Ingrown Toenails

The very thought of a true ingrown toenail is enough to my toes curl! (More on curly toes later!)  It is a very painful condition and by the time a patient seeks help, it is often very inflamed and even infected.

Some people are prone to ingrown toenails, due to the natural shape and condition of the nail plate. Others are unlucky enough to suffer trauma to the nail, which causes it to ingrow.

If your nails are very 'tight', almost like a staple, they are possibly 'involuted'.  This type of nail is often inherited and extremely difficult to cut.

 Attempts to cut these nails may leave small spikes down the sides and, unfortunately, they only become apparent when they start causing pain.  The spike of nail literally grows into the flesh at the side, in the sulcus. At first it is only a slight irritation, but very quickly it rubs, pierces the skin and sets up an inflammatory response. As there is a lot of bacteria present, both in and around the nail, it soon becomes infected.

The skin is an incredible organ and as we all know, makes every attempt to heal itself.  Ingrown toenails are no exception.  The inflammatory response encourages the body to repair the skin break, delivering more blood to the area.  The next stage of the healing process is granulation of the wound. This is when a matrix is laid down in the wound for new capillaries to grow.

With a spike of nail present, the wound can't heal.  The body reacts to this by trying to 'reject' the foreign object and produces more granulation tissue, until there is 'hypergranulation' tissue. 

This is a lump which rises above the level of the surrounding skin.  It isn't painful itself, but it does bleed very easily due to the number of blood vessels present.  This is the stage when people usually seek help as looks quite alarming in addition to the pain.

Your GP will often prescribe antibiotics for this, which will help if there is a bacterial infection present, but will not resolve the problem. The only way to 'cure' the ingrown toenail is to have the spike removed.

This is not as painful as it sounds, even if the toe is very sore. An experienced podiatrist can resolve the problem in a matter of minutes, once the location of the spike has been found.

Once the spike has been removed, relief is immediate. The hypergranulation tissue will usually shrink back within hours and the toe will heal completely within days. 

A very easy resolution to a very painful condition!

Incidentally, the medical term for an ingrown toenail is 'onychocryptosis'. A very suitable name for a condition which is crippling.

So, if you think you have left a spike of nail when trimming your nails or have knocked your nail and think it may have split, hot foot it to your podiatrist who will sort you out in no time :)

Raynaud's Phenomenon

Many of us suffer with cold hands and feet during the winter months, but if a quick trip around the refrigerator aisles of your local supermarket leaves you with white finger  tips and feet that feel like wooden blocks to walk on, it could be that you are a sufferer of Raynaud's Phenomenon.

Raynaud's  is a relatively common condition, affecting more females than males and can occur at any age. although it is rare in the very young. It is named after a French doctor, Maurice Raynaud who discovered that over-active sympathetic nerves cause a constriction of the blood vessels to the extremities.  In 1862 he published a thesis "On Local Asphyxia and Symmetrical Gangrene of the Extremities ".

The condition can be alarming, especially when it happens for the first time and when the colour changes from white to blue to red as the blood slowly reaches the affected areas. There is often numbness and pain associated with it and if this is severe, then a doctor should be consulted.

Being aware that you may have Raynaud's is the first step to managing the condition.   Primary Raynaud's is the more prevalent and  is usually inherited. Secondary Raynaud's  is associated with underlying disorders such as rheumatoid arthritis and scleroderma. In these cases the symptoms are often more acute.

Treatments for the condition vary in their usefulness and obviously if you are worried , then your GP should be consulted.  Sufferers of the disorder  should be aware that it is a relative change in temperature that causes the problem so maintaining an even ambient environment is the best management. Now, we can't all stay indoors, out of draughts and away from air conditioning forever, so the use of hand warmers and layers of thin gloves and socks may help  to maintain the temperature.

Your feet require special care. Raynaud's patients are very prone to chilblains. Be certain that your shoes do not rub and don't use sharp instruments to deal with issues. Always see a podiatrist as there may be ulcerations present which require hard skin removal to promote healing. Your feet will be very sensitive and the skin very fragile.

Washing feet and moisturising daily helps to keep them in good condition and gives you the focus to inspect them for any breaks in the skin which are all too common with this phenomenon.  Here at the Foot care Clinic, we sell a very useful aromatherapy product, ' Warm your Sole'  containing Ginger, marjoram, lemon and geranium. This has all the properties to soothe  your skin  and keep it warm.

The Raynauds and Scleroderma Association website is full of useful information. 

So,  the next time you head for the refrigerator aisles at your local supermarket, wear double layers of thin gloves and socks, don't let your shoes rub and get out of there as fast as you can!!!

Tendonitis

Cure Tendonitis In Seconds

 "Tendonitis" the doctor said. "There is no substitute for rest and gently working your way back to full exercise.  Use a support bandage and if the pain gets too bad, then take some pain killers".

The patient though, was a self employed swimming teacher and  life guard for whom 'rest' wasn't an option. Well, not if she wanted to eat!

 So, it was time for physical therapy, not pills. She saw a practitioner who smiled and agreed that the problem could be resolved in a matter of minutes.  The patient was doubtful.  "I've had the pain in my knee for nearly two weeks and I can hardly bear to walk on it"

The therapist explained that she was going to use the Jones Strain Counterstrain technique.  This is a simple process which was explored fully by Dr Lawrence Jones, an osteopath, in 1955. The theory is that pain occurs when a muscle is forcibly stretched as it is trying to contract. This produces a physiological response which results in inflammation and restricted joint movement, often at the muscle tendon - known as tendonitis.

The simple procedure involved the patient relaxing on the couch whilst the practitioner found the 'sore spot'.  Then with constant feedback from the lady about the level of pain, the practitioner slowly straightened the leg with her finger on the 'sore spot' all the time.  When the patient reported that there was no pain, the practitioner held her finger on the spot, keeping the leg in the optimum position, for 90 seconds.

Once the time had elapsed, the patient straightened her leg, bent it and said,

"That's incredible. There is no pain at all"; The tendonitis had gone!

And the happy ending was that the lady went back to work the same day, took no painkillers, needed no strapping and was able to buy her tea!

Here is a YouTube video which explains treating Foot/Calf Pain with Gentle Technique.

What is a verruca?

Verrucae  can be silent as lambs or roar like lions!  You may not know you have them. You may have been looking at something strange on your foot for weeks, which didn't appear to change at all, or there may be 'craters' all over both feet which appeared alarmingly 'overnight'! It is generally accepted that verrucae are caused by the human papilloma virus (HPV).  They are  contracted through skin that is very wet  and/or through tiny cuts or fissures in the skin. Often, they are transmitted from walking on an infected, wet surface or towel. The virus can be present for weeks before anything is apparent on the surface of the skin.  Even then, it may appear almost dormant, or it can spread rapidly and many lesions are apparent.  A verruca is a wart which develops inwardly due to the pressure on the sole of the foot.  It can occur anywhere on the foot and on areas which take less pressure on walking, such as the tip of the toes. In these places, it will appear more wart like and have a cauliflower appearance. Sometimes it is difficult to tell the difference between a verruca and a corn. There are often small black dots in the centre of a verruca, which are small 'petechiae' or bleeding points. They bleed easily when scratched. If you look very closely at a verruca, the striations or lines on the skin tend to go around the virus.  If you have acorn, these lines will stop at the corn and continue again, beyond it A good diagnostic test for a verruca is to squeeze it from either side. If there is a 'pricking' sensation, then it is almost definitely a verruca. Don't be alarmed if there are suddenly many verrucae all over your feet, they don't necessarily take any longer to go away than if you only have one lesion. You may also find that you develop warts on your hands at the same time. Seek advice if you are worried about your verrucae and opt for treatment if they are painful. In any case, cover your verrucae when you are at the poolside or in the shower. Wipe the tray around after you have used it and stick to your own towel. This prevents spreading it to other house members who will point the finger and ostracise you in an instant!                                                        YouTube video here

Calluses

Hard skin on your feet is otherwise known as a callus. Calluses develop over areas of high pressure on the feet - and, in fact on any area of the body.  Often, people working constantly with heavy machinery develop calluses on their hands.  They are a natural form of protection for the body as they prevent  thinning of   the underlying skin when constant, repeated pressure is present. Sometimes they become more of a nuisance than a protection and may cause more serious problems such as ulcerations. Areas of high pressure are most often associated with bony prominences, which may be more pronounced due to bio mechanical difficulties.  These areas are commonly found over the toes or on the sole of the foot from downward pressure of the metatarsal heads. Other causes of high pressure include ill fitting footwear. Sometimes the inconvenience of a callus is almost negligible, but other times it can be crippling. Left untreated, the callus becomes harder and drier and there is a risk that it may crack, causing painful lesions which can become infected. This happens most often around the heel area, but can occur anywhere. There can be additional complications if the sufferer also has problems with the circulation in the feet, diabetes or in other cases where the nutrition of the skin is compromised. Once the cause of the callus has been identified, it is possible to limit the formation of the callus with padding. Sometimes small changes such as a thicker soled shoe and better fitting footwear can also alleviate the problem. Long term solutions for more difficult cases may be possible with a full biomechanical assessment and insoles. Moisturising feet with a good foot cream can maintain the condition of the callus and help prevent the skin from 'cracking'. Seeking professional advice is always advisable. Here is a fun video on feet!

Treatment for Plantar FAsciitis

Pain in the heel area on the sole of the foot, is very disabling and may be due to a condition called Plantar Fasciitis. The plantar fascia is a structure which supports  the muscular structures on the sole of your foot spanning from the heel, forwards to the metatarsal heads which are on  the 'ball' of the foot.  This can contract and cause excruciating pain when you start walking especially after a period of rest or after an unusual activity such as ladder climbing.  There are exercises which can alleviate the pain caused by plantar fasciitis. They are based around stretching the calf muscles and the plantar fascia and must be performed within a pain free range. You should feel a pulling of the muscles, but not pain.  Exercise 1 Face a wall and stand at a distance of just less than arm's length. Place your hands against the wall at about eye level. Put the affected leg about a step behind your other leg, so that it is straight and the other one bent. Keep the heel of the straight leg on the floor and lean forward. You should feel a strong pull in the calf muscles. Hold this position for about 20 seconds and repeat 4 times. This should be repeated about  2 or 3 times a day and especially before exercise. Exercise 2 Sit down on the floor if you are able and stretch your legs in front of you. Place one end of the towel under your leg with the towel stretching along the length of the sole of your foot  and grab the other end of the towel. Pull the towel from the top of your leg so that the toes are pulled up towards you.  If sitting straight legged on the floor is difficult, this exercise can be adapted for sitting on a chair Roll up a towel and pull it around the toes of your affected foot, holding the towel at both ends.  Straighten your leg and pull the towel gently towards you.  Hold this position for about  15 seconds. Repeat it 4 times. There will be a pull on both the plantar fascia and the calf muscles. Be sure not to cause any pain. Exercise 3 This exercise can be done at any time of the day, especially when you are sitting down in the evening, whilst reading or watching TV. You can use a tennis ball, a can from the cupboard  or an empty bottle. When you are sitting, roll the ball with the arch of your foot back and forth from your heel to the toes. If you are using a ball, you can manipulate it in a circular motion as well. Do this often but stay within the limit of pain. Exercise 4 Using the bottom stair or step, hold the handrail for support and shuffle your feet backwards until your heel is hanging over the edge. Slowly, and within the range of pain, lower your heels below the level of the stair. Hold this position for about 10 seconds and slowly bring your heels back up. Then repeat slowly and carefully about 5 times If these exercises don't relieve the pain, it may be necessary to have a full biomechanical assessment. Orthoses  may be fitted into your shoes to alter the stretch on the plantar fascia and provide much sought after relief!

http://www.youtube.com/watch?v=YPvpvtXfkJI

Symptoms of Plantar Fasciitis

"The pain is worse when I get out of bed in the morning"

"It's strange. It's right in the middle of my heel - underneath"

"Sometime it hurts if I've been standing for  a long time"

"I can't put my foot down"

Plantar Fasciitis is a very painful condition. The pain is felt in the middle of the sole of the heel and is usually at its  worst, first thing in the morning . In the early stages of the condition, the pain may disappear after a few steps, but  sometimes it can become quite disabling and can last for a long time.

The plantar fascia is a structure which supports  the muscular structures on the sole of your foot.

It spans from a midpoint almost central on the heel, forwards to the metatarsal heads which are on  the 'ball' of the foot. The pain is due a pulling effect at the heel and, in the worst cases, inflammation can travel forward along the whole length of the plantar fascia.

It is very painful first thing in the morning, as most people sleep with their toes pointing down.  In this position, the plantar fascia contracts.  The next morning, when the toes are pulled up in order to start walking, there is an  enormous stretch on the heel, causing the pain.  Once the plantar fascia has stretched out, the pain may ease until there is another period of standing or inactivity.

The onset of plantar fasciitis is often associated with exercise that over-stretches the plantar fascia, such as climbing ladders, or anything that involves balancing on your toes.

In some cases the condition can become so severe that a heel spur may begin to develop where the plantar fascia originates.

If you have  these symptoms, you could very well be suffering from plantar fasciitis.