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Conditions

Achilles Tendinitis

In this painful condition we see not only swelling and inflammation of the Achilles tendon, but quite often degeneration of its tissues.

It can often be linked to plantar fasciitis as the two processes are quite similar. Tendinitis is seen less often than fasciitis, however it is essential to nip this in the bud with appropriate assessment of function, often through the gait analysis laboratory, and rapid treatment. A neglected Achilles tendinitis could well lead to rupture and significant morbidity for the foot.

The team at Total Foot Health are expert in dealing with both of these conditions in a sympathetic and pain free manner so, if you are struggling with foot pain, do give us a call and we will be delighted to help you.

Athlete's Foot

Athlete’s foot, also know as tinea pedis, is a common fungal infection of the skin that can affect up to a third of the population.  Some people are more prone than others to developing the infection, which is highly contagious.  It is often seen between the toes as the fungal spores thrive in a moist, dark and warm environment.

It can present in many ways – from what appears to be a soggy mass of skin between the toes to an itchy, red, scaly, dry, cracked or blistered rash.  Due to the cracking of the skin this can lead to a bacterial infection and cellulitis.

This is a particular risk factor for patients who also have a diagnosis of diabetes or other conditions that reduce the immune response.

The infection can spreadTotal Foot Health fungal nail infection over the foot and will commonly infect the toenails causing discolouration, thickening and crumbling of the nail body.

It is important to treat the condition quickly to prevent further spread but it should always be remembered that if you are prone to the infection you will need to monitor for signs of re-infection.

Corns and Callouses

Many people have corns or callouses on their feet. These lesions are caused through an increase in pressure on specific areas of the foot. They are often accompanied by underlying conditions such as hallux valgus (bunion) or hammer toe deformity.

A simple care regime can be extremely effective with clinical treatment of the lesion together with the use of simple supports. It is occasionally necessary to correct the underlying deformity, which can sometimes mean a surgical procedure.

When you attend our clinic the causes of these lesions will be fully discussed with you and simple self help measures, along with treatment in clinic, will often result in a marked improvement in symptoms. We will always recommend appropriate footwear, insoles and skin/nail care. It should be noted that corns can return very quickly unless their causative  factors, such as shoe pressure, are relieved.

  • Sometimes the lesions are caused by other factors such as:
  • Viral infection
  • Nerve and blood vessel enlargement

These tend to be extremely resistant to simple care and often require a small surgical excision under local anaesthetic. Tissue would then be sent for laboratory examination. Sometimes treatment will include cryotherapy where the tissues are frozen, or electro surgery to destroy the painful nerve endings.

Diabetes

A few minutes a day looking after your feet can prevent a lot of problems in the future. The following advice will help you look after your feet properly…

How does diabetes cause foot problems?
Diabetes can lead to nerve damage in the feet and legs, resulting in a loss of sensation. Any trauma or injury to the foot (e.g. a tight shoe causing blisters) may not be felt and could lead to more severe problems, such as ulceration. Diabetes can lead to a restricted blood supply to the feet and legs, resulting in cold, painful feet. Because of this, injuries to the feet may be slow to heal and can quickly become infected.

Examine your feet
Damaged skin can lead to infection. Look at your feet closely to check for cuts and scratches, swellings and inflammation or discolouration. If you cannot see too well ask someone to do this for you. Feeling your feet will also help find lumps, swellings and hot or cold spots. Rinse any cut or scratch with water and apply a plaster.
Contact your podiatrist or doctor.

Avoid burning your feet
Like many people who are diabetic you may not be able to feel heat, cold or pain very well in your feet. You must take certain precautions because of this. Take care not to burn yourself on a hot water bottle. If you use an electric blanket, remember to switch it off before you go to sleep. Do not put your feet too near a fire or against a radiator. Check the temperature of the bath water using your elbow before stepping into it.

Wash your feet often
It is important to wash and examine your feet every day. Use lukewarm water and mild soap. Dry them well, but gently. Do not forget to dry between your toes. Use moisturising cream to keep your skin soft and supple. We recommend the use of Simply Feet Cream. Do not apply this cream between your toes as it may make the skin too moist.

Toenails
Toenails should usually be cut straight across. Do not cut or probe down the sides of your nails. If you have reduced feeling or circulation in your feet it will be safer to leave this to your podiatrist. Ask us for advice.

Corns and callous
Corns and callous should dealt with by your podiatrist. Do not try to cut the corns and callous yourself and do not use corn remedies. Ask us on how to look after these properly.

Do not smoke
Smoking can worsen circulatory problems. Ask for advice and leaflets at your health centre on how to stop smoking. For further details of local stop smoking clinics contact your local Health Promotion Unit.

Check your footwear
Shoes should be a good fit, preferably lace-ups with soft uppers and roomy at the toes. This will allow your foot muscles to work properly and prevent rubbing. When buying shoes, always ask for your feet to be measured. Wear new shoes just for an hour or two at first. Always change into clean socks or stockings which fit well. Examine your shoes, socks and stockings for damage each time before putting them on. Cracks, small stones and nails can irritate and damage your skin.

See also:

Fungal Infections

Fungal infections of the skin and nails are extremely common. The majority of infections are caused by the Dermatophyte species of fungus which can be very resilient to treatment.

Unfortunately some people are much more prone to developing fungal infections than others. We will all be familiar with the term Athlete’s Foot where the skin can become very dry and itchy, quite possibly splitting also. It can however be difficult to tell this apart from everyday dry skin or other skin conditions, such as eczema. At TFH we carry a range of products to help treat fungal infections and are able to advise you on the best ways to help prevent re-infection with the problems.

Nail infections with fungus causes the infected nail to become thick, uncomfortable and difficult to cut. It may be in itself a cause of ingrowing toenail. Discolouration of the nail occurs, which may also seem to crumble away. The difficulty in clinical diagnosis of a fungal nail is that other conditions can cause similar problems and, as such, we now have available to us a simple laboratory test to confirm the diagnosis. This will involve taking a small sample of the infected nail to try dematophyte in trayand culture the fungal elements. Should the test prove positive we can then work with you in recommending the most appropriate treatment for the problem.

Treatment of both skin and nail fungal infection is recommended as secondary problems arising from breaks in the skin have been linked to cases of repeated cellulitis of the legs.

Ingrowing Toenail

As the name might suggest this is an extremely painful condition where a part, or even the whole nail embeds itself into the surrounding soft tissues. The medical term for this is onychocryptosis, all problems with the nails are prefixed with the term onycho, meaning nail.

There are basically two types of ingrowing toenail:
ACUTE – where a piece of nail actually pierces the skin often resulting in infection and overgrowth of reactive tissue. We often see this in younger patients, particularly teenagers, but it can be the result of trauma or poor nail cutting techniques.
CHRONIC – where the nail shape gradually changes over the years, often associated with thickening. The nail edges tend to press into the soft tissues causing pain even with the lightest of pressures. This tends to be seen more from the age of 40 or so and need not be associated with trauma.

Treatments may be as simple as advice and help on toenail care or may require more complex intervention such as a partial nail ablation or surgical nail edge excision. The podiatrists at Total Foot Health are expert in dealing with this condition in a sympathetic and pain free manner.

A partial nail ablation (PNA) with matrix phenolisation has a success rate of about 95%.  Regrowth of nail will occur in 5% of cases.  This will, in all likelihood, require a further procedure to deal with the problem.

A regrowing nail will become obvious within a few months of the original surgery, but this early nail will be of immature quality.  It is wise to allow this nail to become more normal before it is re-operated on as this will improve the chances of success.


INSURED patients will need to check that they are covered by their medical insurance in this unlikely event.


Plantar Fasciitis

Plantar fasciitis is a very common problem that will affect up to 10% of the population at some time during their life. It is typically associated with pain in the heel and often the arch area of the foot.

We can see it in youngsters who are growing rapidly, particularly around the teenage years, through to the older person. Our view of the problem has changed over time as we used to think this was purely an inflammation of a dense band of tissue running from the heel to the forefoot. The band of tissue is very important in allowing the foot to work normally, particularly when changing from the foot loading phase of gait to the more active toe off.Plantar fascia drawing.docx

As part of our assessment of the problem we will take a thorough history of the pain duration and location and combine this with examination of the foot and footwear. Treatment will often depend on just how long the problem has been present, but may consist of appropriate exercises to undertake at home, supportive taping of the foot, advice on footwear, orthotic prescription and specific mobilisation techniques through to injection of corticosteroid. The latter technique however would NOT be undertaken without the need for further investigation through x-rays and ultrasonography.

Verruca

This is a viral infection of the skin by the human papilloma virus. The same virus causes warts to appear on other parts of the body but on the foot, because we keep treading on the area of infection, the soft fleshy wart remains flush with the skin.

The infection is highly contagious particularly when people are around communal changing areas. Many people seem to be prone to the virus whereas others seem to be quite immune. There are a range of treatments that we can offer for this painful condition ranging from caustic application, occlusion therapy, cryotherapy, needling and electrocautery (the latter two treatments are generally NOT suited to the under 16’s).

As with all other foot problems the main priority is to gain a clear picture of the nature of the lesion before undertaking treatment. Verruca needling is proving increasingly popular, particularly with those patients who have long term lesions that have proved resistant to all other forms of treatment.