DR KAYE: I’ve lost the padding in my feet – how can I ever wear high heels?  

This sounds crazy, but my feet seem to have lost their padding. It means that wearing anything other than athletic shoes is uncomfortable. I have a wedding soon and I am dreading it because I will have to wear heels. Is there anything I can do?

It’s not crazy at all – and it could be something called heel fat pad syndrome, otherwise known as fat pad atrophy.

There is a fat pad that supports and cushions the heel, acting as a shock absorber. If this thins out, it can become painful.

The pain is generally in the center of your heel and is worse with high-impact activities, or with prolonged standing or walking. Treatments include rest, applying ice, anti-inflammatory medication, and using cushioning shoe inserts to support the heel.

There is also a condition known as plantar fasciitis where there is inflammation of the connective tissue (fascia) that supports the foot. This pain is often worse in the morning and can be around the arch and heel of the foot. Initial treatment also includes cushioned, supportive shoes, rest, and ice.

There are also exercises and stretches that can help – find them online by searching “plantar fasciitis exercises.”

If it feels like you’re walking on cobblestones or pebbles, you may have a condition called Morton’s neuroma, where there’s a bulge around an irritated nerve in the foot.

Alternatively, there may be a problem with the nerves to the feet causing the change in sensation. This pain can become debilitating and interfere with daily activities so please seek medical advice – you may need a referral to a foot specialist who can provide a wider range of treatments.

I suffer from painful red patches of skin on the inner thighs that I have treated with over the counter antifungal creams. But these don’t seem to work anymore – what can I do to control it instead?

This sounds like tinea cruris, a fungal infection of the groin sometimes referred to as jock itch. It is more common in hot and humid weather and in people who suffer from excessive sweating called hyperhidrosis. Obesity and tight-fitting clothing can also increase risk.

The rash may be scaly, itchy, and red or pink (or look darker on darker skin tones). It can also leave dark patches on the skin once the rash has cleared.

We call this post-inflammatory hyperpigmentation. If it’s mild, it usually goes away in a few months, but it can take longer, and if it’s severe, the spots may be permanent. The color of the dark spots can vary from yellow-brown to blue/grey.

Tinea cruris is generally treated with antifungal creams, several of which are available over the counter. Some need to be used for ten days after the lesions have healed, so depending on the cream, it’s important to keep applying them for the specified period of time, even if the rash is better. If this doesn’t work, see a doctor as there are other skin conditions that could be causing the problem.

If you also have athlete’s foot or a fungal infection of the skin or nails elsewhere, it’s worth treating to reduce the risk of re-infection. Sometimes oral antifungals are needed, so check with your doctor.

My husband has had a minor stroke and heart attack in the past and had two stents placed. His blood pressure fluctuates around 160/80, but sometimes rises further, despite taking the most powerful tablets. Do we have to worry?

High blood pressure, called hypertension, is a common but serious problem. While it doesn’t really cause day-to-day symptoms, it does increase your risk of heart attacks and strokes in the long run, which is why it’s important to get it under control.

Blood pressure is recorded with two numbers: systolic pressure (the top number) is the force at which your heart pumps blood through your body; the diastolic pressure (the lowest number) is the resistance to blood flow in the arteries.

The most important thing to know is that a systolic pressure over 140 and a diastolic pressure over 90 are considered high. These numbers are slightly lower if you measure your own blood pressure at home.

While medication is generally effective at getting readings below this level, some people have drug-resistant hypertension, meaning their blood pressure remains high despite taking the maximum dose of tablets. It may be in these cases that a different kind of blood pressure medication has a better effect. A GP can try this, but if the problem persists, a referral to a cardiologist may be necessary. These heart specialists can investigate further treatment options.

Sometimes the reason a drug doesn’t work is that patients don’t take it regularly because of intolerable side effects. If this is the case, it is important to talk to the doctor to find a solution.

And don’t forget that lifestyle measures can also be helpful in tackling high blood pressure, such as reducing the amount of salt in the diet, losing weight and increasing exercise.

We need the full facts behind the soup and shake diet

The ultra-low-calorie NHS soup and shake diet, which has been shown to put type 2 diabetes into remission, will be offered to all eligible Britons by March next year, the government announced last week.

It has been trialled in 21 areas of England since November 2020 and has so far helped around 2,000 patients improve their health through weight loss.

Studies have shown that dramatic weight loss can interrupt the disease, but I’m concerned. It’s not clear what proportion of patients on this diet manage to maintain their weight long-term, and what happens if they don’t.

I’d love to hear your experiences with the soup and shake diet. Did it get rid of diabetes? Or have you gained weight again and finally feel defeated?

Write to the health team at Dr Ellie’s email address at DrEllie@mailonsunday.co.uk.

Dr. Ellie will be back next week

Don’t make work more difficult

I’ve had a lot of questions about the recently approved pain relief during labor that was announced last week.

Many expectant mothers are concerned because the drug, called remifentanil, is a type of opioid — a powerful and potentially addictive pain reliever — that patients can self-administer. But don’t worry if you’re offered it, because the system is set up so that you can’t take too much.

It also works quickly – within 30 seconds – and wears off in a few minutes. This means women can move around during labour, which can also help ease the pain, unlike epidural which can leave you numb from the waist down.

There’s a lot of pressure on women to have a natural birth, which I think is potentially harmful — the more offered to make childbirth less excruciating, the better.