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All of the following information comes from the College of Podiatry Webpages at www.scpod.org.

Ageing feet 

Ageing feetOlder feet naturally develop more problems because the skin tends to thin and lose it's elasticity. Healing can take longer and wear and tear to the joints over the years may have caused some degree of arthritis.

But painful and uncomfortable feet aren't a natural part of growing old or something to "put-up with". A lot can be done to improve comfort, relieve pain and maintain mobility.

It's not too late to start caring!

Follow the SCP daily foot care routine and keep on the move. Keeping toenails cut and under control will help keep you mobile but you may need help with this from your chiropodist/podiatrist or a friend.

Keeping warm
Try to keep your feet as warm as possible, but don't cook them in front of the fire! Warm stockings or socks can help. Avoid anything too tight which can restrict your circulation or cramp your toes. Wearing fleece-lined boots or shoes or even an extra pair of socks will also keep you warm but do make sure your shoes aren't tight as a result. Bed socks are also a good idea.

Choosing the best footwear
The older you get, the more you need a shoe which holds your foot firmly in place to give adequate support. Throw out those sloppy old favourites as they may make you unstable when you walk.

Look for shoes with uppers made of soft leather or a stretchy man-made fabric which is also breathable. Avoid plastic 'easy clean' uppers which don't allow the foot to breathe and won't stretch to accommodate your own foot shape.

Many shoes have cushioning or shock absorbing soles to give you extra comfort while walking. When buying shoes, ensure that you can put them on and take them off easily. Check that the heel is held firmly in place - you'll find that a lace-up or velcro fastening shoe will give more support and comfort than a slip-on.

Your shoes should be roomy enough, particularly, if you intend to wear them everyday. If you suffer with swollen feet, it's a good idea to put your shoes on as soon as you wake up, before your feet have had a chance to swell.

Exercise
Exercise can help to keep feet healthy – it tones up muscles, helps to strengthen arches and stimulates blood circulation.

Athletes foot

Athlete’s foot is a fungal infection. It can lead to intense itching, cracked, blistered or peeling areas of skin, redness and scaling. It can occur on moist, waterlogged skin especially between the fourth and fifth toes, or on dry, flaky skin around the heels or elsewhere on the foot.



What causes it?

It’s caused by a number of fungal species which you can pick up from anywhere (typically communal areas such as pools, showers and changing rooms) or anywhere where you may walk around barefooted.

The fungus on each bit of skin that falls away from someone else’s feet can be picked up by you if you’re prone.

Once your feet have been contaminated, the warm, dark and sweaty environment of feet cramped in shoes or trainers provides the ideal breeding ground for the fungus. However, athlete’s foot also occurs in dry, flaky areas. It’s quite common in summer sandal-wearers. The sun makes your skin dry out, so it loses its natural protective oils; this combined with the constant trauma from sandals makes them more prone to infection.

Who gets it?

Well, it’s not called athlete's foot for nothing. Walking barefoot around swimming pools and spending your life in trainers make you more likely to suffer. But obviously, you don’t need to be an athlete to suffer.

Is it serious?

If left untreated, the fungus can spread to the toe nails, causing thickening and yellowing of the nail, which is much harder to treat. Fungal infections are highly contagious and can spread to anywhere on your skin – to your scalp, hands and even your groin, especially if you use the same towel for your feet as for the rest of your body.

What can I do?

There are many things you can do to make your feet less hospitable to fungal infections:

Re-think your footwear Firstly, change your footwear on a regular basis. There’s no point sorting your feet out if you constantly re-infect them by putting them into damp, fungally infected shoes. It takes 24-48 hours for shoes to dry out properly, so alternate your shoes daily.

If you really have to wear the same pair day after day (say, if you’re on holiday), dry them out by using the hairdryer on a cold setting,” says Qureshi. “This will get rid of perspiration quickly without creating more heat.”

To help shoes dry out more quickly, take any insoles out. Also, loosen any laces and open your shoes out fully so that air can circulate. Go for trainers with ventilation holes.

If your shoes are so tight that they squeeze your toes together, this encourages moisture to gather between your toes and encourages fungus. Let air circulate between the toes by going for a wider, deeper toebox instead and choose shoes made from natural materials.

Of course, you should also change your socks every day too.

Wear flip-flops in the bathroom and in public showers. This will not only ensure that you don’t leave your dead skin around for others to pick up, but will stop you picking up other species of fungus! And never wear anyone else’s shoes, trainers or slippers.

Re-think your footcare Treatment depends on what type of athlete’s foot you have:

For athlete's foot where the skin conditions are dry If your athlete’s foot occurs on a dry area such as your heel, you need to restore moisture by rubbing in an anti-fungal cream or ointment. However, don’t forget to wash your hands thoroughly afterwards. Even better, use disposable gloves so you don’t get the fungus on your hands at all.

For athlete's foot where the skin conditions have been moist This requires altogether different treatment. Wash your feet in as cold water as you can bear, as hot water only makes your feet fungus-friendly. Then dry them thoroughly after washing – preferably with a separate towel or even kitchen roll. Dab dry, don’t rub as rubbing tends to take away any healing skin. As the aim is to get rid of the moisture - although the skin may appear flaky and dry - never use moisturiser between your toes. Avoid powder too as it can cake up and irritate the skin. A spirit-based preparation can help, such as surgical spirit (it’s cooling, soothing and antiseptic). It might sting a bit,but it evaporates the moisture and allows the skin to heal.

If your athlete's foot is mild or you’ve only just started to suffer, rethinking your foot hygiene may help. Surgical spirit may be enough to see it off. However if an antifungal medication is required, your pharmacist can recommend one.

The mistake most people make is to stop the hygiene regime, shoe rotation and/or medication once their symptoms have gone. Even though your symptoms may disappear after several days or weeks, the fungus can lie dormant and could eventually reappear if the environment is right. Some products require continued treatment for many weeks - always follow the instructions. Also, be alert to symptoms so that you can deal with any problems straight away.

Though you should avoid using anti-fungal powders between the toes, they’re good for dusting inside shoes and trainers.

What can a podiatrist do?

You should be able to get rid of athlete’s foot on your own, but a podiatrist may help you pinpoint the best treatment for your particular type of athlete’s foot. Your podiatrist can also help if the fungal infection has spread to your nails, by reducing the thickness and cutting back the nails, thereby exposing the infected nailbed to a lighter, cooler environment.

Nail infections don’t respond to topical treatments. You need oral medication (i.e. tablets) to kill the fungus in nails. If the fungus is only in the nail and not elsewhere, it is probably caused by an injury. An injury allows the fungus to creep in and multiply under the nail. This can affect the substance of the nail which may become crusty, discoloured and deformed. This oral medication needed, however, can have side effects. So if you have other medical conditions or are on other medication, your GP or podiatrist may recommend that you don’t take it.

Blisters

Blisters are painful, fluid-filled lesions produced by friction and pressure. They can be caused by the following:

Ill-fitting shoes Stiff shoes Wrinkled socks against the skin Excessive moisture Foot deformities
How to prevent blisters
As blisters are a result of friction there are a number of simple techniques:

Keep your feet dry Always wear socks as a cushion between your feet and shoes Wear properly fitting shoes
If a blister does occur, do not pop it. Cut a hole in a 1.5”piece of foam or felt, forming a ‘doughnut’ over the blister; tape the foam or felt in place or cover with a soft gel-type dressing. Treat an open blister with mild soap and water; cover it with an antiseptic ointment and protective soft gel dressing to prevent infection and speed up the healing process.

Bunions/toe deformities

The foot is roughly divided into three sections: the hindfoot or heel, the midfoot and the forefoot & toes.

The function of the toes, especially the big toe, is to help us balance, and to propel us forward during walking or running. The 14 bones of the toes are among the smallest in the body, and, not surprisingly, things can and often do go wrong. Some problems begin in childhood and may go unnoticed. Others begin later on in life, perhaps as the result of injury or the added pressure of incorrect footwear.

What are bunions?


What most people call a bunion is actually known as "Hallux valgus". Hallux valgus refers to the condition in which the big toe is angled excessively towards the second toe – and a bunion is a symptom of the deformity.

“In a normal foot, the big toe and the long bone that leads up to it (the first metatarsal) are in a straight line,” explains podiatric surgeon Trevor Prior. “However, Hallux valgus occurs when the long foot bone veers towards your other foot and your big toes drifts towards your second toe.”

A bunion actually refers to the bony prominence on the side of the big toe. This can also form a large sac of fluid, known as a bursa, which can then become inflamed and sore.

Is it serious?

“Some people have massive bunions that aren’t that painful but cause difficulties with shoes, while others have relatively small bunions that are very painful,” says Trevor. However, just because you have Hallux valgus doesn’t mean you’ll get the bursa.

Pressure from the big toe joint can lead to a deformity in the joint of the second toe, pushing it toward the third toe and so on. Likewise, if the second toe and big toe cross over, it can be difficult to walk.

“Once the big toe leans toward the second toe, the tendons no longer pull the toe in a straight line, so the problem tends to get progressively worse,” explains Trevor.

This condition can also encourage corns and calluses to develop.

Who gets them?

“Women tend to get bunions more than men,” says Trevor. “This could be due to the more restrictive footwear they wear, (such as high heels or narrow toe boxes which force the big toe towards the little toes) but women also tend to have looser ligaments, making them slightly more prone.” You’re also more likely to get bunions if your parents or grandparents have them.

What causes bunions?


“No one single cause has been proven,” explains Trevor. “There are a number of causes, and though shoes can exacerbate the problem, bunions do occur in societies that don’t wear them.”

Michael Ratcliffe, a registered podiatrist who specialises in podiatric clinical biomechanics, explains that we walk on the same type of ground all the time, whereas the human foot was actually designed to adapt to varying terrains. In a sense, a bunion is a type of repetitive strain injury. And like repetitive strain injury, some people are more prone to it than others. One theory - though it remains unproven - is that bunions are caused by one or both of the following:

1) Because the foot wasn’t designed to constantly walk on a level surface, the ball of the big toe is slightly lower than the ball of the rest of your foot. When your foot meets the ground, the ball of the big toe is pushed up, and the big toe joint can’t bend as well as it was designed to. In order for the big toe joint to bend fully as you walk, your foot rolls slightly over to the side (this is also why people with hallux valgus often get hard skin).

2) Also, if your midtarsal joint tends to move from side to side more than it does up and down, the arch in your foot collapses as your foot rolls in. This also makes you more prone to developing bunions.

Such problems can be exacerbated by tight footwear. “Slip-on shoes can make matters worse,” says Trevor. “Because they have to be tighter to stay on your feet, you automatically have less room for your toes. And with nothing to hold your foot in place, your toes often slide to the end where they’re exposed to lots of pressure. Likewise, high heels throw more weight onto the ball of the foot, putting your toes under further pressure.”

If you haven’t got a bunion by adulthood and you later develop one, there could be some underlying arthritis.

What can I do?


One of the best things you can do is to go for wider, deeper shoes. Trevor Prior says there should be a centimeter between the end of your longest toe and end of shoe. You should also choose shoes with an adjustable strap or lace.

Podiatrists often recommend exercises to strengthen muscles and tendons around the big toe. Here’s one you can try yourself. Put your feet side by side, and try to move your big toes towards each other. Do this three or four times a day, while you’re in the bath or in bed.

What can a podiatrist do?


Your podiatrist can recommend exercises, orthoses (special devices inserted into shoes), shoe alterations or night splints (which hold toes straight over night) which may slow the progression of bunions in children. According to Trevor Prior, ‘conservative’ measures such as these may help relieve symptoms, though there is no evidence they can correct the underlying deformity.

“Orthoses are designed to prevent the problem getting worse by decreasing any biomechanical causes of bunions,” says Trevor. In other words, if the biomechanical theory is correct (i.e. if your bunions are caused by the way you walk), orthoses may help you walk in a way that doesn’t exacerbate the problem.

“But it won’t change the already established shape of your foot,” explains Trevor. For that, you need surgery.

What can a podiatric surgeon do?


Your podiatrist can refer you to a podiatric surgeon who will evaluate the extent of the deformity. A podiatric surgeon can remove the bunion and realign the toe joint in an operation generally referred to as a bunionectomy. However, there are actually around 130 different operations that fall under this title - so don’t presume you’ll need the same type of surgery as that friend of a friend who couldn’t walk for 3 months!

The aim of surgery is to correct the cause of the bunion and prevent it growing back. Which type of surgery your podiatric surgeon recommends will depend on the severity of your bunion. Because there are risks and complications with any type of surgery, it’s not usually advised unless your bunions are causing pain – or if it is starting to deform your other toes.Silvers procedure – this is the simplest procedure that involves removing the prominent bump on the inside of the foot. But because it doesn’t cure the underlying deformity, it will only be used in people with mild deformities or in older people. This is a short procedure and recovery is quick.



Austin (Chevron)/Reverdin - green osteotomies – these involve cutting the bone toward the end of the first metatarsal (the long bone leading up to the big toe), before fixing it back into a straighter position. You’ll need to rest the foot for two to four days. You’ll be able to do limited walking and on average, be able to get back into shoe 2-6 weeks after the operation. You’ll walk normally around three months after the operation

Scarf osteotomy – This is similar to the above technique but because more bone is cut, it allows for slightly more correction. Recovery is the same as for the above procedure.

Base wedge osteotomy – This is for more serious deformities. A small wedge of bone can be removed from the base of the metatarsal. Recovery is longer. You’ll need to wear a non-weight bearing cast for 4-6 weeks (ie you can’t walk on it) and possibly a weight-bearing cast for 2-4 weeks.

Lapidus – This is very good for people that have a mobile metatarsal. By removing the bone in a wedge shape from either side of the joint at the base of the metatarsal, this allows the surgeon to correct the position of the metatarsal while fusing the joint, making it more stable. Recovery is similar to that of the base wedge.

Akin osteotomy - In many deformities, you need to straighten the big toe as well as the position of the first metatarsal. A small wedge of bone can be removed from the base of the big toe. This is usually done in conjunction with one of the above procedures and doesn’t lengthen the recovery period.

Keller arthoplasty – this involves removing the bone at the base of the big toe and essentially removing half of the big toe joint. However, this can leave the big toe a little bit unstable and is mainly used for older people with arthritis. Recovery is slightly quicker to that of the Austin procedure.

“Although the vast majority of patients have an excellent outcome,” says Trevor, “surgery cannot guarantee a pain-free toe or that deformity won’t recur again.”


Other Big Toe deformities

A complaint which is more common among men then women is "Hallux rigidus", where, instead of bending normally, the big toe stiffens and forms a bump at the top of the joint, making the 'pushing-off' motion in walking difficult. This often results from stubbing or injury to the toe, perhaps during sport. Women often suffer from "Hallux rigidus" as a result of persistent trauma to the joints from slip-on or shoes that are too tight.

Wearing shoes with low heels and firm soles will act as a supporting splint. Registered podiatrists will be able to provide pads or strapping to stabilise the joint, or appliances (orthotics) to modify the way you walk. In severe cases, footwear may be modified or surgery may be indicated.

Smaller Toes

Another common complaint is "Hammer Toes". The toe most usually affected is the second, which becomes bent up in an inverted "V" shape and can't straighten out during walking. Corns develop where it rubs against the shoe. Some people are born with clawing of the lesser toes, which might be due to muscle imbalance, and can lead to hammer toes. Too-tight shoes and socks make the condition worse.

You can help by investing in shoes that are "foot shaped" - with a straight inside edge, rounded toe and a toe box deep enough to remove pressure on the joints. Registered podiatrists will be able to prescribe treatment, appliances which straighten the toes, or, when necessary, may advise surgery to provide permanent correction.

Curly Or Retracted Toes

Many babies are born with toes that don't lie flat, or are retracted. The problem generally clears up, especially if the toes are not too restricted in the early stages by tight shoes and socks. If the problem continues, muscle strengthening exercises may help, or silicone orthoses may be needed to correct the complaint.

Callus

When we walk or stand, our body weight is carried first on the heel and then on the ball of the foot, where the skin is thicker, to withstand the pressure. When this pressure becomes excessive, some areas of the skin thicken, in the form of corns and callus, as a protective response.

A callus, or callosity, is an extended area of thickened skin on the soles of the feet, and occurs on areas of pressure. It is the body's reaction to pressure or friction, and can appear anywhere the skin rubs against a bone, a shoe, or the ground.

Walking on stones?

Most calluses are symptoms of an underlying problem like a bony deformity, a particular style of walking, or inappropriate footwear. Some people have a natural tendency to form callus because of their skin type. Elderly people have less fatty tissue in their skin and this can lead to callus forming on the ball of the foot.

What to do

You can control a small amount of hard skin by gently rubbing with a pumice stone, or chiropody sponge occasionally when you are in the bath. Use a moisturising cream daily. If this does not appear to be working, seek advice from a registered chiropodist (also known as podiatrist) or pharmacist.

If the callus is painful and feels as if you are "walking on stones", consult a registered chiropodist/podiatrist who will be able to advise you why this has occurred and, where possible, how to prevent it happening again. Your chiropodist/podiatrist can also remove hard skin, relieve pain, and redistribute pressure with soft padding, strapping, or corrective appliances which fit easily into your shoes. The skin should then return to its normal state.

The elderly can benefit from padding to the ball of the foot, to compensate for any loss of natural padding. Emollient creams delay callus building up, and help improve the skin's natural elasticity. Your chiropodist/podiatrist will be able to advise you on the most appropriate skin preparations for your needs.

Chilblains

Many people suffer from cold feet in winter, but not all of them develop chilblains. Whether they do or not depends to a large extent on the efficiency of the circulation.

Chilblains are small itchy, red swellings on the skin, which can become increasingly painful, can swell and then dry out leaving cracks in the skin which expose the foot to the risk of infection. They occur on the toes, particularly the smaller ones, fingers, the face, especially the nose, and the lobes of the ears. They can also occur on areas of the feet exposed to pressure, for instance, on a bunion or where the second toe is squeezed by tight shoes.

Chilblains are caused by the skin's abnormal reaction to cold. Damp or draughty conditions, dietary factors and hormonal imbalance can be contributory factors. If the skin is chilled, and is then followed by too rapid warming next to a fire or hot water bottle, chilblains may result.

Who is most at risk?

This condition mainly affects young adults working outdoors in cold places or people who do not wear socks or tights in winter. Elderly people, whose circulation is less efficient that it used to be, people who don't take enough exercise, and those suffering from anaemia, are also susceptible.

What are the symptoms?

With the onset of the cold weather, susceptible people will experience burning and itching on their hands and feet. On going into a warm room, the itching and burning is intensified. There may be some swelling or redness, and in extreme cases, the surface of the skin may break, and sores (ulcers) may develop.

To help prevent chilblains

Keep your body, feet and legs warm, especially if your circulation is poor and your mobility is limited. The whole body, rather the just the feet, needs to be kept warm. Trousers, long boots, tights and leg warmers or long socks will help.

You can also help prevent chilblains if you follow the a regular foot health routine.

If chilblains have developed

Don't scratch them; soothing lotions such as witch hazel or calamine will take away most of the discomfort.

If the chilblain has ulcerated, apply an antiseptic dressing. If you have diabetes or undergoing medical treatment, have the ulcer assessed by your GP or chiropodist/podiatrist.

If the chilblain hasn't broken you can paint them with a mixture of friar's balsam and a weak solution of iodine, which your pharmacist may make up for you, or an over-the-counter preparation. At night, rub some lanolin ointment well into the feet to help retain heat.

Corns

When we walk or stand, our body weight is carried first on the heel and then on the ball of the foot, where the skin is thicker, to withstand the pressure. When this pressure becomes intense, growths, in the form of corns and callus, may appear.

Corns always occur over a bony prominence, such as a joint.

There are five different types of corns. The two most common are hard and soft corns.

Hard corns

These are the most common and appears as small, concentrated areas of hard skin up to the size of a small pea, usually within a wider area of thickened skin or callous, and can be symptoms of feet or toes not functioning properly.

Soft corns

These develop in a similar way to hard corns. They are whitish and rubbery in texture, and appear between toes, where the skin is moist from sweat, or from inadequate drying. A registered podiatrist/chiropodist will be able to reduce the bulk of the corn, and apply astringents to cut down on sweat retention between the toes.

Seed corns

These are tiny corns that tend to occur either singly or in clusters on the bottom of the foot. They are usually painless.

Vascular corns

These corns will bleed profusely if they are cut and can be very painful.

Fibrous corns

These arise from corns that have been present for a long time. They appear to be more firmly attached to the deeper tissues than any other corn. They may also be painful.

Don't cut corns yourself, especially if you are elderly or diabetic, and don't use corn plasters or paints which can burn the healthy tissue around the corns. Home remedies, like lambswool around toes, are potentially dangerous. Commercially available 'cures' should be used only following professional advice.

You could use a pumice stone to remove the thickened skin a little at a time, or relieve pressure between the toes with a foam wedge, but if you are unsure of what to do, or need special attention, consult a registered podiatrist/chiropodist who will be able to remove corns painlessly, apply padding or insoles to relieve pressure, or fit corrective appliances for long-term relief.

Diabetes

Diabetes may affect your feet in a number of ways. One of the early changes can be loss of sensation in your feet, often starting at the toes. This is known as peripheral neuropathy.
Professional advice is to always wear shoes that fit properly. When buying new shoes, get your feet measured.

One of the first ways in which diabetes may affect your feet is through the loss of sensation within your feet, often starting at the toes. You may experience a cotton wool like feeling or numbness in your feet, this is called neuropathy. Your chances of losing feeling in your feet increases with the number of years that you have diabetes and research suggests that up to one in three people with diabetes have some loss of sensation (called neuropathy). The onset of neuropathy is gradual and often people who develop this complication are unaware of it at the start. Often it occurs between 7 and 10 years of having diabetes, although in some cases it can occur sooner where blood sugar levels have not been so well controlled.

If you have lost feeling in your feet then it is possible that you may unknowingly damage your feet. You may stand on sharp objects like a nail, piercing the skin even down to the bone without realising it. If not noticed and not treated appropriately this can have potentially serious consequences and could lead to an amputation. Such an outcome is less likely if you seek expert advice from your multi-disciplinary foot team.

This explains why your podiatrist checks your ability to feel pressures on the soles of your feet and toes every year. If you are forewarned that you have lost or are losing feeling then you will be able to reduce the risk of problems occurring by undertaking daily inspections of your feet and taking precautions such as not walking bare footed or sitting too close to fires.

Occasionally people with loss of feeling can sense a burning pain in their feet. This can be severe and worse at night. Contact from socks and shoes can also cause discomfort. This is called painful peripheral neuropathy. If you experience these symptoms it is advisable to consult your Diabetic Clinic or Podiatrist, since it is possible in many cases to alleviate the symptoms. Diabetes can also affect blood supply to and within your feet, this can delay healing and increase your risks of infection. Because the implications of poor blood supply can have serious consequences for your feet, your podiatrist will routinely screen your feet for signs of poor blood flow. If necessary you may be referred on to a Vascular Surgeon.

If you have been diagnosed with diabetes then it is possible that you could develop complications in your feet. For example, you are at 15 times increased risk of having a limb amputated.

The risks of complications can be greatly reduced if your blood sugar levels under control. They are also reduced if blood pressure and cholesterol levels are monitored and controlled with medication if needed.


Smoking is not a good idea as it has an adverse effect upon the blood supply to your feet (see www.givingupsmoking.co.uk).


What does the Podiatrist look for?

If you are presently at low risk of an ulcer you can expect your Practice Nurse or GP to check your feet once a year. However if you are at increased risk of an ulcer, these inspections may be more frequent and carried out by a Podiatrist. The Podiatrist will normally check both the blood supply to your feet and evidence of loss of sensation in your feet.

Blood supply will be checked by looking at the colour of the skin, checking the pulses in the feet and by asking questions about certain kinds of pains in your feet and legs. Normally people have two pulses in their feet, one of the top (dorsalis pedis) and one on the inside of the ankle (posterior tibial), most often the podiatrist will check these pulses by feeling the pulse with their fingers. Sometimes they will use a small hand held scanner (called a doplar) to listen to the pulse.

Sensation will most commonly be checked with a monofilament and tuning fork. The monofilament is a plastic probe that is designed to buckle at a given pressure, and is a good indicator for loss of feeling.

The podiatrist will also be looking for any foot deformity or signs of excessive loading that may warrant either footwear advice or in some cases an insole.




Warning signs


Check your feet, hosiery and shoes daily. If there are signs of redness in any part of the foot or leg, or if the foot feels warmer than usual, this might indicate infection of inflammation, which needs prompt professional attention. Awareness of pain and injury may be diminished, so inspect the inside of your shoes daily for objects like nails or torn linings, which might cut the skin.

You should urgently consult your podiatrist or seek medical attention, if you see any of the following in your feet: A breaks in the skin or a discharge The skin changes colour, becoming redder, bluer, paler, blacker over part or all of foot New swelling in your feet

You should also seek an urgent appointment, if you normally have little or no feeling in your feet, but suddenly experience an unexplained pain or discomfort, especially if the surrounding skin is a little warmer to touch, when compared to the same spot on the other foot.

If you see a red or black spot within callus or at a site of a corn, you should see a podiatrist as soon as possible for this to be looked at, regardless of whether it is painful or painless. This is often a sign of excessive pressure that has resulted in localised bleeding under the skin. If left such an area is likely to develop into an ulcer, that may require prolonged treatment. Until you see your podiatrist you should keep off your feet as much as possible.

If your eyesight is impaired, or you have difficulty bending down to check, use a mirror or ask a friend to look for you.
Useful links


· FDUK link: www.footindiabetes.org

Gout

Arthritis is a disease of the joints which causes them to become inflamed and stiffen. There are three types of arthritis - Rheumatoid, Osteo-arthritis and Gout.

Gout is the result of an imbalance of uric acid in the body, and affects more men than women.

The main symptom is waking up in the middle of the night with an acute throbbing pain in the big toe, which is swollen. Usually only one of the big toes is affected. The pain lasts for around three or four hours and will then subside and usually not return for a few months. It can be controlled by drugs, which your GP will be able to prescribe. The application of ice or cooling lotions will help during an acute phase.

All three forms of arthritis can benefit from chiropody care. Registered chiropodists (also known as podiatrists) work in the NHS and in private practice. They will be able to adapt your existing footwear with orthoses or other appliances, which fit easily into your shoes and help redistribute pressure away from the affected parts.

Made-to-measure shoes can also be prescribed, and registered chiropodists/podiatrists will also be able to advise you on the correct type of shoes to wear, and where to obtain them. Registered chiropodists/podiatrists can also provide protective shields for your toes, or padding to relieve pressure and reduce friction. Any secondary problems, like ulcers or corns, can also be treated. They will also refer you to a specialist for further treatment, if they consider it necessary.

Specialist teams of rheumatologists, chiropodists/podiatrists, physiotherapists and occupational therapists, along with specialist nurses, will provide the most effective care and treatment for arthritic patients, especially those with rheumatoid arthritis.

Heel pain

When walking, your heels repeatedly hit the ground with considerable force. They have to be able to absorb the impact and provide a firm support for the weight of the body.

When pain develops in the heel, it can be very disabling, making every step a problem, affecting your posture.

There are various types of heel pain. Some of the most common are: heel spurs (plantar fasciitis); heel bursitis and heel bumps.

Common symptoms:

Heel Spurs: the pain is usually worst on standing, particularly first thing in the morning when you get up. It is relatively common, though usually occurring in the over forty's age group. There are no visible features on the heel but a deep localised painful spot can be found in or around the middle of the sole of the heel. Although it is often associated with a spur of bone sticking out of the heel bone (heel spur syndrome), approximately ten per cent of the population have heel spurs without any pain.

Heel Bursitis: pain can be felt at the back of the heel when the ankle joint is moved and there may be a swelling on both sides of the Achilles tendon. Or you may feel pain deep inside the heel when it makes contact with the ground.

Heel Bumps: recognised as firm bumps on the back of the heel , they are often rubbed by shoes causing pain.

Recommended treatments

Heel Spurs: cushioning for the heel is of little value. Your chiropodist/podiatrist may initially apply padding and strapping to alter the direction of stretch of the ligament. This is often successful at reducing the tenderness in the short term. Your chiropodist/podiatrist may suggest a course of deep heat therapy to stimulate the healing processes, allowing damage to respond and heal faster. In the long term, your chiropodist/podiatrist may prescribe special insoles (orthoses) to help the feet to function more effectively, thereby reducing strain on the ligaments and making any recurrence less likely.

If pain from heel spurs continues, you may be referred to your GP who can prescribe an oral non-steroidal anti-inflammatory. Alternatively, localised hydrocortisone injection treatment may be given by your GP or an appropriate chiropodist/podiatrist. If pain persists, surgery may be considered.

Heel Bursitis: in most cases, attention to the cause of any rubbing, and appropriate padding and strapping by your chiropodist/podiatrist will allow the inflammation to settle. If infection is present, your chiropodist/podiatrist will refer you to your GP for antibiotics.

Heel Bumps: adjustments to footwear is often enough to make them comfortable. A leather heel counter and wearing boots may help. However, if pain persists, surgery may be necessary.

Ingrowing Toenails

What is it?
An ingrowing toenail is one that pierces the flesh of the toe. It can feel as if you have a splinter, and can be extremely painful. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can affect the other toes too.
A nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin isn't an ingrowing toenail, but can feel very painful and also appear red and inflamed as well.

Who gets it?
Active, sporty people are particularly prone, because they sweat more. Younger people are more likely to get it (as they pick their nails more, compared to older people who may not reach their toes!) Women often develop them as a result of cutting nails too low in order to relieve the pressure and discomfort of an involuted nail.

Is it serious?
If left untreated, the infection can spread to the rest of the toe. The quicker you treat it, the less painful the treatment.

What causes it?
There are many genetic factors that can make you prone to ingrowing toenails, explains registered podiatrist Shuja Qureshi, such as your posture (the way you stand), your gait (the way you walk), a foot deformity such as a bunion, hammer toes or excessive pronation of the feet (when your foot rolls in excessively). Your nails may also naturally splay or curl out instead of growing straight, encouraging your nail to grow outwards or inwards into the flesh.

“Tight footwear, tight hosiery and tight socks can also push your toe flesh onto the nail so that it pierces the skin,” says Shuja. “And if you sweat excessively or don’t rotate your footwear, this makes the skin moist, so that it welcomes the nail like a soft sponge. If you have brittle nails with sharp edges or are in the habit of breaking off bits of nails that are sticking out, you’re more likely to get an ingrowing toenail.” However, one of the most common causes is not cutting your toenails properly.

What can I do?
Firstly, learn to cut your nails properly. “Nail cutters aren’t a good idea because the curved cutting edge can cut the flesh and nail scissors can slip,” says Shuja. “It’s best to use nail nippers (available from chemists) because they have a smaller cutting blade but a longer handle.” Cut your nails straight across and don’t cut too low at the edge or down the side. The corner of the nail should be visible above the skin. Also, cut them after a bath or shower when they’re soft.

Good hygiene can go a long way to preventing ingrowing toenails. Avoid moist, soggy feet by rotating your footwear so each pair has a chance to dry out thoroughly. Avoid man-made materials and choose socks and shoes of natural fibre. In the summer, wear open-toed sandals where possible.

If you’ve booked an appointment with a podiatrist, relieve the discomfort in the meantime by bathing your foot in a salty footbath. This prevents infection and reduces inflammation. Then apply a clean sterile dressing, especially if you have a discharge. Rest your foot as much as possible.

If you have diabetes, are taking steroids or are on anti-coagulants, don’t attempt to cut your nails or remove the ingrowing spike of nail yourself.

What can a podiatrist do?

It depends on the severity of your condition. For the most basic painful and irritable ingrowing toenail, your podiatrist will remove the offending spike of nail and cover with an antiseptic dressing.

If your toe is too painful to touch, your podiatrist may inject a local anaesthetic before removing the offending portion of nail.

If you have involuted nails, your podiatrist may remove the bit that’s curling into the flesh and file the edges of the nail to a smooth surface.

If you have bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, you’ll need antibiotics to beat the infection as well as having the offending spike removed.

Shuja explains that not everyone coming to him with an ingrowing toenail actually has an ingrowing toenail. “Sometimes they have a curly nail which has a lot of debris (dirt or fluff) underneath it or a corn or callus down the side of the nail, which can be nearly as painful. However, if it’s a corn, the pain tends to be throbbing as opposed to the sharp pain you get with an ingrowing toenail.” If this is the case, your podiatrist will remove the debris, and if necessary, thin the nail.

If you are particularly prone to ingrowing toenails from underlying problems such as poor gait, your podiatrist may recommend correction of the underlying problem as well as a more permanent solution to the nail itself, such as partial nail avulsion (PNA). This is done under a local anaesthetic, where 8-10% of the nail is removed (including the root) so that the nail permanently becomes slightly narrower. The chemical phenol cauterises the nail and prevents it regrowing in the corners. This is 97-98% successful. You will, however, have to go back to your podiatrist for a number of re-dressings.

After surgery, the overall appearance of the nail looks normal – to the extent that some people even forget which nail they’ve had done!

Osteoarthritis

Osteoarthritis (OA) is often called the 'wear and tear' arthritis. It occurs when the cartilage of a joint (a thin layer of gristle that covers the end of the bones and allows them to glide over each other) becomes damaged. When the cartilage deteriorates, the bone underneath can thicken, causing pain, stiffness and swelling. The joints most affected are the knees, hips, hands and big toes.

OA is uncommon before the age of 40. Though the exact cause of OA is unknown, according to the Arthritis Research Campaign, it is probably due to the fact that as we age, we tend to put on weight thereby putting more pressure on our joints, our muscles become weaker and our body loses its ability to heal itself.

When OA occurs in younger people, it is usually because the joint cartilage has been damaged through injury (such as a sprain or fracture), a bacterial or viral infection or even through overuse of a particular joint as is common in farmers (hips), plumbers (knees) and footballers (knees and ankles). The Arthritis Research Campaign estimates that 8 million Britons are affected by Osteoarthritis, but only 1 million seek treatment.

It can be. In severe cases, the cartilage can deteriorate to the extent that the bones rub together, making it difficult to move the affected joint at all. But symptoms vary from person to person - and some people may have OA without experiencing many symptoms at all. Osteoarthritis does not always get worse.

OA can affect any of the 33 joints in the feet but mostly affects the joints at the base of the big toes. This joint is more prone to wear and tear from the pressures of walking, especially if you over-pronate (ie roll your foot in excessively as you walk). Wear and tear at the ends of the bone cause the cartilage to erode and the bone ends may begin to join together. Eventually your big toe may become rigid (a condition known as hallux rigidus) which makes walking difficult. Or your big toe may drift towards your other toes (hallux valgus) which can leads to bunions.

You may initially feel a toothache-type ache in the affected joint that gets worse when you're active, wearing high-heels or when it's cold and damp. It may progress to the stage where your feet ache at night. In severe cases, the range of movement in the joint may fall to the extent that you can't move it at all.

If you are worried that you have OA, you should see your GP or a podiatrist. The early you are diagnosed, the more effective any treatment will be. If you do have OA, there are many things you can do yourself to help ease the condition:

Footwear Minimise the stress on the joints by choosing well-cushioned shoes. Go for shoes with lace-up fastenings or an adjustable strap: they keep the heel in place and stop the toes being pushed to the front of the shoe. Your feet should keep their natural shape when in shoes. There should be a centimetre between the end of your longest toe and end of shoe. They should also be roomy enough to accommodate any swelling, so go for a wide, deep pair.

Exercise Toes aren't a part of the body we often think of exercising, but by exercising and stretching regularly, you can help nourish the joint cartilage and strengthen the muscles and tendons around the joint. Podiatrist Trevor Prior recommends you put your feet side by side (say, while you're in the bath), and try to move your big toes towards each other. Do this three or four times a day. You should ideally exercise your whole body to keep your joints flexible, your muscles strong and your bone and cartilage tissues healthy. Yoga is a great exercise for all your joints, including your toes. Swimming is also great, because it doesn't put any pressure on your joints.

What can other health professionals do?

Your GP may recommend painkillers or steroids to ease the pain. There are also creams and gels (such as Capsaicin cream) which can be absorbed into the bloodstream if rubbed on the affected joints when they are painful, such as after exercise or at the end of the day. Ideally, you should be seen by a team of rheumatologists, physiotherapists, occupational therapists and podiatrists.

What can a podiatrist do?

Though there is no known cure for OA, there are many ways your podiatrist can help you ease the pressure on the affected joints, and therefore reduce the pain and inconvenience:

Orthoses Orthoses are special shoe inserts that help re-distribute the pressure as you walk. They'll help you walk in such a way that alleviates the pain in your joints.

Shoes Your podiatrist can advise you on the best type of footwear to wear for your exact problem. If you develop hallux valgus (where your big toe drifts towards your second toe), for example, your podiatrist may recommend a shoe with a stiff sole. This relieves pain by reducing the movement of the big toe. In some cases, a shoe with a slight heel raise may be more comfortable.

Strapping and padding Your podiatrist may strap the feet in the short-term to limit joint movement. They can also provide protective shields for your toes or padding to relieve pressure and friction.

Surgery If your problem doesn't improve with the above measures, you may be referred to a podiatric surgeon who will evaluate the extent of your problem and see if you are suitable for excisional arthroplasty (replacement of joint surfaces), interpositional arthroplasty (placing soft tissue, especially joint capsule, between the resected bone surfaces),.osteotomy (decompresses and realigning the joint surfaces), joint replacement (used for irreverisibly damaged joints) or arthrodesis (where the bones are fused together). However, surgery is only used a last resort.

Other resourses

The Arthritis Research Campaign has many information leaflets on its website
http://www.arc.org.uk/

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a condition that causes inflammation in many joints of the body. Unlike osteoarthritis which is caused by wear and tear, rheumatoid arthritis is a chronic inflammatory disease where a faulty immune system attacks the tissue that lines and cushions the joints, leaving them swollen, painful and stiff.

This condition particularly affects the hands, feet, wrists, ankles and knees -and tends to occur symmetrically. That is, if your right big toe joint is swollen and painful, chances are, your left one is too. But RA can also affect other organs. As well as joint pain and stiffness, symptoms include muscle aches, anaemia (a low blood count, leaving you feeling tired) and fever. The stiffness tends to be worse in the morning and after rest.

Women are three times more likely than men to get it and it tends to affect people between the ages of 30 and 50.

The severity of the symptoms vary from person to person. According to the Arthritis Research Campaign. About 1 in every 20 will have RA that becomes progressively worse leading to severe damage in a lot of joints while around 1 in 5 will have mild RA that causes few problems, beyond a little pain and stiffness.

How does rheumatoid arthritis affect the feet? RA affects the smaller joints such as the fingers and toes first, so feet are often one of the first places to be affected. Symptoms usually strike the toes first and may then affect the back of the feet and the ankles. The joints may enlarge and even freeze in one position, so they can't extend fully.

Front of the foot The metatarsal-phalangeal joints are often affected (where the long bones of the feet meets the toes), and can result in Hallux valgus (a condition in which the big toe is angled excessively towards the second toe) and hammer toe deformities (where the toes curl up in a claw-like shape). Each of these deformities can cause further problems, for example, if you have hammer toes, you'll be more likely to develop corns on the tops of your toes.

Midfoot If the joints in the middle of the foot are affected, the arch can collapse leading to a flatfoot deformity and spreading of the forefoot (where the front section of the foot becomes wider). The fatty pads on the balls of the feet may slip forward, causing pain on the balls of the feet and backs of the toes. If this happens, it can feel as if you are walking on stones.

Back of the foot If the joint where the heel bone meets the ankle (the joint that lets you rotate your ankle) is affected, it can lead to a condition known as valgus hindfoot (where the heel bends outwards), making it difficult to walk.

Any kind of foot deformity will cause an uneven distribution of pressure as you walk, making you more likely to develop corns, calluses and ulcers.

You may also get rheumatoid nodules - fleshy lumps that usually occur below the elbows but can appear on the hands and feet too. They may form over bony areas such as the heels and occur in 30 to 40 percent of people with rheumatoid arthritis.

What can I do? There could be many other causes of your joint pain, but if it is arthritis, the sooner you are diagnosed, the more effective treatment will be. According to the Arthritis Research Campaign, many rheumatology departments have Early Arthritis Clinics which your GP can refer you to.

You can help yourself by understanding as much as possible about your disease and treatment. The best starting point is the website for the charity, Arthritis Research Campaign, which has numerous downloadable leaflets on all aspects of arhtritis. See www.arc.co.uk

What can other health professionals do? Your doctor can make a clinical diagnosis using blood tests (which may show changes in the blood caused by inflammation) and X-rays (which can show up damaged joints). It is likely your feet will be x-rayed because the changes caused by rheumatoid arthritis often appear in the feet before they appear in other joints.

Your GP will also decide the most appropriate treatment for you. What treatment you'll need depends on how advanced your Rheumatoid Arthritis is. Drugs available include analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), which reduce pain and swelling, and disease-modifying anti-rheumatic drugs (DMARDs), which slow down the effects of the disease on the joints. If your arthritis is advanced, you may be prescribed corticosteroids. It may take a while to find the drug that's right for you, but it's worth persevering.

Managing arthritis involves a specialist team of rheumatologists, podiatrists, physiotherapists, and occupational therapists, along with specialist nurses.

What can a podiatrist do? There are many things a podiatrist can do to make walking less painful:

Orthoses These are a special type of insole that can be fitted into your shoes. They will help you walk in such a way to minimise the pressure on your affected joints.

Shoes As well as a moulded insole, your podiatrist will help you find shoes that are roomy enough to accommodate your foot - and orthoses - without adding unnecessary pressure. If your toes are beginning to stiffen or curl, for example, it's important for you to wear a shoe with an extra deep toe box. Your podiatrist may make a plaster of Paris copy of your foot, so a shoe can be tailored to your exact foot shape.

Protective shields They can also provide protective shields for your toes or padding to relieve pressure and reduce friction.

Surgery Surgery can correct any bunions and hammertoes caused by RA. If your joint cartilage has been completely destroyed and the joints in your foot have been dislocated to the extent that it's extremely painful to walk, they can be fused together (a process known as arthrodesis). This involves removing the joint cartilage (the substance that allows the bones to glide over each other). The bones are then held together with screws, plates or a rod. The bones eventually merge into one solid bone. Although this results in a loss of movement in that particular joint, it can reduce pain.

Secondary problems Any secondary problems such as ulcers or corns that have been caused by foot deformities can also be treated.


The Arthritis Research Campaign has many information leaflets on its websit

Sweaty Feet

Most of us have suffered from foot perspiration and odour from time to time, yet for some people, sweaty feet are a persistent problem which can be embarrassing and uncomfortable.

Sweaty feet is a complaint known as Hyperhidrosis, or excessive sweating, and has a lot to do with how the sweat glands in this part of the body work. With 250,000 sweat glands, feet do tend to sweat more than other parts of the body. But with a daily hygiene routine, few people should suffer from the embarrassment that it may cause.

Sweat glans in the feet


There are more sweat glands per inch in our feet than anywhere else in the body, and their function is to keep the skin moist and therefore supple. They secrete all the time, not just in response to heat or exercise as elsewhere in the body.

Possible causes

Sweaty feet can be caused by stress on the foot. This may be due to a structural problem, or because the foot is under strain or tired, for example, when you've been standing on your feet all day.

Hot weather can make matters worse, although sweaty feet is a winter, as well as a summer, problem. It can also be an inherited condition.

In adolescents, sweaty feet are probably caused by over-active sweat glands triggered by changing hormonal levels in the body. As the sweat glands on the soles of the feet (and the palms of the hand) respond mostly to emotion, mental or emotional stress is a common cause.

Simple hygiene is usually effective in dealing with sweaty feet. Try following our recommended daily foot hygiene routine.

Footware

Careful consideration of footwear and socks is essential. Well-fitting shoes made of leather, which allow your feet to 'breathe,' are best.

As a lot of sweat is absorbed by insoles or the uppers of shoes, don't wear the same pair every day, and allow them to dry out before wearing them again. Detachable insoles are also a good idea. Socks that absorb moisture well, like wool, cotton, or wool/cotton mixture, will also help. Always wash your socks before using them again.

Other problems

An added problem that often accompanies sweaty feet is foot odour. This is caused by bacteria on the skin breaking the sweat down, which releases an offensive smell.

This can usually be prevented with careful hygiene, or medicated insoles which can have a deodorising effect. Wash your feet with an anti-bacterial soap such as Hibiscrub. There is also a greater risk of minor skin infections, through athlete's foot, or blisters.

Verrucae

A verruca is simply a wart that is usually found on the soles of feet, though they can also appear around the toes. In the early stages, a verruca looks like a small, dark, puncture mark but later turns grey or brown. It may become rough and bumpy with a cauliflower-like appearance and may develop a black spot in the middle, which is caused by bleeding. A verruca can grow to half an inch in diameter and may spread into a cluster of small warts.

Verrucae are caused by the human papiloma virus (HPV). This virus is very contagious, but can only be caught by direct contact. It thrives in warm, moist environments such as swimming pools, changing room floors and bathrooms. So if an infected bare foot walks across the poolside, it may release virus-infected cells onto the floor. If you then walk on the same floor, you can pick the virus up, especially if you have any small or invisible cuts and abrasions that make it even easier for the virus to penetrate. You could also catch the virus from an infected towel.

They are harmless. However, they can cause a sharp, burning pain if you get one on a weight-bearing area such as the ball or the heel of the foot. Because you are constantly pressing on the area when walking, they can protrude into the skin and become more painful.

When you have verrucae on a non-weight-bearing surface (such as on the top of the foot or on the toes), they protrude above skin level, tend to be fleshier and cause less pain.

Who gets them? Then tend to be common in children, especially teenagers. However, for unknown reasons, some people seem to be more susceptible to the virus, whereas others are immune.

What’s the difference between a corn and a verruca? A verruca is a viral infection, whereas a corn or callus are simply layers of dead skin. Verrucae tend to be painful to pinch, but if you’re unsure, your podiatrist will know.

What can I do? Minimise your chances of catching a verruca by keeping your feet clean and dry, and covering any cuts or scratches. Avoid walking barefoot in communal showers or changing rooms (wear flip-flops) and don’t share towels. Verruca socks should be worn when swimming to avoid passing on the virus, and the socks can also be worn as a preventive measure.

If a verruca does appear, avoid touching or scratching it as it may spread into a cluster of several warts. Instead, cover it up with plaster. In some cases, this may cure it.

Do not self-treat if you have diabetes or circulation problems. However, if you are fit and healthy, it’s fine to treat yourself with over-the-counter gels and ointments. Ask your pharmacist for advice or look for products containing salicyclic acid, such as Verrugon, and ensure that you follow the instructions carefully. If, at any stage, your verruca becomes painful or the surrounding skin goes red, stop treatment immediately and see a podiatrist. If you damage the healthy tissue that surrounds the wart tissue you could hamper further treatment.

What can a podiatrist do? Because verrucae usually often disappear in time (fought off by your immune system), the general policy in the UK is to only treat them when they are causing pain. Verrucae generally resolve spontaneously within six months in children. But in adults, they can persist for years.

If yours is causing pain, there are a number of treatment options available – though no one particular treatment can guarantee a cure. A recent review of treatments in the British Medical Journal (August 2002) concluded that the safest and most effective treatments were those containing salicylic acid. This acid is applied to the wart to disintegrate the viral cells and has a cure rate of 75%. It may need to be applied at weekly intervals over a set period of time.

Other treatments include:

Cryotherapy - This involves freezing warts off with liquid nitrogen or nitrous oxide gas. This needs to be done every 2 or 3 weeks for a few months before the verruca is fully removed. However, it can lead to soreness and blistering in some people. You can still swim after this treatment, but it’s not advised for sensitive or anxious children.

Electrosurgery - After a local anaesthetic, the verruca is pared down. An electric needle is then placed in the middle of the wart for a few seconds until the wart boils – the verruca is then scooped out.

Excisional surgery - Similar to above, but using a scalpel.

Laser surgery Lasers are sometimes used to kill the virus. This is useful for treating portions of large verrucae at a time.

In short, you can treat your verruca with an over-the-counter medicine unless you have diabetes or circulation problems. If the verruca appears to be getting bigger, consult a podiatrist.