Help and Advice on Certain Conditions...
Problems with our feet arise from numerous sources, far too many to be able to discuss them all here. However, we do see a lot of common problems and are asked frequent questions about the same problems and so we have tried to help with these in this section.
Common foot problems have been divided into the following categories:
1. Nail conditions
2. Skin conditions
3. Biomechanical / Sports injuries
NAIL CONDITIONS: Ingrown toe nails / Fungal infections / Thick toe nails
Ingrown Toe Nails
A true ingrown toe nail is one which has pierced the skin, often accompanied by an over growth of tissue at the side called hyper granulation tissue. This type must be referred to a podiatrist for removal of the offending portion quickly.
The procedure can often be carried out painlessly but we can give a local anaesthetic if necessary. It is important that the patient does not delay in getting an appointment.
Another form of ingrown toe nail is one where the whole side is abruptly curved and is often an inherited shaped nail or has arisen due to previous trauma. This is known as an involuted nail.
These nails can usually be painlessly treated giving instant relief.
Should the nail condition be long term or permanent, then the podiatrist may suggest nail surgery. This is a simple procedure carried out with a local anaesthetic and should be a permanent cure. We pride ourselves on being able to reassure patients if they are worried and surgery is carried out in a very relaxed atmosphere.
The nail can appear thickened, crumbly and discoloured, or there may be white flecks or areas in the nail plate. These appear in many different forms but the most common being the thick golden brown nail.
Classically, a discolouration appears at one side of the nail and grows across sideways. This is usually a yellow / brown or white colour. The nail often becomes crumbly and flaky and can spread to the other nails as well as finger nails.
White flecks can indicate a fungus present but are often misdiagnosed with nail varnish damage.
Fungal infections are not always easy to diagnose as other conditions such as psoriasis, traumatic damage and nail varnish damage can give a similar appearance to the nail.
If the podiatrist is unsure as to the diagnosis, clippings will be taken for the patient to send them to the pathology lab. There the microbiologist will carry out tests to see if there is any fungus present.
If a positive result is obtained, then anti-fungal nail paints can be supplied by the podiatrist or in cases where the root of the nail has become infected oral medication prescribed by the patientís GP may be appropriate.
Fungal nail infections are very resistant to treatment . Early diagnosis is the key to success.
Thick Toe Nails
These are nails where there is no fungal infection present (see below under athleteís foot), and are given the name of onychauxic or gryphotic nails.
The nails are very thick and can also look discoloured. Often the patient presents with a history of trauma to the nail. These are very common in the elderly and can be very difficult to cut.
For the podiatrist, treatment presents no problem at all. The nail is thinned down easily and painlessly. Often the nails do not grow very quickly and some patients have been known only to need the nail cut once a year.
SKIN CONDIDTIONS: Hard skin / Corns / Sweaty feet / Cracked skin / Blistering /Athleteís foot / Verrucae
This is when the outer layer of the skin thickens in response to abnormal pressure or stress.
The most common cause is footwear, especially if a high heel is worn. The body tries to protect its self but unfortunately if it is allowed to build up too much it can become painful. However, hard skin should never be painful to treat by a competent podiatrist! Relief is usually instant.
Where there is the greatest pressure or stress on the skin a corn may form. These can be the common hard corn, or the multiple pin-headed type, the seed corn. In essence, these are inverted cones of hard skin. Like hard skin, there are no nerves in them and so removal is painless.
If the corn has been left for a long time and has become chronic, it is possible that blood vessels may have grown into the area and produced a vascular corn. These corns are far more sensitive to the patient.
All corns should be removed by a professional as soon as they are detected. They can often be permanently cured if the cause is removed. Self removal can give rise to vascular corns over a period of time and is not recommended. Vascular corns can be permanent.
This can be an embarrassment to many but can have an underlying cause that can be treated.
Adolescence, occupation and footwear are common causes. Hormonal changes, anxiety and pain in the feet can also be responsible. The latter may not be as obvious to the patient as it would be to the podiatrist. Sometimes an imbalance in the way the foot is functioning may be the cause.
The podiatrist will endeavour to ascertain the cause of the sweating , (known as hyperidrosis) and treat accordingly. We are not phased by sweaty and sometimes smelly feet, and so the patient should not be ashamed or embarrassed to see us.
Cracked skin is commonly a very dry skin and needs re-hydrating with a good foot cream usually one containing urea. It often occurs around the heel area as a result of the patientís weight, or open back shoes. If the cracks are allowed to become deep, the edges will not heel unless they are reduced by a podiatrist.
A moist form can occur in between the toes and is often associated with athleteís foot. Usually there is an intense irritation at the site. (See below)
The common form of blister occurs when the superficial layers of skin have an influx of fluid from damaged tissues. This damage is caused through a shearing / fiction stress to the skin. If the blister involves much deeper tissues there can be involvement of blood vessels causing a blood blister.
These blisters should not be burst as they remain sterile and should just be covered to prevent further damage. They will eventually resolve on their own. However, if there is a great deal of pain it may be necessary for the fluid to be released by a professional.
There are many dermatological conditions that can cause blistering such as excessive sweating, psoriasis, athleteís foot, allergies etc. Too many to name here.
Family tendencies can be present and is some cases this is known as bullous pemphigoid.
This is a term used to describe a group of common fungal infections of the skin. On the feet it is called tinea pedis.
Athleteís foot presents as itchy and sometimes blistery. If found in between the toes it usually looks white and peeling but it can also appear dry . Elsewhere on the feet red dots may be seen with inflamed patches.
This condition is very catching and must be treated with an athleteís foot preparation. If left untreated the fungus can invade the nails which is a very difficult infection to clear. (See above under nail conditions).
If the treatment doesnít appear to be working then a different preparation should be acquired. There are many different types of infecting fungi and it is usually trial and error to find the appropriate treatment. Once the fungus seems to be eradicated treatment should be continued for a further 2 weeks. This is so that the remaining dormant spores will be destroyed as well. Often people stop treatment too soon and when the environment is right such as warm, the fungus re-infects the skin. A good practice is also to treat the footwear with an anti-fungal powder.
This is a very common viral infection of the skin picked up by direct contact. This virus likes warm moist damp areas to live and the feet present the perfect environment to live in. Normally, it does no harm to the skin in the long term. Often pain arises through the hard skin that forms over the lesion or the altered pressure response to walking differently.
Verrucae can appear in many different forms from single lesions to multiple. Often black dots are seen but not always. These black dots are small patches of dried blood from broken capillaries within the verruca tissue. Side pressure, such as squeezing the skin may elicit a pricking sensation. This is usually a positive diagnosis for a verruca.
For the majority of people, from the initial contact with the virus the immune system sees it and destroys it. Unfortunately for some however, during the few months it takes the virus to change the appearance of the skin, the immune system does not destroy it and the patient is left with the verruca. Verrucae do not always have to be treated and will usually be destroyed by the bodyís natural defence system.
The decision whether or not to treat the verruca has to be the patientís choice. No one can predict exactly how long treatments will take, but what we will endeavour to do however, is to take a good patient history and advise the patient as to which treatment in our opinion may be the best for each individual. For some patients the best treatment is the conservative approach. This involves removal of the callus only, purely for comfort.
Options for treatment are varied and range from the application of regular acid treatment to the more unusual magic plasters and banana treatments. At our clinic, we offer patients a variety of chemical treatments, freezing with liquid nitrogen, as well as advising on conservative treatment. We constantly keep the patient informed of treatment progress and will discuss with the patient whether a change or combination treatment will speed up the treatment.
BIOMECHANICAL / SPORTS INJURIES
Biomechanics is the study of the body movements and of the forces acting on the musculoskeletal frame work. We apply our biomechanical knowledge to the feet when there appears to be an imbalance causing problems.
Not all podiatrists deal in biomechanics as it is a complex and challenging area of podiatry. If you suspect that your condition may be due to a biomechanical problem, it is advisable when booking to mention this to the receptionist. This way we can make sure that that the best possible care and treatment is given to the patient.
Biomechanical problems can occur at any age, in the athletic type and also in the partially immobile. It is not possible to go into a great deal of detail here as this would end up being a novel! However, the below are common problems we see every day in the clinic.
Heel Pain (Plantar Fasciitis) / Flat feet / High arched feet / Ankle Pain / Lower Leg Pain / Knee Pain / Hip Pain / Lower Back Pain / Sports Injuries
Heel Pain (Plantar Fasciitis or Heel Spur)
This is a condition that is becoming more and more common. The patient presents with a tender pain under the ball of the heel near the mid line of the body. Usually worse straight after rest. The pain lasts a few minutes and then returns later after activity. The pain can eventually progress towards the toes if left untreated. Here at the tender area of the heel, many of the structures under the foot attach into a bony prominence called the medial calcaneal tuberosity. Any condition causing the foot to stretch underneath such as increased body weight, leg length discrepancies (possibly caused through knee or hip surgery), sudden increase in exercise or Ďdropped archesí, can give rise to this condition.
It is essential that a good history is taken to ascertain the cause. Treatment will then be a combination of ice or heat therapies, stretching exercises, supports in shoes (orthotics) and sometimes anti-inflammatories. Treatment must be sort quickly if this condition is suspected. It is not easily treated and we often see patients in the chronic state.
If left untreated, steroid injections may be the suggested treatment. This can be carried out in the clinic quite easily and often gives immediate relief. However, the cause must be rectified otherwise the condition will reoccur.
The correct height of the arch has not been defined but it is important that the feet function as a good shock absorber with the ability to propel the person forwards without causing pain. Often a collapsed arch is incorrectly described as a flat foot, but technically is actually a pronated foot where it is rolling inwards. This can often be easily corrected with orthotics, (arch supports), exercises and good advice.
High Arched Feet
This foot type is usually inherited and can be a very unstable foot type. A true abnormally high arch is the condition known as pes cavus. Should this foot type give rise to pain we will try to stabilise the foot with insoles.
Ankle / Lower Leg / Knee / Hip / Lower Back Pain
All these conditions can arise from a bio-mechanical imbalance of the lower limbs, either occurring naturally over a long period of time, related to different activities or because of surgery. Natural causes may include arthritis or circulatory issues whilst surgery can cause leg length differences and compensation problems in muscles. There are just too many variables to mention here.
A good examination and history taking are key to ascertaining the cause.
These conditions vary from minor sprains to fractures. Too many to go into great detail here. Often the problem is of a bio-mechanical imbalance that has been discussed previously in this chapter or due to a change in exercise activity. Once again, it is essential to inform us at the time of booking that the condition is sport related.
A short list of more common conditions include stress fractures (causing pain in the metatarsals), neuromas (and trapped nerves), tight Achilles tendon, shin splints and all previously mentioned conditions on this site. Often treatment involves footwear advise, orthotics / insoles and/or exercises. We are fortunate enough to have physiotherapists on sight should we feel the need for referral.
ORTHOTICS AND INSOLES
It is worth mentioning here that we are able to manufacture our own orthotics and insoles thus keeping the cost to an absolute minimum. Theses devices may be custom made or bought off the shelf and personally adapted. It is not necessary to spend a fortune to correct these problems or wait a long time for the orthotics to be made.
WE HOPE THAT THIS INFORMATION HAS BEEN OF SOME USE
WE ARE A FRIENDLY PRACTICE THAT TRIES TO WORK WITH PATIENTíS LIFE STYLES AND PREFERENCES. OFTEN A COMPROMISE IS NECESSARY TO ACCOMMODATE FASHION SHOES
PLEASE FEEL FREE TO PHONE SHOULD YOU REQUIRE MORE INFORMATION REGARDING FOOT PROBLEMS
M & C Podiatry Ltd
†34b New Century Clinic, Laindon, Essex, SS15 6AG, Phone: (01268) 416603
18 The Foundry Business Park, Station Approach, Hockley. SS5 4TW, Phone: (01702) 200296
51 Lampits Hill, Corringham, SS17 9AA Phone: 01375 640900
M & C Pod Ltd.
"Sensitive to the needs of the nervous patient"