Common Foot Conditions

Verruca

What is a Verruca?

Verrucae are usually found on the bottom of the foot and is a small skin lesion usually around 1cm in diameter.

Usually associated with children, verrucae are also a common complaint amongst adults.

What causes it?

All verrucae are caused by the human papilloma virus which is common in all environments but does not readily attack the skin. Due to this though verrucae are commonly contracted in communal places such as swimming pools, showers and changing areas, therefore children are more at risk of contracting verrucae in school changing rooms and swimming pools.

If there is excessive moisture or excessive dryness of the skin this can lead to small cracks in the skin which allows the virus to enter.

What will happen if I leave it untreated?

Most of the time Verrucae will heal on their own if left alone however they can easily spread so if the verruca is touched or scratched a sufferer must wash their hands straight away or it can spread to other parts of the body.

What can help?

To avoid verrucae, try to avoid touching other people’s verrucae and that hands are washed if a verruca is touched. It is also best to avoid sharing towels, flannels, shoes, and socks with other people and to make sure that feet and hands are kept clean and dry.

Due to how the virus spreads it is best to avoid going barefoot in public places and communal areas.

Also, if contracted avoid scratching or picking at the verrucae this may spread the infection to other parts of the body.

What are the treatment options?

Verrucae can be treated in a relatively wide variety of methods

In terms of selecting the best treatment for verrucae there are three fundamental questions.

1. What is the verruca like?
2. What is the patient’s expectation?
3. What is the practitioner’s remit?

Verrucae come in all shapes and sizes and about half a dozen different viral subtypes.

The most important part of the equation, the patient. How much is it hurting? How much do they want rid of it? WHY do they want rid of it? Whats their tissue viability like? What, in fact, do they want?

What is the Practitioner’s remit? The options open to Foot Health Practitioner are different to those available to a pod surgeon.

So with that all said, in very broad strokes, all the treatments work about the same way, by triggering an immune response to the virus. Most do this by causing tissue damage to trigger inflamation. And generally, the more tissue damage you do, the better the chance of resolution.

This is not an exhaustive list but in general terms…

 

  • Do nothing. No risk, no cost, background chance the lesion will self resolve. A good option for painless lesions which don’t worry the patient.
  • Occlusion with tape. Minimal risk, minimal cost, minimal chance to resolve the lesion, excellent chance to keep it comfy. Good if the patient’s main concern is pain.
  • Home caustic use, (salacilic acid). Will make it more painful for the duration, circa 30 -40% chance of getting rid within 6 months or so.
  • More concentrated caustics used in clinic. Similar to 3 but with more control over how it is applied. May have a better success rate
  • Cryotherapy. Similar success rate to 3. Hurts a lot if its done well. The Practitioner controls the amount of damage.
  • Verrutop. Still new so data not really there yet but seems to be similar or slightly better than sal acid, but with fewer applications and less pain. Costs more and needs patient to keep coming back in. Circa 50% success rate (Manufacturer’s claim).
  • Needling. circa 60%-70% success rate with 3 treatments. Needs a local anesthetic and its a surgical proceedure, however it does not create an open wound as such.
  • Blunt dissection/curretage. Again, a surgical treatment with local anesthetic. If its a discrete lesion it can be scooped out. Like removing a corn this gives immediate relief once the wound heals, but like everything else here, it can still grow back if the immune response is not triggered.
  • Swift. New machine. Emits microwaves to cook the lesion. Hurts quite a bit but does not need local anesthetic. Success rate is reported to be similar to needling, but again its a new treatment so still waiting on the data. Likely to be expensive.
Ingrown Toenail

An ingrown toenail is an extremely painful condition. It occurs when the edge of a nail penetrates the surrounding tissues of the toe (usually the big toe) and causes swelling, inflammation and infection. Ingrown toenails are commonly caused by poorly fitting shoes, but they can also be caused by improper trimming or by trauma.

When an individual experiences an ingrown toenail, it is not uncommon for them to attempt to rectify the problem themselves to alleviate their discomfort. In the vast majority of cases this serves only to irritate the nail wall, cause infection and worsen the condition.

Painful nails can also occur without the nail penetrating the toe. Shoe pressure on the nail wall can result in callous (hard skin formation) in the nail groove. If untreated this can build up and cause inflammation and infection. With this condition many people believe they have an ingrown toenail and frequently dig down into the groove to cut the nail, which in turn causes an ingrown toenail. Below are some examples of typical ingrown toenails.

The treatment of ingrown toe nails is initially centred on conservative management. This means the practitioner removes the offending splinter of nail and the toe is dressed if necessary. Review appointments are made to ensure the nail does not penetrate the nail wall upon re-growth. Frequently ingrown toenails can be persistent and troublesome. In such cases nail surgery is recommended.

Nail surgery is the removal of a nail splinter, partial removal of a nail or the removal of the complete nail under local anaesthesia. One injection is given to each side of the toe. This numbs the toe and the splinter is removed. With partial or total nail avulsion a chemical may be employed to prevent further re-growth of the nail.

Reasons for Procedure

Nail surgery is most often performed for the following reasons:

  • To relieve pain
  • To relieve swelling (inflammation or infection)
  • To remove a deformed nail
  • To correct abnormal nail growth

How long will it take?

Less than 1 hour

Will it hurt?

Patients report no pain during the procedure once the anaesthetic has been given. There can be a little discomfort during the injection itself but this lasts for a very short period of time. The chemical utilised to prevent re-growth of the nail bed has analgesic properties, which in itself reduces post-operative discomfort.
Are there any complications to the procedure ie. Infection or bleeding?

Infection is always a concern but every step is taken to reduce the possibility of infection by the employment of aseptic techniques.

There is rarely any excessive swelling or bleeding following the procedure.

Outcome

Complete healing takes about four to eight weeks maximum but this does not interfere with most daily activities. If the entire nail is removed, the body generates hard skin to take its place. After the skin has covered the sensitive area, sporting activities can resume, shortly thereafter.

Many people suffer from painful nail conditions and as a consequence find that even with regular treatment the problem returns.

If you would like advice on a more permanent solution to painful nails, or if you have any other foot care concerns, why not consider contacting Considerate Foot Care?

Fungal Infections

A fungal infection of the nail is called Onychomycosis and is very often ‘caught’ from a skin infection called Tinea Pedis or Athletes Foot. They are both essentially the same infection caused by microscopic fungi which are invisible to the naked eye. Fungi love dark, damp places that are moist and warm which enables them to flourish.  They attach human skin and nails at times when the skin or nail is damaged.

This condition affects some 15% of the population of the U.K. and is more commonly found in men.

How are fungal infections caught?

Fungi are very contagious, and the easiest sources of infection are communal showers, swimming pools and most places where activity is done with bare feet.

What do they look like?

If fungi affect your skin it usually starts between the toes. Skin will become sore and inflamed and often (but not always) very itchy. Skin then becomes either moist and weeping or dry and flaky, both will reduce the skins natural defenses and cracks may appear allowing secondary bacterial infections to develop which may case extreme pain.

With a fungal infection in the nail, the nail will appear discoloured and may thicken, if allowed to develop the nail can become crumbly and dry in texture.

The infection does not usually resolve without treatment. It can be passed on very easily and the nails can become disfigured ultimately causing permanent destruction of the nail plate.

Treatment

Tinea Pedis (skin), respond well to topical anti-fungal creams, ointments, foot washes and soaks, applied to the skin.

Onychomycosis (nail) are rather more stubborn to respond to treatments, topical anti-fungal creams, foot washes and soaks are available also paints, powders and sprays but as the nail plate is difficult to penetrate success rates are dependent upon the right treatment regime and dedicated patient input in carrying out that regime.

Can they be painful?

Any skin infection can be painful if not treated as soon as it is noticed. Nail infections can be painful too if they are allowed to progress.

Prevention

As always – prevention is better than cure.

Good routine foot hygiene is the place to start.

  • Wash daily in warm soapy water.
  • Rinse well in clean water and dry especially between the toes.
  • Clean socks and hosiery every day that are not tight and allow you to ‘wiggle’ your toes to allow air to circulate.
  • Surgical spirit between the toes applied with a cotton bud and allowed to ‘air’ dry is a very good preventative
  • Wear breathable footwear made with natural materials
  • NEVER wear anyone else’s footwear.
  • Use your own towel.
  • Have your shoes disinfected by a Foot Care Professional as these can remain a source of re-infection
  • Wash all hosiery, socks, and bedding at 50 degrees or above.

Treatment

There are a host of treatments on the market available for fungal infections of the skin and nail. Make sure you have the right treatment for you by consulting a Foot Care Professional for advice and guidance.

Corns and Callus

When we put pressure and/or friction on our feet, the skin thickens to protect the skin surface. If this pressure or friction becomes intense a corn or callus can be formed.

What is a Corn?

Corns are one of the most common skin problems for our feet. They are most often caused by pressure from ill-fitting shoes. They are concentrated areas of hard skin and there are three types –

* Hard
* Soft
* Neurovascular

Hard Corn

Usually found on the tops of toes or the bottom of feet

Soft Corn

Whitish and rubbery in texture, found between toes where skin is moist from sweat is present or feet have not been dried properly.

Neurovascular Corn

Can be hard or soft, with the added painful element of having vascular and/or nerve tissue within the nucleus.

Treatment

Treatments vary depending on where they are situated. It is not advised to us corn plasters especially if you are elderly, diabetic or have problems reaching your feet, they contain an acid that can easily burn healthy skin and surrounding tissue, which could cause you more problems and issues with healing.

What is a Callus?

A callus is an area of hard skin caused by pressure or friction. It can appear anywhere on the foot where the skin rubs against the bone, shoes, or the ground.

Most are a symptom of another underlying problem such as ill-fitting or
inappropriate footwear, or a problem with the way you walk.

Treatment

Small calluses can be controlled by using a foot file regularly to reduce its thickness, coupled with regular use of a good moisturiser to help improve the skins elasticity. If they become large and painful or you are unable to give yourself a regular foot care routine treatment will vary depending where on the foot they are.

 

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