Calluses on the bottom of the foot are about as common as any condition we see on the foot. Years ago, we used to judge a man’s working ability or performance by the condition of his hands. It was quite simple, a good hard worker had callused hands and as for his feet, they just weren’t part of the job interview. Calluses, like corns, are thickened layers of skin, which are nature’s response to excessive friction and pressure. Initially, a hot spot or blister may be present but if the pressure continues, a callus will often form. These lesions will usually form beneath weight bearing, bony segments of the foot. Characteristically this includes the metatarsal heads or ball of the foot, the heel, and the under surface of certain toes. Contrary to frequent belief, calluses do not grow and spread by any living intention. However, they are capable of involving adjacent skin areas as a result of continued friction and pressure characteristic of certain areas of the foot.
Not all calluses cause discomfort. A callus may be small, medium, or large in area but thin and diffuse in thickness. These are normally non-painful and can be effectively dealt with by paddings, insoles, and certain types of abrasive treatment procedures. On the other hand, calluses may become deep and punctuate with circular type cores in their center. These are the ones that can indeed cause grief and most often will lead to a visit at the local foot doctor’s office. This painful type of callus may be due to an underlying problem in bone structure, a particular type of skin condition, or perhaps a response to a foreign body. Various treatment methods are available by the foot specialist that are geared towards re-establishing proper balance and weight distribution. As with many problems of the foot one could try to accommodate these lesions with padding, try to control foot strike and function by an arch supportive device or correct the orthopedic condition that exists. These problems should be seen as early as possible so as to minimize the necessary treatment involved.
It seems obvious that with most any existing ailment of the body, one of three things can happen. The condition can improve and go away, it can stay the same or it can become worse. Corns are an orthopedic condition and either one has to accommodate the deformity to try to make it go away or correct the deformity. First of all, it is essential to check and modify if necessary, one's shoes so as to minimize excessive pressure at the area involved. Quite often, wearing a better-fitted shoe is enough to remedy the problem. Secondly, one should stay away from store bought medicinal pads and sharp cutting instruments as possible remedies. Self-abuse through the improper use of these items can often result in more serious damage to the skin. A third and most important suggestion for the person with a painful corn is that he seeks professional care.
Appropriate care for this problem is often necessary in order to correct or at least, prevent further progressive changes. Treating one's own foot problem is not necessarily detrimental when performed carefully and under the right conditions. The diabetic, the older aged individual, or the person with obvious circulatory problems are certainly in need of professional care and should not attempt self-treatment procedures. There are some surgical approaches to the treatment of corns to attempt to permanently correct the condition. Everyone can live with a non painful corn, but when the pain interrupts one's daily walking, it often requires professional management.
It is essential to thoroughly evaluate and periodically manage the diabetic patient. We know that diabetics can specifically have impaired circulation, reduced sensation, and a greater tendency to develop infections, ulcerations and other skin problems. Early detection, periodic monitoring, and judicious care are essential in the prevention and management of diabetic complications. The lower legs and feet are primary locations for these problems to occur. Professional care and supervision can be highly effective in minimizing the complication tendencies of patients with diabetes.
Periodic care for these patients can range from a simple examination of one's feet to more involved treatments of such problems as diabetic arthropathy (diabetic arthritis), peripheral neuropathy (loss of feeling), vascular complications, and ulcerations. The podiatrist will examine the feet to make sure that there is adequate blood supply and sensation (feeling) to the feet. A decrease or loss in one or both can lead to infection and potentially more serious problems. In many cases, the podiatrist will involve by referral, other medical specialists to participate in the total team approach to managing the existing diabetic problems.
Many diabetics are seen by their foot specialists on a periodic basis for general foot care. It is important to keep the nails properly trimmed so that they do not become ingrown and cause infection. This is important as many diabetics can not fight infections as well as people without the disease. Also, the skin of diabetic patients is thinner and more susceptible to injury than that of non-diabetic persons. It is important to reduce the calluses to relieve pressure over the bony prominences of the feet. If there is too much callus build-up, the skin may break down and lead to an ulceration. An ulceration can become infected and possibly lead to more serious consequences requiring more involved care.
The topic of foot odor is obviously a personal and sensitive subject. Rarely is it the primary discussion at an evening party and when brought up between close friends, only occasionally does it receive more than a bashful grin. But in all seriousness, offensive foot odors can be a real problem. For many so afflicted, it is common to ignore the condition or accept is as one would hair loss or freckles. However, it should be emphasized that this condition is very treatable. Professional care is available to treat the cause and effects of foot odor. In the majority of cases, a successful resolution of the problem is readily attainable.
Foot odor in general, is usually a manifestation of excessive perspiration. For many, the hands and feet are frequent sites of pooling with resultant wet areas and occasional skin discoloration. Thus, our first line of attack in treating this problem is to effectively reduce or minimize excessive perspiration. An attempt is made to limit the use of nylon stockings and socks which traditionally promote perspiration. Shoes should be changed rather frequently and the use of breathable leathers as opposed to the more occlusive synthetic shoe materials is encouraged. Topical applications, soaks, and occasional oral medications are given for the purpose of reducing the output of perspiration.
Perhaps the most important factor involved in this condition is the chemical make-up of perspiration itself, for it is this factor indeed, which causes odor. The old saying, "You are what you eat," certainly applies in this case. Dietary intake modifications are essential in order to affect the end result. Obviously, garlic, onions and other higher spiced foods must be greatly reduced until the condition is well under control. It is important to keep in mind that an offensive foot odor is a treatable condition, and once the causative factor is identified, one that can usually be remedied.
The treatment methods available for fungus nails are about as numerous as are the varieties of nails themselves. Oral medications are available but their use is expensive, long term and not without potential hazardous changes to the blood. Before starting oral medications for fungused nails one should have a nail culture to make sure it is fungus we are trying to treat. Laboratory tests to determine liver profiles should be taken prior to starting the medication and again at 6 weeks. Localized reduction and periodic care of the nails are purely temporary and resemble the use of Kleenex in treating the common cold. Although beneficial on a limited scale, this form of treatment is geared toward preventing the condition from worsening. Various types of topical medications are available both over the counter and by prescription, which can be effective. Many patients prefer the use of a topical medication over an oral or systemic drug.
An additional method of treatment that is frequently used is to surgically remove the involved nail plate and treat the underlying fungus infection on the nail bed area. Once the hardened plate is removed, the open exposure allows more effective penetration by topical products and medications. Other methods of treatment, less frequently used, are also available. In short, numerous treatment methods are available for the approach to fungus nails. A primary evaluation and decision must be made as to how serious the problem is to the patient. Whether to treat aggressively or periodically observe the condition are viable considerations for the patient. Fungus nails are frequently perplexing and persistent conditions both from a diagnostic and then a therapeutic standpoint. Perhaps, in the near future, more effective medication will become available which will facilitate the management of this problem.
Acute Gout Attack
Acute gout attacks are usually treated with a combination of therapies. Oral medications such as anti-inflammatories, analgesics and colchicine are most commonly used to treat this disorder. Often times, local injections into the affected joint will help relieve symptoms. Various other treatments include warm compresses, elevation of the involved area, physical therapy, and the use of pain relievers such as narcotics. The goal of treatment in acute gout attacks is to end the "flare up" and convert the patient's condition to the chronic state. Going on a low purine diet can help prevent reoccurring attacks.
Certain oral medications are available on a long-term basis to help prevent recurrent attacks and possible systemic damage. One should consult his or her family physician or internist for information on these medications.
Adequate prevention of ingrown nails can be accomplished in most cases by proper trimming and judicious self-care. The nail plate should be carefully trimmed so as to follow the fleshy curve at the end of the toe. Under no circumstance, should a sharp instrument be used or inserted to cut diagonally back into the corners of the nail. Leaving a jagged nail edge, a loose piece, or inadvertently cutting the skin can predictably lead to problems. In those cases where injury has occurred with a subsequent ingrown nail, professional assistance by a foot specialist is suggested. The doctor is well trained and equipped to treat such a problem and with little to no discomfort to the patient.
Ingrown nails may seem simple enough but in actuality have sidelined many a person from his or her daily activities. These annoying and painful nail conditions are frequently encountered in various athletic activities. Soccer, jogging, racquet sports, football, basketball, and baseball all involve running and often lead to digital problems such as ingrown nails. Antibiotic medication, disinfectant soaks, and inactivity are not the total solution. It is essential to reduce and/or remove the offending spicule or nail edge that is causing the problem. Sometimes this can be done to give temporary relief or attempt to permanently correct the condition.
Laser Treatment for Toenail Fungus
The laser is a treatment for nail fungus and is a safe in-office procedure which can restore the normal appearance of your nails. The laser is non-invasive with little to no pain during treatment. The patient can resume normal activity immediately after treatment.
Fungal nail infections are very common in adults and account for nearly half of all nail disorders. Technically known as onychomycosis, fungal nail infections can affect both your fingernails and toenails, but are most frequently seen in the toes. While the infection is a slow-growing one, a nail fungus can eventually cause the overlying nail to discolor, thicken, change texture, become increasingly brittle, break and even detach from the nail bed.
Left untreated an increasingly disfigured toenail can cause discomfort and irritation, especially while wearing shoes or walking. Not only that, fungal nail infections can spread to the other nails. If a diseased toenail breaks, it can also pierce the skin thereby allowing bacteria to enter, which can lead to a more serious type of infection. This is especially dangerous for individuals who have diabetes or a compromised immune system.
For all of these reasons, it is a good idea to give our office a call at the first sign of any discoloration, thickening or deformity of your toenails. Although a fungal nail infection can often be identified by its appearance, other conditions can produce a similar look, and an accurate diagnosis is essential for proper care. One thing is for certain; you can rest assured that our office will consider every aspect of your case in determining the best approach to care. Furthermore, we offer the most effective methods of care including the latest generations of topically applied medications, oral antifungal drugs, laser and surgical procedures.
Imagine if you will, standing barefoot in moist sand with the arch being filled by the smooth sandy undersurface. The heel and ball of the foot leaves a mild depression in the sand while the toes grip the ground without resistance. If one could stand like this for lengthy periods of time, he or she would probably not have sore feet, would experience less fatigue and probably would not have many of those commonly encountered forefoot skin problems such as corns, calluses and ingrown nails. The problems come from standing on cement, asphalt or other non-yielding surfaces. Other causes for foot problems include wearing confining shoes, which further limit foot flexibility, and from lengthy periods of ambulation, which add fatigue and strain to one's body.
Orthotics assist in restoring supportive comfort by bringing the ground surface up to the foot. They serve to improve postural stability, distribute one's weight more evenly and improve the mechanical functioning of the foot and ankle. Although orthotics do not cure every ache and pain in the foot, they are a wonderful approach in providing maximum comfort through improved biomechanics. Standing comfortably in sand is not necessarily an unreachable feeling even while wearing your everyday shoes.
Warts are one of the most misunderstood foot conditions. Usually, these lesions are non-contagious but can spread within the involved area of the same individual. In actuality, warts are encapsulated or walled off growths of viral tissue. Plantar warts on the feet are frequently painful with squeezing type pressure. In the vast majority of cases, the growth of a wart is preceded by some sort of skin puncture, wound defect or breakdown in the normal skins defense barrier that in all probability, allows an entry site for contamination. A lot of patients report getting warts after showering in a public place or at the swimming pool. Keeping the foot moist is one of the ways that the skin breaks down making us susceptible to warts. Once the wart makes a home in our skin it can spread to other parts of our foot. Whether we all have inactive or potential wart viruses circulating in our bodies or gain the virus through the wound is as of yet unclear.
An interesting and often confusing distinction must be made between certain calluses and plantar warts. Skin lines or striations can be seen passing through callus tissue whereas they will pass around a wart. Painful calluses in the ball of the foot are the commonly misdiagnose as warts. In addition, plantar warts, upon close examination, will often demonstrate small black dots which when trimmed will bleed. These are tiny blood vessels, which become caught in the growth itself and are absent in regular callus tissue. A final line of distinction in identifying a wart is in its response to pressure. Squeezing a wart will usually produce extreme pain as opposed to similar pain from direct pressure on calluses.
It is at this point that we frequently find an area of public confusion regarding the treatment of toe fractures. Many of our patients and those not seeking medical care believe that toe fractures will heal by themselves and do not really need supervised medical attention. They tell us that there is nothing to do about a broken toe except tape it to the next toe. We disagree and would like to point out several facts on this issue.
- Fractures of the toe should be seen professionally in order to evaluate the extent of the injury. In other words, not all fractures are the same and some will heal much faster then others while certain ones may not heal at all. A proper evaluation and management are necessary to insure the best possible result.
- Certain fractures may involve deviations or crooked positioning of the involved toe after the injury. These need to be set in proper alignment. Little toes that are angled outward can develop severe and painful corns. These should be treated early on by a specialist in order to prevent future disability and possible problems.
- Proper treatment of a fractured toe should involve some level of immobilization splinting and support. Ignoring the injury and enduring the pain do not create an optimal environment for fracture healing.
In closing, these injuries occur with sudden onset, extreme pain, and obvious shoe wear difficulties. Proper evaluation, management, and periodic monitoring are recommended procedures for this problem.
There are many types of ulcers including those caused by loss of sensation of the skin, decreased blood flow, pressure to a specific area of the foot and ulcers due to problems with the valves in the veins.
The diabetic ulceration is caused by an unhealthy condition of the nerves. Because the nerves are debilitated, they do not function properly and result in a loss of sensation. A diabetic patient may step on a needle or other object in the shoe and not even be aware of the problem due to reduced sensation. The skin will eventually break down and result in an ulceration.
Ischemic ulcerations are ulcers that are caused by decreased blood flow and poor blood supply to the feet due to calcified arteries or blockages of the blood vessels. These are the most painful of all the ulcers. Because the skin is not getting the nourishment it needs to survive from the arteries, it begins to die. This often leads to an ulceration.
A pressure ulceration is caused when a portion of the foot is left in contact with an area such as a bed mattress for an excessive period of time. This type of ulceration is commonly seen in patients that are bedridden and unable to move on their own. The pressure to the area cuts off the blood supply, which can cause tissue death leading to an ulceration.
A venous stasis ulceration occurs due to an incompetent or faulty valve between the superficial and deep veins in the legs. This results in fluid being backed up into the superficial veins. Eventually there is too much fluid in the leg. The fluid has nowhere to go and so it begins to weep onto the skin. Eventually an ulceration will occur.