Skin and nail problems
Skin and nail related problems such as warts, corns, cracked heels, hard skin, athlete’s foot and ingrown toenails can occur at all ages. If you are experiencing any of the skin or nail problems listed below, come in and see us. We can investigate the cause and develop a solution that will work for you in the long term.
Hard skin
Hard skin, otherwise known as callus or hyperkeratosis is a build-up of skin cells in response to pressure and excessive motion of the foot. If it is allowed to build up it can cause an increase in pressure and a breakdown of underlying tissue. This increases the chance of infection, ulceration and in the most serious of cases, amputation.
While hard skin build up can be hereditary, there are numerous other causes which can be managed or resolved with podiatry intervention. The body’s response to increased pressure or traction on the skin is to build up a hard, thick layer of protection (e.g. extra skin). Podiatry intervention aims to counter this by regular paring back of the thickened tissue, footwear interventions/education and stabilisation or correction of the foot using orthotic devices in the shoe. Our podiatrist can also advise you on the best creams that can be used for this problem.
Cracked heels
Cracked heels (also known as heel fissures) generally occur around the edges of the heels on areas of hard, thickened skin. Over time a simple heel fissure can become so deep that it becomes a potential cause of infection. This is especially concerning for anyone who has diabetes or has poor immune function (immunocompromised). Fortunately, this can often be effectively treated by podiatrists. Gently paring back the skin (debridement), stabilising the foot and the application of hydrating creams or dressings can help with this issue.
Warts on the feet
Warts on the feet, also known as verrucae, or plantar warts when they are on the soles of your feet, are caused by the Human Papilloma Virus (HPV). When the warts are on the sole of the foot, especially in a high-pressure area they can become very painful as they grow and press on sensitive nerve endings. Small lumps, black dots and pain when the site is squeezed are all classic signs of a wart.
People with low immunity and those receiving immune therapy can find warts especially difficult to treat. Children are at an increased risk, and this too is thought to be because they have not been exposed to the virus and developed an immunity against it. Most adults have been exposed to the virus and so warts are less likely to cause them problems. However, there appears to be a higher risk of infection in adults who attend gyms and swimming pools on a regular basis.
There are numerous treatments available for verrucae. At CBR Podiatry we assess the health of your feet before proceeding to select a suitable treatment. Often the assessment involves evaluating the blood flow to the feet as well as how well the nerves in your feet are working. A treatment approach that we commonly use involves the gentle paring down of the wart and surrounding skin. This allows a paste of uric acid applied to the wart to penetrate more effectively and therefore work more effectively. Another option is to freeze the wart using a liquid cryogen. The aim is to provide a rapid freezing and thawing of the wart to damage its cell membranes. It is thought that when these cell membranes are damaged its contents and viral antigens are released. Your body recognises these and mounts an immune response to fight the HPV infection.
Corns
Corns can be a very painful condition. Like hard skin, they can be caused by excessive pressure and rubbing but they are usually more painful. This is because they cause a focal point of hardened, thickened skin. They usually become increasingly painful as they penetrate deeper into the tissues and press on nerves. They can appear as a small lump on the skin and often occur on the toes, where they touch your shoes or on the bottom of your feet at high-pressure areas.
Corns are a particular concern for those who are at an increased risk of infection and ulceration. This group includes people who have diabetes. The added complication in this case is that many of the corn treatments sold over the counter in Australia are actually contraindicated for those with diabetes. There is also debate about whether the corn treatments that can be bought over the counter work. The acid that some of the corn pads contain burns and softens the skin which can cause pain. The softening process may even cause the corn to penetrate deeper. The application of such pads can also increase the risk of ulceration and infection, especially if your blood supply is not good or your sensation is reduced. It is especially important to seek the advice of a podiatrist for this problem if you have diabetes, poor circulation, reduced sensation or other health problems that could affect your feet.
Athlete’s foot (Tinea Pedis)
Athlete’s foot is caused by a fungal infection. Signs are follow:
- Peeling skin
- Reddened skin, especially at the edges of the infection and/or areas of whitish skin
- Scaley skin
- Small red dots or blisters on the skin
- Peeling, cracking or splitting of the skin between the toes
While Athlete’s foot may not cause any symptoms (asymptomatic), you may experience itchiness of the affected area or a stinging sensation, especially between the toes if the skin is split.
There are many ways in which we can help you with this problem. We look for ways to minimise your feet being in a warm damp environment, which is where fungi thrive. We advise of the types of socks and shoes that may help. We can also steer you in the right direction when it comes to anti-fungal creams. While many people have repeat episodes of athlete’s foot throughout their lives without any long-lasting problems, others are not so fortunate. If left untreated the risk of secondary infection and ulceration increases, especially in higher risk and older groups. In addition, it is possible that the fungal infection in your skin can transfer to your nails. Nail fungal infections are much harder to treat than an athlete’s foot infection, especially if it is left unchecked. With the above in mind, you may decide to treat any fungal infection sooner rather than later. If so give us a call to discuss how we can help.
Foot ulcers
Foot Ulcers are wounds, usually long-standing, to the full thickness of your skin. They must be taken seriously as there is a real risk that infection could enter via the wound and affect the bones in your foot (osteomyelitis) and/or spread further afield. Ulcers are more common in people with circulation problems or problems with the nerves in their feet. These are things that we routinely screen for, and they can be a good indication of your chances of developing such a wound. Circulatory problems mean that your body finds it harder to heal a wound and to fight infection. Moreover, if an infection takes hold in your foot poor circulation makes it difficult for antibiotics to be effective as they travel down to your foot in the bloodstream. A loss of protective pain sensation (nerves not working properly) can mean that someone can injure their feet without realising it. They are also less likely to feel the pain that ulceration can cause. Both of these issues can mean that the extent of the ulcer is not felt or not realised until considerable damage has been done.
Another cause of ulceration is poor blood return. This type of ulcer is caused when your veins don’t work properly. These commonly occur above the inside of the ankle at a point where a very large vein is situated. Pressure ulcers often occur on the heels and can be linked to increased pressure from footwear, wheelchairs, chairs or mattresses. Both of these types of ulcers can occur at other areas of the body.
Podiatrists most often deal with foot ulceration, either from a circulatory (vascular) and or a nerve (neuropathic) cause or a combination of both. This combination-type ulcer is known as a neuroischaemic ulcer (with the word ischaemic referring to a lack of blood supply). Your podiatrist will address the cause of the ulcer where possible. For example, if hard skin build up is causing pressure to underlying tissues this may be gently pared back. If there is increased pressure to part of the foot, padding or an offloading (reducing pressure) orthotic may be utilised. The ulcer will also be cleaned and dressed, and onward referrals made where appropriate.
Thickened or misshapen nails
Thickened nails are sometimes known as onychauxis. Thickened nails occur when the nail plate is thicker than would normally be expected. The cause is often related to past trauma, so the chances of thickened nails increase with age. Also, people with clawed toes or tight footwear are more likely to develop thickened nails because of the repeated pressure and trauma that their nails are subjected to. There are numerous other causes, and these are shown below:
- Skin conditions such as psoriasis
- Fungal nail infections
- Circulatory issues (poor blood flow)
- Poor nutrition
The thickness of the nail can make self-care (cutting and filing) of the nails difficult. In addition, the added pressure to the affected toe can cause pain as well as a build-up of hard skin or corns beneath or at the edges of the nail plate (an area known as the sulcus). If the nail is left to get too thick, pressure can build under the nails and cause ulceration and a portal of entry for infection. The bone is very close to the nail in such areas and if ulceration does occur, there is a risk of a bone infection occurring (known as osteomyelitis). Thickened nails may appear as yellow in coloration, become crumbly or even come away from the nail bed (the skin under the nail).
Podiatrists use specialised instruments to carry out treatment for thickened nails. This could include any, or a combination of the following:
- Thinning the nail plate using files, rasps or burrs
- Removal of corns
- Clearing of hard skin (occurring commonly in the sulci (the sides of the nails)
There is also the option of having the nail permanently removed through nail surgery, however this is rarely necessary.
A misshapen nail (sometimes referred to as gryphotic nails) can grow in different directions but are usually also quite thick. They are also associated with trauma. The management of gryphotic nails is similar to that required for thickened nails, as explained above.
Fungal infections of the nails
Fungal nails are also sometimes referred to as onychomycosis. Such nails may appear thicker and discoloured. They are often yellowish or white in coloration but can also occur as shades of brown through to black. They can become brittle and flaky and may even come away from the toe. The shape of the nail can also change and lead to discomfort at the sides of the nails as the nail thickens and digs into the skin. It is also sometimes possible to detect an odour from nails that are infected with a fungal infection. The infection can reach the skin underneath the nail and this can become inflamed either due to the fungal infection itself or by the trauma caused by the thickened, flaky and misshapen nail.
Fungal nail infections are caused by fungal infections which begin in the nail itself, in the surrounding skin or on the skin under the nail (the area known as the nail bed). As mentioned above, athlete’s foot can be a cause as can trauma to the toe which creates an easy entry point for the infection, especially if the nail itself is damaged or lifted.
Nail fungal infections are easily misdiagnosed or missed. Numerous other conditions can give the nails a similar appearance. Podiatrists are experienced in identifying the infection and advising on and providing treatment options. It is much easier to treat fungal nail infections sooner rather than later. So, give CBR Podiatry a call and let us check over your nails and initiate your treatment plan.
Ingrown nails
Ingrown toenails can cause extreme pain and if the problem is not taken seriously it can lead to serious complications. The medical name for an ingrown toenail is onychocryptosis. It happens when the edge of a nail penetrates the skin to the side of the nail. This area is known as the sulcus. It can appear red and inflamed, sometimes with discharge (pus) present although sometimes the nail can look completely normal.
There are many potential causes of ingrown toenails and some of these are listed below:
- Poor nail-cutting technique
- Tight footwear
- Sweaty feet
- The shape of your nails – some people have curved nails
- The thickness of your nails
- Debris or corns down the side of your nails (the sulcus)
- An injury to the toe (dropping something on the toe or banging the toe)
- Pressure from adjacent toes
- Foot function – increased pressure on the sides of your nails
We are often able to manage ingrown toenails conservatively, without surgery when:
- The nail has a curved shape (otherwise known as an involution).
- There is a corn present.
- There is debris/hard skin down the side of the nail.
We can also provide education regarding footwear, nail cutting and the use of pressure relieving devices. In addition, we have many options to improve foot function if that is contributing to pressure at the sides of the nails.
We manage ingrown toenails non-surgically by using specialised instruments to trim the edge of the nail and remove the ingrown spike of nail. If treatment is not provided and the problem nail is not removed from the skin, it is likely that pain will increase, and infection will take hold.
CBR Podiatry also offers a very effective ingrown toenail surgery service for patients who have ingrown toenails unsuitable for non-surgical management. During the procedure, liquefied phenol is applied to prevent the painful nail edge from regrowing. Evidence has shown that this solution prevents the recurrence of ingrown nails in 92-98% of cases.
Your safety is our number one priority. At CBR Podiatry you are guaranteed to have nail surgery performed by a podiatrist with at least 10 years of experience. We strive to make the experience as comfortable as possible. In fact, most people report that the only slight discomfort they feel is a small scratch or sting when the local anaesthetic is given. Once you let us know that the anaesthetic is working, we proceed to remove the offending nail edge and prevent it from growing back. During the procedure, liquefied phenol is applied to the nail root at the very edge of the nail. The aim of this procedure is to leave a normal-looking nail while only removing a small section of nail from the edge.
You are able to go home straight after the procedure, but it is very important that you are available to come back into the clinic to attend redressing appointments to monitor healing and minimise the risk of infection. The redressing appointments are included in the price of the nail surgery and should be made at the time of booking the nail surgery procedure. Our podiatrist will provide you with a dressing pack following the procedure and give you thorough instructions for self-care between your redressing appointments.
If you are experiencing pain down the edge of your toenails come in and see us. We can investigate the causes and work on a solution that will work for you in the long term. Often there is a simple solution that can prevent more serious issues in the future.
