Foot Health

Sue Davies MAFHP MCFHP

Foot Health Professional

Feet First

Contents

Introduction- My background- What a Foot Health Professional does

Common foot conditions- Athletes foot- Ingrown toenails- Fungal nails- Bunions- Verrucae- Corns and callus

Potential warning signs

Questions

Introduction

I qualified with the SMAE Institute, Bath Road, Maidenhead in July 2006, which provides specialist training in the Foot Health Profession. Established since 1919, the institute is one of the oldest open colleges of Foot Health Professionals in the United Kingdom, treating over 14,000 patients per year.

Since qualifying, I have been treating patients with a wide range of foot conditions in and around the Maidenhead area and I am an experienced Foot Health Professional capable of providing a complete service to help you look after your feet, providing expert advice, care and attention. Prior to this, I worked in the Banking sector for 15 years and decided to have a career change after having my two children.

The letters MCFHP indicate that the Practitioner concerned is a Member of the Open College of Foot Health Professionals having undertaken extensive training. The letters MAFHP denote that the practitioner is a member of The Association of Foot Health Practitioners. I am bound by the code of ethics, rules of the Association, have professional Insurance and undertake to act professionally at all times.

What does a foot health professional do?

Your initial consultation will last 45 minutes which includes taking a full medical history, foot health check, advice and treatment. Your feet are thoroughly examined for any existing conditions and treated accordingly. Nails are trimmed and filed and a moisturising cream is applied with a relaxing mini foot massage to finish. You need regular foot checks because your feet have to work hard and last you a lifetime. Failure to look after your feet can cause serious ailments and back problems.

How can a Foot Health Professional help you?

You probably never think about it, but your feet are a masterpiece of engineering! When they are in good condition, they work in total harmony with the rest of your body, but if you neglect them, your feet may start to feel uncomfortable or painful, and problem feet can create other health problems too.

In an average lifetime we walk up to 100,000 miles. The foot has a lot of demands made on it and in a normal day can easily walk fifteen miles. In return we rarely give them the attention they deserve, hiding them away in shoes and forgetting about them, until they begin to hurt. They are a complex network of blood vessels, nerves, muscles and bones. There are a number of ways that we can care for our feet at home – and it’s never too late to start!

A Foot Health Professional will advise you how to best care for your feet, and offer you assistance on what products can be used at home or when you need to be referred on to a chiropodist/podiatrist.

What conditions do Foot Health Professional treats?

• Corns and Callus• Fungal Nail Infections• Verrucae and warts• Dry cracked heels• Bunions• Ingrowing toe nails• Diabetic foot care• Bunions• Athletes foot• Thickened nails• Hammer toes• Plantar fasciitis• Nail cutting and filing• Hard skin• Pressure points• Cracks/fissures• Any nail changes• Routine foot and nail care

•Healthy feet•Less pain•Increased mobility•Reduces other health problems

Benefits Include:Foot conditions:

Athletes Foot

• What is athlete's foot? • Athlete's foot is a rash on the skin of the foot. It is the

most common fungal skin infection. There are three main types of athlete's foot. Each type affects different parts of the foot and may look different

• Tinea pedis, is a common infection of the skin of the foot caused by a fungus. The various kinds of fungi that cause athlete's foot belong to a group called dermatophytes.

• These fungi thrive in closed, warm, moist environments and feed on keratin, a protein found in hair, nails, and the epidermis, or the upper layer of the skin.

Symptoms of Athletes Foot

• The affected area may be peeling and have small blisters.

• It may also appear red, dry and itchy. • If left untreated, there may be deep cracks in the

skin which can lead to a secondary bacterial infection.

• It may contain sticky clear fluid. • The patient may experience severe pain from the

condition. Patients often report a burning or stinging sensation and find the lesion very itchy.

Causes of Athletes Foot

• Many people have the fungus present on their skin but are unaffected by the microscopic organism. Conditions such as bruising or cracks in the skin allow entry for the fungus.

• Fungi thrive on moist, warm environments this is why the condition usually occurs in between toes due to an accumulation of moisture.

• It may also spread between individuals. A common port of entry is found within bathrooms, showers, swimming pools and changing rooms.

• Not changing your socks on a regular basis can also encourage the build up of fungi in between the toes.

• People with excessively sweaty feet are more prone to this condition

What it may look like:

On the top of the foot, tinea pedis appears as one or more red, scaly patches. The border of the affected skin may be raised and may contain bumps, blisters, or scabs. Often, the central portion of the patch is clear, leading to a ring-like shape.

Between the toes (the interdigital spaces), tinea pedis may appear as inflamed, scaly, and soggy white tissue. Splitting of the skin, called fissures, may be present between or under the toes. This form of tinea pedis tends to be quite itchy.

On the sole of the foot (the plantar surface), tinea pedis may appear as pink-to-red skin with scales ranging from mild to widespread (diffuse).

Treatment

• Keep your feet clean and dry.

• Use powders or soaking crystals, especially medicated powders to help keep your feet dry.

• Change your socks daily, or more often, if they become wet, especially from perspiration.

• Avoid vinyl, rubber, and plastic shoe materials. These materials do not allow air to flow freely into the shoe.

Prevention

• Go with natural materials. Wear socks that are made of natural material, such as cotton or wool, or a synthetic fibre designed to draw moisture away from your feet.

• Change socks and stockings regularly. If your feet sweat a lot, change your socks twice a day.

• Wear light, well-ventilated shoes. Avoid shoes made of synthetic material, such as vinyl or rubber.

• Alternate pairs of shoes. This allows time for your shoes to dry.• Consider disinfection of shoes. • Protect your feet in public places. Wear waterproof sandals or

shower shoes in communal showers, pools, fitness centres and other public areas.

• If you are prone to Athlete's Feet, or your feet sweat excessively, use powder regularly to help prevent new attacks.

Ingrown Toenails

• Ingrown toenails are one of the most common foot complaints treated by a chiropodist / Foot health professional.

• This condition can be very painful and patients may often be very reluctant to have the condition treated.

• An Ingrown toenail is caused by a splinter of nail or the whole nail causing pressure into the skin.

• Some Ingrown toenails are acute which means that they have occurred due to an injury to the toe. Others are chronic, which means the patient has had the problem for a long period of time.

Symptoms and Signs

• Early in the course of an ingrown toenail, the end of the toe becomes

reddened and painful with mild swelling. There is no pus or drainage. It

may feel warm to the touch, but you will not have a fever.

•Later, extra skin and tissue will grow around the sharp point of the nail. A

yellowish drainage may begin. This is the body's response to the trauma

of a nail irritating the skin and is not necessarily an infection.

•Sometimes an infection develops. In this case, the swelling will become

worse, and there may be white- or yellow-coloured drainage from the

area. A lighter-coloured area of the skin may be surrounded by red skin.

You may develop a fever, although this is unusual.

Causes

• Inherited : Some people grow very wide and rounded nail plate.

• Poor Nail Care : The way you cut your nails may leave sharp spikes

• Footwear : Tight shoes may press on the side of the toenail.

• Injury / infection : Changes the growing area of the nail bed

Types of Ingrown Nail

TYPE 1 Ingrowing Toenail

Type One Ingrowing toe nail often looks as though there is nothing wrong

with the nail, but it hurts in shoes, to touch and sometimes even bed clothes causes pain. This is often due to slight curvature of the nail, tight shoes or poor cutting techniques. Simple trimming by a chiropodist or podiatrist will usually help to resole this problem. If not treated will often progress to a stage 3 Ingrowing toenail.

Type 2 Involuted Ingrowing ToenailThis problem is often seen in those over 50 when the nail has excessively curved ,or sometimes following damage either from some type of trauma or following fungal nail infections: Areas of corns and hard shin build up in the nail borders , causing pain, sometimes becoming infected. If caught early podiatry / chiropody treatment is the management of choice or will often progress to stage 3

TYPE 3 Classical Ingrowing ToenailMost common is the infected and inflamed ingrowing toenail, sometimes very

painful. The skin around the nail appears swollen and red, sometimes pus may be visible under the skin

This is the classical ingrowing toenail, often found in teenagers or poor management of stage 1 or two above. This type of nail problem can also be managed by a podiatrist, sometimes with local anaesthetic if

painful

TYPE 4 Infected Ingrowing ToenailIf the nail has become ingrown several times, or the shape of the nail

is so badly deformed that it is likely to re-grow, a decision may be made to remove part of the nail root. The end result will produce a normal looking but slightly narrower nail.

If the nail has become very deformed or if removing side sections would achieve an unsatisfactory result then the final option is to remove all the toenail.

Prevention

• Switch to longer shoes with a bigger toe box.

• Soak your foot in a solution of salt water once a day for 20 minutes to reduce inflammation and infection.

• Trim your nails as best you can. Do not try to "dig out" a deeply ingrown nail and try and cut straight across the top.

• Apply an antiseptic once a day, preferably after a bath or shower. This is especially important, because one of the greatest dangers of ingrown toenails is the possibility of infection.

Fungal Nail Infection

• Fungal infection of nails is common. The infection causes thickened and unsightly nails which sometimes become painful. Medication often works well to clear the infection, but you need to take medication for several months

• About 3 in 100 people in the UK will have a fungal nail infection at some stage of their life. Toenails are more commonly affected than fingernails. It is more common in people over 55, and in younger people who share communal showers, such as swimmers or athletes.

Symptoms

• Often the infection is just in one nail, but several may be affected. At first the infection is usually painless. The nail may look thickened and discoloured (often a greeny-yellow colour). Commonly, this is all that occurs and it often causes no other symptoms. However, it can look unsightly.

• Sometimes the infection becomes worse. White or yellow patches may appear where the nail has come away from the skin under the nail (the nailbed). Sometimes the whole nail comes away. The nail may become soft and crumble. Bits of nail may fall off. The skin next to the nail may be inflamed or scaly. If left untreated, the infection may eventually destroy the nail and the nailbed, and may become painful. Walking may become uncomfortable if a toenail is affected.

Causes

• Spread from a fungal skin infection. For example, athlete's foot is a fungal skin infection of the toes. This may spread to the toenails if the skin infection is not treated early.

• Fingernail infection may occur after a toenail infection has become established. The fungus may spread to a finger if you scratch your itchy toes and toenail.

• Fingernail infections are also more likely to occur if you wash your hands frequently, or have them in water a lot. For example, if you are a cook or a cleaner. Constant washing may damage the protective skin at the base of the nail. This may allow fungi to enter.

• A nail that has recently been damaged is also more likely to become infected.• You have an increased risk developing a fungal nail infection if you have various

other conditions. For example: diabetes, psoriasis, poor circulation, a poor immune system (for example, if you have AIDS or are on chemotherapy), or general poor state of health.

• Nail infections are more common in people who live in hot or humid climates.• Smoking also increases the risk of developing a nail infection.• In some cases there is no apparent reason. Fungus germs (fungi) are common and

an infection can occur 'out of the blue'.

Prevention and Treatment

• Keep your nails cut short, and file down any thickened nail.

• Use a separate pair of scissors to cut the infected nail(s) to prevent contaminating the other nails. Do not share nail scissors with anyone else (for the same reason).

• Avoid injury and irritants to your nails. For example, if fingers are affected, use cotton and vinyl gloves for wet work. Use heavy cotton gloves for dry work.

• If toenails are affected, wear properly fitted shoes with a wide toebox.

• Keep your feet as cool and dry as much as possible.

• Antifungal tablets will often clear a fungal nail infection. The medication will also clear any associated fungal skin infection, such as athlete's foot.

• A nail lacquer that contains the antifungal drug amorolfine is an alternative for most (but not all) types of fungi that infect nails. You can buy amorolfine nail lacquer from pharmacies as well as get it on prescription.

BunionsA bunion is a bony lump on the side of your foot, which develops when your big toe starts to angle towards your second toe. The bunion eventually causes discomfort and pain. The skin over the lump can become red, blistered or infected. A fluid-filled space called a bursa may also develop under your skin in this area and this can be painful if it becomes inflamed. This is called bursitis.

Symptoms

• If you have a bunion, you may have:

• pain or stiffness of the big toe joint

• swelling of the big toe joint

• difficulty walking

• difficulty finding shoes that fit

• If you have any of these symptoms, see your GP.

Causes

• A bunion occurs as a result of a problem with your big toe known as hallux valgus. Hallux means the big toe and valgus means that it’s pointing outwards towards the other toes.

• In hallux valgus the bone in your foot at the base of your big toe, called the first metatarsal, moves out at the side of your foot. Your big toe angles towards your other toes.

• There is evidence that people can inherit a tendency to develop bunions. However, it doesn’t always follow that if your parents or grandparents have bunions, you will have them too.

• Hallux valgus affects more women than men. This may be because the ligaments in the foot (the structures that connect bones together) are usually looser in women than men.

• The type of shoes you wear may also affect the development of a bunion. If you wear narrow or high-heeled shoes, this puts extra strain on the bones and muscles in your foot, pushing your toes together and forcing your big toe to point towards your other toes. Footwear alone doesn’t cause bunions, but it can worsen them.

• Bunions are also sometimes associated with joint diseases including osteoarthritis. However, there is usually no serious underlying cause.

Treatment

• Using shoe inserts and padding.

• Taking painkillers can help to ease the symptoms of a bunion.

• However, these treatments can’t cure a bunion or stop it getting worse. If you have severe pain or discomfort from a bunion, you will need to have an operation to correct it.

• One of the most important things you can do is to wear the right footwear. You should try to wear flat, wide shoes with laces or an adjustable strap that fits you properly

Prevention

• making sure that the toe of your shoe is wide enough to prevent your toes from being forced together –the widest part of your foot should be in the widest section of your shoe

• choosing shoes with a low heel and a wide toe box where you can wiggle your toes comfortably

• shoes with adjustable fastenings such as laces, buckles or straps that hold your feet inside your shoe

• using soft insoles in your shoes as shock absorbers

Verrucae

A verruca is simply a wart that is usually found on the soles of your 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.

Causes

• 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 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.

Prevention

• Minimise your chances of catching a verruca by keeping your feet clean and dry, and covering up any cuts or scratches. Avoid walking barefoot in communal showers or changing rooms (wear flip-flops) and don't share towels. Though you could wear verruca socks when swimming to avoid passing on the virus, they 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 salicylic acid, such as Occlusal. Ensure, however, 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 Foot Health Professional/ podiatrist. If you damage the healthy tissue that surrounds the wart tissue you could hamper further treatment.

Treatment

• 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 advised 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.

• Another option is to apply Glutarol daily and file every few days.• 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

Corns and Calluses• Corns and calluses are thickenings of skin on the feet that can become painful.

• They are caused by excessive pressure or friction (rubbing) on the skin.

• The common cause is poorly fitting shoes.

• A podiatrist/ Foot Health Professional can pare (cut away) corns and calluses and can advise on footwear, shoe insoles and padding to prevent recurrences.

• A corn is a small area of skin which has become thickened due to pressure on it. A corn is roughly round in shape. Corns press into the deeper layers of skin and can be painful.

• Hard corns commonly occur on the top of the smaller toes or on the outer side of the little toe. These are the areas where poorly fitted shoes tend to rub most.

• Soft corns sometimes form in between the toes, most commonly between the fourth and fifth toes. These are softer because the sweat between the toes keeps them moist. Soft corns can sometimes become infected.

Calluses

• A callus is larger, broader and has a less well defined edge than a corn.

• These tend to form on the underside of the foot (the sole).

• They commonly form over the bony area just underneath the toes. This area takes much of your weight when you walk.

• They are usually painless but can become painful.

Causes• The small bones of the toes and feet are broader and more lumpy near to the

small joints of the toes.

• If there is extra rubbing (friction) or pressure on the skin overlying a small rough area of bone, this will cause the skin to thicken. This may lead to corns or calluses forming.

• The common causes of rubbing and pressure are tight or poor fitting shoes which tend to cause corns on the top of the toes and side of the little toe.

• Also, too much walking or running which tend to cause calluses on the sole of the feet.

• Corns and calluses are more likely to develop if you have very prominent bony toes, thin skin, or any deformities of the toes or feet which cause the skin to rub more easily inside shoes.

TreatmentParing and trimming

• The thickened skin of a corn or callus can be pared down (trimmed) by a Foot Health Professional/Podiatrist by using a scalpel blade. The pain is usually much reduced as the corn or callus is pared down and the pressure on the underlying tissues eased. Sometimes repeated or regular trimming sessions are needed. Once a corn or callus is trimmed down, it may not return if you use good footwear.

• If the skin seems to be thickening up again, a recurrence may be prevented by rubbing down the thickening skin with a pumice stone or emery paper once a week. Some people can do this themselves. It is best to soak the foot in warm water for 20 minutes to soften the thick skin before using a pumice stone or emery paper. A moisturising cream used regularly on a trimmed corn or callus will keep the skin softened and easier to rub down.

Note: do not use a chemical (sometimes included in 'corn plasters') to 'burn' the thickened skin unless under the supervision of a podiatrist. Chemicals can harm the nearby skin and may cause a skin ulcer. In particular, chemicals should not be used if you have diabetes or poor circulation.

Shoes and footwear

• Tight or poor fitting shoes are thought to be the main cause of most corns and calluses. Sometimes a rough seam or stitching in a shoe may rub enough to cause a corn. The aim is to wear shoes that reduce pressure and rubbing on the toes and forefeet. Shoes should have plenty of room for the toes, have soft uppers and low heels. In addition, extra width is needed if corns develop on the outer side of the little toe. Extra height is needed if corns develop on the top of abnormal toes such as 'hammer' or 'claw' toes.

• Correcting poor footwear will reduce any rubbing or friction on your skin. In many cases, a corn or callus will go away if rubbing or pressure is stopped with improved footwear. If you have had a corn or callus pared away, a recurrence will usually be prevented by wearing good footwear. If you are able, going barefoot when not outdoors will also help.

• Some people with abnormalities of their feet or toes will need specialist shoes to prevent rubbing. A podiatrist can advise about this.

Footpads and toe protection

• Depending on the site of a corn or callus, a cushioning pad or shoe insole may be of benefit.

• For example, for a callus under the foot, a soft shoe inlay may cushion the skin and help the callus to heal.

• If there is a corn between the toes, a special sleeve worn around the toe may ease the pressure.

• A special toe splint may also help to keep toes apart to allow a corn between toes to heal. A FHP/ Podiatrist will be able to advise you on any appropriate padding, insoles or appliances you may need.

Surgery

• If you have a foot or toe abnormality causing recurring problems, an operation may be advised if all else fails.

• For example, an operation may be needed to straighten a deformed toe, or to cut out a part of a bone that is sticking out from a toe and is causing problems.

• If you need an operation then you will be referred to a surgeon who will be able to discuss this with you in more detail.

Symptoms and Warning signs• How your feet feel can be a reflection of your general health.

• If they hurt, they may be signalling other more serious conditions. That's why it is so important to look for warning signs.

• They may be your first indication of serious medical problems such as arthritis, diabetes, nerve and circulatory disorders, and other conditions.

Arthritis• Arthritis, the number one crippling disease , affects one in every seven

people, no matter what age.

• If you have pain, tenderness, limited motion or swelling in the joints of your feet that persists or intensifies over time, see your doctor or FHP/Podiatrist.

• When the joints of the feet are involved, medication, physical therapy, exercise, control of foot function with orthotics(foot appliances), braces, special shoes and surgery are among the treatment tools used to relieve pain and restore them to as near normal function as possible.

Diabetes• If you have diabetes or are at risk for diabetes by being overweight, you

need to pay special attention to your feet.

• Diabetes can impair circulation and nerve sensations in the feet, greatly increasing the risk of injuries and their ability to heal.

• Pay attention to symptoms such as tingling, numbness and pain in the lower legs. They may be symptoms of diabetes or other conditions.

Gout• If you are a man older than 30 (especially if you have a family history of gout), an

acute attack of pain in the joints, often in the big toe, may be a sign of gout.

• Left untreated, the pain could last from a few days to over a week.

• Gout is a complex disease of uncertain origin, caused by high levels of uric acid in the blood.

• It is important to seek prompt medical care if gout is suspected so that proper medical attention can be obtained.

Obesity• Since feet support your entire body weight, and your feet are prone to

wear and tear, obese people are more likely to have foot problems.

• When you're walking, the pressure on your feet can exceed your body weight. When you're running, pressure can be four times your weight.

• If you are obese, be sure to discuss any foot problems and discomfort with your doctor/FHP/Podiatrist.

Other

• Conditions of the feet may also signal other problems including rheumatic fever, circulatory problems and nerve disorders.

• Although many people take problems of the feet for granted, ignoring those problems is like ignoring any other health problem.

• Seek medical attention for pain and problems with your feet just as you would for any other condition.

Always look after your FEET FIRST, and they will look after you.

Thank you for listening...

...any questions?