Bunions
A bunion is an enlargement of the joint (first metatarsophalangeal joint) at the base and side of the big toe. The big toe moves out of place, bending toward the others. With further deviation of the toe, the bunion can become larger over time. The lesser toes sometimes over or under ride the fist toe.
Bunions can become quite painful, and some redness and swelling can occur near the area. This pain is usually caused by irritation to the area from footwear, but can also be a result of arthritis. Bunions can lead to many other foot problems: The change in pressure can result in corns or callus commonly on the bunion, big toe, second toe and inter digitally. The change in pressure can also make you more susceptible to an ingrown toe nail.
There are many different treatments available for bunions varying with the type and severity of your bunion. Treatment options can range from padding to orthotics and surgery in some cases.
Fungal nails
Onychomycosis refers to a fungal infection that can affect the finger or toe nails. Signs of onychomycosis include: brittleness, discoloration (yellow/white), crumbling, thickening of the nail plate and the build up of debris under the nail. There are several sub types, which present as follows:
Distal lateral subungal
Discoloration of the nail plate varying from white to brown. Hard skin may develop under the nail, or some lifting of the nail plate can be evident. The nail may also appear eroded.
Superficial white
Presents as small white patches on the surface of the nail plate, these patches can progress the affect the entire nail plate.
Proximal subungal
Affects the nail fold at the base of the nail and can extend into deeper layers of the nail.
Endoyx
Milky white discoloration of the nail plate, with no lifting of the nail.
Total dystrophic
The entire nail appears cloudy and/or yellow brown, and thickened.
Candidal
This type can present as swelling of the nail fold or separation of the nail plate from the base.
A scraping or clipping of the nail can be taken to confirm diagnosis. Onychomycosis can be treated with topical applications or oral medication (prescription from your GP only, after positive clipping). Your Podiatrist can give you advice on an appropriate treatment. Differential diagnosis: Nail trauma, resulting in thickened or deformed nails.
Heel Pain
Heel pain can have a number of causes, but is most commonly related to inflammation of the plantar fascia. The plantar fascia is a thick band of tissue that runs from your heel bone (calcaneus) to the ball of the foot. When this tissue becomes over stretched it can become inflamed and sore. Typical symptoms include pain (in the heel, and/or arch) on the first few steps of the day, or after periods of rest.
Another cause or irritant of heel pain, are heel spurs. Heel spurs can be detected on x-ray of the foot as a spike or boney overgrowth to the base of the heel bone. It is important to be aware that not all heel spurs are symptomatic.
It is important to have the cause of your pain examined. Examination will involve testing of the joints and muscles to the foot and lower limb, along with analysis of your posture and walking pattern, all these things can show cause to the pain.
Treatment of heel pain can involve interventions to improve the way you walk. These interventions will enable your foot to function in a more ‘ideal’ position, and relieve irritation to the problematic area. Interventions can include, footwear advice, and shoe inserts such as orthoses. An initial regime of rest and icing may also be included in your treatment, along with stretching of particular muscle groups if they are contributing to the problem.
Other causes of heel pain can include:
- Trauma
- Stress fracture
- Nerve entrapment
- Arthritic conditions
Tinea (athletes foot)
Tinea also referred to as athletes foot is a common fungal infection of the foot. Tinea affects the superficial layers of the skin. Tinea pedis usually presents as itching of the skin to the plantar surface of the foot and/or in between the toes. As the infection progresses the central area may be inflamed and tender to touch, while the surrounds take on a milky white discolouration. Sometimes a clear discharge will be noted, and the skin will start to peel to the affected area.
Tinea flourishes in dark moist environments, making it important to ensure you dry your feet, paying special attention to your toes. It is also a good idea to air out your shoes, especially if you feet are prone to sweating.
Treatment for tinea is readily available from your local chemist. It is important to treat tinea, as it can lead to a secondary bacterial infection such as cellulitis. Treatment comes in several forms, such as sprays, gel/crème, powders and so on. It is important to use the treatment most appropriate to where your tinea is affecting, for example a crème preparation between the toes may keep the areas too moist so a spray may be more appropriate.
Other things to consider during treating tinea, is regular cleaning of footwear, socks etc, in wash anti fungal preparations area available. When tinea becomes chronic and topical treatments are unsuccessful other options are available, such as socks that have silver impregnated in them which provide and anti-bacterial and anti-fungal properties.
Plantar warts
Plantar warts are caused by the human papilloma virus (HPV) and present as a skin lesion that resembles a callus on the bottom surface of the foot. Usually plantar warts are under 1cm in diameter. They appear as a brown/yellow lesion that may have dark pinpoints (the blood supply to the wart). Plantar warts can also appear in clusters- known as mosaic warts.
A plantar wart may feel like a lump under the foot, and is usually only painful with direct weight to the area or when pressure is applied from either side. If left untreated plantar warts can increase in size, and spread to form clusters on other areas of your feet. There are a number of different treatment options available to remove warts, and it is best to discuss these with your Podiatrist.
Differential diagnoses:
- Corn
- Callus