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Ingrowing Toenail

Conditions We Treat

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What is it?

An ingrowing toenail is one that pierces the flesh of the toe. It can feel as if you have a splinter, be extremely painful and inflamed or infected. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect the other toes too. Whereas a nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin, isn't an ingrowing toenail but can feel very painful and also appear red and inflamed as well.

 

What causes it?

There are many genetic factors that can make you prone to ingrowing toenails including your posture (the way you stand), your gait (the way you walk) and any foot deformity such as a bunion, hammer toes or excessive pronation of the feet (when your foot rolls inward excessively). Your nails may also have a natural tendency to splay or curl out instead of growing straight, encouraging your nail to grow outwards or inwards into the flesh.

 

Tight footwear, hosiery and socks can also push your toe flesh onto the nail so that it pierces the skin. Also, if you sweat excessively or don’t rotate your footwear, this makes the skin moist and weak so that it is easily penetrated by the nail. If you have brittle nails with sharp edges or are in the habit of breaking off bits of nail that are sticking out, you are also more likely to get an ingrowing toenail. In addition, the wearing of support hose that is ill-fitting and squeezes the toes or likewise, the wearing of shoes with tight toe boxes.

 

However, one of the most common causes is not cutting your toenails properly such as cutting nails too low in order to relieve the pressure and discomfort of an involuted nail.

Less common is a fungal infection or in some cases particular types of medication, eg. isotretinoin.

 

Is it serious?

If left untreated, the infection can spread to the rest of the toe and foot and could lead to surgery. The quicker you treat it, the less painful the treatment.

Who gets it?

Active, sporty people are particularly prone, because they sweat more. Younger people are more likely to get it (as they pick their nails more, compared to older people who may not reach their toes!).

 

How do I know I have it?

The most common symptom is pain followed by some form of inflammation in the surrounding nail area.

However, not everyone identifies an ingrowing toenail correctly.  Sometimes, they have a curly nail which has a lot of debris (dirt or fluff) underneath it or a corn or callus down the side of the nail, which can be nearly as painful. However, if it’s a corn, the pain tends to be throbbing as opposed to the sharp pain you get with an ingrowing toenail. If this is the case, your podiatrist will remove the debris, and if necessary, thin the nail.

 

How do I prevent it?

Firstly, learn to cut your nails properly. Nail cutters aren’t a good idea because the curved cutting edge can cut the flesh and nail scissors can slip. It’s best to use nail nippers (available from chemists) because they have a smaller cutting blade but a longer handle. Cut your nails following the shape of the toe and don’t cut too low at the edge or down the side. The corner of the nail should be visible above the skin. Also, cut them after a bath or shower when the nail is much softer.

 

Good hygiene can go a long way to preventing ingrowing toenails. Avoid moist, soggy feet by letting rotating your footwear so each pair has a chance to dry out thoroughly. Avoid man-made materials (synthetics) and choose socks and shoes of natural fibre and which fit properly. Keep your feet clean and dry and in the summer and wear open-toed sandals to let air get to your toes as much as possible.

 

If you have diabetes, are taking steroids or are on anti-coagulants, don’t attempt to cut your nails or remove the ingrowing spike of nail yourself.

 

When should I see a podiatrist about it?

Visit a podiatrist if you experience any:

Persistent pain in your toe from the ingrowing nail

Symptoms of infection, especially if you have Diabetes or a poor immune system

Condition which affects the nerves and/or feeling in your foot.

 

If you experience any foot care issues which do not resolve themselves naturally or through routine foot care within three weeks, it is recommended to seek the help of a healthcare professional, always ensure that any practitioners you visit are registered with the Health Professionals Council (HCPC) and describe themselves as a podiatrist (or chiropodist).

 

What are the treatments?

Before you are seen by a podiatrist, you can relieve the discomfort by bathing your foot in a salty footbath which helps to prevent infection and reduces inflammation. Then apply a clean sterile dressing, especially if you have a discharge and rest your foot as much as possible.

How a podiatrist will treat you will depend largely on the severity of your condition:

 

•For the most basic painful and irritable ingrowing toenail, the offending spike of nail will be removed and covered with an antiseptic dressing.

•For toes too painful to touch, a local anaesthetic will be injected before removing the offending portion of nail.

•For involuted nails, part of the nail that is curling into the flesh is removed and then the edges of the nail are filed to a smooth surface.

•For any bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, antibiotics will be prescribed to beat the infection as well as having the offending spike removed.

For those particularly prone to ingrowing toenails from underlying problems such as poor gait, partial nail avulsion (PNA) may be recommended along with finding a more permanent solution to the underlying condition. This procedure is done under a local anaesthetic where 8-10% of the nail is removed (including the root) so that the nail permanently becomes slightly narrower. The chemical phenol cauterises the nail and prevents it regrowing in the corners. This is over 95% successful. You will, however, have to go back to your podiatrist for a number of re-dressings. After surgery, the overall appearance of the nail looks normal – to the extent that some people even forget which nail they’ve had done!

 

Verrucae

What is it?

Are plantar warts that occur on the soles of the feet or around the toe area.  They are caused by the Human Papilloma Virus (HPV) which is highly contagious through direct person to person contact.  There are various forms of HPV which all relate to various parts of the human body.

 

What causes the problem?

The virus is thought to thrive in moist, damp environments such as swimming pools, changing room floors and communal shower areas.  It is possible to contract verrucae simply by walking across the same floor area as someone with a verruca, especially if you have any small or invisible cuts or abrasions that make it easier for the virus to penetrate.

 

Is it serious?

Verrucae are harmless but can be uncomfortable and painful if they develop on a weight bearing part of the foot.  In addition, callus can form over the top of the verruca increasing the discomfort in this area. There are also some strains of the virus that spread very quickly and can look unsightly.

 

Who gets it?

Verrucae are most commonly seen in children, teenagers and young adults, largely those who use communal changing rooms. It is possible to develop an immunity against the virus over time but most people remain susceptible, although some more than others.

 

How do I know I have it?

The most common appearance is that of a small cauliflower type growth on the soles of your feet with tiny black dots. If when you pinch the area (like when you squeeze a spot) it is painful, you are likely to have a verruca.  They can grow to half an inch in diameter and may spread into a cluster of small warts.  If you are unsure, seek advice from your local pharmacist or visit a podiatrist.

 

How do I prevent it?

To avoid catching verrucae, keep your feel in a regular healthy condition. Always dry them thoroughly after washing and if your feet are sweaty, treat them with surgical spirit; if they are dry, moisturise them with suitable creams and lotions.

Other tips include wearing flip-flops in communal areas, not sharing towels, shoes and socks, and treating conditions such as Athlete’s Foot with specialist treatment from a pharmacist.

If you do have a verruca and want to go swimming, special verrucae socks should be worn to avoid passing on the virus and can also be worn generally as a preventative measure

 

What are the treatments?

In the first instance, avoid touching or scratching it as it may spread into a cluster of warts.  Instead, cover it up with a plaster and this may cure it.  In many cases, evidence suggests that verrucae will disappear of their own accord within six months for children but longer for adults (up to two years). This is because the body’s immune system recognises the presence of the virus and fights the infection naturally but it can take many months for this to happen. If it is painless, no treatment may be required as some treatments can be painful especially for children and can cause side-effects.

For painful and/or unsightly verrucae or ones which are spreading, you can self-treat using ointments and gels from your local pharmacist following the instructions carefully.  Evidence suggests the most effective ones contain salicylic acid which when applied to the wart, helps to disintegrate the viral cells.  Sometimes, merely by rubbing away the dry skin over a verrucae and applying a plaster helps to stimulate the body’s immune system to fight the infection.  However, if your verruca becomes unusually painful or the surrounding skin area goes red, stop treatment immediately and see a podiatrist.  This is because if the healthy tissue around a verruca is damaged, you could hamper further treatment

Treatments provided by a podiatrist involve an assessment of your general well-being and foot health before deciding on a treatment plan.  These may include:

 

* Acid based treatments which are stronger than regular ‘over the counter’ (OTC) treatments        from your local pharmacy

* Cryotherapy which involves freezing the verruca with liquid nitrogen or nitrous oxide gas.

* Electrosurgery which requires a local anaesthetic to be given

* Excisional surgery which is similar to the above

* Laser surgery, particularly for larger areas of verrucae

 

When should I see a podiatrist about it?

If you are worried about your verrucae and/or self-treatment is not working and/or the verrucae appears to be getting larger or more painful, you should seek the help of a HCPC registered podiatrist.  Additionally, if you have diabetes, poor circulation, are pregnant or any other condition affecting your feet (or your immune system), it is important never to treat verrucae yourself and visit a podiatrist instead.

 

 

 

Rheumatoid Arthritis

 

What is it? / How do I know I have it?

Rheumatoid arthritis (RA) is a condition that causes inflammation in many joints of the body which particularly affects the hands, feet, wrists, ankles and knees – and tends to occur symmetrically.  For example, if your right big toe is swollen and painful, chances are your left big toe will be too. In addition, as well as joint pain and stiffness, symptoms include muscle aches, anaemia (a low blood count leaving you feeling tired), and fever. The stiffness tends to be worse in the morning and after rest.

 

What causes the problem?

Unlike osteo-arthritis, which is caused by wear and tear, RA is a chronic inflammatory disease where a faulty immune system attacks the tissue that lines and cushions the joints, leaving them swollen, painful and stiff. RA tends to affect the smaller joints such as the fingers and toes first, so feet are often one of the first places to be affected. Symptoms usually strike the toes first and may then affect the back of the feet and the ankles. The joints may enlarge and even freeze in one position so they can’t extend fully.

Front of the foot

The metatarsal-phalangeal joints are often affected (where the long bones of the feet meets the toes) and can result in hallux valgus (a condition in which the big toe is angled excessively towards the second toe) and hammer toe deformities (where the toes curl up in a claw-like shape). Each of these deformities can cause further problems, for example, if you have hammer toes, you’ll be more likely to develop corns on the tops of your toes.

Midfoot

If the joints in the middle of the foot are affected, the arch can collapse leading to a flatfoot deformity and spreading of the forefoot (where the front section of the foot becomes wider).  The fatty pads on the balls of the feet may slip forward, causing pain on the balls of the feet and backs of the toes. If this happens, it can feel as if you are walking on stones.

Back of the foot

If the joint where the heel bone meets the ankle (the joint that lets you rotate your ankle) is affected, it can lead to a condition known as valgus hindfoot (where the heel bends outwards), making it difficult to walk.

 

Is it serious?

The severity of the symptoms vary from person to person.  According to Arthritis Research UK, about 1 in 20 people will have RA that becomes progressively worse leading to severe damage in in many joints while around 1 in 5 will have mild RA that causes few problems beyond a little pain and stiffness.

Any kind of foot deformity will cause an uneven distribution of pressure as you walk, making you more likely to develop corns, callus and ulcers.

You may also get rheumatoid nodules – fleshy bumps that usually occur below the elbows but can appear on the hands and feet too. They may form over bony areas such as the heels and occur in 30% to 40% of people with rheumatoid arthritis.

 

Who gets it?

Women are much more prone than men to developing RA, although anyone can contract the disease.  It also tends to affect people over the age of 40.

 

How do I prevent it?

You can help yourself by understanding as much as possible about your disease and treatment.  The best starting point is the website for the charity, Arthritis Research UK, which has numerous downloadable leaflets on all aspects of arthritis.

There could be many other causes of your joint pain but if it is arthritis, the sooner you are diagnosed the more effective treatment will be.  According to Arthritis Research UK, many rheumatology departments have Early Arthritis Clinics which your GP can refer you to.

 

What are the treatments?

Your doctor can make a clinical diagnosis using blood tests (which may show changes in the blood caused by inflammation) and X-rays (which can show up damaged joints).  It is likely your feet will be x-rayed because the changes caused by RA often appear in the feet before they appear in other joints.

Your GP will also decide the most appropriate treatment for you.  What treatment you’ll need depends on how advanced your RA is.  Drugs available include analgesics, non-steroidal anti-inflammatory drugs (NSAIDS) which reduce pain and swelling and disease-modifying anti-rheumatic drugs (DMARDS) which slow down the effects of the disease on the joints. If your arthritis is advanced, you may be prescribed corticosteroids.  It may take a while to find the drug that’s right for you but it’s worth persevering.

Specialist teams of rheumatologists, podiatrists, physiotherapists and occupational therapists, along with specialist nurses, will provide the most effective care and treatment for arthritic patients, especially those with rheumatoid arthritis.

 

When should I see a podiatrist about it?

There are many things a podiatrist can do to make walking less painful.

Orthoses

These are a special type of insole that can be fitted into your shoes.  They will help you walk in such a way to minimise the pressure on your affected joints.

Shoes

As well as a moulded insole, your podiatrist will help you find shoes that are roomy enough to accommodate your foot – and orthoses – without adding unnecessary pressure.  If your toes are beginning to stiffen or curl, for example, it’s important for you to wear a shoe with an extra deep toe box.  Your podiatrist may make a plaster of Paris copy of your foot, so a shoe can be tailored to your exact foot shape.

Protective shields

They can also provide protective shields for your toes or padding to relieve pressure and reduce friction.

Surgery

Surgery can correct any bunions and hammertoes caused by RA.  If your joint cartilage has been completely destroyed and the joints in your foot have been dislocated to the extent that it’s extremely painful to walk, they can be fused together (a process known as arthrodesis).  This involves removing the joint cartilage (the substance that allows the bones to glide over each other).  The bones are then held together with screws, plates or a rod.  The bones eventually merge into one solid bone.  Although this results in a loss of movement in that particular joint, it can reduce pain.

Any secondary problems such as ulcers and corns that have been caused by foot deformities can also be treated.

 

Sweaty Feet

 

What is it?

Most of us have suffered from foot perspiration and odour from time to time, yet for some people, sweaty feet (along with sweaty palms and armpits) are a persistent problem which can be embarrassing and uncomfortable.  For some people, this can affect their day-to-day life considerably resulting in decreased social contact with others but the condition is treatable.

Sweaty feet is a complaint known as Hyperhidrosis (or excessive sweating) and has a lot to do with how the sweat glands in this part of the body work. With 250,000 sweat glands, feet do tend to sweat more than other parts of the body but with a daily hygiene routine, few people should suffer from the embarrassment that it may cause.

There are more sweat glands per inch in our feet than anywhere else in the body and their function is to keep the skin moist and therefore supple and regulate temperature when the weather is hot, if you have an unnaturally high temperature or while exercising.  They secrete all the time, not just in response to heat or exercise, like elsewhere in the body.

 

What causes the problem?

Sweaty feet (along with palms and armpits and the face/scalp) tends to be symmetrical.  The exact cause is unknown but due mainly to overactive sweat glands.  In some cases, the cause can be genetic.

Possible other causes include stress on the foot sometimes caused by a structural problem or because the foot is under strain or tired, for example, when you have been standing on your feet all day.

 

Is it serious?

Although hot weather can make matters worse, sweaty feet is both a summer and a winter problem as well as an inherited condition. It also tends to be a long-term condition which may require treatment over a sustained period of time.

In some cases, sweaty feet can lead to athlete’s foot or blisters.

 

Who gets it?

In adolescents and people generally under 25, sweaty feet is probably caused by overactive sweat glands triggered by changing hormone levels in the body.  As the sweat glands on the soles of the feet (and palms of the hand) respond mostly to emotions, both mental and emotional stress is a common cause.

How do I know I have it?

An added problem that often accompanies sweaty feet and signifies its presence is foot odour caused by bacteria on the skin breaking down the sweat and releasing an offensive smell.

How do I prevent it?

Following a simple daily foot hygiene routine is usually effective in dealing with sweaty feet. This may include washing your feet with anti-bacterial soap, applying cream and/or using an absorbent foot powder and not wearing the same footwear everyday but rotating what you wear so shoes have a chance to dry out.

Wearing socks is also considered essential especially those that absorb moisture like wool, cotton or a wool/cotton mixture often helps. In addition, detachable insoles (and medicated insoles which have a deodorising effect) are recommended as a lot of sweat is absorbed by insoles or the uppers of shoes.

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