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Skin and Nail conditions

Podiatrists regularly treat skin conditions that affect the feet. These skin problems include ingrown toenails, callous, corns, warts, ulcerations, fungal foot infections and fungal nail infections.

Ingrown Toenails

Feet endure a lot of stresses and strains with walking, running, wearing shoes, working and playing sport. An ingrown nail will occur when a portion of the nail forms a jagged edge (spicule) and begins to protrude into the surrounding tissue as the nail grows.  This problem commonly occurs on the big toe, however, smaller toes can be affected. There are a number of reasons why ingrown toenails occur and include:

  • Improper nail cutting technique
    – Nails should be cut along the contour of the toe or straight across.
    – Don’t cut down the sides.
  • Poor fitting footwear
    – Tight shoes restrict room for nail growth leading to ingrown nails.
  • Involuted/curled nails
    – Sometimes the nail edge curves into the skin either due to trauma or a congenital disorder.
  • Chubby toes
    – People with chubby toes will find the skin at the side of the toe is more likely to be traumatised or pierced by the nail as it grows out.

It is important to seek podiatry care as soon as an ingrown nail is detected. DO NOT TRY TO CUT DOWN THE SIDE OF THE NAIL!

Ingrown toenails should be treated as quickly as possible as infection often occurs. The nail spicule must be removed, as leaving it will not allow the wound to close and the area is likely to become infected or painful again.

Ingrown toenails may be treated conservatively or surgically, based upon initial assessment and subsequent prognosis of the nail.

In terms of conservative treatment, the podiatrist will remove the problematic spicule and then instruct the patient on how to manage the nails in order to prevent recurrence of the ingrown toenails.

In persistent and severe cases, surgical correction of the toenail may be warranted. Nail surgery is a minor surgical procedure that is conducted under local anaesthetic.

It involves removing an edge or the whole nail plate and then sterilising the nail matrix using a strong alcohol solution to prevent any nail regrowth in the problem area. This is a permanent solution and has a success rate of over 95%.

If a patient detects an ingrown toenail, I recommend soaking it in warm salty water and dressing it with liquid betadine.

Keep the nail clean, dry and dressed until you see the podiatrist. If it becomes very sore and infected, seek immediate advice as you may need anti-biotics to clear the infection.

Callouses

Callouses are a skin condition that present as lesions of hard skin which form over an area as a result of friction or high pressure. Callous is very common on feet and is the skin’s natural protective defence to increased or abnormal pressure.

Callous normally presents as hard, thickened, dry skin. Callouses are often painless.  However, in certain people, it can become a problem as these areas of built-up hard skin can cause pain and discomfort.

Treatment of Callous involves your Podiatrist reducing or debriding back the built-up areas to reduce the pressure on the underlying healthy tissue.

Your Podiatrist will also assess the contributing factors, such as tight or ill-fitting footwear, and may implement customised padding to redistribute pressure or orthoses to offer long term pressure relief.

Corns

Corns are similar to callous in that they are a skin condition characterised as a lesion of hard skin which forms as a result of excess pressure. However corns form over a small area and have a glassy centre or core.

Like callous, the body forms a corn as a protective mechanism to try and reduce further damage to the skin overlying that area.

There are two main types of corns –hard corns, which generally form on the tops and bottoms of the feet, commonly over bony prominences, and soft corns, which form in between the toes. Corns can cause many problems if not treated appropriately and can be very painful.

Podiatry treatment of corns involves your Podiatrist enucleating the corn’s hard centre and then determining the contributing factors such as tight or ill-fitting footwear, and may implement customised padding or toe dividers to redistribute pressure or orthoses to offer long term pressure relief.

Warts (Papilloma or Verruca)

Warts are a viral infection of the skin caused by the Human Papilloma Virus (HPV). They commonly present as a raised lesion with a rough surface and can often look like callous or a corn. It is important you have your Podiatrist diagnose the wart before you start treating it.

Plantar warts are contagious and survive best in wet areas. Therefore, an infection may often result after walking bare-foot around swimming pools or hotel or public bathrooms.

The body’s natural immune system often fights the virus which leads to resolution in most cases. However treatment can minimise the risk of the virus spreading from person to person so it is encouraged.

Podiatry treatment for plantar warts involves topical treatments such as Formalin or Salicylic Acid and persistent warts may require Liquid Nitrogen or a surgery called curettage to excise the lesion out of the skin.

Plantar warts can be very stubborn and treatment may take many months. It is important to note that HPV is very contagious and can also remain in the body for up to 2 years. This makes recurrence a possibility regardless of the treatment.

Ulcers

Patients who have diabetes, a foot deformity or poor circulation, (you) have an increased chance of developing foot sores, or ulcers.

A foot ulcer can present as a shallow red hole that involves only the surface skin, or can be very deep and may involve tendons, bones and other deep structures.

Diabetes is the most common cause of peripheral neuropathy. Peripheral neuropathy is damage to the nerves that supply the feet and legs. When the nerves are damaged the body can no longer warn about pain. An ulcer may appear as a result of excess pressure on a part of the foot that has become numb.

Some patients with peripheral neuropathy are unable to feel when they’ve stepped on something sharp or when they have an irritating pebble in their shoe.

Due to the numbness in their feet, they can injure themselves and not know it. It is vital for patients who have peripheral neuropathy, to regularly inspect their feet for any signs of trauma and contact their Podiatrist or GP immediately if there are any concerns.

Any illness that reduces blood flow to the feet can cause foot ulcers. Patients who have decreased blood flow have less blood reaching the feet, which deprives the skin of oxygen.

This makes the skin more vulnerable to injury and reduces your body’s ability to heal ulcers quickly, making them more susceptible to infection.

Any condition that distorts the normal morphology of the foot can lead to foot ulcers due to abnormal pressure distribution on the feet whilst in shoes and whilst walking.

This is particularly true if the foot is forced into shoes that don’t fit the foot’s shape. Examples of conditions that can alter foot shape are Rheumatoid Arthritis or Club Foot. It is important to have shoes that fit correctly, or Orthoses may be required  to deflect pressure away from high-pressure areas to prevent ulceration.

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