Common Foot Problems

Athletes Foot

The term athlete's foot is a highly misleading word, as this condition does not only occur in athletes. Athlete's foot is a common name given to a fungus infection of the skin that occurs in between toes. This condition can cause a great deal of discomfort and can affect an individual's quality of life.

Appearance of athletes foot:

• The skin involved may be red, swollen and may contain sticky fluid
• The skin may also appear macerated (soggy).

Dermatitis

This is a blanket term meaning any "inflammation of the skin" (e.g. rashes, etc.). There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may be used to refer to eczema, which is also known as dermatitis eczema or eczematous dermatitis. A diagnosis of eczema often implies childhood or atopic dermatitis, but without proper context, it means nothing more than a "rash".

Involuting Nails

Pincer or involuted nail is defined as an over-curvature of the lateral nail edges towards the nail bed. The excess curvature is seen most commonly in the great toe, where it may lead to chronic pain and inflammation as the subungual tissues are compressed.

Ingrowing Nails

An ingrown toenail (onychocryptosis) occurs when part of the nail penetrates the skin (figure 3b.1), which can often result in an infection. The ingrown nail can also apply pressure in the nail fold area without penetrating the skin - this is not technically an ingrown toe nail, but can also be painful (a corn/callus is also common down the side of the nail and is a reaction to this pressure, rather than the nail actually penetrating the skin).

Usually the side of the nail penetrates deep and it is difficult to see the edge of the nail. The severity of appearance of the nail will vary. Some will just have a nail that appears deeply embedded down the side or sides of the nail. In some the corner or a small spike of nail may penetrate the skin (figure 3b.2), just like a knife. This can result in an infection and the development of proud flesh (granulation tissue). The toe will then be red, inflamed and painful.

Long or Thick Nails

These type of nails are caused by damage to the cells that grow the nail. This can be sudden acute damage such as dropping a heavy object onto the toe or can be due to a gradual damage over the years with the toes impacting into the toe box of the shoes or with various sporting activities.

Fungal Nail Infections

Fungal nail infection (onychomycosis) is very common, particularly in the toenails. It affects around 3% of people in the UK.

Around half of all nail problems are due to fungal nail infection. It usually affects adults, and affects more men than women. It also becomes more common as you get older.

There are several types of fungus that cause nail infections. For example, athlete's foot is a fungal skin infection of the toes, which easily spreads to the toenails. Candida is a yeast which can cause an infection of the skin around the nails, usually the fingernails.

Fungal nail infection usually looks unpleasant, but it does not always cause pain or other symptoms.

Looking after your nails properly can help to keep the infection from returning.

Verrucae

Verrucae or warts are problematic lesions to treat. Wart infection is the result of innoculation of human papilloma virus (HPV). The viral inclusion is commonly found in the nuclei of vacuolated cells present in the granular layer and stratum malpighii. The virus will cause a benign epithelial hyperplasia giving the lesion a hard, hyperkeratinized appearance. Because of this appearance, the lesion is often called verrucae (see figure) vulgaris.

Verrucas or plantar warts are hyperkeratotic lesions found particularly over the pressure areas of the feet (heel and ball). They are usually self-limiting but may be treated if symptomatic.

Corns and Callouses

Corns and calluses - When areas of skin are exposed to repeated friction or pressure, thick layers of dead skin cells form the hardened areas we call corns and calluses. Corns usually develop on irritated toes, and calluses form on the soles of the feet and the palms of the hands. For many people, corns and calluses are simply a cosmetic nuisance, but for others, they are a painful and troublesome medical problem.

Warts

Warts are small bumps on the skin that are caused by human papilloma virus (HPV) infection. Plantar warts grow on the soles of the feet. HPV usually is spread by direct contact, typically by touching or shaking hands with someone who already has a wart or by coming in contact with a contaminated surface, especially by walking barefoot on a gym floor or a pool deck or by wearing someone else's shoes.

How are Verrucae Treated?

It is true to say that many verrucae simply disappear of their own volition. This is because the person develops a resistance to the virus infection and fights it off.

However, some do not, and they need help. A qualified practitioner will be able to select the best method of treating your verruca, or multiple verrucae. The practitioner will use either a special ointment or liquid, which has to be applied at regular intervals of between five and seven days. Then it is vital that you return to the practitioner because these ointments are caustic and destroy the verrucae by gentle destruction.

Your practitioner will give you a special advice sheet as to what you should do.

A Simpler Treatment?

Yes there is, using a method called Cryosurgery. It is not surgery in its usual sense, but is a method of freezing the verrucae with a gentle gas and the advantage is that it is frequently quicker in destroying the verruca, often with one application. Another advantage is that it does not matter whether you get the verruca or foot wet whilst it is undergoing treatment. Of course if it blisters or needs a little dressing one must observe normal antiseptic procedures.