Callus is a diffuse area of hyperkeratosis, the development of an abnormal thickening of the outer layer of skin. This is caused by mechanical stress, pressure and friction. Using a pumice stone or foot file regularly and applying emollient cream can help to relieve pain at home. A Foot Health Practitioner or Podiatrist can remove corns and callus by paring down the hyperkeratosis as well as provide soft padding or insoles to take pressure off the painful area.
Corns There are different types of corns – hard corns (heloma durum), seed corns (heloma millare), vascular corns and soft corns (heloma molle). They can be caused by pressure and friction and are usually found over a bony prominence. Corns are more common in middle aged and older patients. Aged feet have a reduced fibro-fatty pad in the deeper layers of the skin and therefore less natural cushioning. This is exaggerated in people with Rheumatoid Arthritis where oral steroids have been taken over a long period of time. Footwear can also be a major contributor to corns developing. When areas of our skin experience persistent mechanical stress or compression, thick skin (callous) develops. If the area of hard skin becomes painful, this can be an indication of a corn being present, often described as feeling like having a stone in your shoe. Corns can be removed using a blade which is a pain free procedure. If the source of pressure is not eliminated or reduced then the corns will return within weeks. Toe props, padding and changing footwear can all help to reduce the mechanical stress causing the corns.
Ingrown nails (Onychocryptosis) occur when a spike or separated edge of nail pierces the skin and penetrates the tissues. As the nail grows and further penetrates the tissue, inflammation and infection presents with acute tenderness and throbbing pain. Ingrown nails are often caused by poor nail cutting or ill-fitting footwear. Treatment involves cutting away the section of the nail that is causing if possible, then irrigating and drying the area with a sterile gauze. If the area is painfully infected antibiotics will need to be prescribed by a GP to reduce the infection before any treatment can take place. A Foot Health Practitioner could treat moderately ingrown toenail.
Involuted nails are described as ‘horseshoe’ nails as they have an increased transverse curvature along the longitudinal axis of the nail. Involuted nails are more likely to dig into the skin and cause pain. Immediate relief from the symptoms are provided by a foot professional trimming back the section of nail causing pressure, called a Partial Nail Resection. This is a painless procedure.
If the root of a toenail is damaged significantly by major trauma or minor trauma over a period of time, the nail will become irreversibly thickened. People wearing ill fitting footwear; with poor peripheral circulation and those who have toes that are hyperextended are more commonly affected. Fungal infections can easily penetrate damaged nails, making them appear even more thickened and discoloured than they normally would. Thickened nails are often crumbly with only part of the nail still attached to the nail bed. They shouldn’t be a cause of concern as they can be treated by a professional. The nail thickness is reduced using a burr which is a painless treatment and one which quickly makes the appearance of the nails much more acceptable.
Fungal nail (Onychomycosis) is a common foot condition resulting in nails becoming discoloured, thick, crumbly and brittle. It is important to treat fungal infections at the first sign of infection. Being consistent with treatment will help to eradicate the fungus. Regular foot care by a foot health practitioner or podiatrist will also support treatment of fungal nail infections. It can take anywhere from 6 months to 2 years for the new healthy nail to grow.
Verruca (Verruca pedis) or plantar warts are caused by infection of the epidermis with human papillomavirus (HPV). The virus enters the skin through tiny breaks in the skin surface. Moistness and maceration of the skin make infection with the wart virus easier. Verrucae can appear anywhere on the feet, often on weight-bearing areas. They have a rough surface protruding from the skin often described as a ‘cauliflower’ appearance. They can be differentiated from corns as they interrupt the fine ridges (striations) on the skin’s surface and cause pain on squeezing rather than with pressure alone.
When thinking about treatment, it is important to note that there is no single treatment that is 100% effective and different types of treatment may be combined. The highest cure rates are seen in the younger people and most go away by themselves in due course. Studies have indicated that up to 65% have disappeared spontaneously after a two year period. For adults with warts; those who have had the infection over a long period and with patients who are immunosuppressed verrucae are less likely to resolve on their own. For these people who experience pain or would like treatment for cosmetic reasons, options are available to help. These will be discussed during the initial consultation.
Athletes Foot (Tinea Pedis), is caused by a fungus, which if left untreated can spread to your nails. Often found between the toes, it can be uncomfortable and itchy. Fungi spores thrive in dark, damp and humid conditions making in between your toes an ideal spot. Good foot hygiene and thoroughly drying the area between your toes after bathing is important. Sprays and creams can treat the problem.
These can develop with dry skin. When we are on our feet, weight and pressure is applied to the fat pad under the heel which expands sideways. If the heel skin is very dry skin it is less elastic under this pressure and therefore more likely to crack. It can become painful and unsightly if left. Gently rubbing the area with a pumice stone and moisturising daily can help. A Foot Health Practitioner or Podiatrist is able to gently remove the area of skin and if required seal the crack with medical glue. They can apply special moisturisers, advise on footwear and recommend pads to prevent further problems.