Onychogryphosis

A gryphotic nail is one which is thickened and deformed. They are often referred to as a 'Ram's Horn'

Onychogryphosis  occurs as a result of damage to the nail either due to one major event, like dropping something heavy on the foot, or multiple minor events.  These minor events can be as varied as having a shoe with a tight toe box causing impaction on the  toes,  to repeated forward movement of the foot in footwear, for example a runner whose toes push to the end of a trainer causing impaction.  Keen walkers are also prone to onychogryphosis, especially hill walkers.

They are difficult to manage at home and usually need professional care from a podiatrist.  If they are not treated they can lead to ulcerations and infections. They can also be very uncomfortable.

Please don't be embarrassed , treatment is very simple and straightforward.

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Chikungunya - The Treatment

 

Chikungunya is a mosquito transmitted virus which is becoming more widespread. It has recently been  reported in the Caribbean and France.  The symptoms usually appear within 3- 7 days of a bite.

To prevent the mosquito attack, use repellants on your skin at all times, wearing long sleeves and long trousers whenever possible. Keep mosquito nets over beds and the doors and windows screened. Better still, use air conditioning whenever it is available.

Don't allow water to stand in containers outside.

 The chikungunya rash

There is no medication available to treat the chikungunya virus.  

It is important to keep your fluid levels high to prevent dehydration and to take anti-inflammatories and pain relievers. Get plenty of rest.

If you suspect a mosquito bite from an area where the virus is present and the symptoms are present, it is essential to seek medical advice.

Some people benefit greatly from physiotherapy and podiatry who can offer therapies which are designed for the relief of  arthritis. Chikungunya sufferers may require orthotics for many months after the virus has passed.

After our lady sufferer had visited our surgery, she said of the Chikungunya Virus

"It has affected me so much that I will never go back to the Caribbean. Even though my son lives there."

Chikungunya - The Symptoms

Chikungunya is a mosquito transmitted virus which has evolved since the 1950's , becoming more widespread. It has recently been  reported in the Caribbean and France.  The symptoms usually appear within 3- 7 days of a bite which are high fever and disabling painful joints, most often in the hands and feet. People who have contracted chikungunya may also suffer with nausea, vomiting, headaches and a rash. Between 72 - 93% of infected people become symptomatic. Death is rare.

It is reported that acute symptoms last for around  one to two weeks, although some people suffer with painful joints for months or even years afterwards.

The symptoms are very similar to another disease called Dengue. 

Dengue is transmitted by the same mosquito as chikungunya,  and displays similar symptoms. 

Dengue is also a killer.

An incidence reported in France mainland recently occurred in two children aged 8 and 10 who had returned from a visit to  Martinique.  They both had acute fever and painful joints. The boy had swollen knees and they both had rashes on their bodies. 

The most vulnerable are the elderly and the very young and those with underlying medical conditions.

Complications due to an episode of the Chikungunya virus include painful eye conditions, retinitis and uveitis. Inflammation of the liver, kidney and the meninges of the brain.  Some patients have repeated relapses of rheumatologic symptoms after the acute phase has passed.

Chikungunya (What - on EARTH??)

A patient called her podiatrist for an appointment this week as she had been suffering with chikungunya and she needed some therapy on her joints.

Naturally some research was required (as this was something not encountered previously!)  and we thought you may like to share our findings. Interestingly, Chikungunya is caused by a mosquito type bite and is most common in hotter lands than the UK;  although there have been reported outbreaks as close as Northern Europe.  Not surprisingly, Chikungunya is on the increase.

 Countries with reported local transmission of chikungunya virus (as of July 2014)

Chikungunya  is a virus and is transmitted by aggressive biting mosquitoes, which attack during the day. Once infected , the person has a high fever and severely debilitating painful joints, very often in their hands and feet. Our lady suffered severe vomiting and was hospitalised for a number of days. She was weakened and the painful joints made it difficult for her to walk. The mosquito responsible in her case, was very large and she witnessed the bite.

Outbreaks have previously been reported in Africa, Asia, Indian and Pacific Oceans. Although the virus has been reported since the 1950's, the incidence has been mainly in developing countries and sadly little interest was shown. An outbreak in the French colony of La Reunion in the Indian Ocean during 2005 motivated France to invest in research.  The first transmission of the virus in the Caribbean, was reported in 2013. So be aware if you are travelling to this popular destination.

Chondromalacia - Diagnosis and Treatment

Chondromalacia patella is a painful condition of the knee caused by a breakdown of the cartilage behind the knee cap, usually caused by overuse or direct trauma.
If you think you may be suffering from chondromalacia patella, the first line of treatment is to rest, apply compression and ice to the area to reduce inflammation.

It is important to visit a professional to have the cause identified. A biomechanical assessment will identify any problems with your walking and the alignment of joints. For example a foot which is not aligned with the knee may be causing the lower leg to rotate, putting a twist on the knee. Any problems can be corrected and strengthening exercises can be prescribed.


Patella taping can be used to instantly reduce pain by preventing the kneecap from constantly rubbing.  A patella knee support can support the patella and relieve pain. In some cases manipulation techniques can ease the discomfort.

A full knee exercise regime should be undertaken.. Exercises aimed at increasing the strength of the muscle on the inside of the knee and stretching the muscle on the outside of the knee is most often needed, although your podiatrist or physiotherapist will advise accordingly.  

The main message is, don't suffer in silence.  Visit your podiatrist and request a biomechanical assessment. Help is out there!

Chondromalacia - What are the symptoms?

Chondromalacia patella is a breakdown of the cartilage in the knee, usually due to trauma or mal-tracking of the patella over the knee joint.

The most common symptom of chondromalacia patella,  is a dull, aching pain in the front of your knee, behind your kneecap/patella. It can flare up after you have been sitting in one position for a long time. For example, your knee may be painful and stiff after a long trip in a car or aeroplane and it is often worse first thing in the morning; it may therefore be confused with an arthritic problem.  The pain can get worse when you go up or down stairs.

Chondromalacia can sometimes make your knee joint "lock" which means you suddenly have trouble moving it past a certain point.  Sometimes the joint may buckle or not support you effectively, which tends to occur when you bend your knee repeatedly, especially when you go up or down stairs. Occasionally the knee may be swollen and hot. 




Chondromalacia can cause a grinding sensation when you move your knee. This is not always a true test of diagnosis, as there are many other conditions which cause the knee to creak.

If you are struggling with chondromalacia, please visit a professional for advice.

Chondromalacia - What is it?

You may have heard of Chondromalacia and know that it commonly refers to a condition of the knee. 
Why would the Footcare Clinic be interested in a knee problem?
Actually, any problem which causes you to walk differently is of paramount importance to your podiatrist because it will be affecting your feet and the problems you may have. Conversely, the way you walk and the angle at which you position your foot during walking may be the cause of chondromalacia in the first place.

The joints in our bodies are cushioned with articular cartilage. As each joint moves, the cartilage helps to cushion the bones and allows them to glide smoothly over one another.

Sometimes, the cartilage inside a joint softens and breaks down. This condition is called chondromalacia. and  as the joint moves, the ends of the bones can rub together, causing pain. Sometimes the cartilage can wear away completely, exposing the bone underneath and then the surface can grind painfully against the other bone(s) in the joint. The cells in the area respond by producing fluid in the joint, called joint effusion, i.e. swelling.


In the knee, chondromalacia-patella can be caused by an acute injury such as sudden impact, or from overuse usually due to the position of the patella itself, known as mal-tracking, where the patella moves sideways as a result of a muscle imbalance.
It is common in young athletes who depend on knee activity, especially runners, skiers, cyclists and other athletes. Anyone who spends a lot of time kneeling is also at risk, for example, floor layers.

If you are suffering with knee pain, get it checked out and remember to mention it when you visit your podiatrist. They may be able to help with a biomechanical assessment and orthotics.

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.