Question: What can cause pain in the front half of the foot? I cannot recall injuring it in anyway.
Gout is a severe and obvious cause of foot pain, but there are several other common causes.
Metatarsalgia is a condition common in athletes. It is an inflammation of the bones that form the ball of the foot, and is due to prolonged running, jumping or walking, usually on hard surfaces. Soldiers on route marches may develop the condition. Severe pain may develop in the ball of the foot, and the treatment is primarily rest, and anti-inflammatory medications. A ‘march fracture’ of the fore foot bones, due to the stress of continued walking or running on the foot may be another cause. There are minimal changes on x-ray, but excruciating pain on attempting to walk. Six weeks rest heals these fractures. In the elderly, foot pain may be the first sign of poor circulation, diabetes, rheumatoid arthritis or neuralgia.
Because these conditions can be serious, the cause of the pain must be investigated by a doctor and the correct treatment started.

Question: I have two bunions on each foot on the large toes. They give me pain. Would you advise operation? If so, could I have them done at the same time?
If the big toe is constantly pushed across towards the smaller toes by high-heeled shoes, tight shoes, or a poor way of walking, the big toe may become semipermanently deformed in this direction. The end of the long bone behind the two big toe bones in the front half of the foot (called a metatarsal) is exposed by the deflection of the toe bones, and starts pushing against the skin.
A protective, fluid-filled sac (called a bursa) forms between the bone end and the skin to protect the bone. This sac slowly enlarges to cause a lump that may become tender and painful. This is a bunion. Bunions are becoming less common with more sensible and better-made footwear, and a wealthier society in which correctly fitted shoes can be purchased regularly for a child’s growing feet. Bunions usually start in childhood, but may not cause significant discomfort until adult life.
A number of surgical procedures are available to cure a bunion, but in elderly people, it may be preferable for a protective pad to be worn inside soft or specially made shoes. When bunions are repaired, it is normal for only one side to be done at a time, but in elderly people, in whom immediate mobility is not a concern, both sides can be done at once.

Question: I suffer constantly from cold feet, mainly when in bed, and have been told it is a medical problem. I await your comments.
Cold feet are usually due to poor circulation of blood to that area. If insufficient warm blood reaches your feet, they will feel cold, and may be white or blue, and painful. In older people, hardening of the arteries (atherosclerosis), heart failure and diabetes are the main causes of poor circulation, while in younger people, spasm of an artery may be responsible. Raynaud’s phenomenon is a condition in which arteries go into spasm, narrow down, and fail to supply adequate blood to the hands or feet, which become cold and painful.
As you can see, a number of conditions may be responsible for your problem. You will need to be investigated to determine which problem is affecting you. Once this is known, the appropriate treatment can be given to cure or control the disease.

Question: I have severe pain under my heel. It is making it very difficult to walk, and I spend a lot of time on my feet in my job. What could be the cause?
Pain under the heel is one of the most common problems seen by a GP. It can be caused by a spur on the bottom of the heel bone, by inflammation of the large fibrous band that maintains the arch of the foot, or from damage to the heel tissues from running on hard surfaces. Joggers are particularly susceptible to heel pain, and should ensure that they wear good running shoes, and run on grass rather than roads.
Rest is the most important part of treatment. Swimming and cycling can be substituted for exercise while the damaged tissue recovers. Anti-inflammatory medications prescribed by a doctor may ease the discomfort, but some patients require injections of steroids into the heel. These are very successful in curing what can become a chronic problem, although they may be rather painful to receive. Many doctors inject local anaesthetic with the steroid to minimize the discomfort.

Question: I have plantar fasciitis that has been plaguing me with pain for years. What causes this problem? Can massage or other treatments help?
The problem may start after excessive exercise (eg. an unusually long run or walk), after a sudden sharp injury (eg. landing heavily after jumping), or it may start for no apparent reason.
The most important treatment is rest, and several weeks on crutches may be very beneficial. Other treatments include the anti-inflammatory tablets that you have already taken, pain-killers, physiotherapy and occasionally steroid injections into the foot. As a last resort, the foot may be put in plaster for a few weeks to ensure total rest. Massage would be more likely to irritate the problem than help.