STEP 2 - CARING

CONDITIONS, TREATMENTS AND PREVENTIONS

For many of us who suffer from foot problems, going barefoot in public is a feat in itself. Those cratered nubs, cartoon like toe bulges, and reptile like skin can be an embarrassment and a sight we wouldn't want to reveal to others. However, ignoring foot problems will not only lead to embarrassment but also serious and costly medical problems.

Whether painful to the eye or simply painful, the following are some of the most common foot problems and ways to treat and prevent them.

ATHLETE'S FOOT

Athlete's foot is a fungus infection. The fungi that cause athlete's foot are like small mushrooms that multiply in dark, damp places. Everyone is susceptible to athlete's foot, but unless the growing conditions are ideal the infection is not likely.

Athlete's foot is indicated in a variety of ways. For some, the skin between the toes (especially the last two toes), peels, cracks and becomes scaly. For others, there is redness, scaling and blisters on the soles and along the sides of the feet. Often these skin changes are accompanied by itching and burning. Toenail infections can also occur and are typically very stubborn to treat. These infections result in scaling, crumbling and thickening of the nails and can also result in nail loss.

TREATMENT

As not all rashes on the feet are athlete's foot, it's prudent to have your foot specialist or dermatologist properly diagnose the condition and prescribe the correct medication. Using over-the-counter products on a rash that is not athlete's foot may make your condition worse.

Once the fungus is diagnosed, your doctor can prescribe an anti fungal cream to remedy simple cases. In more severe cases, your foot specialist and dermatologist may prescribe foot soaks before applying anti fungal creams (see coming post). If your athlete's foot is stubborn, anti fungal pills are also available. If athlete's foot is not treated, the skin blisters and cracks can lead to bacterial infections.

As with all medications, it is important to continue the use of your prescribed anti fungal creams and to take all medication even if the condition seems to have improved or healed. While your skin may look better, the infection can remain for some time afterward and could recur.

PREVENTION

• Wash your feet daily. If you are prone to athlete's foot wash your feet twice a day and dry them thoroughly, especially in between your toes.
• Wear shoes like flip-flops in places that fungi like to grow, such as public showers and other dark, moist places.
• Wear cotton or other natural-fiber socks and change frequently throughout the day if they become damp. Avoid shoes made with synthetic materials as well.
• Avoid tight footwear, especially in the summer. Sandals are the ideal warm weather footwear. However, it is even better to go barefoot as often as possible to allow your feet to dry out and "breathe."

BLISTERS

Blisters are fluid-filled pouches on the top of the skin. They form when the skin rubs against another surface, usually the inside of a shoe, causing friction. A tear occurs within the five upper layers of the skin, or the epidermis and a space forms between the layers into which a clear fluid flows, filling up the space and pushing out the surface, which is still intact, causing a blister.

TREATMENT

Note: Those diabetes or poor circulation should not self-treat and should consult a podiatrist or primary-care physician.

The easiest way to prevent blisters is to wear shoes that fit you well. Choose shoes that fit comfortably, with about a thumb's width between your longest toe and the tip of the shoe. narrow shoes can cause blisters on the big toe and little toe. Tight-fitting shoes can lead to blisters on the tops of the toes, while loose shoes can create blisters on the tips of the toes as they rub against the toe box of the shoe (see coming post).

When trying on shoes, bring along the same socks, insoles and orthotics that you normally wear. Since feet tend to swell during the day, shop for shoes in the afternoon or evening.Walk or jog around the store before buying shoes and then put them on again when you arrive home to identify areas of discomfort.

Most blisters can be self-treated, only needing medical attention if they become infected, recur frequently, form in unusual locations, or are very severe. Signs of infection include pus draining the blister, warm and/or very red skin around the area, and red streaks leading away from the blister. Small, intact blisters that are not bothersome should be left alone since the blister's own skin, or "roof," is nature's most effective bandage. For additional protection, cover blisters with a small adhesive bandage.

Larger or more painful blisters that are intact should be drained without removing the roof. To do this, first clean the blister with rubbing alcohol or wash with an antibiotic soap. Sterilize a straight pin over a flame until it glows red, then allow it to cool before puncturing a small hole at the edge of the blister. Drain the fluid with gentle pressure and then apply an antibiotic ointment. Cover the blister with a bandage and change the dressing daily or more frequently if it becomes wet, soiled or loose.

Blisters with small tears should be treated the same as those that you have manually punctured. Blisters with larger tears should be "unroofed" carefully with fine scissors and the base should be cleansed thoroughly, followed by an antibiotic and a bandage.

Additional padding may be necessary during exercise or sports. Ring-shaped adhesive pads made of felt can be placed on the skin around the blister, which disperses weight away from the blister. Larger blisters may require a larger sterile adhesive bandage. If you find that the bandages on your feet fall off during exercise, tape the bandage in place with either cloth or duct tape. To further decrease friction, you can also apply a thin layer of petroleum jelly to the feet underneath socks or you can apply a foot powder or foot antiperspirant spray that will keep your feet dry.

The best way to avoid discomfort is to take a break from physical activities. But if blisters do surface, prompt treatment will get you back to form quickly and help prevent infection.

PREVENTION

• Minimize friction placed on your feet. If you know you will be participating in an activity likely to cause blisters, such as running or wearing new shoes, you can apply a thin layer of petroleum jelly to the feet before you put on your socks.
• Keep feet dry: Foot powders and foot antiperspirant spray decrease moisture.
• Break in shoes by wearing them for 1 to 2 hours on the first day and gradually increase the amount of time you wear them.
• Wear shoes appropriate for a particular sport.
• Use cloth tape or duct tape over areas prone to blistering before you exercise or play a sport.

BOTCHED PEDICURES

Pedicures can be the source of many problems, not only of fungal infection but also bacterial infection and Hepatitis C. All are caused by the use of unsterile instruments.

TREATMENT When a nail is improperly trimmed, in many instances you have to just let it grow out. However, if you have any symptoms such as warmth, redness or drainage from the nail, which are all signs of an infection, you must consult your foot-care specialist.

PREVENTION Do not feel inhibited to bring your own instruments to a professional manicure. It is important to feel comfortable and if you have a good relationship with your pedicurist, he/she will understand. If you do not have a good relationship, try to develop one. It is increasingly common for people to bring their own pedicure instruments with them, even at reputable salons.

BUNIONS

A bunion is a protuberance of bone and/or tissue around the big joint. A bunion at the base of the little toe or on the outside of the foot is called a "bunionette" or a "tailor's bunion."

The joint at the base of the big toe is very complex. Here the bones, tendons and ligaments work together to distribute the body's weight. Should this joint become abnormally stressed over an extended period of time, a bunion may result. Bunions at the base of the big toe usually begin when the big toe starts moving toward the smaller toes, usually as a result of a faulty biomechanics or pointy or poor-fitting shoes. Any crowding of the toes puts pressure on the joint, pushing it outward. The movement of the joint in this outward direction starts the formation of a bunion.

People with flat feet or low arches are more susceptible to bunions and should be especially wary of wearing high-heeled or improperly fitting shoes. Bunions are also associated with various forms of arthritis. Arthritis can cause the joint's protective covering of cartilage to deteriorate, leaving the joint damaged and with a decreased range of motion. For this reason, older people are more vulnerable to bunions.

Pain from a bunion can range from mild to severe, making it difficult to walk in normal shoes and, more notably, heels. The skin and deeper tissues around the bunion may also become swollen or inflammed.

A bunion can affect the other toes as the big toe pushes inward toward the smaller toes. Toenails may begin to grow into the sides of the nail bed, the smaller toes can develop corns or become bent (hammertoes), or calluses may form on the bottom of the foot.

TREATMENT Treatments vary depending on the severity of pain and extent of deformity. Left untreated, bunions tend to get larger and usually more painful. An evaluation by a podiatric surgeon should be given at the first sign of pain or discomfort so that severe deformity can be prevented. The main goal of early treatment is to relieve pressure on the bunion and smaller toes and to diminish the progression of joint deformities.

Padding the bunion is an important first step, as is wearing shoes such as sandals, athletic shoes, or shoes made from soft leather that are large enough to comfortably accommodate the bunion. Stiff leather shoes may be stretched slightly for greater comfort. Tight, confining, or high-heel shoes should be avoided.

A doctor may start you on non steroidal anti-inflammatory drugs or cortisone injections. These prescriptions can help to ease pain and inflammation caused by joint deformities. Physical therapy, ultrasound treatment and whirlpool baths can also provide temporary relief.

Orthotics (shoe inserts) may be useful in controlling abnormal foot movement and may reduce symptoms for those with a painful bunion that has not yet caused a significant bony abnormality at the joint. If a systemic disease like rheumatoid arthritis or gouty arthritis is related to the bunion, appropriate medical treatment aimed at those diseases may be recommended.

When conservative treatment does not provide satisfactory relief from symptoms or when the condition interferes with physical activity, surgery is necessary. In addition to easing pain, the purpose of bunion surgery is to remove the enlargement and realign the joint to restore normal function so that the foot can carry the body's weight properly. Postoperative orthotics or support devices may be recommended to improve the foot's function.

PREVENTION

• Wear comfortable shoes as often as possible.
• See your doctor at the earliest onset of symptoms.

COLD FEET

Cold feet occur when the very small arteries in the feet (and hands) go into spasms and constrict the blood flow to the tissues. It is a common malady for women who suffer from the benign genetic condition known as Raynaud's disease. Besides feeling cold the feet may also turn a different colour, from white to red to blue.

Cold feet is also a symptom that occurs when other factors, such as external temperature, caffeine and tobacco, irritate the arteries in the feet. Mild cases can be treated with warming socks, toe warmers and precaution. Contact your doctor if any of the following occur: Your toes turn black or dusky blue, pain persists for more than two hours, red toes do not turn back to your natural colour when pressure is applied to them.

CRACKED SKIN

Fissures, or deep cracks in the skin, are caused by excessively dry skin or thick calluses, usually found at the perimeter of the heel. Sandals and slingback shoes contribute to calluses and dry, cracked skin on the heel, since the heel is exposed when it spills over the back of the shoe. Fissures can be painful and may become infected unless treated.

TREATMENT Treat dry skin by rubbing the heels of the feet with a pumice stone after a shower when the skin is softer. Do not try to cut or grate rough skin yourself nor should you allow your pedicurist to smooth your skin with anything other than a pumice stone - only a podiatrist should be trusted to use a scalpel or razor blade on your foot. Finish by applying an emollient like lanolin or cream with urea; both are available over the counter at most drugstores. These creams provide a barrier and do not allow moisture to leave the skin.

PREVENTION

• Pumice dry skin regularly.
• Moisturize your feet, especially in chapped areas. Wear socks over moisturized feet to bed.
• Soak feet
• Avoid backless shoes.

FOOT PAIN

RUNNING

While runners swear by their highs, it does not often include the feet. The feet carry the weight of the entire body, and as a result active feet are more prone to problems. It is essential for runners to wear proper shoes. Runners should keep their nails trimmed and inspect their feet on a regular basis. Bruises are common and typically not a problem. However, if they are persistent and frequently recur, seek medical attention.

Stretching before and after exercise can often thwart problems. If pain does occur, reduce your exercise regimen and end with a warm bath or shower and a foot massage to soothe tired muscles.

BEING OVERWEIGHT

Most people who are overweight also suffer from foot pain. Maintaining your proper weight is essential for relief from foot pain.

HAMMERTOES

A hammertoe occurs when any of the little toes curl under themselves. This happens when ligaments and tendons have tightened, causing the toe's joints to buckle, the toe to curl and the middle part of the toe to propel upward. Shoes then rub on the prominent portion of the toe, leading to bursitis (inflammation of the joints) and eventually corns and calluses.

During its early stages, a hammertoe remains flexible, allowing it to straighten when pressure is applied to the buckled area. As time passes, however, the toe can become permanently buckled or rigid, requiring surgery for correction. Painful calluses on the bottom of the foot may accompany rigid hammertoes due to pressure generated on the joint.

TREATMENT It is important to wear shoes that comfortably accommodate the contracted toe. Your doctor may recommend a splint or pad that can hold your toes straight and felt padding that can cushion corns. If your symptoms are severe, surgery may be needed. If your joints are flexible, the tight tendon is cut and repositioned. If the joint is rigid, a piece of bone may be removed to help straighten the toe.

HEEL PAIN

Many people suffer from a sharp pain, aching or stiffness on the bottom of one or both heels. This discomfort is often most intense first thing in the morning and after a period of rest or inactivity. The pain may cause people to hobble or limp for a few minutes while their feet adjust to a comfortable stride. The pain may also occur as weight is applied to heels during walking or standing.

Heel pain originates deep within the foot, directly on the heel bone or within the foot's connective tissues, called the fascia. Several layers of fatty tissue surround the heel bone, softening the impact of walking and running and protecting the bones and muscles of the foot. Beneath this padding the fascia extends from the heel bone all the way to the toes, and acts as an arch support in between. Pain can result when the fascia become irritated or inflammed. This inflammation may cause a heel spur to grow on the heel bone.

TREATMENT Heel pain can be avoided and cured, with simple stretches that are also beneficial in the treatment an prevention of many other foot problems. Since many foot injuries are a result of muscle and tendon imbalances, stretching some muscle groups while strengthening others can often prevent and reduce pain.

Stretches that involve the foot should concentrate on the Archilles tendon and calf muscles. The following stretches are most effective in treating these areas and should be done twice a day:

BASIC RUNNER'S STRETCH Bend one leg forward in a semi-lunge position and thrust the other leg straight back. Hold for one minute and switch legs.

STEP STRETCH Stand on a step, balancing on the balls of your feet with your heels hanging over the edge. Drop heels below the step and hold for one minute.

PREVENTION

• Stretch at least twice daily.
• If you are more than your optimum weight, begin a weight-loss program to relieve pressure on the heels.
• Wear high heels as little as possible.

OTHER HEEL CONDITIONS

While injury, overuse and poor-fitting shoes can cause pain or discomfort to the heel, a painful heel could also indicate a more serious condition. A few of these conditions are:

• Arthritis
• Collagen disorders
• Gout
• Heel-bone abnormalities
• Nerve injuries
• Psoriasis
• Tumors

HEEL SPURS

A projection or growth of bone is a spur. They can grow where the muscles of the foot attach to bone. While some heel spurs are painless, others result in chronic heel pain that requires medical treatment or surgery.

TREATMENT In most cases, heel spurs can be relieved without surgery. Simple treatments include alternating heel heights, taping and padding the foot, or modifying or temporarily eliminating sports and other vigorous activities. Orthotics also relieve the strain on the tissues and permit the heel to recover. Also, a stretching routine involving the Achilles tendon and calf muscles (see above) should be practiced three times a day - in the morning, before exercising, and in the evening.

If self-care measures fail to relieve the pain, a podiatric surgeon may recommend various treatments to reduce inflammation. Some of these may include:

• Nonsteroidal anti-inflammatory medications to reduce both pain and inflammation.
• Extracorporeal Shock Wave (ESW) - a new treatment that uses high-energy shock waves to promote healing of the plantar fascia. ESW has been used for years to treat kidney stones.
• Cortisone injections.
• Physical therapy - a podiatrist or physical therapist may treat heel pain with ultrasound, electrical stimulation, or hydrotherapy. Each of these methods may help reduce inflammation.

PREVENTION

• Modify daily routines to exclude activities that are stressful on the feet.
• Apply ice at first onset of pain.
• Alternate shoe height between low and high heels.
• Replace shoes, especially athletic footwear, regularly.
• Begin any new exercise regimen slowly. If you experience any pain, immediately end the exercise and consult a specialist.
• Stretch at least three times a day.

INGROWN AND THICKENED TOENAILS

Ingrown and thickened nails are common toenail disorders. Both have the same treatment and prevention programs. Ingrown nails occur when the nail grows into the surrounding skin; it is quite common in the big toe. Symptoms of an ingrown nail include redness, swelling and infection. Thickened nails can develop through pressure from footwear, fungal infections and various other conditions, including diabetes and psoriasis.

Sometimes a toe injury changes the nail's contour, which can lead to an ingrown toenail. Toe deformities (such as bunion), and high-heel or pointy shoes also apply pressure between the nail and soft tissues, eventually forcing the nail to grow into the skin. Ingrown nails can be accompanied by other toe disorders, such as excess surrounding tissue or an outgrowth of bone beneath the nail. Painful ingrown nails may be congenital, caused by an overcurvature of the nail or an imbalance between the width of the nail plate and the nail bed.

TREATMENT Daily soaking in a salt bath may be recommended, and if the toe is inflammed or infected, a topical antibiotics should be applied for three to seven days. If the infection is severe, an oral antibiotic may be prescribed.

In severe cases, surgery is often necessary to ease the pain and remove the offending nail. However, only a portion of the nail may be removed. If the entire nail is badly affected or there is severe nail deformity, the nail plate and matrix (the cells that grow the nail) may be entirely removed.

PREVENTION

• Cut your nail straight across. Do not cut the nail too short; leave a bit of the white tip, and trim them often so they do not get too long.
• Wear well-fitting shoes with low to moderate heels.

NEUROMA

A neuroma is a pea-shaped mass of nerves that is pinched between two bones of the foot, usually between the third and fourth toes. The pinched nerve becomes thickened and painful. Many patients describe the pain as feeling like they are standing on a cord. Signs of a neuroma include intermittent cramping, burning and numbness that is aggravated by wearing shoes. Typically, this pain occurs from wearing tight-fitting shoes and can be dramatically reduced by removing the shoe and massaging the painful area.

TREATMENT Conservative treatment usually includes wearing proper-fitting shoes, orthotics or arch supports. These conservative therapies may provide complete, partial or no relief of symptoms. Surgical removal of a neuroma is performed when conservative treatment proves ineffective.

• Wear proper-fitting shoes that have enough room for the toes.
• Modify exercise and physical activities.

SMELLY FEET

Smelly feet, known as bromhidrosis, occurs when the foot's perspiration provides optimal growing conditions for bacteria. There is a very high concentration of eccrine glands (sweat-producing glands) in the skin on the sole of the foot. In addition, the temperature inside of a shoe can reach 102 degree ferenheight. Sweat is a good media for bacteria to grow in and the bacteria secretes isobaleric acid, which is what causes the odour.

TREATMENT Smelly feet are exacerbated by synthetic shoes that do not breath; vinyl and plastic shoes are notorious for this. However, even well-ventilated shoes need to air out for 24 hours before they are worn again. It is imperative to keep feet dry: Damp feet promote bacteria that secreate odour - causing chemicals. If necessary, change your shoes more frequently, even throughout the course of a day. Socks that breathe are equally important. In addition to providing conditioning and warmth, socks wick moisture away from the surface of the skin. Cotton blends are the best, as cotton asborbs the moisture and certain synthetic materials wick it away.

The most essential remedy for smelly feet is frequent washing and foot powders. You can also by deodorant soaps and sprays made specifically for the feet. Soak your feet in a mixture of vinegar and water (see coming post). Combine essential oils with your everyday body lotion and apply to your feet after you shower. If all else fails, your doctor can prescribe internal and topical medication to help reduce perspiration on the soles of the feet.

PREVENTION

• Avoid wearing the same pair of shoes within a 24-hour period, giving them plenty of time to effectively air out.
• Wear socks made with cotton-synthetic blend.
• Frequently changing shoes, even throughout the course of a day if necessary, will minimize sweat.
• Apply talcum powder or foot spray to feet and shoes.
• Wear well-ventilated shoes; sandals are best for warmer weather.
• Use a noncaustic fabric deoderizer in your shoes.

SPLINTERS

Most splinters can safely be removed with household tweezers. The area should be clean, dry and adequately lit. Do not soak your foot prior to removing the splinter, as this causes the splinter to absorb the water and get larger, making it more difficult to remove. Grasp the end of the splinter with the tweezer and extract along the same line it entered, being careful not to bend or break the splinter. If there is rednessaround the splinter or pus or other draining fluids, all of which indicate infection, consult a physician immediately and do not try to remove the splinter yourself. After removal, clean the area thoroughly with soap and water and cover with an antibiotic ointment and bandage. Wear soft shoes for a day or two and remember to wear shoes when walking on wooden floors or decks.

SWOOLEN FEET

Feet are known to swell, a condition known as oedema, especially in airplanes and warmer temperatures. In the summer, you may notice that your feet begin the day normally, but by day's end they are as puffed up as a peacock. Most often, swelling is a benign condition and is usuallt due to gravity's effect on fluids. Other factors that cause swelling include high salt intake (salt draws fluid out of the cells and into the spaces between the cells), immobilization, pregnancy and medication. Swelling can also be the result of a failure in the small valves within the veins of the legs. When healthy, these valves only allow the blood to flow to the heart. If these valves are unhealthy, blood pools in the legs and feet.

Although swollen feet is often a benign condition, it can also be an indication of systemic disease, including kidney dysfunction, diabetes and thyroid disease, as well as several diseases pertaining to the veins. Consult a doctor if conservative treatments such as elevating your feet above your hear and wearing support socks do not work.

TREATMENT Keep your feet properly ventilated. As with smelly feet, shoes should be rotated to keep them dry. You want to allow at least 24 hours for a pair fo shoes to air out. During a long plane flight you may notice that your feet are prone to swelling, which is due to their immobile, confined position. Walking about the cabin every so often should remedy the problem.

PREVENTION

• Keep feet clean and dry.
• Wear socks or stockings.
• Drink lots of water, especially if you indulge in coffee and alcohol.
• Follow your doctor's recommendation about salt intake.

TOE DISORDERS

The most common toe deformities are hammertoes, mallet toes curled toes, bone spurs and overlapping and underlapping toes, all of which may or may not be painful. Corns - a buildup of skin on the affected joint that is often associated with bursitis (inflammation of small pouches, called bursas, which lie above the joint between the tendon and skin) - are perhaps the most noticeable and bothersome symptoms. If left untreated, mobility of the toes could be affected and other problems, such as skin ulceration, may develop.

Arthritis, which slowly destroys the joint surface, is another major cause of toe discomfort and deformity. Toe deformities can be aggravated by restictive or poor-fitting shoes worn for a prolonged period of time.

BONE SPURS

A bone spur is an overgrowth of bone that may occur alone or along with a hammertoe. Commonly found on the sides of the toes and on the heel, they cause painful lesions called soft corns. Calluses are another major symptom. Left untreated, a bone spur may eventually be accompanied by bursitis or a small skin ulceration. (see Heel Spurs, above).

MALLET TOES

Mallet toes and claw toes are similar in appearance to hammertoes, but affect different joints in the toe. The joint at teh end of the toe buckles in a mallet toe, while a claw toe involves abnormal positions of all three joints of the toe.

OVERLAPPING AND UNDERLAPPING TOES

Toes can overlap or underlap each other because of ill-fitting shoes, an untreated bunion, a genetic imbalance of the tendons, or a congenital condition of the bones within the toes. Pain, inflammation and small corns may result. This interferes with the normal function fo the foot and, if left untreated, may lead to enlargement of bone spurs.

TREATMENT Less advanced conditions featuring only minor discomfort may be treated without surgery. This usually involves:

• Trimming or padding corns and calluses
• Wearing supportive orthotics in shoes. This helps relieve pressure and allows the toes and major joints of the foot to function more appropriately by preventing pronation.
• Splints or small straps to realign the toe.
• Wearing shoes with a wider toe box.

In certain cases, anti-inflammatory medications may be injected to relieve pain and inflammation. Medications have proven to be successful in relieving the discomfort associated with bursitis. While conservative treatments provide temporary relief of symptoms, they may not correct the deformity and surgery may be required.

TOENAIL DISORDERS

Nail problems can be caused by improper trimming, minor injuries or just being clumsy. Some nail disorders, such ingrown nails, can also be congenital. In their protective role, nails bear the brunt of daily activities. All or a portion of the nail plate can be damaged when the feet are injured or abused.

CUTICLE INFLAMMATION

Inflammed cuticles, also known as paronychia, occur from excessive pressure on the skin. This can result from a too-rigorous pedicure or constantly picking at your cuticles. Infection can easily occur if not treated.

TREATMENT Inflammed cuticles can be self-treated by soaking feet in a warm bath and applying moisturizing creams. If the inflammation remains after a few days of this treatment, your doctor may prescribe antibiotics. If badly infected, a podiatric surgeon will need to drain the affected area.

PREVENTION

• Cut your nails straight across.
• Do not pick at your cuticles.

FUNGAL INFECTIONS

Most fungi are harmless until they penetrate the skin. A fungus can invade through minor cuts or after an injury that causes the nail to separate from the nail bed.

When a fungus has fount its way into the nail bed, the nail may thicken and become yellow or brownish. As the fungus grows, foul-smelling, moist debris that is dry, white and has a cheeselike consistency is produced. Pressure from a thickened nail or the buildup of debris may cause pain.

TREATMENT Naturally, it is best to treat the fungus in its earliest stages of infection. Treat athlete's foot (see above) as soon as possible and look out for discolouration along the tip of the nail. Left untreated, the accumulation of debris under the nail plate can lead to an ingrown nail or to a more serious bacterial infection that can spread beyond the foot.

To reduce the pain of a thickened, infected nail, a surgeon files the nail plate down with a surgical burr. Filing will not, however, prevent the infection from spreading.

Oral medication can be prescribed to eradicate the fungus. This medication can have side effects and is not for anyone with liver problems. Your podiatric surgeon should monitor the results of oral prescriptions.

HAEMATOMA (BLOOD BENEATH THE NAIL)

A common result of an active lifestyle is a heamatoma, or blood beneath the toenail. Haematomas are especially coomon among people who jog or play tennis, when the toes repeatedly rub against the inside of a shoe. However, a haematoma might also indicate a fractures bone, especially after an injury. Any time you see blood beneath the toenail, see a podiatric surgeon for proper diagnosis and treatment.

TREATMENT Because haematomas are a result of excessive rubbing against the shoe, it is important to wear thin but scushioned socks and comfortable shoes. If the haematoma is treated within the first few hours of forming , the podiatic surgeion will create a tiny hole in the nail plate. This releases the blood and relieves the pain and is itself a painless procedure. Following this simple drainage, the toe should be soaked in warm salt water and treated with topical antibiotics.

If left untreated and several days have passed and the blood clot becomes painful, the nail plate may require removal so that the nail bed can be cleaned. Some podiatric surgeion prefer to remove the nail plate whenever blood forms beneath it because the blood can promote bacterial growth and lead to infection. A couple of weeks after surgery, the body will generate a hardened skin covering to protect the sensitive nail bed. When this covering has developed, normal activities can be resumed. Nail plates that have been removed will grow again within three to six months.

PREVENTION

• Wear shoes with a large toe box.
• Wear socks that cushion the toe but do not add bulk.
• Treat haematomas promptly by draining the blood clot. Often it can save the nail.

RIDGED NAILS

Ridged nails are usually the result of internal traumas such as high fevers or stress; or external stresses such as too-tight toe boxes on shoes and repetitive physical stress from running or exercise. Similar to the bark rigs of a tree trunk, the nails reflect stresses of the body and mind but these ridges may not show up until several months after the trauma has occurred. The ridges will grow out as the nail grows.

TREATMENT The only treatment is to gently file the nail flatter, being aware that it will thin the nail plate. You can also use topical nail-ridge fillers sold over the counter.

YELLOW NAILS

When your nails turn a dusky honey colour, it could be an indication of a variety of stresses. A fungal infection, pressure caused by ill-fitting shoes, or strenuous exercise are all potential culprits. To determine the cause, your podiatrist needs to analyze a sample from the nail. If the discolouration came about around the time you took up running or began wearing a new pair of pointy shoes, it should not take too long to figure out the source of the trauma.

TREATMENT If your doctor diagnoses a fungal infection, he or she will prescribe either a topical cream or oral medication. Since it takes at least three to six months for a toenail to grow out, regardless of what ails it, be prepared to wait a while before it is back to normal.

PREVENTION

• Treat a fungal infection at its first onset so it does not spread to the nails.

WARTS

Most often seen on the bottom of the foot, warts usually appear as soft spots that are red, gray, brown or black. They are typically gray or brown with a center that appears as one or more pinpoints of black. Warts are caused by viral infections that typically invade the skin through small cuts and abrasions.

Though warts are hightly treatable, they can nevertheless be quite painful. Because they most commonly appear on the plantar surface, or sole of the foot, they are known as plantar warts. Most warts are harmless and are often mistaken for corns - layers of dead skin that build up to protect an area that is being continuously irritated.

Plantar warts tend to be hard, flat and rough on the surface with well-defined boundaries. They are generally fleshier when on the top fo the feet or the toes. The plantar wart is often contracted by walking barefoot on dirty surfaces where the virus lurks. The virus propagates in warm, moist environments, which is why many people associate warts with communal bathing facilities such gym locker rooms. It is therefore important to keep the feet clean and dry.

Warts can grow to an inch or more in circumference and spread into clusters of several warts. As with any other infectious lesion, avoid direct contact with other people as wel l with as other parts your own body. If the wart bleeds, be especially careful not to allow the infected blood to touch any other areas of the body.

Warts can last for varying lengths of time, but the average is about 18 months. Occasionally, they spontaneously disappear after a short time. Just as frequently, they can recur in the same location or elsewhere.

When plantar warts develop on the weight-bearing areas of the feet - the ball of the foot or heel, for example - they can be the source of very sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can also be painful.

TREATMENT Before attempting a remedy, it is sensible to consult a specialist about any suspicious growth on the feet. Your podiatrist may wish to prescribe and supervise your use of a wart-removal preparation. Another option is to remove the wart by a simple surgical procedure.

One common way to remove a wart is to freeze it off with liquid nitrogen, or another process known as cryocautery. Often a second application, some days after the first, is required, and occasionally additional treatments are necessary. Another removal process is electrocautery, which destroys the wart by burning it with an electric needle.

PREVENTION

• Avoid walking barefoot on unclean surface. For example, wear flip-flops in public bathing facilities.
• Keep feet clean and dry and change your shoes daily.
• Avoid direct contact with warts
• Do not ignore skin growths or changes in your skin.