The big toe joint (called the metatarsophalangeal joint or MPT joint) is an important joint that needs to be able to bend for the foot to work as efficiently as it should. Sometimes, for a variety of reasons, the joint can become stiff and make walking painful at this area – and sometimes it can become so bad that it results in a complete loss of movement.
Footwear is important in these cases. If the joint cannot bend, then a shoe with a stiff sole – or rocker sole like the examples pictured below- can be useful. A shoe with a decent heel height may make symptoms worse as this will ask more of the joint and so may be best avoided – or at least limited. It is also important to point out that themake and price of the shoe/trainer is not important, as long as it is fit for purpose.
If you do not see any sign of improvement after 6 – 8 weeks of following the advice and exercises in this leaflet, please phone 0141 347 8909 to see a healthcare professional who can assess your foot and potentially recommend further treatment.
As a portion of nail punctures the surrounding skin it can cause pain, inflammation and at times infection. This is known as an ingrown toenail and is a common complaint that can be treated effectively by a Podiatrist.
Further information on ingrown toenails
Why does this happen?
There are many reasons this can occur including:
Cutting nails too short
Cutting or trimming the sides of the nail where it meets the skin
Picking toenails
Tight or ill-fitting shoes or hosiery
Excessive moisture (sweat)
Damage to the nail or toe
Fungal infection
Increased curve of the nail.
How can I prevent this?
There are things you can do to prevent an ingrown toenail as part of your personal footcare routine. Further information and support available from our personal footcare site.
Important points to remember:
Ensure you are using the appropriate equipment and technique when cutting your nails.
Change socks regularly throughout the day to prevent increased moisture
If you have an ingrown toenail, and self-treatment has failed, you will require treatment by a qualified Podiatrist. To access podiatry treatment you can self-refer by contacting NHSGGC Podiatry Referral Management Centre:
At your initial appointment the Podiatrist will assess your concerns, treatment options and the risks and benefits of treatments. This will allow you to make an informed choice of your treatment plan. If there is infection present the podiatrist can arrange for antibiotics to treat the infection. Treatment may be performed on the day to remove the problematic portion of nail however, in some cases you may need further treatment which may require a local anaesthetic (nail surgery). Your Podiatrist will discuss all your treatment options and will refer you for nail surgery if deemed necessary.
Nail Surgery
What is nail surgery?
Nail surgery involves removing a piece or all of a problematic toenail. The option to have the nail permanently removed or allowing it to grow back will be discussed with your Podiatrist.
What will happen at my nail surgery appointment?
Your Podiatrist will discuss your general health and it may be helpful to bring a list of your medication. If you are diabetic we advise having your HBA1C (blood sugars) checked before your procedure date. Having this information will allow you both to agree on what procedure you are best suited for. The procedure will require your toe(s) to be numb which is achieved using a local anaesthetic injection. Your Podiatrist will explain the procedure and answer any questions you may have. A family member/friend may accompany you to your appointment for support if needed.
Preparing for the appointment
Ensure you have breakfast/lunch depending on the time of your appointment
Bring open toe shoes (sandals, flip flops etc.) to accommodate the dressing that will be applied
Ask of family member/friend to drive you or consider public transport. If this is not possible you may drive
Ensure you are able to rest the foot following the procedure. The Local anaesthetic will wear off in approximately 2-3 hours, take care not to damage it while it is numb.
After the procedure
You will be provided with information to help you manage your care at home. This will include:
Pain relief
Dressings
Footwear
Activity.
Aftercare and what to expect
You will be expected to change your own dressings while the wound is healing. This will normally involve:
Allow the dressing to get wet in the shower/bath
Remove dressing and allow the water to run down your body and over the toe – avoid direct water pressure on the toe
Allow the area to air dry, do not use a towel to dry the toe
Apply a breathable dressing available from local supermarkets or pharmacies. We advise you obtain these before your procedure date
It is important to avoid foot baths, prolonged soaking and any type of scrubbing of the area.
Healing times may vary from 4 – 12 weeks, depending on your medical history and the procedure undertaken. The application of the chemical (Phenolisation) to prevent the nail growing back will increase healing time. Normal healing from phenolisation may include:
Redness localised to the tissues around the nail bed
The nail bed may be moist and leak some fluid onto the dressing initially
A thin yellow film may form over the nail bed
Area may look slightly yellowish before getting better and looking more like a normal wound.
All of the above should reduce gradually and result in a dry scab forming with no fluid leaking onto the dressing.
Infection
It is important to monitor the area for signs and symptoms of infection and contact your local Podiatry department if you have concerns. If you follow the aftercare advice this should help prevent infection occurring. Signs that infection may be present include:
Significant increase in redness and swelling
Significant increase in pain and discomfort
A foul smell from the area
Flu like symptoms (Out of hours, contact NHS 24 on 111 if podiatry service not available).
What will it look like once healed?
If the nail has been allowed to re-grow this will normally take 3-6 months. If the aim is to prevent the nail growing back the area will heal over with normal skin that will toughen slightly over time. There is a chance the nail could grow back however this can often be managed with light regular filing or further treatment if causing significant issues.
Podiatry provide assessment, management and foot health education to individuals with conditions affecting the lower limb, enabling self-care where possible. We have highlighted some of the most common problems and created resources which you might find helpful in supporting your foot health concern below.
At the Specialist Weight Management Service (SWMS), patients are encouraged to take a realistic approach to weight loss. We want to challenge the notion of ‘going on a diet’. Unlike some fad diets, SWMS is based on current expert opinion and research evidence. Patients are asked to explore not only what they eat, but also when they eat, why they eat and how they eat.
SWMS encourage dietary and lifestyle changes that are realistic, achievable and that can be sustained in the long-term. The focus is improvement in health, through healthy eating and realistic weight loss, rather than striving for the perfect figure or an ideal bodyweight.
Lifestyle Intervention
The 12 week programme made up of 7 fortnightly sessions. Each session lasts 1.5 hours which covers information and support on diet, activity, and behaviour change strategies.
A Personalised Dietary Prescription (PDP,) is calculated based on height, gender, age, weight and level of physical activity. The Eatwell Guide outlines a healthy, nutritionally balanced diet that allows for personal food choices.
The minimum target weight loss in the lifestyle intervention phase is 5-10kg (11.5 lbs to 1.5 stone). This equates to a steady weight loss of 0.5-1kg (1-2 lbs) a week.
All About Obesity provides education, information, support and advocate for those living with obesity.
Better Health
Better Health offers information to kickstart better health for you.
PCOS (Polycystic Ovary Syndrome)
Polycystic Ovary Syndrome (PCOS) is a common complex hormonal condition which affects how the ovaries work. Lifestyle choices such as the type and amount of food you eat, as well as the activity you do, can improve symptoms.
Self monitoring using online apps are becoming more popular. They are a quick and convenient way to assess and track dietary intake. You can download apps on your smart phone – some of which are free and very easy to use. Some commonly used dietary apps are listed below.
Nutracheck (calorie counter +)
Nutracheck (calorie counter +) provides food and exercise tracking, UK food database with over 250,000 products with photos (verified data), scans barcodes, links with Apple Health. This app has a fee and is approved by ORCHA.
MyFitnessPal
MyFitnessPal provides food and exercise tracking, barcode scanner, large food database with over 6 million foods including restaurants menus. The app can connect with popular apps and devices such as – Garmin, Strava, Runkeeper, Fitbit. The app allows you to share your progress with friends and is free.
Lifesum
Lifesum is a food and exercise tracking app. The ‘basic’ plan (food and activity diary,) is free, however, you would need to pay a monthly subscription fee to access healthy recipes, sync the app with health apps, etc.
LIVA
LIVA is an integrated digital platform for disease management and lifestyle change. The app allows you to monitor physical activity, sleep, mood and dietary intake. Users can also record biometric parameters e.g. blood sugar levels, blood pressure, lung function.
Designed to provide support and guidance for people at risk or living with chronic diseases such as Obesity, pre and type 2 diabetes, hypertension. This app is free and approved by ORCHA.
Easy Meals
The Easy Meals app is free and provides over 150 easy, calorie counted recipes across breakfast, lunch and evening meals and puddings. The app also has a handy shopping list to make planning and shopping easier.
Change4life Smart Recipes
Change4life Smart Recipes allows you to search over 160 easy, calorie-counted recipes, easy to follow instructions and all the ingredients you’ll need to feed a family of 4 for around £5, create a shopping list, tips on how to make healthier choices.
Change4life Food Scanner
Change4life Food Scanner is an easy to use food scanner designed to help you make healthier food and drink choices. Barcode scanner will show you the total sugar and saturated fat contents of foods.
Carbs and Cals app
The Carbs and Cals app helps people control their diabetes and weight. The app contains over 3,500 food photos to help you manage your calorie intake and portions. The Carbs and Cals app also provides useful nutritional information such a carbohydrate, fat and fibre content of foods. This app has a fee.
The prevention and control of infection throughout healthcare is everyone’s responsibility and is a major component in the drive towards a safer NHSScotland.
These Standards are one part of the drive for a safer NHSScotland, so should be seen as complementary to HAI and patient safety work undertaken by other bodies, e.g. Scottish Patient Safety Programme (SPSP). These Standards for HAI apply to all healthcare environments in which patients are treated.
GIRFEC – Getting It Right For Every Child is the national approach in Scotland to improving outcomes and supporting the wellbeing of our children and young people by offering the right help at the right time from the right people. It supports them and their parent(s) to work in partnership with the services that can help them.
At NHSGGC we have a key role to play, whenever we come into contact with children and young people – whether we are caring directly for them, or other members of their family or household. Where extra support is needed, the GIRFEC approach aims to make that support easy to access and seamless, with the child at the centre.
GIRFEC Frequently Asked Questions – start here for answers to the most commonly asked questions about Getting it right for every child
Here is a list of the main problems and concerns we would recommend you get checked out by a health professional before starting self-management exercises. These are called ‘Red Flags’ and may indicate a more serious problem that requires medical assessment.
Symptoms that are present After Trauma
If your symptoms are caused by a recent traumatic incident (e.g. a fall, football tackle) and you have any of the following symptoms:
Extensive bruising and/ or swelling
Discolouration e.g. your foot looks pale, blue or red
Severe pain and very limited movement
Joint deformity eg foot looks like it is in the wrong place
New lumps and bumps that appear after the trauma
Great difficulty putting weight through your leg
Numbness/ tingling into your foot after trauma
Feeling of instability
Please Note: If you have a known diagnosis of osteoporosis (low bone density) a small amount of force may cause problems that require medical assessment.
Symptoms where No Trauma was Involved
Sudden loss of active movement with or without pain
Redness, heat and swelling of the joint/ surrounding area
Increasing numbers of joints that are painful and/or stiff
Fever or generally feeling unwell at same time as your foot pain developed
Unexplained numbness/ tingling into your foot
Constant pain which does not change with rest or activity
Significant worsening pain at night
Unexplained weight loss and/ or a previous history of cancer
Unexplained lumps and bumps that appear or are changing/ growing
Difficulty lifting the front part of your foot/ catching or dragging your foot when walking
Please Note: Special attention should be taken if you have a history of long-term steroid or immunosuppressive drug use, recent joint replacement, recent steroid injection, rheumatoid arthritis or other joint disease, recent infection, Intravenous drug use or alcohol misuse.
Our colleagues in the NHS Greater Glasgow and Clyde Podiatry team have developed a range of information resources for specific foot conditions – see what resources are available.
Foot and Ankle Exercises
Please make sure you have read through the important information about foot pain before proceeding.
Here are some beginner-to-progressive exercises to help you get your foot/ankle moving better. You may need to build these exercises up gradually.
You may be uncomfortable when you start doing these exercises – make sure the level of discomfort feels acceptable to you and that it doesn’t take too long to settle once you are finished.
The exercises should get easier the more consistently you manage to practice them and this may allow you to progress to more difficult exercises.
These are self help exercises:
Try to enjoy the exercises and work at a pace and level that feels safe.
Please use a common sense approach when deciding which ones to try.
The exercises listed are not designed as an alternative to professional advice.
