Skin and Nail

Fungal infection of the skin of the foot is referred to as tinea pedis (athlete’s foot). It is caused by various types of fungus, and can be spread in places where people go barefoot such as public showers or swimming pools. It can present as; Itchy, dry, scaly, Cracked skin with inflammation or small blisters on the feet, soles or between the toes.

  • Management involves avoiding walking barefoot especially in shared/public spaces. Practicing good foot care such as washing feet with soap and drying thoroughly especially between the toes.
  • In people with sweaty feet, socks may need to be changed more than once a day especially when undergoing treatment.

Antifungal powders, sprays and/or creams may be used to treat athlete's foot. But you should see your podiatrist for advice on best treatment and management and prevention of this condition.

Blisters occur when the foot intensely and repeatedly rubs up against the inside of the shoe. Blisters are usually a fluid-filled bubbled skin area. Sometimes they can be filled with blood (blood-blister) due to a break in the soft tissue under the skin. Wearing poor fitting shoes, long periods of continuous walking or running can bring on blisters.

  • Most blisters heal on their own. If a blister develops, it is important to clean it well and apply a pad to help cushion and protect the area. For blisters that are large and/or painful, a podiatrist may need to drain, clean and dress the area.

Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet.

Foot deformities such as hammertoes, bunions create high pressure areas that have increased friction areas leading to corns and calluses.

A condition referred to as Fat Pad Atrophy can be a source of continuous callus and corns problems. This is because the fat pad beneath the soles of the feet absorb shock during walking or running. When the shock absorbent capacity of the feet is lost, pain develops with prolonged standing, walking or running.

Treatment should include:

  • Well-padded insoles in all shoes
  • Not walking about barefoot.
  • Orthotics with shock absorbing materials to cushion the bones of the feet.

Dry and cracking of heel and skin of the bottom of the feet are a very common problem for many people. Dry skin can lead to cracking of the skin, if untreated cracked skin develops into fissures which are deeper splits in the skin and can be painful and in some cases bleed. There may be hard skin present on the heel along the with the cracks. Many condition contribute to cracked heels and fissures, these include; being overweight, diabetes, nerve damage (neuropathy), poor circulation, some medications including some cancer treatments, even poor nutritional status. Symptoms of heel cracks and fissures go from mild to severe.

  • Treatment always starts with moisturizing the feet two times a day especially after a shower/bath or after washing one’s feet. Shoes play an important role as they protect the feet from the drying effect of the elements, hold moisture and with soft insoles, reduce pressure and friction on the heel.
  • In the case that poor circulation is present, further investigation can be performed to identity the point of blockage (if that is the case) so vascular surgical intervention can be performed swiftly.
  • Eating a healthy well balanced diet is always encouraged for overall well-being.

Ingrown nail occurs when the toenail begins to curve and grow into the skin. This can be cause by tight fitting shoes, trauma from stubbing the toe or sports including hiking, netball basketball and running. Other factors include cutting the nails too short or cutting around the corner but leaving a spicule behind. Potential for ingrown toenails can also be due to genetics, making it hard to prevent because of the nature of the toes or toenails.

Symptoms often start with pain in the corner, swelling, redness of the area and infection, there can also be proud flesh growth in cases on long standing ingrown toenails.

A lot of times patients will see their GP for the infection and are given antibiotics. As much as antibiotics are useful in the presence of an infection, it important to reserve such prescription for patient with delicate health issues. People with diabetes, nerve damage, or poor circulation should never try to treat/remove the ingrown toenails themselves, instead seeking a health care professional. Most healthy individuals with adequate blood flow require the removal of the offending nail in order for the condition to improve, and a podiatrist can recommend of antibiotics are needed afterwards. In most cases, even after two courses of antibiotics, the condition returns in a matter of week because the piece of nail causing the problem is still “buried” in the skin.

Initial treatment can include:

  • Soaking the foot in warm water with Epsom salts or Bicarb soda for about 15 mins
  • gentle massage of the affected area to express any pus that may be present,
  • applying some antiseptic cream or solution such as betadine,
  • dressing the toe with a padded bandage,
  • and seeing a clinician ASAP

In some cases, surgery may be required as a permanent solution for chronic recurring ingrown toenail and infections. Please see here for more details.

Onychomycosis (fungal infections of the nail) affects mostly adults especially those with compromised immune system, and young adults, in not so frequent cases children can be affected.

There are different types of fungal infections of the nail, and the most common type cause by the same fungus that causes Athlete’s Foot.

Fungal nail infection can present as:

  • A white, yellow or brown nail
  • Thickened or crumbling nail with thick build up under the edge of the nail.
  • Nail splitting or lifting from the nail bed
Treatment modalities include:
  • Debridement of nail and use of topical medication Laser treatment of infection nails (not advised for children or pregnant women).
  • Oral medication – requires some basic work up before prescription if written by GP.
  • In addition to the treatment options above, the patient most practice proper foot, sock and shoe hygiene to prevent recurrence of the infection.
What are Warts?

Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus and can appear anywhere on the skin. Those that appear on the sole of the foot are called plantar warts. Children, especially teenagers, tend to be more susceptible to warts than adults.

Causes

The virus that causes warts generally invades the skin through small or invisible cuts and abrasions. The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.

If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart.

Symptoms/Identification

Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses, which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.

Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. It is important to note that warts can be very resistant to treatment and tend to reoccur.

When plantar warts develop on the weight-bearing areas of the foot they can be the source of sharp, burning pain.

Diagnosis and Treatment

It is possible that your podiatrist will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts will be done by chemical application, cryotherapy (freezing), or a simple surgical procedure, performed under local anaesthetic.

Prevention
  • Avoid walking barefoot
  • Change shoes and socks daily
  • Keep feet clean and dry
  • Check children's feet periodically
  • Avoid direct contact with warts from other persons or from other parts of the body
  • Do not ignore growths on, or changes in, your skin
  • Visit your podiatrist as part of your annual health check-up.
Compared to fingernails, toenails grow much more slowly – about 1 mm a month.