What causes fungal nails?

A number of fungi can cause fungal nail, the most common culprit is a dermatophyte called trichophyton rubrum. Podiatrists often do a nail culture test to see if a nail is fungal, and what kind of fungus it is.

Fungi thrive in warm, moist dark environments, therefore footwear – particularly trainers – provide the perfect breeding ground. The big toe nail is most commonly affected.

Who gets fungal nails?

Anyone can contract a fungal nail infection, however some people are more at risk of fungal nails than others, and these include:

Older people (over 55) and Children
People with diabetes ( twice as common)
People with sweaty feet
Athletes and people who frequent gyms and swimming pools
People who live with someone who has a fungal nail
People with athlete’s foot
People who have a nail that has been damaged
People with psoriasis
People who have a weakened immune system
People with peripheral vascular disease (poor circulation)

What are the signs and symptoms of fungal nails?

The signs of a fungal nail vary, but may include:

Thickened nails
Discoloured nails
Debris beneath the nail plate
Cracks in the nail
Types of fungal nails:

Benefits of podiatry for fungal nails

The Podiatrist can advise you on treatment, as well as provide information and advice on how to prevent the infection from either spreading or recurring. If nails are thickened your podiatrist can thin the nail/s making them less unsightly. Thinning the nail will also allow any topical antifungals to penetrate the nail; making treatment more effective.

What would podiatry for fungal nails involve?

Following assessment, this will include taking down a medical history as well as a history of the problem. This information along with examination of the affected nail/s and an assessment of the foot will enable the podiatrist to reach a diagnosis.

There are a number of treatments for fungal nails, this is dependent upon the extent of the infection and the individual patient.

It is important to remember that the treatment of fungal nail takes time and patience. This is because it takes a lot of time for new, uninfected nail to grow through. If the whole nail is infected, this can take up to one year.

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Verrucae are plantar warts that commonly occur on the soles of the feet or around the toe area. They are caused by the Human Papilloma Virus (HPV), which is 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 verrucae?

The HPV 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.

Who gets them?

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 them?

The most common appearance is that of a small cauliflower-type growth on the soles of your feet with tiny black dots. If it is painful when you pinch the area (like when you squeeze a spot), you are likely to have a verruca. They can grow to 1cm in diameter and may spread into a cluster of small warts. If you are unsure, seek advice from a podiatrist.

Are they serious?

Verrucae are harmless but can be uncomfortable and painful if they develop on a weight bearing part of the foot. In addition, hard skin (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.

What are the treatments?

In the first instance, avoid touching or scratching a verruca as it may spread into a cluster of warts. Instead, cover it up with a plaster. 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 that are spreading, you can self-treat using ointments and gels from your local pharmacist following the instructions carefully. Sometimes, merely by rubbing away the dry skin over a verruca 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. This 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.

How can I prevent them?

To avoid catching verrucae, keep your feet in a 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 or lotions, but avoid applying between the toes.

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

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

When should I see a podiatrist?

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

Source: The College of Podiatrists cop.org.uk

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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, and result in decreased social contact with others. But the condition is treatable.

There are more sweat glands per inch in our feet than anywhere else in the body. Their function is to keep the skin moist and 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.

Excessive sweating, also known as hyperhidrosis, has a lot to do with how the sweat glands in the feet 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.

What causes the problem?

Sweaty feet (along with palms and armpits and the face/scalp) tend 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 are 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 the condition?

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 every day but rotating what shoes you wear so they 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. In addition, detachable insoles (and medicated insoles that have a deodorising effect) are recommended as a lot of sweat is absorbed by insoles or the uppers of shoes.

In terms of footwear, well-fitting shoes made of leather, which allow your feet to breathe, are considered best.

What are the treatments?

For more serious cases where normal foot care is not effective and for more longer term conditions, your doctor may refer you for Iontophoresis (electrical stimulation) and Botulinum toxin injections (botox).

Source: The College of Podiatry cop.org.uk

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Osteoarthritis (OA) is often called the ‘wear and tear’ arthritis. It occurs when the cartilage of a joint (a thin layer of gristle that covers the end of the bones and allows them to glide over each other) becomes damaged. When the cartilage deteriorates, the bone underneath can thicken, causing pain, stiffness and swelling. The joints most affected are the knees, hips, hands and big toes.

In severe cases, the cartilage can deteriorate to the extent that the bones rub together, making it difficult to move the affected joint at all. Symptoms vary from person to person and some people may have OA without experiencing many symptoms at all.

What causes it?

As our joints are being used continuously through daily movement, wear and tear is inevitable, but for some people the natural repair process does not function properly and causes severe wear and tear (OA).

OA can affect any of the 33 joints in the feet but mostly affects those at the base of the big toes. This joint is more prone to wear and tear from the pressures of walking, especially if you over-pronate (i.e. roll your foot inwards excessively as you walk). Wear and tear at the ends of the bone causes the cartilage to erode and the bone ends may begin to join together. Eventually your big toe may become rigid (a condition known as hallux rigidus), which makes walking difficult, or your big toe may drift towards your other toes (hallux valgus), which can lead to bunions.

Is it serious?

The symptoms of OA tend to be mild in most cases and tend not to get worse over time; symptoms can vary and also come and go over time.

Who gets it?

OA is uncommon before the age of 40 and is more common in women than men. Though the exact cause of OA is unknown, it is probably due to the fact that as we age, we tend to put on weight and thereby put more pressure on our joints and our muscles become weaker and our body loses its ability to heal itself.

When OA occurs in younger people, it is usually because the joint cartilage has been damaged through injury (such as a sprain or fracture), a bacterial or viral infection or even through overuse of a particular joint as is common in farmers (hips), plumbers (knees) and footballers (knees and ankles). Arthritis Research UK estimates that 8 million people in the UK are affected by OA but only 1 million seek treatment.

How do I know I have it?

You may initially feel a toothache-type ache in the affected joint that gets worse when you’re active, wearing high heels or when it’s cold and damp. It may progress to the stage where your feet ache at night. In severe cases, the range of movement in the joint may fail to the extent that you can’t move it at all. If you are worried that you have OA you should see your GP or a podiatrist. The earlier you are diagnosed, the more effective any treatment will be

What can I do to ease the problem myself?

If you do have OA in your feet, there are many things you can do yourself to help ease the condition.

Footwear
Minimise the stress on joints by wearing well-cushioned shoes. Choose shoes with lace-up fastenings or an adjustable strap: they keep the heel in place and stop the toes being pushed to the front of the shoe. Your feet should keep their natural shape when in shoes. There should be a centimetre between the end of your longest toe and end of the shoe. They should also be roomy enough to accommodate any swelling so a wide, deep pair are best.

Exercise
Toes aren’t a part of the body we often think of exercising but by doing so and stretching regularly, you can help nourish the joint cartilage and strengthen the muscles and tendons around the joint.

It is recommended that you put your feet side by side (say while you are in the bath) and try to move your big toes towards each other and do this regularly three or four times a day. You should ideally also exercise your whole body to keep your joints flexible, your muscles strong and your bone and cartilage tissues healthy. Yoga is a great exercise for all your joints, including your toes. Swimming is also great because it doesn’t put any pressure on your joints.

What are the treatments?

Your GP may recommend painkillers or steroids to ease the pain. There are also creams and gels which can be absorbed into the bloodstream if rubbed on the affected joints when they are painful, such as after exercise or at the end of the day. Ideally, you should be seen by a team of rheumatologists, physiotherapists, occupational therapists and podiatrists.

When should I see a podiatrist?

Although there is no known cure for OA, there are many ways your podiatrist can help you ease the pressure on the affected joints and therefore reduce the pain and inconvenience.

Orthoses are special shoe inserts that help redistribute the pressure as you walk. They’ll help you walk in such a way that alleviates the pain in your joints.

Shoes

Your podiatrist can advise you on the best type of footwear to wear for your exact problem. If you develop hallux valgus (where you big toe drifts towards your second toe), you may be recommended a shoe with a stiff sole as this relieves pain by reducing the movement of the big toe. In some cases, a shoe with a slight heel raise may be more comfortable.

Strapping and padding

Your podiatrist may strap the feet for a short time to limit joint movement. They can also provide protective shields for your toes or padding to relieve pressure and friction.

Surgery

If your problem doesn’t improve with the above measures, you may be referred to a orthopaedic or podiatric surgeon who will evaluate the extent of your problem and see if you are suitable for:

Excisional arthroplasty (replacement of joint surfaces)
Interpositional arthroplasty (placing soft tissue, especially joint capsule, between the resected bone surfaces)
Osteotomy (decompresses and realigning the joint surfaces)
Joint replacement (used for irreversibly damaged joints)
Arthrodesis (where the bones are fused together)

However, surgery is only used as a last resort.

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.

Source: The College of Podiatry cop.org.uk

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An ingrowing toenail is where a piece of nail 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. 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 can also appear red and inflamed.

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.

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.

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.

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

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 be able to reach their toes!).

How do I know I have it?

The most common symptom is pain followed by 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.

Is it serious?

Not usually, unless you have an existing condition such as diabetes, poor circulation or a reduced immune system. However, if left untreated, infection could develop in the rest of the toe and foot and in very rare cases could get into the blood stream. The quicker you deal with it, the less painful the treatment.

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 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 may be prescribed to manage the infection as well as having the offending spike removed. To do that, your Podiatrist may need to do a wound swab to determine the type of infection you have and the best antibiotic to treat it.
For those particularly prone to ingrowing toenails from underlying problems such as poor gait, a 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 part of the nail is removed (including the root), leaving a permanently narrower nail. In some cases a total nail avulsion (TNA) may be performed, where the entire nail plate and root are removed. In either case, the chemical phenol is used to cauterise the nail and prevent it regrowing. This is over 95% successful. You will, however, have to go back to your podiatrist for a number of re-dressings.

How can 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 straight across 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 an ingrowing spikes of nail yourself.

Source: The College of Podiatry cop.org.uk

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The heel is a specialised part of the body designed to absorb the impact of your body weight when walking, running or undertaking any other form of physical exertion or weight-bearing exercise. When pain does develop, it can be very disabling, making every step a problem, which in turn affects your overall posture.

What causes the problem?

Heel pain is a common occurrence and in most cases the pain is caused by some form of mechanical injury caused by small repetitive injuries that occur at a rate faster than the body can heal them.

Heel pain can also be caused by lower back problems or inflammatory joint conditions.

The following types of heel pain are not exhaustive but may help you appreciate the complexity of heel pain and why specialist advice can be helpful.

Plantar fasciitis (or fasciopathy):

This is the most common caused by damage to the fascia ‘band’ (similar to a ligament) which connects the heel bone to the base of the toes. This condition can be caused in various ways including extensive running, walking or standing for long periods of time, especially when you have a sedentary lifestyle. In particular, a change of surface (e.g. road to track), poor shoe support, being overweight, overuse or sudden stretching of your sole, as well as a tight Achilles tendon, can lead to this condition.

Heel bursitis (subcalcaneal bursitis):

This is an inflammation of a bursa (a fluid-filled fibrous sac) under the heel bone where the pain is typically more in the centre of the heel than that experienced with plantar fasciitis and significantly worsens during the day. This condition can be caused following a fall from a height on to the heel.

Heel bumps:

These are firm bumps on the back of the heel, usually caused by excessive shoe rubbing in the heel area, or the thickening of the tissues associated with a tight Achilles tendon.

Tarsal tunnel syndrome:

This can feel like a burning or tingling sensation under the heel within the arch of the foot with occasional loss of sensation on the bottom of the foot. This is caused by compression of the tibial nerve as it passes the inside of the ankle. Tapping of the nerve just behind the ankle bone (known as Tinel’s test) will stimulate the symptoms of the condition.

Chronic inflammation of the heel pad:

This is caused by a heavy heel strike or sometimes a reduction in the thickness of the heel pad which can give rise to a dull ache in the heel which increases during the day.

Fracture:

Often caused following injuries such as falling from a height or landing on an uneven surface.

Sever’s disease (calcaneal apophysitis):

This painful condition affects young children, usually between the ages of 8 and 12, especially those who are physically active or undergoing a growth spurt. It results from inflammation of the Achilles tendon where it attaches to the heel.

Achilles tendonosis:

This condition occurs when the Achilles tendon is placed under more pressure than it can cope with and small tears develop along with inflammation and in some cases can lead to tendon rupture. These tears become a source of further injury, which can lead to swelling within the tendon, hence the name ‘tendonosis’ (sometimes referred to in error as ‘tendonitis’).

Who gets it?

Heel pain can affect everyone, whatever your age, but those more commonly affected include those in middle age (over 40s age group), those who are overweight or stand for long periods of time, as well as athletes.

How do I know I have it?

With plantar fasciitis, there are often no visible features on the heel but deep localised painful spots found in or around the middle of the sole of the heel, and pain is usually worse on standing after long periods of rest, particularly first thing in the morning.

With bursitis, pain can be felt at the back of the heel when the ankle joint is moved and there may be a swelling on both sides of the Achilles tendon. Or you may feel pain deep inside the heel when it makes contact with the ground.

Is it serious?

Heel pain is a common condition and in most cases will diminish following some routine self-care measures. If the pain persists longer than three weeks, it is best to seek professional advice from a podiatrist, as there are many types of heel pain, each with their own different causes and separate forms of treatment.

What are the treatments?

If you experience heel pain, some simple self-care measures include:

Avoid wearing ill-fitting or uncomfortable shoes
Wear shoes with good heel cushioning and effective arch support
Minimise walking or exercising on hard ground
Rest regularly and try not to walk or run too fast
Wear a raised heel (no more than 6-10 mm higher than normal)
Lose weight if you are overweight

More specialist treatments include:

Plantar fasciitis (or fasciopathy):

Treatment can take many forms, from resting your foot as much as possible, stretching exercises and deep-heat therapy to steroid injections and even medication or surgery to release the tight tissue ‘band’. In the acute stage, use ice compresses for 10 minutes twice a day, and ibuprofen (always check with your GP or pharmacist before taking any new medication). In some cases, padding and strapping is applied to alter the direction of stretch of the ligament to alleviate symptoms in the short term. However, for the long term, special insoles (orthoses) may be prescribed to help the feet to function more effectively and help to make any possible recurrence less likely.

Heel bursitis (calcaneal bursitis):

Medication and ultrasound can give relief but for the long term, a shoe insert may be necessary. In addition, attention to the cause of any rubbing and appropriate padding and strapping will allow inflammation to settle.

Heel bumps:

Adjustments to footwear is usually enough to make them comfortable, although a leather heel counter and wearing boots may help. In more serious, recurring cases, surgery may be necessary.

Tarsal tunnel syndrome:

Special shoe inserts can reduce the pressures on the nerve and may be appropriate for certain foot types whereas, on other occasions, local injections of medication to the area where the tibial nerve is inflamed may be necessary.

Chronic inflammation of the heel pad:

A soft heel cushion can help this condition.

Fracture:

If this is suspected, an X-ray is required to confirm final diagnosis and to determine the extent of the injury and a follow-on treatment plan.

Sever’s disease (calcaneal apophysitis):

This condition is temporary and self-limiting but can be painful at the time. Rest and stretching exercises may help.

Achilles tendonosis:

Treatment involves special exercises that strengthen the tendon and increasing the height of the heel with an insole on a temporary basis.

Source: The College of Podiatry cop.org.uk

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What is gout and what causes it?

Gout is the result of an imbalance of uric acid in the body and manifests via a build-up of uric acid in the blood. Small crystals may form, which collect in the joint causing irritation and inflammation, and which can be very painful and severe.

Is it serious?

Apart from the severe pain that gout causes, most other effects of gout are uncommon but it can include kidney damage via crystals forming to create kidney stones which are notorious for being extremely painful to pass.

Who gets it?

1 in 200 people are affected by gout and more men than women are affected. It tends to appear in middle age but can run in families also.

How do I know I have it?

The main symptom of gout is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen. Usually only one of the big toes is affected. The pain lasts for a few hours and usually subsides then doesn’t return for a few months.

How do I prevent it?

You can reduce your chances of having attacks by leading a healthy lifestyle by:

Maintaining a healthy weight
Eating a healthy diet including what you drink (i.e. avoiding too much alcohol or fizzy drinks)
Making sure there is plenty of Vitamin C in your diet.

What are the treatments?

Gout can be controlled and regulated with anti-inflammatory drugs, which your GP will be able to prescribe, and these will alleviate the attack over 24 hours or so. An immediate measure is to levitate your leg to help reduce swelling along with the application of ice or cooling lotions while waiting for your medication to take effect.

Your Podiatrist will also be able to help alleviate issues by adapting your existing footwear with orthoses or other appliances which fit easily into your shoes and help redistribute pressure away from the affected parts.

Your podiatrist may also advise you on the correct type of shoes to wear and where to obtain them. He or she can also provide protective shields for your toes or padding to relieve pressure and reduce friction. Any secondary problems like ulcers or corns can also be treated. They can also refer you to a specialist for more serious cases.

Source: The College of Podiatry cop.org.uk

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When we walk or stand, our body weight is carried first on the heel and then on the ball of the foot, where the skin is thicker to withstand the pressure. When this pressure becomes excessive, some areas of skin thicken in the form of corns and callus, as a protective response to the body’s reaction to the friction of skin rubbing against a bone, shoe or the ground.

Callus (or callosity) is an extended area of thickened, hard skin on the soles of the feet. It is usually symptomatic of an underlying problem such as a bony deformity, a particular style of walking or inappropriate footwear. Some people have a natural tendency to form callus because of their skin type. Elderly people have less fatty tissue in their skin and this can lead to callus forming on the ball of the foot.

Corns are caused by pressure or friction over bony areas, such as a joint, and they have a central core which may cause pain if it presses on a nerve. There are five different types of corns, the most common of which are ‘hard’ and ‘soft’ corns:

Hard corns – these are the most common and appear as a small area of concentrated hard skin up to the size of a small pea usually within a wider area of thickened skin or callus. This may be a symptom of the feet or toes not functioning properly.

Soft corns – these develop in a similar way to hard corns but they are whitish and rubbery in texture and appear between toes where the skin is moist from sweat or from inadequate drying.

Seed corns – these are tiny corns that tend to occur either singly or in clusters on the bottom of the foot and are usually painless.

Vascular/neurovascular corns – these are corns that have both nerve fibres and blood vessels in them. They can be very painful and can bleed profusely if cut.

Fibrous corns – these arise when corns have been present for a long time and are more firmly attached to the deeper tissues than any other type of corn. They may also be painful.

What are the treatments?

It is advised not to cut corns yourself, especially if you are elderly or have diabetes. A podiatrist will be able to reduce the bulk of the corn and apply astringents to cut down on sweat retention between the toes in soft corns.

Always consult a podiatrist for advice before using commercially available products. In particular, be careful about using corn plasters, as they contain acids than can burn the healthy skin around the corn, which can lead to serious problems such as infection. Home remedies, like lamb’s wool around toes, are potentially dangerous. People with diabetes, poor circulation or a reduced immune system should not self-treat, but instead seek advice from a podiatrist.

A podiatrist will be able to remove corns painlessly, apply padding or insoles to relieve pressure or fit corrective appliances for long-term relief. For callus, your podiatrist will also be able to remove hard skin, relieve pain and redistribute pressure with soft padding or corrective appliances that fit easily into your shoes.

Elderly people can benefit from padding to the ball of the foot, to compensate for any loss of natural padding. Emollient creams delay callus building up and help improve the skin’s natural elasticity. Your podiatrist will be able to advise you on the best skin preparations for your needs.

How can I prevent them?

If you have corns or callus, you can treat them yourself occasionally by gently rubbing with a pumice stone or a foot file when you are in the bath and apply moisturising cream to help soften thickened skin a little at a time or relieve pressure between the toes with a foam wedge. Do not self-treat if you have diabetes, poor circulation on a reduced immune system, instead seek help from a podiatrist.

You may also need to wear more supportive or wider fitting footwear to reduce pressure on the affected area.

Source: The College of Podiatry cop.org.uk

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Chilblains (also called pernio) are small itchy, red (and sometimes purple) swellings on the skin, which can become increasingly painful, can swell and then dry out leaving cracks in the skin that expose the foot to the risk of infection. They occur on the toes (particularly the smaller ones), fingers, the face (especially the nose) and the lobes of the ears. They can also occur on areas of the feet exposed to pressure, for instance on a bunion or where the second toe is squeezed by tight shoes. They can also lead to blisters and break down to become a small ulcer prone to infection.

What causes them?

Chilblains develop when the tiny blood vessels under the skin constrict under cold conditions reducing the flow of blood until the area warms up again and causes some leakage of fluid into the surrounding tissue. They are caused by the skin’s abnormal reaction to cold but not everyone develops them as this depends to a large extent on the efficiency of your circulation. People with poor circulation and other health problems involving their blood vessels are likely to be more prone to developing chilblains. In addition, damp or draughty conditions, dietary factors and hormonal imbalance can also be contributory factors. It is thought that rapid temperature changes from cold to hot can also be a cause. If the skin is chilled and is then followed by too rapid warming next to a fire or through using a hot water bottle, chilblains may result.

Who gets them?

Although chilblains are common, the condition mainly affects young adults working outdoors in cold places or people who do not wear socks or tights in winter. Elderly people, whose circulation is less efficient than it used to be, people who don’t take enough exercise and those suffering from anaemia are also susceptible.

How do I know I have them?

During the onset of winter, susceptible people will experience burning and itching on their hands and feet. Upon entering a warm room, the itching and burning is intensified. There may also be some swelling or redness and in extreme cases the surface of the skin may break and sores (ulcers) may develop.

What are the treatments?

If you have developed chilblains do not scratch them, instead use soothing lotions such as witch hazel and calamine on them to take away most of the discomfort.

If the chilblain has ulcerated, apply an antiseptic dressing. If you have diabetes or are undergoing medical treatment, do have the ulcer assessed by your GP or podiatrist.

If the chilblains have not broken, you can paint them with a mixture of friar’s balsam and a weak solution of iodine, which your pharmacist may make up for you or an over-the-counter preparation. At night, rub some lanolin ointment well into the feet to help retain the heat.

How can I prevent them?

The best way to prevent chilblains is to keep your legs, feet and body warm, especially if your circulation is poor and your mobility is limited.

The whole body, rather than just the feet, needs to be kept warm. Trousers, long boots, tights, leg warmers, long socks and gloves will also help.

Source: The College of Podiatry cop.org.uk

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A bunion, also known as ‘hallux valgus’, is a deformity of the big toe in which the big toe excessively angles towards the second toe and leads to a bony lump on the side of the foot. This can also form a large sac of fluid, known as a bursa, which can then become inflamed and sore.

What causes them?

They are most often caused by a defective mechanical structure of the foot, which is genetic, and these certain foot types make a person prone to development of a bunion. Poorly fitting footwear tends to aggravate the problem as tight or narrow footwear can squeeze the forefoot, crowding the toes together and exacerbate the underlying condition, causing pain and deformity of the joint.

Bunions can also be caused by the big toe pushing over on to the second, causing crossover of the toes, which makes it difficult to walk due to pressure on the toes from footwear. Once the big toe leans toward the second toe, the tendons no longer pull the toe in a straight line, so the problem tends to get progressively worse. This condition can also lead to corns and calluses developing.

Bunions can also be caused by age, arthritis or playing sport.

Who gets them?

Although anyone can get a bunion, they tend to be more common in women, possibly due to some of the more restrictive footwear typically worn (more than 15% of women in the UK suffer from bunions). Women also tend to have looser ligaments. If your parents or grandparents have them, you may also be more prone to developing them.

Are they serious?

Some people have large bunions that cause no pain but do cause difficulties with footwear, while others have relatively small bunions that can be very painful. Although some treatments can ease the pain of bunions, only surgery can correct the defect.

In some cases, pressure from the big toe joint can lead to a deformity in the joint of the second toe, pushing it toward the third toe and so on. However, just because you have a bunion, does not mean you’ll get a bursa as well.

What are the treatments?

Your podiatrist may recommend the following:

Exercises
Orthoses (special devices inserted into shoes)
Shoe alterations or night splints which hold toes straight during sleep (helps to slow the progression of bunions in children)

These are all conservative measures and, although they may help relieve symptoms, there is no evidence they can correct the underlying deformity. Your podiatrist will be able to identify any significant deformity and/or defect and may refer you for surgery, which can involve a combination of removing, realigning and pinning of the bone.

Once referred, your orthopaedic or podiatric surgeon will evaluate the extent of the deformity. They can remove the bunion and realign the toe joint in a common operation known as a first metatarsal osteotomy (‘bunionectomy’). However, there are more than 130 different types of operation that fall under this title, so each individual surgery is different.

The aim of surgery is to address the underlying deformity to prevent recurrence. As with all surgery, there are risks and complications, so it is not usually advised unless your bunions are causing pain – or are starting to deform your other toes.

How can I prevent them?

Wearing sensible shoes that fit well is a good preventative measure. If you notice a bump developing where your big toe joins the foot, it may be time to switch your footwear. Try to opt for wider shoes that provide your toes with room to move and keep your heel height to no more than 4cm for maximum comfort. The following also serves as a useful guide:

Wear backless, high-heeled shoes in moderation. Backless shoes force your toes to claw as you walk, straining the muscles if worn over a long period.
Vary your heel heights from day to day, one day wearing low heels and the next day slightly higher heels.
If you want to wear a heel every day, keep heel heights to 4cm or less.
Wearing a shoe with a strap or lace over the instep holds the foot secure and helps stop your foot sliding forward.
Calf stretches to counteract the shortening of the calf can help to keep feet supple.

Source: The College of Podiatry cop.org.uk

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