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.

"Is It a Bunion?" - Part 2 - Hallux Valgus

"My bunion is playing up" 

"Is it really a bunion?"

"It'll be those stupid shoes I wore when I was young."

 

There are many misconceptions about bunions. . Many people believe that  bunions are self inflicted and may unnecessarily suffer the pain of bunions for years before seeking treatment.

A true bunion is called  hallux valgus or hallux abducto valgus.  The hallux (or big toe)  leans towards the second toe instead of pointing forwards,  producing a 'bump' on the side of the foot.  The bump is actually the head of the metatarsal bone which is not normally visible. It is a progressive disorder with the angle of the bones changing over time  and symptoms often appear at later stages. Some people are lucky enough never to have any symptoms.

Foot anatomy is inherited, as are foot mechanics. The bunion is not inherited; it is the foot type that are prone to bunions. Wearing shoes that crowd the toes won't cause bunions, but in a person with predisposing factors, they may make the condition more obvious and more painful.

A person who has a bunion may experience a variety of problems. There may be pain, swelling and/ or inflammation over the 'bump'; sometimes bursitis occurs, occasionally with the presence of a corn or callus. The area may develop a  burning sensation or become numb. Other problems as a result of having a bunion, include a corn between the hallux and the second toe  and a hammered second toe.                                                                                                                              

High heels and narrow toe boxes will probably make the symptoms and effects of bunions worse, as will standing for long periods of time.  

The forces occurring on and within the foot are very difficult to overcome and an asymptomatic bunion is best left untreated. In many other cases, some type of treatment is needed. Early treatments are aimed at easing the pain of bunions, but they won’t reverse the changes.  Inflammation may be reduced by applying ice to the area and avoiding tight footwear and high heels. Beyond this, a visit to your podiatrist is recommended and you may be advised to use padding to deflect pressure from painful sites or to see a biomechanics specialist, who can prescribe custom orthotic devices

Sometimes it is necessary to seek advice on surgical interventions. There are many different procedures available ranging from removal of the 'bump' to correction of the bony structure and soft tissue changes. Surgery aims to reduce pain.   Everyone has their own unique set of problems which must be addressed on an individual basis.

Don't suffer in silence.

"Is It a Bunion?" - Part 1 - Hallux Rigidus

"My bunion is playing up".

 The big toe joint causes a lot of trouble for some people, but it isn't always a bunion, even if the joint is swollen, red and painful.                                

Quite often it is a condition called Hallux Rigidus. The 'Hallux' refers to the big toe and 'Rigidus' means that the toe is rigid, or does not move easily. It requires very different treatment to a bunion.

 It is actually  a form of degenerative arthritis which is a progressive condition  and with time, stiffness develops in the toe.  In the early stages when movement is only slightly limited it is referred to as 'Hallux Limitus', but eventually the motion deceases and when the joint is very stiff, it becomes Hallux Rigidus.

We use the big toe joint for many activities, walking, climbing, kneeling, stooping or even standing and so, any inflammatory condition affecting the joint is very painful.

This type of arthritis is often referred to as 'wear and tear' and may be  attributed to the internal 

architecture of the foot, the way in which the joint moves in relation to the other joints in the foot.  There are many biomechanical discrepancies that can lead to this problem including excessive 'pronation' of the foot. Some people have occupations  that require putting excessive strain on the joint, for example climbing ladders or squatting for long periods of time. This may be the sole cause or it may be adding to the inherited problems. There is often a family history of Hallux Rigidus which may be due to the inherited predisposition and the bony alignment or even that career paths may also 'run in families'.

Hallus Rigidus may be caused by injury or trauma, such as stubbing the toe(common in athletes); or through suffering other inflammatory conditions such as gout or rheumatoid arthritis.

As Hallux Rigidus develops, the symptoms progress. Pain and stiffness are the first signs which are aggravated by cold, damp weather and made worse during certain activities (squatting, running). There may be inflammation around the joint combined with swelling. All of these may cause a limp and, as a result of the altered gait, knee, hip and back pain are often evident.

Your podiatrist can usually diagnose this condition by manipulating the toe, but an x ray would determine it.

Treatment involves reducing the inflammation and pain.

 Keeping the joint straight is very helpful and so thick stiff soled shoes are advised. For once, flexible trainers are not advised by the professionals! Well placed pads inside the shoe can reduce the movement in the joint and high heels are definitely not recommended. Avoid all activities which include repeated trauma on the joint, such as jogging. Once the inflammation has reduced, the pain will subside.  Ultimately the toe may become completely inflexible. This may not necessarily cause any problems, as  instinct is to hinge off the second toe joint if the first one is not functioning.