COMMON FOOT DISORDERS

Athlete's Foot

This fungal infection is most commonly seen on the feet of athletes who spend much time in locker rooms, showers and steam rooms. It often starts between the little toes. Symptoms include intense itching, dryness and mildly red and scaly skin. If the infection is allowed to progress without treatment, blisters may appear.

Treatment requires perseverance; it should be continued over a period of several weeks. If athlete's foot occurs on a dry area, such as your heel, restored moisture by applying an antifungal cream or ointment. Wash hands thoroughly afterwards to prevent the infection from spreading.

Moist conditions require different treatment: dry feet thoroughly every time you wash; rethink your foot hygiene; wash with cold water instead of hot, which encourages fungal breeding; and apply surgical spirits regularly.

If your treatment regime fails, ask a podiatrist to ensure you are using the best treatment for your particular type of athlete's foot. Several other skin problems can masquerade as athlete's foot; your GP can prescribe a broad-spectrum oral antifungal medication.

Be aware of any symptoms that develop and ensure that you deal with them immediately. Here are some tips:

• Rotate your shoes to ensure they dry out thoroughly. Frequent sock changes will also help.
• Avoid applying antifungal powder in damp places such as between your toes; it will cake up and irritate your skin. Rather sprinkle the powder inside shoes and trainers. Surgical spirits also help to evaporate the moisture and allow skin to heal.
• Do not rub your feet dry as this removes any new skin; rather pat any moisture away with a towel or disposable paper towel.
• Avoid using moisturizer between your toes; even though the skin is dry and flaky, you need to eliminate any moisture.
• Maintain your shoe rotation, your daily health routine and all treatments even when symptoms vanish. Continue treatment for several weeks after the infection clears as the fungus lies dormant and will reappear if the right conditions present themselves.

Bunions

A bunion, or Hallux valgus, is an inflammation and thickening of the joint of the big toe, caused by the big toe being angled excessively toward the second toe. The bunion itself is a symptom of the deformity and can form a large sac of fluid, known as a bursa. Often inflammed and sore, it is aggravated by tight shoes and excessive weight load. If ignored, a bunion will progressively increase in size and become painful.

Women are more prone to bunions than men, partly due to the narrow toe-boxes of fashionable shoes that force the toes into a tapered point. If bunions run in your family, reduce your risk of following in granny's footsteps by wearing well-fitting, low-heeled shoes with a wide toe-box to accommodate the bunioned foot and remove the source of pressure. If you are not prepared to stop wearing restrictive shoe styles, the bunion will get larger and become painful. Try placing a pad over it to minimize friction.

In addition, talk to your podiatrist, who might recommend exercise, orthoses (special devices inserted into your shoes) or shoe alterations. If necessary, a bunion can be surgically removed.

Calluses

Calluses are thickened, raised layers of hard, dead skin that form on your feet from repeated friction and pressure where your feet rub against your shoes. When pressure becomes excessive, some areas of skin thicken and form corns and calluses as a protective response. They can be formed if you wear shoes that are too tight or too short, even if you walk barefoot a lot.

Calluses can become painful if they are allowed to grow too thick. Use pumice stone, foot file or chiropody sponge three times a week to rub away hard skin after you have soaked in the bath. Then, follow up with an emollient cream to boost your skin's natural elasticity and delay the callus from building up.

If your calluses are not responding to home treatment, consult a professional. If it feels as though you are 'walking on stones', a podiatrist will remove hard skin, relieve pain and redistribute pressure with a corrective device that fits into your shoes. He or she will also advise you on how to prevent it from happening again.

The best advice on how to avoid these protective calluses from becoming a problem is to take care of your feet: wear shoes that fit; never cut or scrape calluses; and avoid walking on hard concrete surfaces for long periods.

Corns

As already explained, corns and calluses are a build-up of dead skin in a small area as a result of pressure and friction. Unlike calluses, however, corns are usually found over a bony protuberance, such as a joint or bone.

There are five different types, with hard and soft corns being the most common.









Hard Corns

• Hard corns are the most common, comprising a tough, cone-shaped thickening of the skin, usually within a thickened area of skin or callus. They often have a nucleus in the centre, surrounded by inflammed skin.
• Soft corns are usually found between the toes as a result of friction. They are whitish, soggy and rubbery in texture as a result of the sweat or moisture between the toes, which softens the normally hard tissue. Dry your feet thoroughly. A podiatrist might suggest an astringent chemical to help minimize moisture retention.
• Seed corns are usually tiny and painless, occur either singly or in clusters underneath the foot, and generally take longer to grow back than other corns. They are formed by callus build-up around cholesterol beads or other anomalies in the sole of the foot.
• Vascular corns are either hard or soft corns that also contain blood vessels, which are forced into the growing corn by the squeezing or pinching effect of your shoes. They will bleed profusely if cut and can be exceptionally painful.
• Neuro-vascular corns are similar to vascular corns but with both nerve tissue and blood vessels within the growing corn. They often become inflammed and can be very painful.
• Fibrous corns result from corns that have been present for a long time. They appear to be more firmly attached to the deeper tissues than other corns, and may be painful.

Self treatment of corns is not a good idea, especially if you are elderly or diabetic. You could try using a pumice stone to remove the thickened skin a little at a time. Alternatively, use specially designed corn pads to form a protective cushion between the corn and your shoe. However, avoid using corn plasters or paints as these contain caustic chemicals that can damage the healthy tissue around the corns.

Avoid wearing shoes that are too tight, too loose, or have very high heels. Once you relieve the pressure and friction, the corn should gradually start to disappear. Consult your podiatrist, who will be able to remove the corn painlessly and apply padding or prescribe insoles to help minimize pressure, as well as to assist with advice on long-term relief.

Heel Pain

The heel bone is the largest bone in the foot. It provides firm support for your body weight and absorbs shock and pressure when your feet hit the ground. Heel pain can be disabling, making each step a problem, even affecting posture. The most common types of heel pain are:

• Heel spur: This develops as an abnormal growth of the heel bone and feels like a painful bruise. Calcium deposits form when the plantar fascia - which is a broad band of fibrous tissue along the bottom of the foot - pulls away from the heel area, causing a bony protrusion, or heel spur, to develop. This injury may cause bone growth to project into the flesh of the foot. Heel spurs can cause extreme pain, especially when you are standing or walking. Your podiatrist may apply padding to alter the ligaments' direction of stretchy, or apply deep-heat therapy to encourage healing. Alternatively, he or she may decide to prescribe special insoles (orthoses) to help your feet function more effectively and prevent recurrence.
• Heel bursitis: This is a constant irritation, resulting in inflammation of the heel's natural cushion (bursal). It is caused by chronic overuse, trauma, rheumatoid arthritis, gout or infection. Pain is left at the back of the heel when you move the ankle joint, or deep inside the heel when it touches the ground. Immobilization of the affected area, anti-inflammatory medication, the correct orthoses, and cold compresses can be useful to reduce swelling. If not, pay attention to the cause of any rubbing, and get your podiatrist to pad and strap it appropriately. If it is infected, your doctor may need to prescribe antibiotics or to aspirate fluid from the bursa.
• Heel bumps: These are recognizable as firm bumps at the back of your heel where the Achilles tendon attaches to the bone. They are aggravated by shoe friction. Mules and slingbacks will help to avoid exerting any pressure on the heel. If pain persists, surgery may be necessary.

Dry Cracked Heels

Dry skin often leads to painful cracking of the skin, particularly around the edges of the heels. For many, this may simply be unsightly, but when the fissures are deep, the skin bleeds easily and is painful.

Open-backed shoes, where the rim of the sole causes irritation, may aggravate the condition. Using very hot water can also be a contributing factor.

Use an emollient moisturizing cream on the affected heels daily (look for urea on the list ingredients). Gentle use of a pumice stone or foot rasp will also help, but never try to pare down the hard skin yourself with a razor blade or a pair of scissors!

Chilblains

Chilblains are small itchy, red swellings on the skin, which become painful when exposed to damp and cold. As they swell and the surface of the skin cracks open, sores (ulcers) may develop and may become infected.

Chilblains are the result of your skin's abnormal reactions to cold. They occur on the toes, particularly the smaller ones, and sometimes on the face and fingers. They can also occur on areas of the feet that are exposed to pressure - for instance, on a bunion or where your toes are squeezed by tight-fitting shoes.

Many people suffer from cold feet in winter, but whether or not they develop chilblains depends largely on the efficiency of their blood circulations, as well as dietary factors and hormonal imbalances can also play a role. To prevent chilblains, a course of calcium before winter may be helpful.

Keep your body, feet and legs warm, especially if your circulation is poor and your mobility is limited. The whole body should be kept warm, not just the feet; trousers, long boots, tights and leg warmers or long socks will help. However, avoid warming chilled skin too rapidly next to a fire or hot-water bottle as this can in fact exacerbate the problem.

Do not scratch chilblains; soothing lotions with 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 are undergoing medical treatment, have the ulcer assessed by your GP or podiatrist.

Sweaty Feet

There are some 250,000 seat glands in our feet, more per centimetre than anywhere else in the body. They release nearly a cup of moisture every day.

Most people suffer periodically from excessive perspiration and foot odour, yet for some sweaty feet are an embarrassing, persistent problem. Hyperhydrosis (excessive sweating) has much to do with how the sweat glands in the feet work. Excessive odour or sweating of the feet is systemic in some cases, such as anaemia or hyperthyroidism (overactive thyroid).

The sweat glands' function is to keep the skin moist and supple. Throughout the average day, the body naturally perspires to regulate heat in the body. Sweaty feet can also be caused by stress on the foot due to a structural problem, or because the foot is under strain or is tired - for example, when you have been standing all day.

Hot weather may aggravate the condition, even though sweaty feet are not only a summer problem. Since sweat glands on the feet and hands can also be triggered by emotional responses, mental or emotional stress may be a contributing factor. In teenagers, sweaty feet are often triggered by hormonal changes.

Medicated insoles may help to prevent foot odour.


Frequently accompanying sweaty feet is foot odour, which occurs when bacteria on the skin break the sweat down. Simple hygiene is usually effective in dealing with this problem:

• Wash your feet daily with anti-bacterial soap to minimize the risk of minor skin infections, athlete's foot or blisters.
• Wear well-fitting shoes made of leather, which allow your feet to 'breathe'. Synthetic fibres contribute to the production of excessive perspiration and promote bacterial growth.
• Always wear socks that absorb moisture well; choose natural fibres like wool, cotton, or wool/cotton blends.
• Do not wear the same pair of shoes every day as sweat is absorbed by insoles and uppers; allow shoes to dry out before wearing them again.
• Detachable insoles that can be washed are a good idea, as are medicated insoles, which have a deodorizing effect.

Blisters

A friction blister is a raised area of skin filled with fluid, usually formed between the outer and inner layers of the skin. Blisters form as a result of heat, moisture, friction and pressure. The friction from walking causes the skin to be dragged back and forth across the underlying tissue. This leads to a tear in the upper layers of the skin, which fills with fluid - a result of leakage from blood vessels under the skin.

Although most commonly caused by wearing ill-fitting shoes or by using inappropriate footwear for a particular activity, blisters can also appear as a result of infections, burns, skin diseases and insect bites.

Blisters start to form when a sock or shoe clings to damp skin. Reduce friction and moisture and you can help to prevent blisters from developing. Blisters should be left unbroken wherever possible because they provided valuable protection to the damaged tissue. When a blister has been opened accidentally, always disinfect it with antiseptic and protect it with sterile bandages. Note that blood blisters can result from sharp pinching of the skin when blood collects inside the blister space.










Powdering your feet before putting on socks or shoes should help to absorb any excess moisture that may promote the formation of blisters.


To avoid blisters:

• Buy shoes that fit correctly. Do not forget to allow room for the swelling that is bound to occur as your feet become hot. Add insoles or heel cushions if necessary.
• Wear in new shoes before using them to compete in any sporting activity.
• Consider the type of sock you will wear with the shoe; do not forget that thick socks reduce the volume of a shoe.
• Wear wool or cotton socks that do not bunch up or crease. Wearing two pairs of sock also helps to reduce friction.
• Powder your feet to absorb or reduce moisture and decrease blister-forming friction.
• If the blister continues to cause discomfort, it may need to be lanced and drained. Do not remove the layer of skin covering the blister as this protects the underlying skin from further abrasion. Dress the area with antiseptic ointment, then cover it with a protective plaster.
• Never attempt self-treatment if you have circulatory problems or you are diabetic.