‘Painful toes: What can I do to fix them?’

Q: Painful toes — how can I fix tension that wakes me up several times a night. I have to tighten them, relax them and sometimes I get up and massage them with deep heat ointments. I also have sore calf muscles often at the same time as the toes hurt. Ideas, please? My daughter says it might be that I have anaemia and that my toes appear to her to be deforming at the first joint like they have arthritis.

Thanks for your email. There are many things this might be. I’d suggest seeing a podiatrist, however, the most common cause of this type of pain is nocturnal leg cramps or night cramps. This condition is idiopathic, which means the exact cause isn’t known. Unfortunately, night cramps are common but it’s important to get a proper diagnosis, and if it is night cramps they are quite hard to treat. Limited evidence supports treating these cramps with exercise and stretching, or with medications such as magnesium, calcium channel blockers, carisoprodol or vitamin B12.

Dr Frances Henshaw recently answered a reader question about bunions.

Q: I have developed bunions and can’t walk very far without getting sore feet. What can I do? My doctor says nothing can be done. I have used toe sleeves but they only make it worse. I’m on a Department of Veterans’ Affairs pension because I have a total and permanent incapacity. Hope you can help.

Bunions are largely attributable to the foot type that you were born with. If you look at foot X-rays, some people have foot bones in a slightly angled position that makes them more prone to bunions; flat feet can also contribute. This is because if your metatarsal bones (connected to the bones of the toe) are angled or not in the right position, your feet muscles can pull the big toe slightly to one side instead of straight up when you walk.

Lots of people spend money on orthotics but there’s not a lot of high quality evidence to support their effectiveness in treating bunions. Night splints are of limited help as most of the harm is being done when you walk. The best option is to get shoes that will accommodate the deformity. If you’re a DVA TPI your podiatrist may be able to prescribe these for you if your doctor writes a referral. Otherwise the only real option is surgery. I always say to my patients, that it’s best to put up with the pain, get good shoes and if you can’t live with the pain, then consult with a surgeon. But be prepared that surgery is not without risks and can alter foot function. For example, it may result in less bend at the ball of the foot, which may cause further bother.

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