Chilblains - now what do I do?

It's all very well understanding what causes chilblains and how to prevent them, but what do you do when you actually have a chilblain?

They will have started as red itchy patches caused by an abnormal reaction to a change in temperature, then they will have turned a dark blue which has become increasingly painful. Now you face the prospect of them drying out and an ulcer forming from infection.

Corns and calluses in the area will make the chilblain worse and so removal of these will help. Padding of the area to  deflect the pressure will ease the pain and these are  issues your podiatrist can assist with.

A cracked area that has become ulcerated certainly requires professional intervention. Your podiatrist will be able to help with this and any other foot problems you may encounter. If you suffer with a medical condition such as diabetes, you must visit your G.P.

Footcare Clinic, Macclesfield.

Chilblains - how do I stop them?

Prevention is better than Cure.  We all know this and, as the cold weather starts to descend, chilblains start to affect us.

Chilblains are caused by a rapid change in temperature, such as moving from the cold outside into a centrally heated room. Some people are more susceptible to chilblains than others and whereas it is uncertain why this is, those most likely to develop the condition include teenagers, the elderly and those with a sedentary lifestyle. Chilblains rarely cause any long lasting damage, but they are however very painful and, as they dry out, the skin may crack and leave the area susceptible to infection. 

There are precautions that can be taken to help prevent chilblains from occurring:

        ·         Take regular, if gentle, exercise.
·         Dry feet thoroughly after washing
·         Apply Body Essentials 'Warm Your Sole' which contains marjoram to soothe and calm and  ginger, to warm the area.

        ·         Wear natural fibres next to your skin
·         Wear good fitting footwear
·         Attempt to keep the whole body warm, not just extremities by wearing several layers
·         Avoid the temptation to 'hug' radiators.

       For further advice, visit the Footcare Clinic in Macclesfield.

Chilblains - what are they?

  If you have become aware of a small red itchy patch of skin on your toes after you have been exposed to the cold, it may be that you have a chilblain. If it is a chilblain, then moving into a warm environment will cause it to itch even more.   If you have had this for a little while and noticed that it has become increasingly painful and is turning blue, it is most probable that you have a chilblain. This chilblain may not only be on your toes, but your fingers, nose and/or earlobes.

Chilblains are an abnormal response of the blood vessels in the extremities, after exposure to cold temperatures. The vessels constrict as a reaction to the cold and when they are warmed they fail to expand to allow the blood to flow through.  The blood then leaks into the tissues, causing a chilblain.

Clearly, not everyone moving from cold to warm environments develop chilblains. Those who are most susceptible include the elderly, teenagers, those with a sedentary lifestyle and sufferers of certain medical conditions, such as anaemia.

Here at the Footcare Clinic in Macclesfield, we see many patients suffering with chilblains during the winter months. Among other treatments and advice available, we recommend Body Essentials 'Warm your Sole' prepared specifically to soothe skin traumatised by chilblains.

Pop in to see us, or make an appointment....

Athlete's Foot

If you find yourself rubbing your foot across the back of your legs or peeling off your socks and shoes to get to an itch between your toes, you may be suffering from Athlete's Foot. 

Athlete's foot is a fungal infection of the foot caused by dermatophytes, which are parasites on the skin.   Athlete's foot , known as tinea pedis, is a fungal infection that develops mainly in the moist areas between the toes. It is more common in men than in women. The most common species of dermatophyte causing  Athlete's foot are Microsporum, Epidermophyton and Trichophyton, accounting  for 90 per cent of all skin fungal infections. We all have fungi on our bodies, which feed on dead skin cells and are usually harmless. The fungi love warm, moist places with the result they are primarily a problem for people who wear tight-fitting trainers, don't dry their feet properly or those who have foot conditions which prevent separation of the toes for evaporation.


Damp footwear and warm, humid conditions also promote fungal growth; plastic shoes in particular provide a favorable environment for fungal growth and infection. Athletes are at increased risk, hence the common name for the condition, due to increased sweating and closed trainers. Those who necessarily wear rubber footwear due to workplace regulations are also prone to infection.

The fungus can live in footwear and on the surfaces of mats, rugs and clothes for up to six months.

The condition is contagious and is often picked up from going barefoot in places where people with the fungus have walked.  It can also be spread by skin-to-skin contact between people and, those with weakened immune systems are particularly susceptible to athlete’s foot and other fungal infections.

Common symptoms of athlete's foot include itchiness between the toes, particularly the little toe. Sometimes this is accompanied by a burning or stinging and breaks in the skin. The infection can spread to the rest of the foot and sometimes to the palms of the hands.

Important first steps to take involve washing your feet daily and drying them thoroughly before putting on shoes and socks. You should use a separate towel to dry your feet  and to avoid passing on the infection, you should not share your  towels with others.  Allow the air to get to your feet as much as possible and wear cotton socks which will have a wicking effect, taking moisture away from the feet.

If possible, try to wear shoes that are not made of synthetic materials and use an antifungal powder or spray on the inside of all footwear. Unfortunately, the condition may also cause a fungal infection of the nails.     Check your feet a few times a week, especially between the toes, to see if there are any indications of athlete’s foot. If you have diabetes, please check your feet every day.

There are many antifungal creams, sprays, liquids and powders that are available from pharmacists without a prescription. A very good first line treatment is with our own 'Ditch that Itch', an aromatherapy product from our Body Essentials range                             

  Other antifungal products  include clotrimazole ( Canesten) and miconazole (Daktarin); terbinafine(Lamisil  AT) ), zinc undecenoate,(Mycota)  and tolnaftate (Mycil).  If in any doubt about the diagnosis or treatment of athelet's foot, please pay a quick visit to the Footcare Clinic and chat to your podiatrist.

An itchy foot is not normal and a quick reaction from you may prevent the spread of this uncomfortable disorder.

Piezogenic Papules

Although they are quite alarming in appearance, piezogenic papules are quite harmless and mostly painless. They are soft  and compressible lumps, often on the back  or the side of the heel  and often,  on both feet.  

Another distinctive feature is that they are not visible when the foot is off the ground

They are caused by small herniations of fatty tissue breaking through tiny tears in the fascia of the heel, which is why they are not  apparent when the foot is lifted from the floor.

 Often the person who has piezogenic papules is young and athletic.  The papules tend to occur more commonly in women than men.

People who have the connective tissue disorder, Ehlers-Danlos syndrome are more susceptible to these papules as are those who stand for long periods of time.  Athletes, especially long distance runners often develop piezogenic papules. They are not age-related nor do they affect any specific ethnic group.. Occasionally, obesity may be a  causative factor.

Piezogenic papules range in size from 2 mm to 2 cm and are usually pain free. Sometimes there is pain present if nerves are herniated through the fascia along with the fatty tissue. These painful papules  are usually a little larger than 2cm and they occur less frequently.  If pain is present it is usually associated with a history of standing for long periods.

Painful Piezogenic papules may require some changes in lifestyle, to reduce the amount of weight bearing exercise and if appropriate, to reduce body weight.  Compression stockings may help by preventing the herniations whilst heel cups or heel taping often relieves pain.

A visit to your podiatrist will guide you towards the best day to day management regime of Piezogenic papules and orthotics may be prescribed to reduce the pressure on the heel.

If the papules are painless, no treatment is necessary.  

Severs Disease

A young person aged between 10 and 15 suffering with pain and tenderness at the back of the heel may have Severs Disease.  Tenderness will be felt especially if you squeeze the back of the heel from the sides. Sometimes there may be a lump over the painful area. Often the pain goes away when taking a rest from sporting activities, only to return when training is resumed.

Severs disease is a type of apophysitis which occurs in the heel bone. Children's bones have growth plates from where the bone grows and matures. The Achilles tendon inserts into the back of the calcaneum, or the 'heel bone'.  Severs disease is often associated with a rapid growth spurt. As the bones grow, the muscles and tendons become tighter as they do not grow at the same rate as the bone, the tendon then pulls on the calcaneum. The point at which the achilles tendon attaches to the heel becomes inflamed and the bone starts to crumble. This happens before the calcaneum fuses at the site of the growth plate after the age of around 15. It can occur in one or both heels.

Walking on the damaged foot or feet will delay healing and as a result, rest is very important - stopping any activity which make it worse.  Ice wrapped in a tea towel and applied to the area may help.

Sometimes footwear may be worn down or damaged at the heel, which will make the condition worse. Replacing this footwear is an excellent start to relieving the pain.

A podiatrist may suggest a heel pad or heel raise into the shoes. This has the effect of raising the heel and shortening the calf muscles and so taking the strain off the back of the heel. Stretching exercises are very important, they should be performed within pain limits, under the supervision of a professional. 

A full biomechanical examination will help determine if there are any issues which are contributing to the problem.

Tarsal Tunnel Syndrome

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (flexor retinaculum) that protects the structures contained within the tunnel—arteries, veins, tendons, and nerves.

Tarsal tunnel syndrome is a painful condition of the foot caused by pressure on the posterior tibial nerve as it passes along the tarsal tunnel just below the bony bit on the inside of the ankle. It produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot. It is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.

Tarsal tunnel syndrome is caused by anything that causes pressure on the posterior tibial nerve, including;

• An injury, such as an ankle sprain, which often produces swelling in or near the tunnel, results in nerve compression
• An enlarged or abnormal structure that occupies some of the space in the tunnel can cause pressure on the nerve. These include a ganglion, varicose veins and a bony spur.
• The outward tilting of a foot which is 'flat' can cause the tunnel to narrow and put pressure on the nerve
• Diseases such as diabetes or arthritis can cause swelling and compress the nerve

People who suffer with tarsal tunnel syndrome complain of tingling, burning, or a sensation similar to an electrical shock which is ,mainly felt on the inside of the ankle or the sole of the foot. Sometimes there is pain - usually a shooting pain which may extend to the heel and the toes and there can be numbness. The symptoms often appear very suddenly.
It is advisable to consult your podiatrist if you suffer from any of the symptoms of tarsal tunnel syndrome. It can be confused with other conditions and if left untreated it may cause unwanted and unnecessary permanent damage.

Treatment advice would always start with resting the affected foot. It promotes healing without causing further damage. If it is very painful or inflamed, applying an ice pack to the area may reduce swelling. Always put a thin towel between the ice pack and the skin. Your podiatrist may suggest some exercises for you to do and a biomechanical assessment may be necessary. The biomechanist may prescribe orthotic devices to be worn inside your shoes to reduce the nerve compression. Sometimes, immobilising the foot with a cast or walking boot, may be necessary.
The symptoms often subside very quickly, especially if the problem was caused by injury. As ever, don't suffer in silence...

The Footcare Clinic can help!

Posterior Tibial Dysfunction

People who suffer with Posterior Tibial Dysfunction often complain about a pain on the inside of the ankle, swelling in the area and often, they are unable to stand on their toes. This is more common in women over 40 years old, but it does happen to men too.

The posterior tibial tendon starts in the calf, passes down behind the inside of the ankle and attaches to bones in the middle of the foot. It provides support as you push off on your toes when walking. If this tendon becomes inflamed, or damaged, there is pain on the inner ankle and a gradual loss of the inner arch on the bottom of your foot, leading to flatfoot. This condition is also called 'Adult Acquired Flat Foot'. It is not hereditary but may be caused by an inherent abnormality of the tendon. Inflammation of the tendon may be caused  by excessive force on the foot, such as running uphill, or in sports where there is a rapid change of direction, for example football, hockey or tennis.

Those who are living with diabetes or inflammatory diseases such as rheumatoid arthritis are more likely to develop this condition, as is anyone with previous trauma to the foot. Obesity and pregnancy often put more pressure on the tendon and lead to inflammation.

An easy diagnostic exercise is to stand facing a wall. Support yourself against the wall and lift the unaffected foot out of

the way, whilst rising onto tiptoes of the other.  From behind, a companion will be able to see if the heel of the affected foot turns inward. If there is no inward rotation, then dysfunction of the posterior tibial tendon is indicated and a trip to your podiatrist is recommended.

Treatment of the disorder will involve orthotics, ranging from small shoe inserts to fixed ankle supports. Sometimes a walking boot is recommended.

Without treatment, the flatfoot that develops from posterior tibial tendon dysfunction eventually becomes rigid.  Pain increases and spreads to the outer side of the ankle and consequently, the way you walk may be affected causing pain in the hips knees and back.

If you think you may have this disorder, rest is recommended, especially reducing the amount of exercise which causes the pain. Utilise low impact exercise instead, such as swimming. Always warm up with stretches before exercising and using ice on the area can reduce inflammation. For specific advice on orthoses, a biomechanical assessment is recommended.

Please don't ignore this problem, it will get worse and your podiatrist can help you.

Charcot Foot

We are all aware that diabetes is a very serious condition. If you are in any doubt about the effects it can have, then look no further than Charcot foot.  

Diabetes, along with other conditions, can cause neuropathy which is a loss of the ability to feel temperature, pain and trauma. People with neuropathy, especially those who have had it for a long time, are at risk of developing Charcot foot. It is named after Jean-Martin Charcot, a French neurologist who in 1868 first associated neuropathy with bone and joint destruction in the foot.

The problem is due to the inability to ‘feel’ the ground as you walk, a lack of 'proprioception'. A good example of this is when walking on uneven ground. As the foot hits the ground, proprioceptors in the foot and leg recognise the position of the ground and adjustments are made in order to keep walking forward. When sensation in the feet is lost, the connection is not made between the feet and the brain; the feet do not adjust properly, causing excessive strain on the joints and bones. Over time these joints and bones begin to break down. The bones are weakened enough to fracture and with continued walking, the joints collapse and the foot takes on an abnormal shape.

The damage to the joints results in a foot that no longer functions properly. There are pressure points on the foot which may ulcerate and become infected which may in turn lead to osteomyelitis.

Nobody wants this to happen, so it is very important to understand the process and be able to recognise the symptoms.

The first stage is very destructive and the foot displays signs of inflammation; redness, swelling and increased heat. Under the surface the bones may be fractured, even though there is probably still no pain. Next, the body attempts to heal the fractured bones to restore normal joint function, but they are already damaged and with continued pressure from walking, they are deformed.

If Charcot's is treated early, the damage can be limited. Usually, a total contact cast is applied to the affected foot to evenly distribute the weight, although non-weightbearing is best. This prevents further damage and helps the bones to heal properly. If damage has occurred, then specialist footwear will help to minimise pressures on the foot and prevent ulcerations. Severely deformed feet may require surgery to remove bony prominences and to fuse weakened joints in order to prevent further damage.

SO VERY IMPORTANTLY:

• With diabetes, keep blood sugar levels under control to help reduce the progression of nerve damage in the feet.
• Check both feet every day. Charcot usually occurs in one foot, so if there is a difference between your feet, such as one is warmer and more swollen than the other, then contact your podiatrist or GP IMMEDIATELY
• Be careful to avoid injury, such as bumping the foot or overdoing an exercise program.
• Visit a podiatrist regularly.

Haglunds Deformity

What is Haglund's Deformity?

Haglund’s deformity is a bony enlargement or lump on the back of the heel bone (calcaneus), where the Achilles tendon attaches to the foot area. When that bony enlargement rubs against the heel counter of a shoe, the soft tissue near the Achilles tendon becomes inflamed, often leading to bursitis .

People suffering with Haglund's deformity complain of a rubbing pain which makes them limp when they put their foot to the floor, in shoes. They have a noticeable bump on the back of the heel, which is swollen and inflamed. It is relieved when walking barefoot.

The calcaneum, or the heel bone, is shaped differently on different people and those with a prominent bump are more likely to develop Haglund's deformity.

As with many foot disorders, Haglund’s deformity may be due to inherited foot structures. These  include

A prominent heel bump squeezing the tissues between the shoe counter and the heel.

A high-arched foot

A tight Achilles tendon

A tendency to walk on the outside of the heel.

Treatment of Haglund’s deformity is generally conservative, aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Your podiatrist will be able to advise on the best treatment options for you, but for immediate relief, ice may reduce the swelling of the inflamed area. Wearing shoes with modified heel counters or open-backed shoes will take pressure off the bump, as will walking barefoot.

Longer term, placing pads or cushions inside the heels of shoes can help take pressure off the back of the heel and orthotics may help to stabilise and control the motion of the foot. Some people find that wearing padded socks can also help take pressure off the back of the heel.

Whereas the bony protrusion will not change with conservative treatment, the thickened soft tissues may shrink back to normal size in time, once the pressure is removed.

Anyone who has suffered from Haglund's deformity will want to prevent it happening again. Logical steps to take include:

Wearing appropriate shoes - avoid shoes with a rigid heel back

Performing stretching exercises to prevent the Achilles tendon from tightening

Avoiding running on hard surfaces and running uphill  

Using orthotic devices as prescribed by your podiatrist

As ever, please don't suffer in silence. Call in to see us and ask for our help.

Psoriasis

It's itchy, red, scaly and embarrassing! 

As with most conditions, the severity of psoriasis changes from person to person and, the effects it has on each person, is individual. One thing all sufferers have in common is that they don't want it.

There are several different types of psoriasis, the most common being plaque psoriasis.                    

Psoriasis is a long term chronic condition that often lasts a life time, with flare ups that vary in severity. It is caused by skin cells developing quicker than the body sheds them, resulting in thick patches of red or silver plaques. Skin cells normally grow gradually and flake off about every 21 days, while new skin cells are growing to replace them. In psoriasis the new skin cells move quickly to the surface causing the build up.

The plaques can appear anywhere on the body and range in size from small to large, almost complete covering of parts of the body, for example, the whole back.  Psoriasis is most common in adults, but anyone can be affected; it isn't contagious.

People with psoriasis often notice times when the condition worsens. This can be caused by infections, stress, dry skin, and taking certain medication.

Continue reading below...

Experts believe that psoriasis occurs when the immune system overreacts, causing inflammation and flaking of skin. Some believe that psoriasis is genetic. Many cases of psoriasis are easily diagnosed and mild. 

Treatment begins with skin care, including keeping the skin moist with unperfumed moisturiser and those specifically prepared such as Body Essentials, Soothe Your Skin. 

In some cases, psoriasis can be hard to treat and it may be necessary to try different combinations of treatments to find what works for you.

About half the people affected by psoriasis also have psoriatic nails, although psoriatic nails may occur without psoriasis anywhere else.   It is often seen in the toenails and is sometimes difficult to tell apart from a fungal nail. In fact, a psoriatic nail, is more likely to be affected by a fungus and so it could be that both are evident. The signs of a psoriatic nail are:

• Pitting on the surface of the nails, probably due to defects in nail growth caused by psoriasis
•  Separation of the nail from the bed causing white spots on the surface of the nail
• Redness around the nail
• Yellow Colour
• Dead skin under the nail

A psoriatic nail is as difficult to treat as psoriasis itself and, it is advisable to seek medical advice.

One thing is certain about psoriasis is that many people are affected and it is nothing to be embarrassed about.

Cellulitis

Any area of the skin that is  red, warm, swollen and painful may be cellulitis.  

Cellulitis often begins as a small area of tenderness, which is swollen and red and spreads to adjacent areas.

The involved skin may also feel warm. There may be red lines under the skin before the generalised redness appears.  As this red area begins to enlarge, the affected person may begin to feel unwell developing a fever and nausea as the infection enters the blood stream or the lymphatic system. 

There are other conditions which look similar to cellulitis.  Poor leg circulation can lead to a red scaly skin, but this is not infectious.

The lower leg is the most common site of the infection, particularly over the front and in the foot.

Cellulitis  occurs when bacteria enters the skin through a crack or break. Sometimes the break in the skin is obvious, such as a scratch or an insect bite. Other times it can be due to a tiny crack in the skin caused by a fungal infection such as  athletes foot, or a cracked heel. Eczema or psoriasis  cause skin damage, as does radiation therapy. Any of these may lead to cellulitis. 
People who are living with diabetes or have a weakened immune system, such as those who have had chemotherapy,  are particularly susceptible to developing cellulitis, as are those who have conditions affecting the circulation in the legs. These include pregnancy and surgery.

As cellulitis is an infection of the  deeper layers of the skin, it is not contagious.  The top layer of the skin provides a cover over the infection.

If you suspect cellulitis, you should visit your GP as soon as possible as antibiotics are usually prescribed. This is dependent on many factors  including general health, the condition of any wound, the site of the problem, the bacteria involved and the extent of the inflammation.

If there is an underlying problem, such as athletes foot, ulceration or overall dryness of the skin, these must be treated to reduce the chance of re-infection. A visit to your podiatrist is recommended.

Cellulitis is not always preventable, but sensible precautions are always advised:

* Trim your toenails carefully.
* Moisturize your skin regularly to avoid peeling and cracking.
* Attend to any infections, such as athlete’s foot.
* Check your feet and legs regularly to detect any early signs of infection.

Hammer Toes

What is a Hammer Toe

Hammer toes may occur in any toe except the big toe, most commonly the 2nd, 3rd and 4th. The toe is permanently bent at the middle joint  and may be flexible or rigid, The rigid toe is

often the most disabling as it is not capable of relieving pressure of its own accord and it often causes a 'back pressure'  onto the metatarsal area of the foot, in the metatarsals.  
There is often discomfort on the top of the toe due to rubbing against the shoe, resulting in corns and calluses both here and over the heads of the metatarsals.

What Causes It?

A Hammer Toe results from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight causing the toe's joints to curl downwards.

People who have high arched feet may develop a hammer toe because the toes begin to slide upwards on the metatarsal heads, just behind the toes. This change in the structures on the sole of the foot causes the ligaments and tendons on the top of the foot to lengthen and weaken.

Also, those with flat feet will also tend to develop hammer toes because as the weight is transferred across the middle of the feet during walking, the smaller toes are trying to gain purchase on the ground, curling in an attempt to grip.

Arthritis can lead to many different forefoot deformities, including hammer toes. This is due to changes within the joint caused by inflammation and destruction. Shoes that are too narrow, too short or too shallow will contribute to the problem whilst Hallux Valgus, or bunions, may overcrowd the 2nd toe, pushing it upwards.

What happens next...

When these damaged toes are forced into shoes, the shoe rubs on the bony prominences. This added friction commonly produces a corn, or callus overlying the prominent part of the toe, which is over the hammered joint, or on the end of the toe.  Constant pressure will also cause the toe to become red and swollen in that area and is very painful. This may result in bursitis.

Treatment and Prevention

It is really important that footwear has enough depth for the toes, to prevent friction and rubbing. Having the callus and corns removed by a podiatrist is recommended, especially if the person lives with diabetes. In this case, the corn may not be painful, but may be causing a breakdown of skin underneath the corn, leading to infection.

Conservative treatments include gel toe shields and gel toe caps to eliminate friction between the shoe and the toe, while providing comfort and lubrication.

A word of warning, please do not use medicated corn pads as these often make the surrounding skin very moist and can cause an infection.

If the a hammer toe is causing a lot of problems and is a cause for concern due to infection, surgery may be appropriate.