Skin Conditions

Corns (Helloma Durum)

A corn is a small concentrated area of hard skin usually conical in shape which presses on the underlying nerve endings and can cause severe pain.

They are caused by pressure. They can be found anywhere on the foot particularly where the joints are prominent such as hammer toes.

Pressure may also be increased by the shape of the foot, various activities or occupations that require long hours of standing , inappropriate footwear and poor foot function. Over the counter remedies, usually in the form of corn plasters, come in two varieties: Foam rings which try to reduce the pressure on the corn. Medicated corn plasters which often contain an acid which aims to soften and dissolve the corn. There is a risk with this type that the liquid may dissolve healthy skin if not applied precisely. This may not only be painful but in the case of diabetics and those with poor circulation, very dangerous. It is very important not to leave corns unchecked if they are neglected they may become inflamed and in severe cases ulcerated. A Foot Health Practitioner can remove corns using a scalpel which is a painless procedure.

 

Callus

A callus is a larger area of hard skin but has no central nucleus like a corn. If calluses become too thick they often produce an unpleasant burning sensation particularly if on the ball or heels of the feet. They are caused by pressure and friction which may be aggravated from ill fitting footwear, foot shape, occupation and bio-mechanical problems within the feet.

Treatment is painless removal of excessive callus using a scalpel and providing instant relief.

 

Athletes Foot (Tinea Pedis)

Tinea Pedis is a fungal infection that usually starts on the skin and sometimes spreads to the toe nails. It can manifest in a number of different ways depending on the type of fungi that is present on the skin.

It commonly appears between the toes and the skin looks white and soggy usually where there is excessive moisture. Sometimes the skin will split and will become itchy and smelly.

Other areas of the feet such as the soles may become affected by different types of fungi appearing as blisters or flaky dry skin.

It is caught in damp environments such as gyms changing rooms and shower floors.

Treatment should aim to control moisture and perspiration whilst also treating the infection with the appropriate drugs and topical remedies.

 

Chilblains

Chilblains are a seasonal vasospastic condition. They often appear as small sore inflamed itchy red patches on the feet and hands and are frequently mistaken for blisters. They occur more frequently in the winter months because of our cold and damp climate. This causes the peripheral arterioles to constrict temporarily restricting blood flow into various parts of the tissues and skin creating sore areas. Abrupt changes in temperatures often aggravate chilblains and they tend to appear after cold feet have warmed up.

 

Anihidrosis (Dry Feet)

Anihidrosis is a term used to describe dry skin on the feet. It is important to distinguish ordinary callus from anihidrosis. Calluses generally develop on weight bearing areas or prominent joints on the feet and are caused by pressure. The skin is often thicker and different in texture. Anihidrosis usually appears on other parts of the foot and body and is thin dry and flaky in comparison. In some cases calluses may coexist with anihidrosis and this tends to affect areas such as the heels where the build up of callus causes them to develop fissures which may split bleed and become painful. Anihidrosis may also be caused by other problems such as athletes foot, eczema, psoriasis, poor circulation, diabetes and poor nutrition. 

 

Ulcers (Open wounds)

An ulcer is a breach or open wound in the skin that may be intensely painful and difficult to heal depending upon the underlying reasons that caused it. There are several different types of ulcers each with different causes.

 

Pressure Ulcers

One of the most common ulcers treated in this clinic are pressure ulcers which are caused by neglecting corns and calluses. If the skin becomes too thick the build up increases the trauma and pressure causing the underlying tissue to break down into an open sore. This problem is commonly associated with the elderly particularly if they have been using medicated corn plasters.

 

Arterial Ulcers

Ulcers are also caused by peripheral arterial disease (narrowing of the arteries) because there are insufficient quantities of blood to supply the tissues with nourishment. This means that wounds fail to heal and ulcers developing on the feet become frequent.

 

Venous Ulcers

Varicose veins cause ulcers usually around the inside of ankles, poor venous return causes oedema of the tissues varicose eczema and irritation which causes open wounds.

 

Neuropathic Ulcers

Neuropathic ulcers are caused mainly by diabetes because the loss of sensation allows calluses to become thick leading to abnormally high pressure on the affected tissues causing areas of skin to break down. Diagnosis is normally from clinical examination sometimes patients may need referrals to a vascular specialist. Once an ulcer has healed regular podiatrist treatments to monitor and control pressure sites may be necessary to prevent problems occurring in the future.

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Verruca Pedis (Plantar Warts)

Verruca Pedis are caused by the Human Papilloma Virus HPV and are very common. It is sensible to treat verrucae as early as possible. They may appear as rough areas of skin and fibrous in texture with a well defined border, some types have black spots inside them. Verrucae may be singular or multiple and some are very painful when they appear on weight bearing areas such as the heel or ball of the foot.

Occasionally verrucae may be very persistent and require regular treatment over a long period of time.

Differentiating between verrucae and corns can prove difficult.

 

Nail Conditions

Thickened Nails (Onychauxis)

Onychauxis is another word for thickened toe nails. It is a frequent complaint and can affect all the toe nails. Nail cutting is difficult and if the nail becomes too thick the pressure from footwear can be painful.
This problem may be caused for several reasons such as athletes foot which has infected the toe nails, severe injuries or medical conditions like psoriasis.

 

Fungal Nails (Onychomycosis)

Onychomycosis is a fungal infection that has usually spreads from the skin on the feet into the toe nails.

Fungal toe nails often appear to have white yellow or brown patches and may alter in its structure. It can affect a small part of the toe nail or the whole the nail sometimes making it thick crumbly and brittle and very difficult to cut.

Communal areas where there are showers changing rooms and gyms are where people are most likely to come in to contact with this type of infection.

 

Involuted Toe Nails (Curved nails)

An involuted toe nail is when the edges of the nail plate curve towards each other squeezing the flesh underneath causing considerable pain and discomfort even with the slightest pressure.

One of the main causes of this problem is trauma as it damages the cells in the nail matrix altering its structure and shape. Wearing foot wear that is far too tight is another common cause.

 

Rams Horns (Onychogryphosis)

Some people have toe nails that are grossly deformed so much so that they resemble rams horns. This is very common in the elderly when their toe nails grow far too long and their feet are neglected.

Some toe nails become deformed due to injury because the cells in the nail matrix have been damaged or if the nail become too long and thick the pressure from footwear can cause considerable discomfort.

 

Ingrown Toe Nails (Onychocryptosis)

Ingrown toenails are when a nail splinter or spike penetrates the flesh at the side of the toe causing inflammation pain and infection.

It most commonly affects the big toe in teenagers and young adults, however it can affect any age group, due to poor nail cutting, involuted nails, sweaty feet, injury and tight footwear.

Treatment involves removing the offending nail splinters. 

 

Toe Problems

Gout

Gout is a condition caused by abnormally high levels of uric acid in the blood. The large toe joint in the foot is commonly affected. The crystals accumulate around the joint causing acute inflammation and intense pain. The initial attack is usually the worst as the onset is sudden and often comes on at night. Repeated attacks of gout can cause arthritis in the affected joints if left untreated.

 

Bunions

A bunion is a bone deformity caused by an enlargement of the joint at the base and side of the big toe. The movement of the big toe angles in toward the other toes. The growing enlargement or protuberance then causes irritation or inflammation. In some cases, the big toe moves toward the second toe and rotates or twists. Wearing shoes that are too tight may accelerate the development of bunions however they are linked to genetics, normally because of a malfunctioning foot structure. Foot injuries, flat feet, and pronated feet can contribute to their formation. Bunions can also lead to secondary problems, such as hammertoe, bursitis or arthritis. Many people with bunions suffer from discomfort and pain from the constant irritation, rubbing, and friction of the enlargement against shoes. The bigger the bunion gets, the more it hurts to walk. Because they are bone deformities, bunions do not resolve by themselves. 

 

Hammer Toe

These terms are used to describe deformities that sometimes develop in the lesser or smaller toes. They are common in people with bunions or people who have very flat feet or feet with very high arches. A hammer toe is when the inter mediate joint of the little toes are bent right over and eventually the joint becomes completely rigid. A mallet toe affects the distal joint at the end of the toes, if both joints are curled over they are called ‘claw toes’. All these deformities can cause corns and calluses where the prominent joints rub against the shoes or the ground. In severe cases extreme pressure can cause the affected areas to ulcerate.

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Arthritis

Osteoarthritis

Osteoarthritis is a degeneration of the joint or joints usually involving swelling of the affected joint, commonly called the "wear-and-tear" arthritis. There is often associated pain and weakness. It can appear in any joint in the foot and is caused when the cartilage between bones has become worn and is no longer cushioning the joint as well as it used to.

 

Rheumatoid Arthritis

Rheumatoid Arthritis is a systemic auto immune disease affecting multiple joints throughout the body. Usually symptoms appear in several joints on both feet first and include pain, swelling, stiffness and muscle weakness. Bony changes can often lead to misalignment or partial dislocation of the joints.You may develop corns, bunions, claw toe or hammer toe.

Rheumatoid Arthritis often shows up in the feet first.

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Ball of Foot Problems

Morton’s Neuroma

Morton’s Neuroma is an enlarged nerve causing pain in the forefoot normally between the third and fourth metatarsal heads. Potential causes are tight footwear or exercise, certain foot deformities - bunions, hammer toes, flat feet amongst others.

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Heel Pain

Cracked Heels (Fissures)

Fissures is the medical term used to describe cracked heels and initially manifests as thick callus around the heels. It is not the callus alone that causes the cracks to appear though. Cracks appear when the skin becomes excessively dry because the skin looses its suppleness or because the patient has a condition such as athletes foot. Other factors may be if you are carrying a bit too much weight, as increased weight places the feet under a lot of stress.

Some cracks may bleed and become painful and if care is not taken can cause infection.

 

Severs Disease

Severs disease is a condition that causes heel pain and affects children and young adults between the ages of 10-18 years of age. It is nearly always associated with activity particularly running and jumping. This is because it places the Achilles tendon under enormous stress causing muscle fatigue.
During a growth spurt the soft tissues are unable to keep up with bone growth causing the muscles and tendons at the back of the heel to become tight. During high impact activity the Achilles tendon pulls the bone away from the maturing growth plate leading to avascular necrosis and pain. The condition can be very disruptive to an individuals quality of life.

 

Bursitis

Bursitis means inflammation of the bursa which are small sacs of synovial fluid situated between the bones, tendons, muscles and joints. They act as buffers to protect these structures during movement. If a particular body part becomes injured or an infection has developed it can cause inflammation and pain of the affected bursa. The heels are often affected by bursitis.

 

Heel Spurs

A heel spur develops as an irregular growth of the heel bone as calcium deposits are laid down as the plantar fascia pulls away from the heel. Heel spurs can cause extreme pain in the rear of the foot especially when standing or walking.

Causes can be due to biomechanical dysfunction and being overweight as this places the plantar fascia under enormous stress.

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Haglands Bump (Pump Bump)

Haglands bumps are enlargements of the posterior aspect of the Calcaneus that occur on the heel. It is more common in women than men, or in those that have rear foot varus.

It is not always painful but can be unsightly and inflamed and is linked to genetics.

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Plantar Fasciitis (Heel Spur)

Plantar Fasciitis is a common cause of heel pain. It is when the plantar fascia which is a band of fibrous tissue that stretches from the heel to the forefoot is inflamed. This condition can be very painful and can be felt as a dull ache with episodes of a sharp pain in the heel or under the arch. Often worse in the morning or after periods of rest and improves during the day. Contributory factors can include weight gain, increase in activity amongst others and poor foot mechanics.

 

Diabetes

Diabetic Foot

Diabetes is a condition where the production of insulin is defective. There are two types of diabetes but ultimately the disease causes similar effects on the body. People with Diabetes are at a high risk of developing problems with their feet. One of the effects of Diabetes is that it reduces the circulation and sensitivity of your feet due to nerve or blood vessel damage. You may not feel extremes of temperatures or pain and as a result problems may occur without you even knowing. The skin can also become dry due to automatic nerve neuropathy increasing the likelihood of problems as diabetes affects the rate of healing and so breaks in the skin can take longer to heal. Therefore if you suffer from Diabetes you must pay particular attention to your foot health. Good diabetic control means less damage and fewer problems. It is important to inspect your feet on a daily basis. If you have diabetes it is recommended that you should have your feet professionally examined at least once a year. Early intervention and treatment is the crucial to avoiding serious foot problems. http://www.diabetes.org.uk