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PODIATRISTS & CHIROPODISTS

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FOOT PROBLEMS


Ingrowing Toenails | Fungal Infections | Verrucae | Bunions | Corns & Hard Skin | Cracked Heels |
Heel Pain | Ulceration | Sports Injuries | Broken Toes

INGROWING TOENAILS

There can be a number of causes but what does it mean?

A true ingrowing toenail occurs when the edge of the nail penetrates the flesh of the toe. This is more painful than you would imagine and of course the toe itself can then become infected by bacteria which seize the opportunity to hop into the wound created by the nail. The ingrowing nail can be easily cut away by a podiatrist who can also determine the cause of the problem. It may be simply due to bad nail cutting technique or an injury but then again, it could have been caused by a badly fitting shoe or even by the way the foot has been functioning within the shoe.

A recurrent ingrowing toenail may require a simple surgical procedure to correct it and this can be done at Pembridge Practice using a local anaesthetic to numb the toe beforehand. The healing period afterwards is usually 4 weeks and it is best to wear sandals during this time to prevent any pressure on the toe.

FUNGAL INFECTIONS

There are many types of fungi which can grow on your skin and your feet provide the ideal growing medium for them (being shut away in a dark, warm shoe most of the time). When you come to the practice we need to find out what sort of fungus has invaded your foot, to do this we take a piece of the infected skin or nail and send it off to a pathology lab. It usually takes 3 weeks to receive the result. Once we know which fungus we are dealing with we know what will kill it. In the meantime we will usually give you a simple antifungal preparation to use. We will also advise you on how to treat your shoes and socks as the fungus usually invades these too.

Sometimes bacteria can invade your skin giving it a pitted appearance.

Fungus prefers a moist skin or skin which is excessively dry.

VERRUCAE

Verrucae (warts) are caused by a skin virus which spreads from one person to another via direct contact or by picking up a minute piece of infected skin while walking barefoot in a communal area. People of all ages can be infected and the only prevention is to wear flip flops/ sandals when walking around swimming pools, gym changing rooms, steam rooms, etc.

As with any viral infection, if you are super healthy you will fight it off, if you are tired, stressed or unwell your body won't easily fight it.

Most verruca treatments are targeted at destroying the piece of skin which has been invaded by the virus.

There are many treatments available and none of them are foolproof as verrucae can be difficult to get rid of;

Phytotherapy, i.e. low frequency laser treatment, is a painless treatment which involves paring away some skin then using an 880nm laser on the verruca for 2 minutes per area. This has to be used weekly for about 6 weeks and is a good treatment for mosaic verrucae.

Swift emblation Microwave Treatment

www.treatverruca.com

Fractionation/ needling involves numbing the verruca using local anaesthetic then piercing the skin using small sterile needles. The aim of this is to induce an immune response to the area. A scab forms after the treatment which takes about 4 weeks to drop off.

Electrosurgery involves numbing the verruca then using a radiowave machine to cut out the verruca. You have to attend the surgery 3 days later to have the wound redressed then every day for 4 weeks you do a salt soak and apply antiseptic and a sterile dressing. After 3 weeks you need to come back to see us for a checkup. The healing time is normally 4 weeks.

Herbal treatment using Tagetes i.e. Marigold paste. This is a good treatment for children or anyone who would prefer a gentle approach. It involves coming to the clinic once a week to have some skin pared away then the Tagetes paste is applied. You have to keep it on between treatments which means no swimming, but you can bath or shower normally. This usually takes about 6 weeks to work.

Homeopathy works well too, a 13 day course of pills has to be taken which then continues to work in your body for a month, so it takes 6 weeks to know whether or not it has worked. It is however completely painless which makes it especially useful if you have multiple verrucae. The only tricky part is that during the 13 day course of pills you really do have to observe some dietary restrictions, e.g. no coffee, limited alcohol, no spicy foods etc. Some people struggle with this.

BUNIONS

The term 'bunion' is commonly used to refer to a deviation of the big toe joint. It is usually a hereditary problem but as long as the joint is still flexible there is a lot that can be done to make it look better and to improve its function.

It's not just the look of a bunion that matters; when the joint becomes malaligned it also affects the way your foot functions. It can be very painful and finding shoes to fit becomes even more difficult than normal.

CORNS AND HARD SKIN

Hard skin (callouses) and corns tend to form either because your foot is sliding around in a shoe which has stretched out of shape causing your foot to slide around within it, or because you are wearing a shoe which is too small for you. They can be removed painlessly and we can advise you on the type of shoe which would be most suitable for you. Sometimes corns keep reappearing in the same place despite having been removed; this is because the foot is not functioning properly within the shoe. In this case we need to take a look at you walking, you might need an orthosis to wear in the shoe to improve your foot function.

CRACKED HEELS
This usually happens during the summer as a result of wearing sandals or flip flops. The best solution is to come in to have the hard skin around the cracks thinned down so they can heal and then to apply cracked skin salve twice a day. Sometimes a fungal infection can cause the skin to crack so we may need to check for this as well.
HEEL PAIN

There are many causes of painful heels, it can be as simple as having bruised your heel by jumping off something and landing heavily on the heel. On the other hand it can be the ongoing and sometimes difficult to treat plantar fasciitis.

It can also be due to an inflamed bursa under the heel, this responds well to laser treatment and supportive taping.

We can refer you for an X-ray of your heel to check for fractures or the growth of a "heel spur", we can use our laser to reduce the swelling so you will be more comfortable. You might need some foot orthoses to change your way of walking. The heel pain may actually be the result of a lower back problem in which case we would refer you to our osteopath.

Heel pain is very common in adults.

In children it might result from an inflammation of the growth centre within the heel.

ULCERATION
An ulcer looks like an open wound and can occur between your toes, particularly in cold weather. It is often mistaken for a corn and can sometimes appear under a corn. It is in general more painful than a corn and should be taken seriously. If there is a corn on top of the ulcer this needs to be removed to reduce the pressure, then we will use the laser to stimulate healing (and of course apply antiseptic and a sterile dressing). The laser is most effective if used 24 hours apart for the first two treatments then 3 days later. Once the ulcer has healed you will have to wear a removable silicone protector over it to prevent a recurrence of the problem.
SPORTS INJURIES

Stress fractures are common in runners and other sports people, the stress referring to repeated micro-trauma through the bone usually indicative of a biomechanical imbalance. So, initially the fracture can be treated using the laser to stimulate the healing and you would have to wear a walking cast for several weeks to reduce the stress through the injured area. Once it has healed we need to have a look at you walking and running to ascertain the cause of the stress.

You might need corrective orthoses but it could just be a shoe related issue.

Sprains, strains and muscle imbalance injuries can be treated at an acute level but also in terms of diagnosing the underlying issues. Working between the podiatrist, osteopath and doctor we can cover most issues.

BROKEN TOES
It's not true that there is no treatment for fractured (broken) toes. They respond very quickly to a combination of laser treatment and a supportive silicone splint. We need all our toes to function properly so we can walk efficiently.
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