Ingrown toenails

An ingrown toenail (onychocryptosis) occurs when part of the nail pierces the soft tissue at the side of the nail. As the nail grows the spicule becomes embedded further in the flesh of the nail fold.

An ingrown toenail

Causes

·      Poor nail cutting technique may leave a sharp spike or corner of the nail. Trimming too far down the sides is a common cause of an ingrown toe nail.

·      Nail shape- some people are predisposed to getting recurrent ingrowing toenails due to the shape of their nail. a nail that is more curved from side to side rather than being flat is more likely to become an ingrown nail.

·      Footwear that is tighter is more likely to increase pressure between the skin in the nail fold and nail, increasing the risk on an ingrown nail.

·      Trauma to the nail may alter the shape of the nail, making it more prone to becoming ingrown

·      A fleshy toe is more likely to have a nail grow into it. Those whose feet swell are a lot are more prone to having this happen

Signs and Symptoms

Acute inflammation of the surrounding soft tissues occurs, the skin becomes red, shiny and the toe becomes swollen. There is a throbbing pain and the toe is very sensitive to pressure. If the nail continues to in grow, excessive granulation tissue (proud flesh) may form on the side of the nail. The wound can easily become infected where it increases in redness, heat, swelling, and tenderness and develops pus.

Treatment

Self Treatment

At home you should bathe the wound in salt water after showering and dress daily with Betadine and a band aid until you are able to seek help from your podiatrist. If an infection sets in antibiotic treatment must be sought from your GP.

Conservative Treatment

If the toenail is only mildly ingrown in the early stages the nail may be cleared painlessly by trimming it with nail nippers.

Nail Surgery (Source: American Academy of Family Physicians)

Surgical Treatment

If conservative treatment is not possible then nail surgery will be needed to remove the nail spicule. Initially a partial nail avulsion will remove a section of the entire offending border to the matrix under local anaesthetic. This can be done here in the clinic.

If the nail recurrently becomes ingrown then a partial nail avulsion with matrix phenolisation may be performed. In this procedure, part of the nail is removed and the root killed with a caustic substance (phenol) so it cannot regrow in the problem area. The likelihood of the ingrown nail returning is very low after this procedure.

Please note that this information is not to be used as a substitute for the advice of a health professional

Achilles Tendonitis

Achilles tendonitis is an inflammation of the large tendon in the back of the lower leg known as the “Achilles Tendon”. This tendon attaches your two calf muscles (the gastrocnemius and soleus) to the heel bone. Pain and tenderness may be present over part or all of the Achilles tendon, and is aggravated by activities applying force to the tendon, such as running and jumping. Achilles tendonitis is commonly associated with overuse, resulting in inflammatory and/or degenerative changes to the tendon. In some cases the pulling of the Achilles tendon may result in spurring or calcification of the tendon at the site of insertion at the back of the heel.

Who Gets It

Achilles tendonitis can occur at any age and is common in athletic individuals whose sport involves running and jumping. However, as we get older, the water content of the tendon diminishes, which causes the tendon to lose some of its resilience, making the middle aged to elderly population more prone to the condition. Poor circulation to the Achilles tendon contributes to the tendonitis being a chronic condition. In some cases a rupture may occur.

How Does It Develop?

Tendonitis develops when the tendon and/or sheath are exposed to excessive forces that cause it to be damaged. Achilles tendonitis may develop acutely after a sudden injury, or more commonly, chronically, over a period of exposure to low-grade stress. As the tendon is damaged due to abnormal forces, an inflammatory reaction begins causing pain and swelling. The cycle of damage and inflammation continues over a period of time. During this time the tendon sheath begins to thicken and the tendon degenerates and develops scar tissue. The tendon becomes weak and vulnerable to further injury at this time.

Symptoms

·      Pain may be immediate or may begin gradually and worsen with activity

·      Pain on palpation at the back of the leg, anywhere from mid calf to the bottom of the heel

·      Pain on stretching the calf muscles

·      Limping to avoid weight bearing

·      Swelling may be localised or diffuse

·      Hard “nodules” or “thickening” may be felt along the tendon

·      Stiffness in the calf and tendon, worse in the morning and after rest

·      Crepitus or creaking with movement along the tendon

Causes

·      Physiological changes to the tendon tissue with age

·      Overuse

·      Poor or inappropriate training surfaces and regime

·      Poor biomechanics of the lower limb and foot. These include: flat feet, tight calf muscles, leg length discrepancies, and high arched feet causing bowing or overload of the tendon.

·      Inappropriate footwear: too tight across the back of the foot or not enough support

·      Sudden change in exercise or rapid increase in intensity

·      Direct trauma to the Achilles tendon

·      Other causes include: arthritic conditions, nutritional, hormonal or metabolic abnormalities, which may affect the health of the tendon

Treatment

Treatment varies depending on the stage of the injury and the causative factor. The stage depends on whether it is a new “acute” injury, if inflammation is present, or if the tendon is already beginning to heal.

Aims: In the early stages they are to reduce pain and inflammation, avoid re-injury while its strength is low and try to maintain strength and flexibility of surrounding tissue (such as calf muscles).

These aims can be achieved by:

·      Rest

·      Physical Therapies: ice, heat, massage, electrotherapy (e.g. ultrasound)

·      Anti-inflammatory medication

·      Gentle calf stretches

·      Change of footwear

·      Heel Raise: short term

·      Exercise program modification

Recovery

The speed and success of treatment will depend on how quickly the Achilles Tendonitis is diagnosed and how quickly treatment is commenced. If the tendonitis is recognised immediately before any significant damage is done to the tendon, one can expect to recover within 2-4 weeks providing adequate rest is maintained in this period. Those who have suffered tendonitis for any length of time before commencing rest and receiving any treatment will usually take much longer to recover. This time will vary from patient to patient but will generally be at least as long as the time the tendonitis has been active. This time allows for healing of damaged tissue, resolution of scar tissue and rebuilding of strength. In severe cases complete recovery may take up to 2 years.

Prevention

·      Address any biomechanical abnormalities

·      Warm up before and after exercise

·      Address the cause: footwear, training regime or surface

  

Please note that this information is not to be used as a substitute for the advice of a health professional

Warts

Warts (Plantar Warts, Verruca, Verrucae Pedis)

Plantar Warts (circled with a pen)

What are Warts?

Warts (also known as Plantar Warts, Verrucas, or Verrucae Pedis) are caused by a viral infection. They can occur anywhere on the body, but are most frequently found on the hands and feet. If they occur on the bottom of the foot—“Plantar” refers to the sole of the foot—they can be very painful.

Warts are caused by a type of virus called the Human Papilloma Virus (HPV), which invades the skin through small cuts and abrasions. Other predisposing factors include the use of communal bathing facilities, sport centres, swimming pools and gymnasiums. Once the skin is infected with the virus it may remain latent within the skin, or develop into a wart, and become clinically observable. Plantar warts may present in either single, multiple or mosaic type pattern.

Who Gets Them?

Warts can affect any age group, but most commonly affect children and young adults.

Signs and Symptoms

Common features of warts include:

·      Loss of normal skin pattern (the lines which you can see in finger prints)

·      Presence of many minute dark spots, which are the tips of small blood vessels

·      Overlying thickened skin (callous)

·      Warts tend to be flat and hard with a rough surface and well-defined borders

·      Pain with lateral compression (squeezing from side to side) rather than direct compression, and sometimes pain on weight bearing

Treatment

There is no single treatment for warts because no treatment type has been shown to be successful in every case. In many cases warts may resolve spontaneously in sometime between a few weeks, and a few years, but this is unpredictable. Treatment is indicated if there is concern with the possible spread of the virus, the wart is growing quickly, or pain is present. The following treatment options may be considered:

·      Chemicals which break down skin tissue (Keratolytic agents);

·      Cryotherapy or freezing of the wart;

·      Caustic agents to chemically “burn” the wart;

·      Curettage or surgical removal of the lesion under local anaesthetic.

Generally, all methods have some possibility of the wart coming back.

Preventative Measures

·      Foot hygiene: avoid walking barefoot, changing socks daily, keep feet dry and clean

·      Avoid direct contact with warts from other people

·      Take note of any unusual growths or changes on your skin, and get them checked by your doctor or podiatrist

  

Please note that this information is not to be used as a substitute for the advice of a health professional