questions and answers

Corns

Q. What is a corn?

A. A corn is a localised pressure point that causes the underlying skin cells to die. As the body replaces the skin cells they gradually get compressed together making a nucleus of tightly compact skin, it is this that is responsible for causing the pain associated with corns. The nucleus usually has an overlying callous.

Q. What is the best way to treat them?

A. The best way is to have them treated professionally by a chiropodist. The overlying callous will be pared down with a scalpel exposing the nucleus beneath. By careful enucleation the nucleus can be successfully removed. As the chiropodist is removing dead skin tissue there is no, or very little discomfort to the patient.

Q. Can they return?

A. If the pressure that caused them in the first place is maintained, once the corns are removed the chances are that they will return. Corns and hard skin are symptoms of an underlying cause, the benefit of visiting a chiropodist is that they will try to establish what the cause is and take steps to correct it.

Q. Where can they appear?

A. Corns appear anywhere pressure may occur. The main areas are: the balls of the feet under the heads of the metatarsal bones; on the top surface of the toes where they rub against the shoes; the end of the toes for the same reason; in between the toes where a bone in one toe will gently rub against a bone in the adjoining toe. They can even occur under toe nails.

Q. Can they cause serious injury?

A. In order to avoid pain when walking people change their gait pattern to take the weight or pressure away from the corn. This action can produce secondary problems such as pain in the lower back, hips, knees, or lower legs. If ignored for a prolonged period corns can cause the underlying tissue to break down and an abscess will form. This will greatly increase the level of pain and discomfort, and increase the need to have it treated.

Verruca

Q. What is a verruca?

A. A verruca is a virus, the human papilloma virus, and the same virus that causes warts on the fingers. There are a few strains of the virus that cause different types of verruca. Verrucas are very vascular and they develop a layer of hard skin tissue over their surface. Sometimes the blood in the small capillaries caught up in the verruca stops flowing and congeals, this give the appearance of a dark coloured spot within the verruca.

Q. How are they transmitted?

A. They are transmitted by direct or indirect contact. All you need is a small micro scratch or breach in the skinís surface and if it comes into contact with the virus it can take hold. Walking around bare-footed in a communal environment such as changing rooms or swimming pools are most associated with picking up the virus. It is also possible in hotel bathrooms, gyms, and even sharing a towel with an infected person.

Q. What treatments are available?

A. There are many treatments available and any good chiropodist will be able to offer many options. In theory the quickest, most convenient method is cryosurgery. This is where verrucas are frozen. I use nitrous oxide for this, as the depth of freeze is less severe than liquid nitrogen. Once frozen the patient can forget about the verruca until the next visit. They can swim without fear of passing it on to anyone else.

For those where cryosurgery is not suited topical treatments containing salicylic acid can be used. There are many varieties available to choose from. I use a machine called a Bio-gun that direct a stream of negatively charged ions at the verruca and as they pass through they help to kill off the virus, this is used in conjunction with a topical treatment.

There are homeopathic remedies available such as Teatree oil, Marigold tincture, and Thuja. All treatments are best administered on the advice of the chiropodist.

Q. Will they disappear without treatment?

A. They can disappear on their own without treatment, although they can last for many years. In the meantime they can get bigger, spread across the foot, and other people can become infected

Q. Can I treat verruca myself?

A. You can buy over the counter treatments such as gels and paints containing salicylic acid that you can apply yourself. The important thing to remember is to remove as much hard skin as you can before applying the topical treatment, by using an emery board. This treatment must be carried out daily for it to be successful. Please remember there is no guarantee that any verruca treatment will work. It depends on the type of the verruca and on the general health of the person who has it.

Fungus

Q. How many fungal infections are there?

A. The two main fungal infections are Athletes foot, and fungal infections of the nail. Each type is broken down into smaller categories but the treatments will be the same. Athleteís foot affects the skin between the toes, sometimes spreading onto the upper surface and the underside of the foot.

Q. How are the caught?

A. The fungal spores are mostly air-born, so any communal area can be source of infection.

Q. What are the best treatments?

A. A chiropodist can give good advice on treatments available. Athleteís foot is easy to treat with many over the counter creams, lotions, or sprays all being successful. However, it is very easy to re-infect yourself by wearing contaminated shoes. Regularly spray the inside of your shoes with an anti-fungal spray to help kill any spores hiding in the toe area.

Toe nails are a different matter as the nail protects the fungus. A visit to the chiropodist is the best course of action to receive professional treatment.

Q. What are the symptoms?

A. With Athletes foot itching is common with the skin breaking down, macerating, so that it can become quite sore and open.

Nail infections cause the nail to appear yellow, becoming hard and brittle. Thickening of the nail is also common.

Q. My nails are thick; does this mean a fungal infection?

A. Thickened nails do not necessarily mean a fungal infection. Although it can make nails grow thicker. Traumas such as dropping a heavy weight onto the nails, or someone treading on them can cause the growth patterns of the nails to change making them grow thicker. Usually these changes in grows patterns are irreversible.

Poor circulation, particularly in the elderly, can cause nails to thicken as well. Skin complaints such as eczema can affect nail growth, but when the eczema is controlled the nail can grow normally again.

Perspiration

Q. My feet are quite sweaty, what can I do?

A. Excessive perspiration can be a problem. The skin between the toes can become broken, blisters may occur more frequently, and they are more prone to pick up fungal infections. Washing them regularly is essential, and wiping them over with surgical spirit is very good in controlling perspiration. It will also help stop blisters occurring. This will need to be done daily. Also it help to let your feet breath, when you can, take your shoes off and wear open sandals.

Q. My feet smell, does it mean they are dirty?

A. Smelly feet do not mean dirty feet. The odour comes from decomposition of keratin, a substance found in the skin, due to excessive perspiration. It gives the skin between the toes and the balls of the feet a worm-eaten pitted effect. Fungal development will worsen the situation. Regular washing, wiping with surgical spirit, using anti-fungal talcum powder, and letting the feet breath are all good methods of bringing the situation under control.

Q. My skin gets so dry it cracks, particularly at the heel, why is this?

A. One of the characteristics of skin is elasticity, it is able to stretch and return to normal. When the skin gets excessively dry or thick it loses its elasticity but it still needs it stretch, particularly when the heel hits the ground during walking, so it just cracks. This can become very painful. There are two things you can do to help. Firstly, regularly use a foot file to remove surface dry, dead skin cells. Do this when the feet are dry and not wet. Having done this then bath or shower, dry thoroughly, and apply a good penetrating cream. I use a cream that contains 25% urea, a substance that helps the skin retain moisture thereby reintroducing elasticity back to the skin. This will need to become part of your normal routine.

Drink lots of water daily and take oil supplements such as cod liver oil capsules to help rejuvenate the skin.

Why are my feet developing bunions?

A. Bunions are usually hereditary and related to posture. There are certain predisposing factors that bring on the development of bunions. Even if you wear flat shoes all the time if you have any of these factors then bunions will gradually appear. High heels and pointed toes will speed up the process. If you are concerned that you may be developing bunions then visit a chiropodist. In my case I will give you a full biomechanical assessment to establish exactly which factors are causing them and prescribed a pair of orthotics. Orthotics are in-soles made specifically for individuals from casts taken of the feet. They help realign the posture and compensate for the factors causing the bunions, dramatically slowing down, or stopping their development further.

Q. Why do diabetics need to take special care of their feet?

A. Diabetes, whether insulin-dependent or non-insulin-dependent, is a disease that has a nasty effect on many parts of the body and in particular the feet. The three main factors that cause concern are; the blood supply to the feet is reduced because of disease in the arteries and smaller blood vessels making them thinner. The sense of feeling is reduced or disappears completely because of peripheral neuropathy. The immune response system is greatly reduced thereby the patient is not able to fight off infection.

It is possible for diabetics to walk around with splinters, thorns, or drawing pins in their feet and not know they are there. Therefore the resulting infection will be very difficult to treat because the body is not able to help itself due to diminished blood supply and immune system. The result very often is a diabetic ulcer, leading to gangrene and amputation. By being careful and having regular trips to the chiropodist and the doctors the condition can be successfully controlled without the need for such severe conclusions

Any diabetic should never in any circumstance walk around barefooted, and they should also visit the chiropodist regularly to have their toe nails cut and have their feet checked over properly.

Nail Surgery: Frequently Asked Questions

Nail surgery is a clinical procedure to remove part or the whole of a problematic, painful nail. The procedure can be made permanent by the use of a chemical (phenol) that will prevent the nail from growing back.

What kind of nail problems is the procedure suitable for?

The most common reason for nail surgery is to treat an in-growing toe nail. This is a painful condition that can sometimes be a one off episode, or a repetitive complication that can affect people of all ages for a very long time unless treated correctly by a registered Podiatrist. There are many other nails conditions that may be suitable for nail surgery such as fungal nails, involuted nails (curved) or thickened nails, these can be discussed at the consultation. All options will be discussed with you in order to decide if surgery is the best option for you.

What happens during the surgery?

Before the procedure is carried out, we will take a detailed medical history and carry out an initial assessment to ensure that you and your foot/feet are suitable for surgery. We will explain the procedure in detail, answer any questions you may have and once you are happy to proceed you will then be asked to sign a consent form. The surgery is carried out under a local anaesthetic, which involves two injections into the base of each toe being treated. Once the toe is numb, we will remove part or all of the affected nail, and apply a chemical called Phenol which will prevent the nail from growing back. The toe is then dressed and padded which stays in place until your follow up.

What happens after the surgery?

We will dress the toe, and ask you to return 2-3 days later so that we can assess the progress and redress the wound/s. The next follow up is arranged in the next couple of weeks or earlier if necessary.  You will be provided with dressings and information about changing your dressings at home. You may need to continue dressing the toe for up to 6 weeks until the wound is completely dry.

Will the nail ever grow back?

If you choose to have the surgery without having the Phenol applied, then the nail will grow back. If you choose to have phenolisation, the nail bed is prevented from growing, and so your nail should never grow back. However, even with Phenol, there is a small chance that you will experience some re-growth, although this is unusual. Please feel free to discuss any concerns with us.

Is the procedure painful?

The only discomfort caused is whilst the local anaesthetic (LA) is injected. This is often described as a sharp stinging sensation. Once the LA has worked, the rest of the procedure is painless. You will feel movement as the procedure is carried out but no pain. We will ensure that the anaesthetic has worked fully before we commence. You may have some discomfort after the LA has worn off, and you will be advised to rest the foot. Generally people have had more pain prior to the procedure and find it a relief once it is done. You may require some mild painkillers for a couple of days after the procedure.

Will you have to remove all of my nail?

Not always, although it is sometimes necessary. Where possible we will justremove a piece of nail from the affected side or a small piece of nail from bothsides of the nail if needed. We will discuss the treatment options with you at your appointment.

Are there any reasons that would prevent me from having the surgery?

There are several factors that are of concern. We would not be able to perform the surgery under any circumstances if you are allergic to the anaesthetic, if you have an infection at the site of injection (not at the nail itself) or if you do not sign the consent form. We would also be concerned about surgery during early stages of pregnancy, and for certain medical conditions. We may also recommend you seek advice or antibiotic treatment from your GP before we perform the procedure. We will be able to discuss any concerns with you, so please feel free to contact us.

Will you be able to perform the surgery at my first appointment?

It may be possible but generally no as the initial consultation would need to be carried out to determine the most suitable option for you. However, we will provide any treatment we can on the day and then we are usually able to book nail surgery within a week.

What Shoes can I wear?

You need to wear an open toed shoe the day after the procedure and until your first follow up. After the redressing appointment it is recommended to wear a comfortable shoe that is not too tight around the toes.

Can I drive afterwards?

You should not drive for the remainder of the day after you have had your nail surgery. This is because immediately after nail surgery your toe(s) will be numb from the local anaesthetic therefore making it dangerous to drive and this may also invalidate your car insurance. For the rest of the day you should rest your toe. The day after your nail surgery you may resume driving.

Do I need to book time off work?

Yes you will need to have the remainder of the day off from work. If you work night shifts, we would recommend you book the shift off work. You will be fine to go to work the next day dependent upon what you do. Footwear is important afterwards so please discuss this with your podiatrist at the assessment.

What if I don’t want surgery or would prefer another option?

An appointment can be offered for a Podiatrist to assess your toenail(s) and try to resolve your problem conservatively (without surgery).

What if I am diabetic?

If your diabetes is controlled by tablets, diet or insulin, you will need a HbA1c blood test within one month prior to your surgery. If your diabetes is insulin controlled we will also require a record of your blood test readings for the two weeks prior to the appointment. Surgery will NOT be carried out if your HbA1c results are not available or if your result is above 8% or 64 mmol/mol.

What if I am currently taking Warfarin?

Before nail surgery can take place we need you to have an up to date INR level taken and therefore please contact us for further instruction

How much will the procedure cost?

This will depend on what treatment that you are having. Nail surgery prices start at £275. Prices include the initial assessment and consultation, the nail surgery and local anaesthetic, a redressing appointment 48 hours later, dressing pack and a further follow up which can be arranged as and when necessary.

If you normally require antibiotics before DENTAL treatment or if you have suffered from mitral valve stenosis, valve replacement or rheumatic fever, please contact your GP before this appointment as he/she may wish for you to have antibiotic cover.

If you have any questions you would like to ask, e-mail me and I will do my best to answer quickly.