot
promote healing. Relief is usually
gradual, and multiple sessions are
required. This procedure might not
be covered by insurance.
• Steroid injections — An injection of
corticosteroids into the foot often
can reduce pain for 1 to 3 months.
However, the number of annual
injections is usually limited to
prevent tissue damage.
• Dry needling — Thin needles are
inserted near trigger points to
stimulate muscles and improve pain.
• Platelet-rich plasma (PRP) injections
— Plasma is processed from your
own blood and injected into the
foot, which may encourage healing.
When surgery is required
Surgery is successful for 75% of people
who don’t respond to basic treatments
for plantar fasciitis.
Surgery typically involves a partial
cut in the plantar fascia to reduce
tension. This is done through a small
incision under local anesthesia.
Another procedure is minimally
invasive tenotomy. Various technologies
have been developed to break up and
remove damaged tissues in the plantar
fascia. One system, called Tenex, uses
a probe inserted into the foot that
vibrates the injured tendon to break up
and then remove the tissue. Another
system uses a jet of water to do the
work. Recovery can take 4 to 6 weeks.
Special Report 5
 STRETCH THE PAIN AWAY
The exercises shown here are
very effective for treating plantar
fasciitis on your own. But they
must be done regularly over
many months to see sustained
improvement.
Heel cord stretch — With your shoes
on, stand an arm’s length away from
a wall. Your feet should be pointing
forward with your heels on the
ground. Move your right foot closer
to the wall, bending that knee.
Keeping the left knee straight, lean
toward the wall to gently stretch out
the left heel cord. Hold for 20 to 30
seconds. Now switch sides. Do 2 to
3 repetitions up to three times a day.
Typical arch
Fallen arch
6 MCPress.MayoClinic.org/HealthLetter
Towel pickup — While seated, pick up
a crumpled paper towel with your toes
repeatedly for 2 minutes each evening.
Ice roll — Freeze a plastic water
bottle and roll it beneath your foot
for two minutes each evening.
Always wrap ice in a towel rather
than applying directly to the skin to
avoid tissue damage.
Flatfeet
The arch is the upward curve in the
middle of the foot. Some people
don’t have arches. Rather, their feet
are flat and make contact with the
ground from heel to toe. This is a
condition called flatfeet or fallen
arches. Both names aptly describe
how the feet look.
Flatfeet is a common condition.
Up to one-third of the population is
estimated to have flatfeet. It often
causes no pain or functional problems.
But for some people, it can lead to
minor pain, or even joint problems
with the knees or hips.
Many people are born with feet
that are flat. Arches develop as most
children grow and bear weight during
walking. But some people never
develop arches. Other people develop
the condition as they age. Flatfeet is
most common among people over age
40, either because of an injury or
because of wear and tear on the feet.
The arch forms the base you stand
on, distributing weight over your foot.
It also stores and releases energy
when you walk — a literal spring in
your step. The integrity of your arch is
maintained by ligaments, tendons and
muscles that work together to provide
stability to the bones and joints of
your feet. Your arch is primarily
supported by the posterior tibial
tendon, which runs from your lower
calf along the inside of your ankle and
attaches to the bones in the foot.
This tendon can wear with age and
fail to supply the tension it once did,
allowing the arch to sag. Obesity
increases the stress on the tendon and
can contribute to flatfeet. Repeated
impact, such as from running on hard
surfaces, also can wear down the
tendon. In a version known as flexible
flatfeet, the arch appears when you
are not standing, but vanishes with
weight bearing. In rigid flatfeet, the
arch is never apparent.
If you suspect that you have flatfeet
and it is causing discomfort, see a
health care professional. An exam
will include an inspection of your
feet with and without you bearing
weight on them. The exam also will
include observations of the position
of your toes and ankles. Sometimes,
imaging tests may be necessary.
Minor pain from flatfeet can often
be managed with nonprescription
pain relievers. Shoe inserts, either
store-bought or custom-made versions,
can give added support and reduce
discomfort in your knees, hips and
back. Losing excess weight also can
improve symptoms.
Physical therapy strengthens
muscles and tendons and can improve
gait. Surgery for flatfeet is rare, but it
might be done in some circumstances.
 Corns
When skin repeatedly experiences
friction — such as from a too-tight
shoe — it reacts by building up thick,
protective layers of skin.
A callus represents a thickened layer
of skin, usually on the heel or the ball
of the foot. A corn is a smaller area of
thickened skin that develops over bony
structures — commonly on a toe or
even between the toes. A corn may
have a hard core, which can be painful
when pressed. Corns often form where
toes rub against each other or where
the foot rubs against a shoe.
A DOCTOR’S DIAGNOSIS ON SHOES
Martin Ellman, D.P.M., is a podiatrist at
Mayo Clinic in Rochester, Minnesota,
with over three decades of experience.
Many of the problems he sees are made
worse — or even caused by — the shoes
people wear. Here, he shares insights on
how to choose shoes that will promote
healthy, comfortable feet.
Q: What should you consider when
shopping for shoes?
The first thing is to check the return
policy. A lot of people try shoes on in
the store and say, “Oh, these feel great.
I’m going to take them.” They bring
them home and say, “These feel awful!
After wearing them for 20 minutes, I
can’t wear them anymore.”
I always recommend buying shoes that
fit the shape of the feet. Some people
have a foot structure with an inward flare
— the toes tend to curve in. So look at
the bottom of the shoe and see if it has
that same type of contour as your foot.
Some shoes fit very straight. People with
flatfeet have feet that want to flare out.
Shoes with a straighter outer sole might
fit the shape of these feet better.
Always try to find shoes that will give
adequate room for your feet. Your
shoes should not feel extremely snug,
and they should not feel extremely loose.
You should have at least a finger’s-width
length between the end of the longest
toe and the end of the shoe. A lot of
people wear their shoes way too short.
Corns are common, especially among
athletes, people who wear ill-fitting
shoes or narrow shoes, or people with
gait problems. Corns become more
common as people age due to the
fatty foot pads wearing away. Other
foot problems, such as hammertoe,
contribute to corn growth. By one
estimate, nearly half of all people will
develop a corn at some time.
It may be possible to reduce a corn on
your own. Soaking your foot and using
a pumice stone or emery board can rub
away the corn’s layers. Then use a
moisturizer to soften the callused skin.
Q: Are dress shoes a problem?
When considering dress shoes, many
people let fashion and style trump
form and function. In an attempt to
look good, people may opt for narrow-
toed shoes that have 2- to 3-inch
heels. Or they wear shoes with a really
narrow toe box. Well, that’s not healthy
for the feet. These fashionable shoes
aren’t made for the natural form of the
foot structure.
If you need to wear business shoes,
minimize your time in them. If heels are
a must, I suggest no more than a 1-inch
or 1 1/2-inch heel. I like a round or square
toe box. Often in the business world that
doesn’t work, I know. Just stay away
from the really narrow-toed styles. Make
sure that your shoes fit well. Have a few
pairs of shoes available. If your feet
bother you during the day, change into a
different pair so that you don’t have the
same pressure points all day.
Q: Is arch support important?
I tend to suggest that people wear
shoes that are fairly supportive. But
not everyone needs shoe inserts or
orthotics. If there’s a good foot structure,
let the foot do what it’s designed to do.
If there’s callus formation from
poor weight distribution on the ball
of the foot or if the feet are in need
of additional support because of a
structural issue or poor alignment, I
may recommend arch supports.
Another option is topical solutions
and medicated corn pads, which can
be used at home. However, people
with certain health problems —
including diabetes, poor circulation,
a suppressed immune system or lack
of feeling in the feet — should only
use these products under the care of
a podiatrist.
With diabetes and other foot-related
health concerns, a corn should be
removed by a health care professional.
The rough skin can be pared away with
a scalpel and the hard core of the corn
removed. Anesthesia is rarely needed.
Q: Are flat shoes such as sandals OK?
Again, if the foot structure is good and
there are no problems, that’s fine. But
as your feet start to change, you may
want to start supporting them a little
bit better.
Some people like wearing flip-flops.
You can use them, but there are potential
problems that can come along with these
over a long period of time, particularly as
your feet tend to change. If you’re using
shoes you have to grip with your toes all
the time, that may have some effect on
some of those structures.
Martin Ellman, D.P.M.
Special Report 7
 THE MECHANICS OF PRONATION prevent small cuts. If you cannot see
or reach your nails, or if they are
Your doctor and the salesperson at the shoe store might give you the same thick and yellowed, have them cut
answer when you ask about your foot pain: You might be overpronating. by a health care professional.
In a typical step, the heel hits the ground first. As weight is applied from the • Wear shoes and socks, even around
heel to the ball of the foot, the foot then rolls inward (pronates), to evenly the house, to prevent small injuries
distribute the weight across these bones. This is called neutral pronation. As that you might not notice. Wear
the heel starts to lift off the ground, the foot then rolls outward (supinates), shoes that fit properly and are made
acting as a rigid lever for push-off. These motions are very subtle. of breathable material.
When you overpronate, your foot rolls inward too much during each step, • Put your feet up when you can if your
increasing the load on the structures on the inner side of the foot. This feet tend to swell. Wiggling your toes
may cause additional wear and tear on that part of the foot. Overpronation for a few minutes several times a day
can contribute to a number of foot conditions, including bunions, plantar also keeps the blood flowing.
fasciitis and flatfeet. It also can lead to knee and hip pain and other problems • Don’t use a pumice stone or emery
that can affect your quality of life. board to remove calluses unless
In underpronation, your foot does not roll inward enough. It remains in a told to do so by your health care
more supinated position while walking, and too much weight is borne on team. You can injure your foot and
the outside of the foot. This also can lead to foot problems. create serious complications.
A look at the bottom of your shoes might help you see if you overpronate • Don’t use liquid corn and callus
or underpronate. If the shoes show more wear on the inside edges of the removers or medicated pads.
sole beneath your heels and the balls of the feet, you may be overpronating.
Shoes that are worn on the outside edges can reveal underpronation. When to seek urgent care
Shoes and inserts that support your arches can help correct pronation There are times when foot pain
problems. Ask a health professional to help you choose a supportive option. may require immediate medical
attention. Seek medical care right
away if you have:
• Severe pain or swelling.
A corn will likely return if the such as ulcers that won’t heal and joint • A wound that is oozing pus or has
underlying issues are not addressed. damage. These ulcers and sores can other signs of infection, such as
To prevent the return of a corn, reduce lead to infection in the soft tissue or a change in color, warmth and
or eliminate friction. This includes bone. With poor circulation, whether tenderness, or if you have a fever.
wearing better fitting shoes, using shoe a wound is present or not, tissue death • A wound that is not healing.
inserts or wearing cushioning pads. can develop. These complications can • A wound that is discolored, swollen
If these treatments fail, surgery lead to amputation. or warm and you have diabetes.
to reduce the bony bulge beneath Here are some tips for caring for
the corn may be necessary. Surgery your feet if you have diabetes: Make an appointment with your care
has a high success rate. • Check your feet daily. You may have a team if you have swelling that doesn’t
sore, cut or blister that you can’t feel improve after 2 to 5 days or pain that
Diabetes and foot care due to diabetic neuropathy. Inspect doesn’t improve over several weeks. It’s
If you have diabetes, you must pay between your toes and use a mirror, also important to seek care for burning
especially close attention to your feet. if necessary, to see all parts of your pain, numbness or tingling, especially
Diabetes can damage nerves and feet. Immediately seek medical on the bottom of your foot.
reduce blood flow to the feet. This attention if you have sores or blisters
makes it hard to feel an injury and can that don’t heal in a few days. Other
slow or prevent healing. reasons to seek care immediately
More than 37 million Americans include a change in color or
have diabetes. By some estimates temperature of your feet, cracked Image Credits: All photographs and illustrations are
copyright of MFMER.
about half of those people experience skin, or pain or swelling in your feet. Illustration on page 7 by Jim Rownd.
the nerve problem known as diabetic • Wash your feet daily in warm water, Copyright © 2023 Mayo Foundation for Medical Education
neuropathy. Neuropathy commonly no hotter than 95 degrees Fahrenheit. and Research, Rochester, MN 55905. All rights reserved.
begins in the feet and legs. But don’t soak them. Gently dry your To inquire about your subscription, call Customer Services
Diabetic neuropathy can cause feet, particularly between your toes. at ­800-333-9037. For bulk orders of 25 issues or more, email

• Trim your toenails straight across.

numbness, tingling, pain, muscle
weakness and sensitivity to touch.
It can lead to serious foot problems,
­Corporate Sales at SpecialSales@Mayo.edu
Gently smooth the freshly cut edges Printed in the USA
ISSN 0741-6245
with an emery board or nail file to MC2020-0823 • 110823

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