Foot HealthSue Davies MAFHP MCFHPFoot Health ProfessionalFeet First
Contents Introduction- My background- What a Foot Health Professional does Common foot conditions- Athletes foot- Ingrown toenails- Fungal nails- Bunions- Verrucae- Corns and callus Potential warning signs Questions
IntroductionI qualified with the SMAE Institute, Bath Road, Maidenhead in July 2006, whichprovides specialist training in the Foot Health Profession. Established since1919, the institute is one of the oldest open colleges of Foot Health Professionalsin the United Kingdom, treating over 14,000 patients per year.Since qualifying, I have been treating patients with a wide range of foot conditions inand around the Maidenhead area and I am an experienced Foot HealthProfessional capable of providing a complete service to help you look after yourfeet, providing expert advice, care and attention. Prior to this, I worked in theBanking sector for 15 years and decided to have a career change after having mytwo children.The letters MCFHP indicate that the Practitioner concerned is a Member of the OpenCollege of Foot Health Professionals having undertaken extensive training. Theletters MAFHP denote that the practitioner is a member of The Association of FootHealth Practitioners. I am bound by the code of ethics, rules of theAssociation, have professional Insurance and undertake to act professionally at alltimes.
What does a foot health professional do?Your initial consultation will last 45 minutes which includestaking a full medical history, foot health check, adviceand treatment. Your feet are thoroughly examined forany existing conditions and treated accordingly. Nails aretrimmed and filed and a moisturising cream is appliedwith a relaxing mini foot massage to finish. You needregular foot checks because your feet have to work hardand last you a lifetime. Failure to look after your feet cancause serious ailments and back problems.
How can a Foot Health Professional helpyou?You probably never think about it, but your feet are a masterpiece of engineering!When they are in good condition, they work in total harmony with the rest of yourbody, but if you neglect them, your feet may start to feel uncomfortable orpainful, and problem feet can create other health problems too.In an average lifetime we walk up to 100,000 miles. The foot has a lot of demandsmade on it and in a normal day can easily walk fifteen miles. In return we rarelygive them the attention they deserve, hiding them away in shoes and forgettingabout them, until they begin to hurt. They are a complex network of bloodvessels, nerves, muscles and bones. There are a number of ways that we can carefor our feet at home – and it’s never too late to start!A Foot Health Professional will advise you how to best care for your feet, and offer youassistance on what products can be used at home or when you need to be referredon to a chiropodist/podiatrist.
What conditions do Foot HealthProfessional treats?• Corns and Callus• Fungal Nail Infections• Verrucae and warts• Dry cracked heels• Bunions• Ingrowing toe nails• Diabetic foot care• Bunions• Athletes foot• Thickened nails• Hammer toes• Plantar fasciitis• Nail cutting and filing• Hard skin• Pressure points• Cracks/fissures• Any nail changes• Routine foot and nail care•Healthy feet•Less pain•Increased mobility•Reduces otherhealth problemsBenefits Include:Foot conditions:
Athletes Foot• What is athletes foot?• Athletes foot is a rash on the skin of the foot. It is themost common fungal skin infection. There are threemain types of athletes foot. Each type affects differentparts of the foot and may look different• Tinea pedis, is a common infection of the skin of thefoot caused by a fungus. The various kinds of fungi thatcause athletes foot belong to a group calleddermatophytes.• These fungi thrive in closed, warm, moist environmentsand feed on keratin, a protein found in hair, nails, andthe epidermis, or the upper layer of the skin.
Symptoms of Athletes Foot• The affected area may be peeling and have smallblisters.• It may also appear red, dry and itchy.• If left untreated, there may be deep cracks in theskin which can lead to a secondary bacterialinfection.• It may contain sticky clear fluid.• The patient may experience severe pain from thecondition. Patients often report a burning orstinging sensation and find the lesion very itchy.
Causes of Athletes Foot• Many people have the fungus present on their skin but areunaffected by the microscopic organism. Conditions such asbruising or cracks in the skin allow entry for the fungus.• Fungi thrive on moist, warm environments this is why thecondition usually occurs in between toes due to anaccumulation of moisture.• It may also spread between individuals. A common port ofentry is found within bathrooms, showers, swimming poolsand changing rooms.• Not changing your socks on a regular basis can alsoencourage the build up of fungi in between the toes.• People with excessively sweaty feet are more prone to thiscondition
What it may look like:On the top of the foot, tinea pedis appears as one ormore red, scaly patches. The border of the affectedskin may be raised and may contain bumps, blisters,or scabs. Often, the central portion of the patch isclear, leading to a ring-like shape.Between the toes (the interdigital spaces), tinea pedismay appear as inflamed, scaly, and soggy whitetissue. Splitting of the skin, called fissures, may bepresent between or under the toes. This form oftinea pedis tends to be quite itchy.On the sole of the foot (the plantar surface), tinea pedismay appear as pink-to-red skin with scales rangingfrom mild to widespread (diffuse).
Treatment• Keep your feet clean and dry.• Use powders or soaking crystals, especiallymedicated powders to help keep your feet dry.• Change your socks daily, or more often, if theybecome wet, especially from perspiration.• Avoid vinyl, rubber, and plastic shoe materials. Thesematerials do not allow air to flow freely into theshoe.
Prevention• Go with natural materials. Wear socks that are made of naturalmaterial, such as cotton or wool, or a synthetic fibre designed todraw moisture away from your feet.• Change socks and stockings regularly. If your feet sweat alot, change your socks twice a day.• Wear light, well-ventilated shoes. Avoid shoes made of syntheticmaterial, such as vinyl or rubber.• Alternate pairs of shoes. This allows time for your shoes to dry.• Consider disinfection of shoes.• Protect your feet in public places. Wear waterproof sandals orshower shoes in communal showers, pools, fitness centres andother public areas.• If you are prone to Athletes Feet, or your feet sweatexcessively, use powder regularly to help prevent new attacks.
Ingrown Toenails• Ingrown toenails are one of the most common footcomplaints treated by a chiropodist / Foot health professional.• This condition can be very painful and patients may often bevery reluctant to have the condition treated.• An Ingrown toenail is caused by a splinter of nail or the wholenail causing pressure into the skin.• Some Ingrown toenails are acute which means that they haveoccurred due to an injury to the toe. Others arechronic, which means the patient has had the problem for along period of time.
Symptoms and Signs• Early in the course of an ingrown toenail, the end of the toe becomesreddened and painful with mild swelling. There is no pus or drainage. Itmay feel warm to the touch, but you will not have a fever.•Later, extra skin and tissue will grow around the sharp point of the nail. Ayellowish drainage may begin. This is the bodys response to the traumaof a nail irritating the skin and is not necessarily an infection.•Sometimes an infection develops. In this case, the swelling will becomeworse, and there may be white- or yellow-coloured drainage from thearea. A lighter-coloured area of the skin may be surrounded by red skin.You may develop a fever, although this is unusual.
Causes• Inherited : Some people grow very wide and roundednail plate.• Poor Nail Care : The way you cut your nails may leavesharp spikes• Footwear : Tight shoes may press on the side of thetoenail.• Injury / infection : Changes the growing area of thenail bed
Types of Ingrown NailTYPE 1 Ingrowing ToenailType One Ingrowing toe nail often looks as though there is nothing wrongwith the nail, but it hurts in shoes, to touch and sometimes even bedclothes causes pain. This is often due to slight curvature of the nail, tightshoes or poor cutting techniques. Simple trimming by a chiropodist orpodiatrist will usually help to resole this problem. If not treated will oftenprogress to a stage 3 Ingrowing toenail.
Type 2 Involuted Ingrowing ToenailThis problem is often seen in those over 50 when the nail has excessivelycurved ,or sometimes following damage either from some type of traumaor following fungal nail infections: Areas of corns and hard shin build up inthe nail borders , causing pain, sometimes becoming infected. If caughtearly podiatry / chiropody treatment is the management of choice or willoften progress to stage 3
TYPE 3 Classical Ingrowing ToenailMost common is the infected and inflamed ingrowing toenail, sometimes verypainful. The skin around the nail appears swollen and red, sometimes pusmay be visible under the skinThis is the classical ingrowing toenail, often found in teenagers or poormanagement of stage 1 or two above. This type of nail problem canalso be managed by a podiatrist, sometimes with local anaesthetic ifpainful
TYPE 4 Infected Ingrowing ToenailIf the nail has become ingrown several times, or the shape of the nailis so badly deformed that it is likely to re-grow, a decision may bemade to remove part of the nail root. The end result will producea normal looking but slightly narrower nail.If the nail has become very deformed or if removing side sectionswould achieve an unsatisfactory result then the final option is toremove all the toenail.
Prevention• Switch to longer shoes with a bigger toe box.• Soak your foot in a solution of salt water once a day for 20minutes to reduce inflammation and infection.• Trim your nails as best you can. Do not try to "dig out" adeeply ingrown nail and try and cut straight across the top.• Apply an antiseptic once a day, preferably after a bath orshower. This is especially important, because one of thegreatest dangers of ingrown toenails is the possibility ofinfection.
Fungal Nail Infection• Fungal infection of nails is common. The infection causesthickened and unsightly nails which sometimes becomepainful. Medication often works well to clear theinfection, but you need to take medication for several months• About 3 in 100 people in the UK will have a fungal nailinfection at some stage of their life. Toenails are morecommonly affected than fingernails. It is more common inpeople over 55, and in younger people who share communalshowers, such as swimmers or athletes.
Symptoms• Often the infection is just in one nail, but several may be affected.At first the infection is usually painless. The nail may look thickenedand discoloured (often a greeny-yellow colour). Commonly, this isall that occurs and it often causes no other symptoms. However, itcan look unsightly.• Sometimes the infection becomes worse. White or yellow patchesmay appear where the nail has come away from the skin under thenail (the nailbed). Sometimes the whole nail comes away. The nailmay become soft and crumble. Bits of nail may fall off. The skin nextto the nail may be inflamed or scaly. If left untreated, the infectionmay eventually destroy the nail and the nailbed, and may becomepainful. Walking may become uncomfortable if a toenail is affected.
Causes• Spread from a fungal skin infection. For example, athletes foot is a fungal skininfection of the toes. This may spread to the toenails if the skin infection is nottreated early.• Fingernail infection may occur after a toenail infection has become established.The fungus may spread to a finger if you scratch your itchy toes and toenail.• Fingernail infections are also more likely to occur if you wash your handsfrequently, or have them in water a lot. For example, if you are a cook or a cleaner.Constant washing may damage the protective skin at the base of the nail. This mayallow fungi to enter.• A nail that has recently been damaged is also more likely to become infected.• You have an increased risk developing a fungal nail infection if you have variousother conditions. For example: diabetes, psoriasis, poor circulation, a poorimmune system (for example, if you have AIDS or are on chemotherapy), orgeneral poor state of health.• Nail infections are more common in people who live in hot or humid climates.• Smoking also increases the risk of developing a nail infection.• In some cases there is no apparent reason. Fungus germs (fungi) are common andan infection can occur out of the blue.
Prevention and Treatment• Keep your nails cut short, and file down any thickened nail.• Use a separate pair of scissors to cut the infected nail(s) to prevent contaminatingthe other nails. Do not share nail scissors with anyone else (for the same reason).• Avoid injury and irritants to your nails. For example, if fingers are affected, usecotton and vinyl gloves for wet work. Use heavy cotton gloves for dry work.• If toenails are affected, wear properly fitted shoes with a wide toebox.• Keep your feet as cool and dry as much as possible.• Antifungal tablets will often clear a fungal nail infection. The medication will alsoclear any associated fungal skin infection, such as athletes foot.• A nail lacquer that contains the antifungal drug amorolfine is an alternative formost (but not all) types of fungi that infect nails. You can buy amorolfine naillacquer from pharmacies as well as get it on prescription.
BunionsA bunion is a bony lump on the side of your foot, which develops whenyour big toe starts to angle towards your second toe. The bunioneventually causes discomfort and pain. The skin over the lump canbecome red, blistered or infected. A fluid-filled space called a bursa mayalso develop under your skin in this area and this can be painful if itbecomes inflamed. This is called bursitis.
Symptoms• If you have a bunion, you may have:• pain or stiffness of the big toe joint• swelling of the big toe joint• difficulty walking• difficulty finding shoes that fit• If you have any of these symptoms, see your GP.
Causes• A bunion occurs as a result of a problem with your big toe known as hallux valgus.Hallux means the big toe and valgus means that it’s pointing outwards towards theother toes.• In hallux valgus the bone in your foot at the base of your big toe, called the firstmetatarsal, moves out at the side of your foot. Your big toe angles towards yourother toes.• There is evidence that people can inherit a tendency to develop bunions.However, it doesn’t always follow that if your parents or grandparents havebunions, you will have them too.• Hallux valgus affects more women than men. This may be because the ligaments inthe foot (the structures that connect bones together) are usually looser in womenthan men.• The type of shoes you wear may also affect the development of a bunion. If youwear narrow or high-heeled shoes, this puts extra strain on the bones and musclesin your foot, pushing your toes together and forcing your big toe to point towardsyour other toes. Footwear alone doesn’t cause bunions, but it can worsen them.• Bunions are also sometimes associated with joint diseases including osteoarthritis.However, there is usually no serious underlying cause.
Treatment• Using shoe inserts and padding.• Taking painkillers can help to ease the symptoms of a bunion.• However, these treatments can’t cure a bunion or stop it getting worse. Ifyou have severe pain or discomfort from a bunion, you will need to havean operation to correct it.• One of the most important things you can do is to wear the right footwear.You should try to wear flat, wide shoes with laces or an adjustable strapthat fits you properly
Prevention• making sure that the toe of your shoe is wide enoughto prevent your toes from being forced together –the widest part of your foot should be in the widestsection of your shoe• choosing shoes with a low heel and a wide toe boxwhere you can wiggle your toes comfortably• shoes with adjustable fastenings such as laces, bucklesor straps that hold your feet inside your shoe• using soft insoles in your shoes as shock absorbers
VerrucaeA verruca is simply a wart that is usually found on thesoles of your feet, though they can also appeararound the toes. In the early stages, a verruca lookslike a small, dark, puncture mark but later turns greyor brown. It may become rough and bumpy with acauliflower-like appearance and may develop a blackspot in the middle, which is caused by bleeding. Averruca can grow to half an inch in diameter and mayspread into a cluster of small warts.
Causes• Verrucae are caused by the human papiloma virus (HPV). This virus is verycontagious, but can only be caught by direct contact.• It thrives in warm, moist environments such as swimming pools, changingroom floors and bathrooms.• So if an infected bare foot walks across the poolside, it may release virus-infected cells onto the floor. If you then walk on the same floor, you can pickthe virus up, especially if you have any small or invisible cuts and abrasionsthat make it even easier for the virus to penetrate.• You could also catch the virus from an infected towel.• They can cause a sharp, burning pain if you get one on a weight-bearing areasuch as the ball or the heel of the foot. Because you are constantly pressing onthe area when walking, they can protrude into the skin and become morepainful.• When you have verrucae on a non-weight-bearing surface (such as on the topof the foot or on the toes), they protrude above skin level, tend to be fleshierand cause less pain.
Prevention• Minimise your chances of catching a verruca by keeping your feet cleanand dry, and covering up any cuts or scratches. Avoid walking barefoot incommunal showers or changing rooms (wear flip-flops) and dont sharetowels. Though you could wear verruca socks when swimming to avoidpassing on the virus, they can also be worn as a preventive measure.• If a verruca does appear, avoid touching or scratching it as it may spreadinto a cluster of several warts. Instead, cover it up with plaster. In somecases, this may cure it.• Do not self-treat if you have diabetes or circulation problems. However, ifyou are fit and healthy, its fine to treat yourself with over-the-counter gelsand ointments. Ask your pharmacist for advice or look for productscontaining salicylic acid, such as Occlusal. Ensure, however, that you followthe instructions carefully. If, at any stage, your verruca becomes painful orthe surrounding skin goes red, stop treatment immediately and see a FootHealth Professional/ podiatrist. If you damage the healthy tissue thatsurrounds the wart tissue you could hamper further treatment.
Treatment• Because verrucae usually often disappear in time (fought off by your immunesystem), the general policy in the UK is to only treat them when they are causingpain.• Verrucae generally resolve spontaneously within six months in children. But inadults, they can persist for years.• If yours is causing pain, there are a number of treatment options available - thoughno one particular treatment can guarantee a cure. A recent review of treatmentsadvised that the safest and most effective treatments were those containingsalicylic acid. This acid is applied to the wart to disintegrate the viral cells and has acure rate of 75%. It may need to be applied at weekly intervals over a set period oftime.• Another option is to apply Glutarol daily and file every few days.• Other treatments include : Cryotherapy• This involves freezing warts off with liquid nitrogen or nitrous oxide gas. This needsto be done every 2 or 3 weeks for a few months before the verruca is fully• removed. However, it can lead to soreness and blistering in some people. You canstill swim after this treatment, but its not advised for sensitive or anxious children
Corns and Calluses• Corns and calluses are thickenings of skin on the feet that can become painful.• They are caused by excessive pressure or friction (rubbing) on the skin.• The common cause is poorly fitting shoes.• A podiatrist/ Foot Health Professional can pare (cut away) corns and calluses andcan advise on footwear, shoe insoles and padding to prevent recurrences.• A corn is a small area of skin which has become thickened due to pressure on it. Acorn is roughly round in shape. Corns press into the deeper layers of skin and canbe painful.• Hard corns commonly occur on the top of the smaller toes or on the outer side ofthe little toe. These are the areas where poorly fitted shoes tend to rub most.• Soft corns sometimes form in between the toes, most commonly between thefourth and fifth toes. These are softer because the sweat between the toes keepsthem moist. Soft corns can sometimes become infected.
Calluses• A callus is larger, broader and has a less well defined edgethan a corn.• These tend to form on the underside of the foot (the sole).• They commonly form over the bony area just underneath thetoes. This area takes much of your weight when you walk.• They are usually painless but can become painful.
Causes• The small bones of the toes and feet are broader and more lumpy near to thesmall joints of the toes.• If there is extra rubbing (friction) or pressure on the skin overlying a small rougharea of bone, this will cause the skin to thicken. This may lead to corns or callusesforming.• The common causes of rubbing and pressure are tight or poor fitting shoes whichtend to cause corns on the top of the toes and side of the little toe.• Also, too much walking or running which tend to cause calluses on the sole of thefeet.• Corns and calluses are more likely to develop if you have very prominent bonytoes, thin skin, or any deformities of the toes or feet which cause the skin to rubmore easily inside shoes.
TreatmentParing and trimming• The thickened skin of a corn or callus can be pared down (trimmed) by a FootHealth Professional/Podiatrist by using a scalpel blade. The pain is usually muchreduced as the corn or callus is pared down and the pressure on the underlyingtissues eased. Sometimes repeated or regular trimming sessions are needed. Oncea corn or callus is trimmed down, it may not return if you use good footwear.• If the skin seems to be thickening up again, a recurrence may be prevented byrubbing down the thickening skin with a pumice stone or emery paper once aweek. Some people can do this themselves. It is best to soak the foot in warmwater for 20 minutes to soften the thick skin before using a pumice stone or emerypaper. A moisturising cream used regularly on a trimmed corn or callus will keepthe skin softened and easier to rub down.Note: do not use a chemical (sometimes included in corn plasters) to burn thethickened skin unless under the supervision of a podiatrist. Chemicals can harmthe nearby skin and may cause a skin ulcer. In particular, chemicals should not beused if you have diabetes or poor circulation.
Shoes and footwear• Tight or poor fitting shoes are thought to be the main cause of most corns andcalluses. Sometimes a rough seam or stitching in a shoe may rub enough to causea corn. The aim is to wear shoes that reduce pressure and rubbing on the toesand forefeet. Shoes should have plenty of room for the toes, have soft uppersand low heels. In addition, extra width is needed if corns develop on the outerside of the little toe. Extra height is needed if corns develop on the top ofabnormal toes such as hammer or claw toes.• Correcting poor footwear will reduce any rubbing or friction on your skin. In manycases, a corn or callus will go away if rubbing or pressure is stopped with improvedfootwear. If you have had a corn or callus pared away, a recurrence will usually beprevented by wearing good footwear. If you are able, going barefoot when notoutdoors will also help.• Some people with abnormalities of their feet or toes will need specialist shoes toprevent rubbing. A podiatrist can advise about this.
Footpads and toe protection• Depending on the site of a corn or callus, a cushioning pad or shoe insolemay be of benefit.• For example, for a callus under the foot, a soft shoe inlay may cushion theskin and help the callus to heal.• If there is a corn between the toes, a special sleeve worn around the toemay ease the pressure.• A special toe splint may also help to keep toes apart to allow a cornbetween toes to heal. A FHP/ Podiatrist will be able to advise you on anyappropriate padding, insoles or appliances you may need.
Surgery• If you have a foot or toe abnormality causing recurring problems, anoperation may be advised if all else fails.• For example, an operation may be needed to straighten a deformedtoe, or to cut out a part of a bone that is sticking out from a toe and iscausing problems.• If you need an operation then you will be referred to a surgeon who willbe able to discuss this with you in more detail.
Symptoms and Warning signs• How your feet feel can be a reflection of your general health.• If they hurt, they may be signalling other more serious conditions. Thatswhy it is so important to look for warning signs.• They may be your first indication of serious medical problems such asarthritis, diabetes, nerve and circulatory disorders, and other conditions.
Arthritis• Arthritis, the number one crippling disease , affects one in every sevenpeople, no matter what age.• If you have pain, tenderness, limited motion or swelling in the joints ofyour feet that persists or intensifies over time, see your doctor orFHP/Podiatrist.• When the joints of the feet are involved, medication, physicaltherapy, exercise, control of foot function with orthotics(footappliances), braces, special shoes and surgery are among the treatmenttools used to relieve pain and restore them to as near normal function aspossible.
Diabetes• If you have diabetes or are at risk for diabetes by being overweight, youneed to pay special attention to your feet.• Diabetes can impair circulation and nerve sensations in the feet, greatlyincreasing the risk of injuries and their ability to heal.• Pay attention to symptoms such as tingling, numbness and pain in thelower legs. They may be symptoms of diabetes or other conditions.
Gout• If you are a man older than 30 (especially if you have a family history of gout), anacute attack of pain in the joints, often in the big toe, may be a sign of gout.• Left untreated, the pain could last from a few days to over a week.• Gout is a complex disease of uncertain origin, caused by high levels of uric acid inthe blood.• It is important to seek prompt medical care if gout is suspected so that propermedical attention can be obtained.
Obesity• Since feet support your entire body weight, and your feet are prone towear and tear, obese people are more likely to have foot problems.• When youre walking, the pressure on your feet can exceed your bodyweight. When youre running, pressure can be four times your weight.• If you are obese, be sure to discuss any foot problems and discomfortwith your doctor/FHP/Podiatrist.
Other• Conditions of the feet may also signal other problems including rheumaticfever, circulatory problems and nerve disorders.• Although many people take problems of the feet for granted, ignoringthose problems is like ignoring any other health problem.• Seek medical attention for pain and problems with your feet just as youwould for any other condition.
Always look after your FEET FIRST, and they willlook after you.