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INGROWING TOENAILS
An Ingrowing toenail is one that pierces the
flesh of the toe. It can feel as if you have a
splinter, and can be extremely painful. In more
severe cases, it can cause pus and bleeding.
Ingrowing toenails most commonly affect the big toenail,
but can affect the other toes too.
A nail that is curling (involuted or convoluted) into the flesh,
but isn’t actually piercing the skin isn't an ingrowing toenail, but
can feel very painful and also appear red and inflamed as well.
This condition is something I specialise in and i have treated many
hundreds of patients successfully over the last 23 years.
Treatment
Treatment depends on the severity of your condition. For the most basic
irritable ingrowing toenail, I will carefully remove the offending spike of nail
and cover with an antiseptic dressing. For a more painful condition or if is a
recurring problem I will always recommend nail surgery
Nail surgery is carried out using local anaesthetic. The whole procedure takes less than an hour and the surgery is then followed by two or more visits to monitor its progress. The patient is able to return to work immediately, and there is usually only minimal discomfort post operatively.
In most cases this will cure the problem and stop the nail in the painful area growing back.
Results are generally very cosmetically pleasing and the procedure should not be confused with more radical, painful operations which are often carried out at hospitals.
THICK TOENAILS
Nails can become thickened usually as a result of damage, and/or gross neglect, and may be complicated by the presence of a fungal infection, which will also make the nail “crumbly”. When the nail is thick it can become very uncomfortable and will often press on your shoe or dig into other toes. It may be seen on single or multiple toes, often depending on the cause.
How to treat thickened nails
Thick nails are often very difficult and sometimes painful to cut. Some patients have even resorted to wire cutters to try and trim them. The best and easiest way to manage these nails is to try and get them cut to a comfortable length and thinned down. Self help with regular filing can help to keep them comfortable.
At my clinic such nails are cut and thinned down totally painlessly, and advice given if there is a suspected fungal or other type of infection .
FUNGAL NAIL
Also known as onychomycosis is when fungal spores enter the nail and pass through the nails layers. This condition can start with a small area of discolouration (white, brown or yellow) to one nail and can continue till the whole nail or nails become thickened, discoloured and crumbly.
Generally the nail is not usually painful unless it becomes very thick and thus leads to excessive pressure from your shoes. Some nails will also have a musty smell to them especially when they are cut or filed.
Treatment
When you first notice a small area of fungus on the nail the most effective treatment would be an antifungal paint, which can be purchased over the counter or on prescription from your doctor. If more nails have become infected or the condition has caused the nails to become thickened and uncomfortable an antifungal tablet may be a better course of treatment and your GP will be able to prescribe this for you if he feels it is appropriate.
Often your doctor will take a small clipping of your infected nail to be analysed to provide a positive diagnosis of fungus.
Having the nail thinned down will help make any treatments more effective and keep the toes more comfortable
ATHLETE’S FOOT / TINEA PEDIS
Tinea is a common fungal skin infection, affecting various parts of the body. On the foot, tinea initially begins in the web spaces and becomes white and soggy in appearance. Odour may develop and the skin thickens and peels. If left untreated it can spread to the nails.
Treatment:
- Dry carefully between toes and use antifungal powder after drying
- Use methylated spirits or surgical spirit in mild cases
- Change shoes and socks daily, nylon stocking may aggravate the problem
- Use flip flops when showering in public places, and don’t share towels, socks and shoes
- Topical medication or tablets in very severe cases.
- On attending my practice have your footwear' Klenzed' to remove all fungi which maybe still living in the shoe leather or insole.
- Seek professional help if no improvement after a few days
CALLUS
Callus is caused by excessive production of keratin (hyperkeratosis)
Most calluses are symptoms of an underlying problem like a bony deformity, a particular style of walking, or inappropriate footwear. Some people have a natural tendency to form callus because of their skin type. Elderly people have less fatty tissue in their skin and this can lead to callus forming on the ball of the foot.
Treatment:
- Remove the cause of pressure or friction if possible
- Use mild abrasives such as an exfoliating sponge or pumice stone
- Use a moisturising cream daily such as CCS foot care cream
- Protective padding to deflect pressures
- Painless removal of the callus by a chiropodist/podiatrist- instant relief!
CHILBLAINS
These are red, blotchy blue patches, which are extremely itchy. They occur on exposed areas of the body especially the hand and feet as a result of extreme exposure to heat and cold. These areas can become badly infected.
Treatment:
- Prevention is better than a cure
- Always wear warm clothing in cold weather
- Keep feet and hands warm by wearing thick gloves and socks
- Avoid sitting to close to open heat
- Cooling lotions and at the early stages
- Contrast foot bathes (if skin is not broken)
- If chilblains broken, keep dry and cover with sterile dressing.
CORNS / HELOMATA
When we walk or stand, our body weight is carried first on the heel and then on the ball of the foot, where the skin is thicker, to withstand the pressure. When this pressure becomes intense, growths, in the form of corns and callus, may appear. Corns always occur over a bony prominence, such as a joint.
Hard corns are painful conical areas of hardened skin, caused by pressure. They are usually found over prominent joints, such as clawed toes or under the ball of the foot.
Soft corns occur between the toes, because the small joints rub up against each other. They are usually whitish and rubbery in appearance.
Seed corns are usually multiple small lesions and are usually associated with pressure and dry skin
Treatment:
- The demarcated core/nucleus will need to be removed by a podiatrist. This can be done with very little, if any discomfort.
- Prevent or remove the pressure against the toes and feet
- Never use “corn cures” or pads. They contain acids which can’t differentiate between normal skin and extra keratin. This may lead to an ulcer developing in the area.
WARTS / VERRUCA
Warts are a contagious viral skin infection caused by the human papilloma virus. They are most commonly caught by direct contact or walking bare-foot in wet areas, such as public showers and swimming pools. Warts may appear singly or in clusters.They may or may not have black spots in them.
Plantar verrucas occur on the sole of the foot and usually have overlying callus.These warts are usually very tender and often feel as though you’re walking on a pebble.
Mosaic warts are clustered superficial warts that tend to look dry and have rough irregular surfaces. They form a mosaic pattern and usually cover a larger area than plantar warts.
Podiatrists in general would prefer to see and start treating verrucae in adults as soon as possible. There is a much better chance of a quick resolution. Once verrucae have spread, or have got very large in size, they can be very time consuming to treat.
Even the most experienced podiatrist cannot tell by looking at a verruca how long it will take to get rid of. Not only do the warts vary in themselves but also every person reacts differently to treatment.
Treatment:
- Small lesions can be treated with Pharmacy cures which are applied daily after rubbing the area gently with a pumice stone
- I treat warts with Salicylic and/or Monochloroacetic acid. These preparations will be considerably stronger than can be obtained over the counter- and consequently much more effective. Usually once weekly dressings over 4- 6 weeks is enough to resolve the problem.
- Cryotherapy involves freezing with Nitrous Oxide . At my practice I use the latest technology using a Cryopen. This ensures accurate, effective treatments with minimal discomfort and fewer treatments.
- Warts are easily confused with corns, so it is important to seek professional advice before embarking on any treatments.
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