Common Foot Problems: Over-the-Counter Treatments and Home Care

 

Am Fam Physician. 2018 Sep 1;98(5):298-303.

  Patient information: See related handout on home treatments for common foot problems, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Most foot disorders do not require podiatry referral or complex interventions. After the clinical diagnosis is made, these conditions can typically be managed with over-the-counter (OTC) and home remedies, with guidance from the primary care physician. Stretching and strengthening exercises, along with the use of heel cups, resolve most plantar fasciitis cases and are at least as effective as nonsteroidal anti-inflammatory drugs or steroid injections. Hallux rigidus is best managed with a hard-soled shoe or rigid insert that relieves pain by restricting motion across the metatarsophalangeal joint. Hallux valgus responds to use of wide toe box shoes, and surgery is not clearly beneficial beyond one year. Plantar warts can be treated effectively at home with OTC salicylic acid and cryotherapy topical agents, which have equal effectiveness to liquid nitrogen. In patients with corns and calluses, OTC topical salicylic acid has short-term benefits, and pads and inserts that more evenly redistribute contact forces have long-term benefits. Inserts are commonly recommended to redistribute forefoot pressure and relieve pain. Several OTC preparations are available for the treatment of tinea pedis, with topical allylamines being the most effective. Although OTC topical treatments have been widely used for onychomycosis, they have poor long-term cure rates compared with prescription oral medications.

Foot pain reportedly affects 30% of the general population.1 In addition to causing pain and inconvenience, some foot problems are associated with disability and fall-related morbidity.2 Many common foot ailments do not require podiatry referral or complex interventions and are best managed with appropriate over-the-counter (OTC) treatments and home care, with careful guidance from the family physician.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

The use of a heel cup is at least as effective as steroid injections for the long-term improvement of plantar fasciitis.

B

15

A stiffening shoe insert relieves hallux rigidus pain.

C

2426

Topical salicylic acid and cryotherapy are equally effective treatments for plantar warts.

A

35

Topical salicylic acid is at least as effective as scalpel debridement for treatment of corns.

B

42, 43

The fungicidal allylamine terbinafine (Lamisil) is effective in the treatment of tinea pedis, and has slightly higher cure rates and requires less time to cure than other topical over-the-counter treatments.

A

50


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

The use of a heel cup is at least as effective as steroid injections for the long-term improvement of plantar fasciitis.

B

15

A stiffening shoe insert relieves hallux rigidus pain.

C

2426

Topical salicylic acid and cryotherapy are equally effective treatments for plantar warts.

A

35

Topical salicylic acid is at least as effective as scalpel debridement for treatment of corns.

B

42, 43

The fungicidal allylamine terbinafine (Lamisil) is effective in the treatment of tinea pedis, and has slightly higher cure rates and requires less time to cure than other topical over-the-counter treatments.

A

50


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

Plantar Fasciitis

Each year, more than 800,000 Americans younger than 65 years seek outpatient treatment of plantar fasciitis.3 In 80% of plantar fasciitis cases, symptoms resolve with OTC and home therapies alone, most often within six months of commencing treatment.4 Those who seek care within 12 months of onset are more likely to have resolution of symptoms.4 Many therapies address biomechanical and environmental factors, such as a reduced angle of ankle dorsiflexion, prolonged standing for work, and obesity.5 Stretching is likely effective because it counteracts shortening of the plantar fascia. The plantar fascia is contiguous with the Achilles tendon at its origin, where it then goes on to insert at the toes in individual bands.6,7 The plantar fascia is also vulnerable to compressive trauma at the base of the calcaneus, where it is protected only by a fat pad that thins with age.8

There may be

The Authors

show all author info

BLAIR A. BECKER, MD, is a faculty physician at the Kaiser Permanente Washington Family Medicine Residency in Seattle....

MARC A. CHILDRESS, MD, is associate director of the Primary Care Sports Medicine Fellowship at Virginia Commonwealth University Fairfax (Va.) Family Practice.

Address correspondence to Blair A. Becker, MD, Kaiser Permanente Washington Family Medicine Residency at Seattle, 125 16th Ave. E., CSB-540, Seattle, WA 98112. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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