Here are 20 common questions that podiatrists are often asked. A brief answer is provided. If you require further information please contact the Australian Podiatry Association or contact your local podiatrist.

Q. I've heard feet have the most bones of any part of the body. Is this true? 
Q. I've got a corn. How did I get it and how can I get rid of it? 
Q. How do I get rid of smelly feet? 
Q. My son, aged 12, has developed tinea. How did this happen? 
Q. I have bunions. What can be done to relieve the pain? 
Q. I run about five kilometres three to four times a week and sometimes when I get up in the morning, I can barely walk because my arches are so sore. 
Q. I'm about to buy a new pair of running shoes. What can you recommend? 
Q. My daughter is 15 months old and is still not walking. Should I be concerned? 
Q. I have diabetes and have been told to see a podiatrist regularly. How often should I go? 
Q. My son's feet smell most of the time even though he makes an effort to keep them clean. Are there predispositions for smelly feet? Or is it just a cleanliness issue? 
Q. I play netball once a week and jog occasionally. Quite often afterwards my shins get very sore and it almost feels like the pain is in the bone itself. I also sometimes get an ache in the base of my foot which can be quite painful when I walk on it. Is there any particular cause for these problems? 
Q. There's an increasing trend to have inserts in shoes. Is this a good idea or is it just a sales pitch for podiatrists and the shoe industry?
Q. What is the difference between chiropody and podiatry?
Q. What are flat feet? What are fallen arches?
Q. Is walking or standing on concrete harmful for your feet?
Q. Can ankle supports, like lace-up boots ease the effect of sore feet?
Q. What is the value of arch supports? Do some people need custom-made orthoses to alleviate foot pain?
Q. What are papillomas? Are they the same as warts, how do you get them?
Q. Are high heels bad for you, is it okay to wear them now and then? Or should you wear different shoes everyday?
Q. How do you get ingrown toenails? 

Q. I've heard feet have the most bones of any part of the body. Is this true?

Yes it is. The feet have a quarter of the body's bones (a total of 52).

Q. I've got a corn. How did I get it and how can I get rid of it? 

Corns, like blisters and calluses, are the skin's natural protection against injury and are caused by pressure and friction, usually through poor-fitting shoes that press against parts of the feet. Calluses can also be caused by feet sliding around in shoes which are too big. If left untreated, corns and calluses can lead to painful ulcers, this is of particular concern if you have diabetes or poor circulation. Relieving the pressure and friction may reduce the recurrence of calluses and corns and using a moisturiser may also help. A podiatrist can also treat these conditions.

Q. How do I get rid of smelly feet?

The feet have 250,000 sweat glands each and produce a total of about a cup of sweat daily. Excessive perspiration combined with bacteria can cause offensive foot odour. Wearing nylon socks can exacerbate the problem - it is like putting a plastic bag over the feet. Wearing wool or cotton socks is recommended. Some over the counter anti-perspirants in the form of sprays or powders can help, whilst alternating shoes from one day to the next helps reduce problems with smelly shoes. If problems still persist seeking advice from a Podiatrist is recommended.

Q. My son, aged 12, has developed tinea. How did this happen?

Tinea is easy to catch and is often picked up by wearing bare feet in communal areas - perhaps the showers at school. It is most likely to develop between the toes causing the skin to become red, moist and itchy. Over-the-counter anti-fungal creams can be used to treat tinea.

Similarly, plantar warts (sometimes known as papillomas), can be picked up in communal areas and occur when the human papilloma virus penetrates the skin through cracks in the feet. Plantar warts should be treated by a podiatrist.

Encourage your son to wear shoes whenever possible, and if he is using a communal area, wearing a pair of thongs in the shower is a good idea. But be warned - thongs, while good for preventing the spread of viruses, are not good for your feet as they don't offer them any support.

Q. I have bunions. What can be done to relieve the pain?

Bunions are a foot deformity where the big toe joint of the foot is distorted, leading to the toe pointing inwards and the bone protruding. The joint is easily inflamed by pressure and can be very painful. Their formation is largely genetic and can be exacerbated by shoes that are too tight. A podiatrist can offer advice on how to relieve pain and sometimes surgical correction may be required.

Q. I run about five kilometres three to four times a week and sometimes when I get up in the morning, I can barely walk because my arches are so sore.

Pain on standing first thing in the morning is a classic symptom of plantar fasciitis, which is an inflammation of the band of tissue under the foot. It is one of the most common problems experienced by runners, accounting for about 10 per cent of running injuries. Typically starting with low-grade pain in the arch and/or heel of the foot, it gradually worsens until it is impossible to continue running. Treatment includes rectifying poor foot biomechanics, muscle imbalances, poor training techniques and programmes and incorrect footwear. Persistent problems may require a cortisone injection or surgical intervention.

Q. I'm about to buy a new pair of running shoes. What can you recommend?

The most important piece of equipment a sportsperson needs is appropriate footwear. These should provide cushioning for shock absorption as well as medial and lateral stability. They should be able to bend easily at the ball of the foot area and the heel should not slide in the shoe. Another important consideration is proper stretching exercises. If the body is warmed up, the strain on muscles, tendons and joints is reduced.

Q. My daughter is 15 months old and is still not walking. Should I be concerned?

No. While the average age for when a child takes his or her first steps is 13.7 months, the normal range is between 10 months and 18 months.

Some suggestions to help ensure the normal development of a baby's feet include keeping covers loose so they can kick, preparing them for walking. Also avoid placing babies on their stomach for long periods, as this can place excessive strain on feet and legs. When a child first learns to walk let him or her walk in socks or without shoes to help normal muscle development and if shoes are worn, make sure they are fitted by an experienced shoe fitter

Q. I have diabetes and have been told to see a podiatrist regularly. How often should I go?

National diabetes guidelines recommend podiatric assessment at least every 12 months. People with diabetes are at greater risk of developing serious foot problems than the average person - in fact, an estimated 60 per cent will develop some kind of problem.

Because the feet are furthest from the heart, they are usually the first to have circulatory problems. People with diabetes are more likely to experience poor blood circulation so nerve degeneration in their feet and legs are more likely to occur, causing a decreased ability to fight infection. These factors all contribute to a reduced ability to heal, even from minor cuts and abrasions.

If diabetes is not well-controlled a loss of sensation in the feet can lead to injuries that can't be felt and therefore may become infected. Gangrene and amputation are the most extreme examples of foot problems which may arise for people with diabetes.

The two main risk factors for the feet of people with diabetes are circulation impairment which results in delays to healing, and nerve damage which causes individuals to lose sensation in their feet. This means a person may not know that their shoe is rubbing, that the heater is too hot, or that they've stood on something sharp and cut their foot.

For these reasons it's important that people with diabetes check their feet daily for cuts, blisters, bruises or signs of injury they may not have felt happening. It's also important they wear shoes which protect feet from injury and which do not rub.

Q. My son's feet smell most of the time even though he makes an effort to keep them clean. Are there predispositions for smelly feet? Or is it just a cleanliness issue?

I am sure you would know that the complaint you describe, especially in relation to young boys, is a common one. The reason for smelly feet is quite simple and relates to the overgrowth of certain bacteria on the feet. Many types of bacteria inhabit the skins surface all the time, however in certain conditions this balance can be upset.

A breeding ground for bacteria
The foot is a common place for this to happen because of the amount of sweat that is produced on the sole which, in a closed, dark, warm environment can be the perfect breeding ground for some bacteria. These bacteria on the sole of feet actually produce gases. Believe it or not, these gases are similar to those released by bacteria used in producing cheese, hence the name 'cheesy feet'.

Knowing the cause of the problem and that it relates to the environment of the shoe helps us to treat the condition. It is important to remember that the bacteria responsible for the problem normally live on the skin and we do not need to eradicate them forever, we just need to reduce their numbers. In severe cases some people actually use topical (applied to the skin) or even oral (by mouth) antibiotics to kill off the bacteria. However there are a number of products you can get over-the-counter at the chemist that will do just the same or even a better job.

Mild antiseptic solutions or soaps can be useful, as well as light powders which can help to absorb some of the moisture on the sole of the foot. Avoid synthetic socks, wear shoes that allow good air-circulation and allow the foot to breathe (leather is good). Also change your shoes regularly.

Condy's crystals is another over-the-counter common remedy for the problem as it helps to reduce perspiration of the feet and your son may just require a short course of this treatment to improve the problem. Applications of methylated spirit once or twice a day to help dry the skin may also be useful.

If these fail, consultation with a podiatrist is recommended. In relation to your questions, there certainly are people more prone to this problem than others and it often relates to their age (quite often teenagers who are experiencing sweatier feet than usual) or skin type. Certain ethnic races appear to be more prone as well.

Smelly feet are not dirty feet
Cleanliness as I outlined above, is an issue but it does not necessarily mean that people with smelly feet are 'dirty' people. Even the most fastidiously clean people can suffer from this problem.

Q. I play netball once a week and jog occasionally. Quite often afterwards my shins get very sore and it almost feels like the pain is in the bone itself. I also sometimes get an ache in the base of my foot which can be quite painful when I walk on it. Is there any particular cause for these problems?

The condition you are referring to is colloquially referred to as shin-splints, a collective term used to describe any pain occurring during or after sport in the shin area.

The pain can come from a variety of structures in the shin area including tendon, muscle, bone and ligaments. The pain you refer to, which feels like it is in the bone, is quite common and occurs at an interface point where muscle attaches to bone at the front or inside of the shin.

The reasons for this sort of shin pain can be related to many things. Usually shin pain occurs as a consequence of poor biomechanics (the way in which the foot and leg move whilst running or playing sport), poor training techniques or in some cases over-training. Often the surface that you are running or playing your sport on can also have an effect on these injuries. Podiatrists will look at all of these elements when assessing your shin pain and indicate which they feel are most likely to be contributing to the problem and advise you as to the best remedy.

Always remember to warm-up, cool down and stretch after playing sport, and build your jogging up gradually as these are common reasons which contribute to the development of shin pain.

The ache you are experiencing in the base of your foot could be a result of inflammation of one of many different structures in your foot. Common examples are sesamoiditis (inflammation of small bones under the big-toe joint, and plantar fasciitis (inflammation of a ligamentous like structure which runs the length of the foot). The fact that you are experiencing these problems in addition to the shin pain tends to suggest that you may have a mechanical problem with your feet which is making you prone to these injuries. If this were the case you may require a prescription insole to improve the mechanical function of your feet as well as an assessment of the footwear you use in sport. A podiatrist will be able to assess whether this is in fact the case and treat you accordingly.

Q. There's an increasing trend to have inserts in shoes. Is this a good idea or is it just a sales pitch for podiatrists and the shoe industry?

An analogy would be to compare the shoe insert industry with optical glasses and contact lens market. They can be great for people who need them but not everyone requires them. Obviously some may wear glasses or contact lenses purely for fashion reasons (sunglasses and coloured contacts). The same could be said for the insert industry where we are seeing some runners choosing to wear them as an accessory rather than out of necessity.

There are different types of shoe inserts each of which are used for different reasons. A lot of insoles can be bought 'over-the-counter' at pharmacies and sports stores. These are generally made from softer materials and made for a generic arch shape - one arch shape fits all.

Many inserts not tailored for feet
There are some obvious limitations to these devices, as they often don't come in specific sizes (only small, medium and large) and are not contoured specifically to your arch shape. For some people these may be quite adequate to relieve all or some of their problems whilst others may in fact be very uncomfortable or do nothing at all.

Q. What is the difference between chiropody and podiatry?

Chiropody is the old term for podiatry. The first-ever recorded chiropodist in Victoria operated in Geelong in 1842 and the first meeting of the Chiropodists Association of Victoria - now the Australian Podiatry Association (Vic) - was held in May 1929. In 1968, after decades of lobbying, the Chiropodists Act, which provided for registration of chiropodists, passed through Parliament.

In 1963, American chiropodists formally adopted the designation 'podiatry' and 'podiatrist', meaning 'physician of the foot', mainly to avoid the possible mix-up with the chiropractic profession. Australian chiropodists followed suit and officially changed the name of their profession to podiatry in 1977.

Q. What are flat feet? What are fallen arches?

Flatfeet and fallen arches are lay terms used to describe lowering of the long inner arch of the foot. For a long time flat-feet were thought to be the sign of a poorly developed or structured foot. However in recent years it has been found to be no more prone to injury or soreness than any other foot structure. In fact recent research involving army recruits has shown that those army recruits with flatter feet tended to suffer less problems than those with normal or high arched feet.

In recent years it has been felt that it is not necessarily how flat or high your arches are but it is in fact the way in which you walk with your feet and the way in which they move which are the most critical factors. Podiatrists are particularly interested in assessing this movement. Often during an examination they will undertake tests to determine whether your feet move normally or not. If your feet move abnormally whilst you are walking or standing this can make you more prone to injuries and foot soreness.

Q. Is walking or standing on concrete harmful for your feet?

The foot is designed to adapt to a variety of surfaces including hard surfaces like concrete. However, periods of protracted weight bearing on flat hard surfaces like concrete can give rise to discomfort. This is worse in some feet than others depending on the way in which your foot is structured. The structure of some people's feet may cause them to be uncomfortable on concrete.

People who spend a lot of time on concrete tend to be more prone to heel and forefoot pain and tend to develop more calluses and corns on the high-pressure areas of the foot. In some people these can become severe to the point that individuals are unable to complete their normal duties.

There are some simple things you can do to reduce the effect of concrete on your feet, these include:

·         Lay rubber matting over common walkways to cushion the ground underfoot

·         Wear shoes which have softer soles and innersoles

·         Wear more supportive shoes to help reduce the pressure points of the feet, preferably lace-up style.

·         Use simple over-the-counter arch supports in your shoes to help distribute weight over a larger surface are of your foot, so that weight is not just focused on the heel and forefoot

·         Try to sit whenever it is appropriate to do so.

In some cases a persons foot structure is so badly suited to walking on concrete that none of the above suggestions improve their foot comfort. In that case they need to see a podiatrist to assess there needs for treatments such as customised shoes and/or insoles or perhaps looking more closely at their working environment.

Q. Can ankle supports, like lace-up boots ease the effect of sore feet?

In simple terms it is generally better if the foot is aligned with the leg, that means it should neither roll too far inwards or too far outwards. Lace-up boots are particularly effective in maintaining the alignment of the leg so that the muscles and ligaments on either side of the foot have even amounts of pressure placed on them.

Distributing pressure more evenly over a wider number of structures can help to reduce foot soreness. One of the hazards of lace-up boots, especially those that come up a long way above the ankle is that they can in fact restrict the range of motion at the ankle joint. As a general rule try to wear boots that don't come too high above the ankle and ensure they fit comfortably around the front of the ankle, preferably with a padded tongue. Be aware that lace-up boots will not solve all sore feet problems and if you experience ongoing problems, talk to a podiatrist about other possible treatment options.

Q. What are the value of arch supports. Do some people need custom-made orthoses to alleviate foot pain?

Arch supports are devices used to support and help align the foot to improve the manner in which it functions. There are various types of arch supports available. They range from 'over-the-counter' styles of devices to custom prescribed devices which people receive from podiatrists. In simple terms over-the-counter orthoses are made typically with only one arch shape and fairly limited sizes. For some these may be adequate to reduce their foot pain and indeed podiatrists often recommend such insoles where they feel they are appropriate.

For other people however their problem cannot be remedied by simple over-the-counter orthoses and they require an orthotic that is made specifically for their foot. This would be made from a cast of their foot and sent, with a specific prescription, to a laboratory. Because these devices are essentially 'one of a kind' and can't be mass-produced they are more expensive, however they are made of materials that are long wearing.

Q. What are papillomas? Are they the same as warts, how do you get them?

Papillomas is actually a synonym of wart and also verrucae. They are all one and the same. The term papilloma has been used commonly over the years to describe warts that are found on the foot. However they do not differ technically from warts on the hands or indeed any other part of the body. They all involve an infection of the skin by a particular group of viruses. It is now known that there are well over 50 strains of this particular virus. The fact that there are different strains of this virus probably accounts for the differences in the way they appear ie. some large some small, some spread easily, etc.

Papillomas are infectious and can be caught simply by touching an infected site of another infected individual. However, more likely environments tend to be public showers and swimming pools. The reason for this is quite simple. The often warm, humid environment of showers and pools help to preserve the virus outside of the human skin. The abrasive surface of public showers and pools can cause minor abrasion to the skin (like sandpaper would). These minor abrasions open the skins surface up and make it more prone to infection from the virus. Thus the foot is most likely to be affected in these environments. Subsequently, the wearing of thongs or other protective footwear is recommended in the prevention of papillomas.

It should be noted that papillomas at this stage are not thought to be a health risk to humans and unless they are painful do not theoretically need to be removed. Papillomas of the foot are frequently painful because the infected individual is walking on them and they subsequently push into the skin.

Q. Are high heels bad for you, is it okay to wear them now and then? Or should you wear different shoes everyday?

Theoretically high heels are a bad shoe because of the unnatural position it places the foot into. The raised heel actually has affects not just on the foot but also on the posture of the entire body. In order for you to walk in high heels the musculoskeletal system of the body has to alter its posture quite significantly so you can remain balanced over the shoe. Prolonged periods of walking in high heels can therefore place quite unnecessary and indeed significant stresses on parts of the body, particularly it is believed, the back and neck.

The postural changes that occur can also become quite permanent or fixed. Thus it is not uncommon for women to suffer from worse pain when they move back into flat heels. We especially see this in retiring women who have been in high heels for most of their working lives. When they start to regularly wear flat shoes again they can experience significant discomfort.

There are of course other problems we see associated with high heels. The high heeled shoe tends to cause much greater pressures on the forefoot. This typically gives rise to a build-up of callouses under the forefoot. Eventually this can cause pain and a burning sensation in the ball of the foot when walking. Furthermore, the typically pointed toe of the high-heeled shoe can cause significant pressure against the toes. Over time this can give rise to permanent deformity of the toes including bunions, claw toes and associated corns and thickening of the nails.

In respect to the above information it obvious that the high heeled shoe is not good for the foot. However, it is very much a personal decision and the wearing of high-heeled shoes in primarily sedentary jobs for short periods of time, or for special occasions is probably without too many bad consequences. Importantly, if you do wish to wear high heels try to wear styles that offer good support in the arch and across the instep, try to avoid pointed toes, choose shoes with a wide base of support, ensure they fit well and make sure they are made of good quality leather.

It is generally recommended that you do alternate your shoes from one day to the next. Not only does this help to vary the posture of the foot and therefore distribute the load over a greater range of joints and muscles but it is also probably good for hygiene reasons. Allowing shoes to air over a day or two helps the shoe to dry out and reduce the growth of bacteria.

Q. How do you get ingrown toenails? 

Ingrown toe-nails occur generally from one of three reasons; poor cutting technique, abnormal nail shape and poor footwear.

The majority of ingrown toenails that podiatrists see are a result of poor cutting technique. Simply, nails should not be cut into the corners. If you do so you are risking the chance of leaving a spike of nail along the side of the nail which can embed itself into, or irritate the flesh next to the nail. If you do have to cut your toe-nails into the corners (which some people do due to the shape of their nails) always make sure that such a nail spike is not left behind.

Some people are born with or develop very difficult toenails - some of which are either too wide or are too rounded from side to side. These people are prone to ingrowing toenails regardless of the way they cut their nails. In these cases the only solution is to remove the outer margins of the nail. This can be done as a minor surgical procedure and is a permanent cure for the problem. It is actually a relatively painless operation and the post-operative recovery is very quick. Certainly the pain of the operation is better than having a life of ingrowing toenails.

Footwear can play a big part in the cause of ingrowing toe-nails. We see this typically for three different reasons; safety footwear with steel toes that do not fit properly, in children who have grown out of their shoes and therefore have shoes which are too small, shoes that are worn out and do not offer good support. In all these cases the shoe causes the toe to rub against the shoe in a way which makes the wearer more prone to ingrown toenails.