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Why do we get corns

When we walk or stand, our body weight is carried first on the heel of the foot and then on the ball of the foot, where the skin is thicker to withstand the pressure. When this pressure on our feet becomes intense, growths in the form of corns and calluses may appear.

 

What are Corns?

Corns are similar to calluses in that they are a build-up of skin cells, but concentrated in areas of excessive direct pressure. The central core distinguishes a corn from a callus, and corns are often accompanied by greater discomfort and pain in the foot.

Corns and circulatory issues

For those with circulatory problems or sensory deficit, it is very important to have either a corn or a callus seen to by a professional. Have your feet checked regularly by a Registered Chiropodist like Hayes and Associates. This will reduce the likelihood of further complications of the feet arising in the future.

 

Why do I get corns?

When we walk or stand, our body weight is carried first on the heel of the foot and then on the ball of the foot, where the skin is thicker to withstand the pressure. When this pressure on our feet becomes intense, growths in the form of corns and calluses may appear.

 

Where do corns appear?

Corns always occur over a bony prominence, such as a joint.

 

Are there different types of corns?

Yes, there are five different types of corns. The two most common are hard corns and soft corns.

 

What is a hard corn?

Hard corns are the most common type of corn and appear as small, concentrated areas of hard skin on the feet, up to the size of a small pea, usually within a wider area of thickened skin or callus, and can be a symptom of feet or toes not functioning properly.

 

What is a soft corn?

Soft corns develop in a similar way to hard corns. They appear as a whitish and rubbery texture between toes, where the skin is moist from sweat, or from inadequate drying. A Registered Podiatrist  / Chiropodist like Hayes and Associates will be able to reduce the bulk of the corn between the toes, and apply astringents to cut down on sweat retention between the toes reducing the risk of corns reappearing.

 

What are seed corns?

Seed corns are tiny corns on the bottom of the foot that tend to occur either singly or in clusters. Seed corns are usually painless.

 

What are vascular corns?

If you cut a vascular corn it will bleed profusely and these corns can be very painful. Never cut a corn yourself.

 

What are fibrous corns?

These arise from corns that have been present for a long time. These corns appear to be more firmly attached to the deeper tissues than other types of corn. They may also be painful.

 

How do I treat corns?

Don’t cut corns yourself, especially if you are elderly or diabetic, and don’t use corn plasters or paints which can burn the healthy tissue around the corns. Home remedies, like lambswool around toes, are potentially dangerous. Commercially available ‘cures’ should be used only following professional advice from a Registered Chiropodist / Podiatrist like Hayes and Associates.

You could use a pumice stone to remove the thickened skin a little at a time, or relieve pressure with a foam wedge between the toes, but if you are unsure of what to do about your corns, or if you are worried about corns, consult a registered Podiatrist / Chiropodist like Hayes and Associates who will be able to remove your corns painlessly, apply padding or insoles to relieve pressure, or fit corrective appliances for long-term relief from corns.

Book an appointment with us today to have your feet checked by one of our highly trained professionals.  Hayes and Associates have a wealth of experience in debridement techniques, and are only to happy to share their expertise and offer the best treatment plan for your corns.

If you need further advice on corns, or indeed any foot problems, don’t be afraid to give us a call or send us an e-mail to make an appointment.

 

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Have I a Callus on my foot?

Registered Chiropodists Hayes and Associates are experts in the treatment of Calluses and Corns on the foot.  As well as treating the condition they can also offer professional advice on preventing Calluses and Corns from re-occurring.

What is a Callus?

Callus or hard skin on the foot is an accumulation of several layers of the epithelium (top layer of our skin). This occurs due to a variety of factors, some of which include:Callus and hard skin on the heel

  1. Unsuitable or poorly fitting footwear
  2. Deformity of the foot (hammer toe, bunions etc)
  3. High activity levels can cause Calluses or hard skin on the foot.
  4. Standing for long periods of time can be one of the factors that can cause a Callus or hard skin on your foot.

What are the signs of a Callus?

As the stresses of friction and pressure on the skin occur, the body’s way of protecting the area is in the formation of hard skin or Callus and / or Corns on your feet. The visible signs of a Callus is hard skin on the heel, hard skin on the toe or hard skin on the foot. This then causes extra pressure and less room in your footwear, thus resulting in a cycle of Calluses and Corns.

 

What causes a Callus?

When we walk or stand our body weight is carried, first on the heel of our foot and then on the ball of our foot where the skin is naturally thicker to withstand the pressure. When there is excessive pressure on your feet some areas of the skin thicken in the form of a Corn or Callus. This is a protective response by the body to limit injury to your foot and can appear anywhere the skin rubs against a bone, a shoe, or the ground. This friction can be what causes a Callus or Corn.

 

Inappropriate footwear can be a factor in the formation of a Callus or Corn

Most Calluses are symptoms of an underlying problem like a bone deformity, a particular style of walking, high activity or inappropriate footwear. Some people have a natural tendency to form Calluses because of their skin type. Elderly people have less fatty tissue on their feet and this can lead to a Callus forming on the ball of the foot.

 

How to treat a Callus?

You can control a small amount of hard skin by gently rubbing with a pumice stone, or chiropody sponge occasionally when you are in the bath. Use a moisturising cream daily on your feet. If this does not appear to be working, seek advice from registered chiropodists Hayes and Associates.

 

Painful Callus on my foot

If the callus is painful and feels as if you are “walking on stones”, consult registered chiropodists Hayes and Associates who, as well as treating the condition, will be able to advise you as to what caused the Callus and where possible, how to prevent Calluses forming again.

Hayes and Associates can also remove hard skin, relieve foot pain, and redistribute pressure on your foot with soft padding, strapping the foot, or corrective appliances which fit easily into your shoes. The skin on your feet should then return to their normal state.

 

Loss of natural padding on the foot

The elderly can benefit from padding to the ball of the foot to compensate for any loss of natural padding that may occur. Emollient creams can delay Callus building up on the foot and help improve the skin’s natural elasticity. Hayes and Associates are the best people to advise you on the most appropriate skin preparations for your feet. It is always better to consult the experts and when it comes to foot care Hayes and Associates are number one in the North East.

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Ingrown Toenails

What is an ingrown toenail?

An ingrown toenail (Onychocrypytosis) is a very common condition, and most often seen in the big toe. This is when the nail becomes imbedded into the surface of the skin causing a portal entry for fungus and bacteria, which can lead to infection if untreated.

 

 

First sign of an ingrown toenail?

A build-up of hard skin on the toe and debris at the borders can cause redness, swelling and discomfort – this is usually the first sign of an ingrown toenail. Hayes and Associates, Podiatrists and Chiropodists are experts in the treatment of ingrown toenails and use their vast experience and expertise to treat the symptoms of ingrown toenails and clear any infection that might be present with the least amount of discomfort for the patient.

Early stage symptoms of an ingrown toenail: The skin at the edge of the nail becoming red and swollen, possible fluid build-up and painful to touch.

Advanced stage symptoms (infection present) of an ingrown toenail: Heightened pain to touch, redness on toe, swelling around toe, skin growth around the problematic area, bleeding and pus from nail infection on the toe.

 

What causes an ingrown toenail?

There are many reasons as to why an ingrown toenail can occur – tight fitting footwear; cutting the toe nails incorrectly; picking the corners of your toenails, irregular and curved toenails; abnormal gait; trauma to your toes, e.g. stubbing your toe; genetic predisposition and those who are athletic are at a higher risk of getting ingrown toenails because of the consistent pressure put on the feet over long periods of time. These are just some of the reasons why we get ingrown toenails. Whatever the cause – Hayes and Associates are experts in the treatment of this condition.

So, how do we treat ingrown toenails?

Through an assessment with Hayes and Associates, we will discuss these factors in more detail. We will distinguish the cause of the ingrown toenail, if antibiotic cover may be required to combat any infection under the nail, and in more severe cases of ingrown toenail surgical removal of a section of the nail may be necessary.

We would highly recommend being seen by one of our highly trained Podiatrists at Hayes and Associates if any of the symptoms of ingrown toenail are experienced. For an appointment and further advice on the symptoms, the cause and the treatment of ingrown toenails please call 01-8413350.

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Orthotics

Do I need Orthotics

Sometimes feet can be a real pain.

You have only one pair of feet and they take you everywhere. So, it’s a good idea to take care of them. But, most people don’t give their feet a second thought … that is, not until they hurt. And once those feet are hurting, most have no idea of how to eliminate the pain. They often soak their aching feet or take time out for a quick foot rub, but outside of those remedies, their feet just go on hurting. That can lead to serious trouble. Most foot pain is the result of a faulty relationship between the bones and muscles of the foot. Even the slightest misalignment of the bones and muscles can cause a lot of discomfort. Misalignment can result in a number of problems, such as pronation, flat feet, persistent ankle sprains, bunions, corns, calluses … even back and neck pain.

But there is something that can help these problems. Something better than warn water in a tub and occasional massages. Prescription orthotics.

What are orthotics?

Some people call them “arch supports” but they really aren’t, they’re much more. Prescription orthotics are custom-made forms which correct your individual foot problems. They are made of high-impact materials, such as plastic and super-strength woven fibres, and they’re designed to be inserted right into your shoes.

The most important feature of a pair of orthotics is they’re made specifically for your feet. You and someone else may have a similar foot problem, but your feet are unique. They’re not like anyone else’s. That’s why orthotics are custom-made.

Once orthotics are slipped inside your shoes, they fit comfortably to your foot. So comfortably, in fact, that once you start wearing them you won’t want to walk without them again.

How do they work?

As your foot rests on the orthotic it is gently and consistently directed into the correct position for walking, running, and standing. With a pair of orthotics, pressure points, improper rotation of the foot, and painful muscle strain are all eliminated because your foot is functioning properly.

How are orthotics made?

First you must be fitted for them. It’s not hard. Your podiatrist gives you a complete examination and determines your particular foot problem. A plaster impression will then be made of your feet held in the correct position. When the casts are finished, they are sent to the orthotic laboratory where they are used to produce your orthotics. Here, technicians, following your podiatrist’s specifications, add special heel lifts, or built-ups to customise an orthotic to correct your specific problem.
The lab sends them back to your podiatrist … and they’re ready for fitting.

How long will I have to wear them?

There’s really not an answer to this question. You see, orthotics rarely cure your foot problem. They work on the same principle as glasses … an eye specialist may prescribe glasses for you, but they won’t cure your vision problems. Instead, orthotics simply modify the function of your foot as you continue to wear them. However, in some young patients, the early use of prescription orthotics before the body is fully developed may actually correct a foot problem. Or at least, they can insure that the problem does not develop further.
In other words … you’ll need to wear orthotics as long as you want to avoid discomfort.

Remember, your feet are the foundation for your entire body. Obtaining and consistently wearing orthotics can be the best investment you can make in your overall well-being.

Now, talk to your podiatrist

Half of your foot problem is already over. You accomplished that just by coming in to have your feet examined. Now, the other half is treating the problem. Orthotics may be what your podiatrist prescribes.

Facts to know about orthotics

Orthotics are made by prescription only and designed for your particular foot problem.

Warning! Many imitations are sold over the counter by sport shops and pharmacies. Genuine orthotics are prescription medical devices which correct your abnormal foot function and minimise your foot problem.

 

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Bio mechanics

Bio Mechanical Evaluation

What is Podiatric Biomechanics?

Podiatric biomechanics is a specialisim concerned with preservation, restoration, and development of the function of the foot and its associated structures.

The foot is unique, intricate, and mechanically complex structure made up of 26 major bones and associated joints. The efficiency with which the foot functions when walking depends on the way in which those bones and joints move in relation to each other. Efficiency and pain-free function also depends heavily on the foot’s angle to the leg and to the ground. If things do not work well in either of these areas, painful problems may often be the result.

Biomechanics refers to the use of the mechanical methods, such as electronic pressure plates or observation, in the diagnosis and treatment of the function of the foot and leg.

What problems can occur?

Obviously the foot plays a crucial part in the process of walking and often suffers as a result of poor function. The painful foot problems that may result from inefficient function include corns and callus, painful toenails, pain in the ball of the foot, in the arch, or in the heel. Not only painful foot problems; less obvious, but very important, is the fact that inefficient foot function has an influence on other parts of the body.

A small structural or functional imbalance in the foot may often cause no foot pain at all. Instead, it may cause problems in the ankles, knees, hips, back, neck or even the jaw – all parts of the body that are connected to the feet by the skeleton. The effect may show as pain, instability, restricted movement, or in some cases, just fatigue.

How does the foot function?

Nature produced a magnificent architectural and functional design in the foot. It is intended to work efficiently under excessive loads and demands, often in extreme conditions imposed on it by footwear and the environment in which it has to work. However, impressive though it is, this complex structure’s function depends heavily on having its correct functional angles and joint movements maintained.

In walking or running, the foot needs to be flexible enough to absorb the shock of hitting the ground thousands of times a day. It also has to be firm enough not to collapse as the body’s weight moves over it at each and every step. Small wonder then, that sometimes things start to go wrong with foot function, and pain or disability results. In most cases, it is not until heavy or unusual demands are made on the feet by work, sport, injury, or simply by the passage of time, that potential weaknesses are revealed.

What is a biomechanical examination?

Podiatric biomechanics is very technical and requires a high level of skill to deal with problems of standing, walking and running. It is the use of this skill in performing a biomechanical examination that enables podiatrists to identify and treat functional faults..

A biomechanical examination involves taking a series of measurements of the feet and legs with the patient standing or lying down and may include checking joint movements and assessing muscle strength and flexibility. It will often include watching the patient walk to assess the way in which the foot works.

State Registered Chiropodists / podiatrists* may approach various parts of the biomechanical examination in different ways. Many depend entirely on their skill and experience in conducting a physical examination and use simple observation of the patient walking to arrive at their results. Others, however, may choose to use video analysis to examine the way the patient walks, computer connected insoles in shoes, or pressure plates on the floor. Much depends on the podiatrist’s personal preference.

As modern technology advances, so does the variety of new equipment available to podiatrists to gather information from a biomechanical examination. Nevertheless, the most important factor in any examination will remain the highly trained podiatrist’s professional skill in interpreting the information gathered, and using it to prescribe the specialist treatment that will most benefit the patient.

The results of a biomechanical examination enable the podiatrist to assess the positions of the feet and legs and the amount of excessive motion occurring. Once that is established, the podiatrist will be able to decide which treatment can help the feet to function more efficiently.

 

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Ageing feet

Ageing Feet

Older feet naturally develop more problems because the skin tends to thin and lose it’s elasticity. Healing can take longer and wear and tear to the joints over the years may have caused some degree of arthritis.

But painful and uncomfortable feet aren’t a natural part of growing old or something to “put-up with”. A lot can be done to improve comfort, relieve pain and maintain mobility.

It’s not too late to start caring!

Follow the SCP daily foot care routine and keep on the move. Keeping toenails cut and under control will help keep you mobile but you may need help with this from your chiropodist/podiatrist or a friend.

Keeping warm

Try to keep your feet as warm as possible, but don’t cook them in front of the fire! Warm stockings or socks can help. Avoid anything too tight which can restrict your circulation or cramp your toes. Wearing fleece-lined boots or shoes or even an extra pair of socks will also keep you warm but do make sure your shoes aren’t tight as a result. Bed socks are also a good idea.

Choosing the best footwear

The older you get, the more you need a shoe which holds your foot firmly in place to give adequate support. Throw out those sloppy old favourites as they may make you unstable when you walk.

Look for shoes with uppers made of soft leather or a stretchy man-made fabric which is also breathable. Avoid plastic ‘easy clean’ uppers which don’t allow the foot to breathe and won’t stretch to accommodate your own foot shape.

Many shoes have cushioning or shock absorbing soles to give you extra comfort while walking. When buying shoes, ensure that you can put them on and take them off easily. Check that the heel is held firmly in place – you’ll find that a lace-up or velcro fastening shoe will give more support and comfort than a slip-on.

Your shoes should be roomy enough, particularly, if you intend to wear them everyday. If you suffer with swollen feet, it’s a good idea to put your shoes on as soon as you wake up, before your feet have had a chance to swell.

Exercise

Exercise can help to keep feet healthy – it tones up muscles, helps to strengthen arches and stimulates blood circulation.

Source:
The Society Of Chiropodists And Podiatrists

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Athlete’s foot

Athlete’s foot

What is it?

Athlete’s foot is a fungal infection. It can lead to intense itching, cracked, blistered or peeling areas of skin, redness and scaling. It can occur on moist, waterlogged skin especially between the fourth and fifth toes, or on dry, flaky skin around the heels or elsewhere on the foot.

It’s caused by a number of fungal species which you can pick up from anywhere (typically communal areas such as pools, showers and changing rooms) or anywhere where you may walk around barefooted. The fungus on each bit of skin that falls away from someone else’s feet can be picked up by you if you’re prone.

Once your feet have been contaminated, the warm, dark and sweaty environment of feet cramped in shoes or trainers provides the ideal breeding ground for the fungus. However, athlete’s foot also occurs in dry, flaky areas. It’s quite common in summer sandal-wearers. The sun makes your skin dry out, so it loses its natural protective oils; this combined with the constant trauma from sandals makes them more prone to infection.

Who gets it? Well, it’s not called athlete’s foot for nothing. Walking barefoot around swimming pools and spending your life in trainers make you more likely to suffer. But obviously, you don’t need to be an athlete to suffer.

Is it serious? If left untreated, the fungus can spread to the toe nails, causing thickening and yellowing of the nail, which is much harder to treat.  Fungal infections are highly contagious and can spread to anywhere on your skin – to your scalp, hands and even your groin, especially if you use the same towel for your feet as for the rest of your body.

What can I do? There are many things you can do to make your feet less hospitable to fungal infections:

Re-think your footwear Firstly, change your footwear on a regular basis. There’s no point sorting your feet out if you constantly re-infect them by putting them into damp, fungally infected shoes. It takes 24-48 hours for shoes to dry out properly, so alternate your shoes daily. If you really have to wear the same pair day after day (say, if you’re on holiday), dry them out by using the hairdryer on a cold setting. This will get rid of perspiration quickly without creating more heat.

To help shoes dry out more quickly, take any insoles out. Also, loosen any laces and open your shoes out fully so that air can circulate. Go for trainers with ventilation holes.

If your shoes are so tight that they squeeze your toes together, this encourages moisture to gather between your toes and encourages fungus. Let air circulate between the toes by going for a wider, deeper toebox instead and choose shoes made from natural materials.

Of course, you should also change your socks every day too.

Wear flip-flops in the bathroom and in public showers. This will not only ensure that you don’t leave your dead skin around for others to pick up, but will stop you picking up another species of fungus! And never wear anyone else’s shoes, trainers or slippers.

Re-think your footcare Treatment depends on what type of athlete’s foot you have:

For athlete’s foot where the skin conditions are dry If your athlete’s foot occurs on a dry area such as your heel, you need to restore moisture by rubbing in an anti-fungal cream or ointment. However, don’t forget to wash your hands thoroughly afterwards. Even better, use disposable gloves so you don’t get the fungus on your hands at all.

For athlete’s foot where the skin conditions have been moist This requires altogether different treatment. Wash your feet in as cold water as you can bear, as hot water only makes your feet fungus-friendly. Then dry them thoroughly after washing – preferably with a separate towel or even kitchen roll. Dab dry, don’t rub as rubbing tends to take away any healing skin. As the aim is to get rid of the moisture – although the skin may appear flaky and dry – never use moisturiser between your toes. Avoid powder too as it can cake up and irritate the skin. A spirit-based preparation can help, such as surgical spirit (it’s cooling, soothing and antiseptic).  It might sting a bit, but it evaporates the moisture and allows the skin to heal.

If your athlete’s foot is mild or you’ve only just started to suffer, rethinking your foot hygiene may help. Surgical spirit may be enough to see it off. However if an antifungal medication is required, your pharmacist can recommend one.

The mistake most people make is to stop the hygiene regime, shoe rotation and/or medication once their symptoms have gone. Even though your symptoms may disappear after several days or weeks, the fungus can lie dormant and could eventually reappear if the environment is right. Some products require continued treatment for many weeks – always follow the instructions. Also, be alert to symptoms so that you can deal with any problems straight away.

Though you should avoid using anti-fungal powders between the toes, they’re good for dusting inside shoes and trainers.

What can a podiatrist do?

You should be able to get rid of athlete’s foot on your own, but a podiatrist may help you pinpoint the best treatment for your particular type of athlete’s foot. Your podiatrist can also help if the fungal infection has spread to your nails, by reducing the thickness and cutting back the nails, thereby exposing the infected nailbed to a lighter, cooler environment.

Nail infections don’t respond to topical treatments. You need oral medication (i.e. tablets) to kill the fungus in nails. If the fungus is only in the nail and not elsewhere, it is probably caused by an injury. An injury allows the fungus to creep in and multiply under the nail. This can affect the substance of the nail which may become crusty, discoloured and deformed. This oral medication needed, however, can have side effects. So if you have other medical conditions or are on other medication, your GP or podiatrist may recommend that you don’t take it.

What your GP can do:

Your GP can prescribe a broad-spectrum anti-fungal medication to eliminate the fungus if local treatment or your prevention regime has failed.

Source:
The Society Of Chiropodists And Podiatrists

 

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Bunnions and Toe Deformities

Bunions & Toe Deformities

The foot is roughly divided into three sections: the hindfoot or heel, the midfoot and the forefoot & toes.

The function of the toes, especially the big toe, is to help us balance, and to propel us forward during walking or running. The 14 bones of the toes are among the smallest in the body, and, not surprisingly, things can and often do go wrong. Some problems begin in childhood and may go unnoticed. Others begin later on in life, perhaps as the result of injury or the added pressure of incorrect footwear.

Bunions

What are bunions? What most people call a bunion is actually known as “Hallux valgus”. Hallux valgus refers to the condition in which the big toe is angled excessively towards the second toe – and a bunion is a symptom of the deformity.

In a normal foot, the big toe and the long bone that leads up to it (the first metatarsal) are in a straight line. However, Hallux valgus occurs when the long foot bone veers towards your other foot and your big toes drifts towards your second toe.

A bunion actually refers to the bony prominence on the side of the big toe. This can also form a large sac of fluid, known as a bursa, which can then become inflamed and sore.

Is it serious? Some people have massive bunions that aren’t that painful but cause difficulties with shoes, while others have relatively small bunions that are very painful. However, just because you have Hallux valgus doesn’t mean you’ll get the bursa.

Pressure from the big toe joint can lead to a deformity in the joint of the second toe, pushing it toward the third toe and so on. Likewise, if the second toe and big toe cross over, it can be difficult to walk.

Once the big toe leans toward the second toe, the tendons no longer pull the toe in a straight line, so the problem tends to get progressively worse.

This condition can also encourage corns and calluses to develop.

Who gets them?

Women tend to get bunions more than men. This could be due to the more restrictive footwear they wear, (such as high heels or narrow toe boxes which force the big toe towards the little toes) but women also tend to have looser ligaments, making them slightly more prone. You’re also more likely to get bunions if your parents or grandparents have them.

What causes bunions?

No one single cause has been proven. There are a number of causes, and though shoes can exacerbate the problem, bunions do occur in societies that don’t wear them.

Michael Ratcliffe, a registered podiatrist who specialises in podiatric clinical biomechanics, explains that we walk on the same type of ground all the time, whereas the human foot was actually designed to adapt to varying terrains. In a sense, a bunion is a type of repetitive strain injury. And like repetitive strain injury, some people are more prone to it than others. One theory – though it remains unproven – is that bunions are caused by one or both of the following:

1) Because the foot wasn’t designed to constantly walk on a level surface, the ball of the big toe is slightly lower than the ball of the rest of your foot. When your foot meets the ground, the ball of the big toe is pushed up, and the big toe joint can’t bend as well as it was designed to. In order for the big toe joint to bend fully as you walk, your foot rolls slightly over to the side (this is also why people with hallux valgus often get hard skin).

Because the foot wasn’t designed to constantly walk on a level surface, the ball of the big toe is slightly lower than the ball of the rest of your foot. When your foot meets the ground, the ball of the big toe is pushed up, and the big toe joint can’t bend as well as it was designed to. In order for the big toe joint to bend fully as you walk, your foot rolls slightly over to the side (this is also why people with hallux valgus often get hard skin).

2) Also, if your midtarsal joint tends to move from side to side more than it does up and down, the arch in your foot collapses as your foot rolls in. This also makes you more prone to developing bunions.

Such problems can be exacerbated by tight footwear. Slip-on shoes can make matters worse because they have to be tighter to stay on your feet, you automatically have less room for your toes. And with nothing to hold your foot in place, your toes often slide to the end where they’re exposed to lots of pressure. Likewise, high heels throw more weight onto the ball of the foot, putting your toes under further pressure.

If you haven’t got a bunion by adulthood and you later develop one, there could be some underlying arthritis.

What can a podiatrist do?

Your podiatrist can recommend exercises, orthoses (special devices inserted into shoes), shoe alterations or night splints (which hold toes straight over night) which may slow the progression of bunions in children. Prior, ‘conservative’ measures such as these may help relieve symptoms, though there is no evidence they can correct the underlying deformity.

Orthoses are designed to prevent the problem getting worse by decreasing any biomechanical causes of bunions. In other words, if the biomechanical theory is correct (i.e. if your bunions are caused by the way you walk), orthoses may help you walk in a way that doesn’t exacerbate the problem.

But it won’t change the already established shape of your foot. For that, you need surgery.

What can a podiatric surgeon do?

Your podiatrist can refer you to a podiatric surgeon who will evaluate the extent of the deformity. A podiatric surgeon can remove the bunion and realign the toe joint in an operation generally referred to as a bunionectomy. However, there are actually around 130 different operations that fall under this title – so don’t presume you’ll need the same type of surgery as that friend of a friend who couldn’t walk for 3 months!

The aim of surgery is to correct the cause of the bunion and prevent it growing back. Which type of surgery your podiatric surgeon recommends will depend on the severity of your bunion. Because there are risks and complications with any type of surgery, it’s not usually advised unless your bunions are causing pain – or if it is starting to deform your other toes.

Trevor Prior rounds up the main types:

Silvers procedure – this is the simplest procedure that involves removing the prominent bump on the inside of the foot. But because it doesn’t cure the underlying deformity, it will only be used in people with mild deformities or in older people. This is a short procedure and recovery is quick.

Austin (Chevron)/Reverdin – green osteotomies – these involve cutting the bone toward the end of the first metatarsal (the long bone leading up to the big toe), before fixing it back into a straighter position. You’ll need to rest the foot for two to four days. You’ll be able to do limited walking and on average, be able to get back into shoe 2-6 weeks after the operation. You’ll walk normally around three months after the operation

Scarf osteotomy – This is similar to the above technique but because more bone is cut, it allows for slightly more correction. Recovery is the same as for the above procedure.

Base wedge osteotomy – This is for more serious deformities. A small wedge of bone can be removed from the base of the metatarsal. Recovery is longer. You’ll need to wear a non-weight bearing cast for 4-6 weeks (ie you can’t walk on it) and possibly a weight-bearing cast for 2-4 weeks.

Lapidus – This is very good for people that have a mobile metatarsal. By removing the bone in a wedge shape from either side of the joint at the base of the metatarsal, this allows the surgeon to correct the position of the metatarsal while fusing the joint, making it more stable. Recovery is similar to that of the base wedge.

Akin osteotomy – In many deformities, you need to straighten the big toe as well as the position of the first metatarsal. A small wedge of bone can be removed from the base of the big toe. This is usually done in conjunction with one of the above procedures and doesn’t lengthen the recovery period.

Keller arthoplasty – this involves removing the bone at the base of the big toe and essentially removing half of the big toe joint. However, this can leave the big toe a little bit unstable and is mainly used for older people with arthritis. Recovery is slightly quicker to that of the Austin procedure.

Although the vast majority of patients have an excellent outcome, surgery cannot guarantee a pain-free toe or that deformity won’t recur again.

What can I do? One of the best things you can do is to go for wider, deeper shoes. There should be a centimetre between the end of your longest toe and end of shoe. You should also choose shoes with an adjustable strap or lace.

Podiatrists often recommend exercises to strengthen your muscles and tendons around the big toe. Here’s one you can try yourself. Put your feet side by side, and try to move your big toes towards each other. Do this three or four times a day, while you’re in the bath or in bed.

Other Big Toe Deformities

A complaint which is more common among men then women is “Hallux rigidus”, where, instead of bending normally, the big toe stiffens and forms a bump at the top of the joint, making the ‘pushing-off’ motion in walking difficult. This often results from stubbing or injury to the toe, perhaps during sport. Women often suffer from “Hallux rigidus” as a result of persistent trauma to the joints from slip-on or shoes that are too tight.

Wearing shoes with low heels and firm soles will act as a supporting splint. Registered podiatrists will be able to provide pads or strapping to stabilise the joint, or appliances (orthotics) to modify the way you walk. In severe cases, footwear may be modified or surgery may be indicated.

Smaller Toes

Another common complaint is “Hammer Toes”. The toe most usually affected is the second, which becomes bent up in an inverted “V” shape and can’t straighten out during walking. Corns develop where it rubs against the shoe. Some people are born with clawing of the lesser toes, which might be due to muscle imbalance, and can lead to hammer toes. Too-tight shoes and socks make the condition worse.

You can help by investing in shoes that are “foot shaped” – with a straight inside edge, rounded toe and a toe box deep enough to remove pressure on the joints. Registered podiatrists will be able to prescribe treatment, appliances which straighten the toes, or, when necessary, may advise surgery to provide permanent correction.

Curly or Retracted Toes

Many babies are born with toes that don’t lie flat, or are retracted. The problem generally clears up, especially if the toes are not too restricted in the early stages by tight shoes and socks. If the problem continues, muscle strengthening exercises may help, or silicone orthoses may be needed to correct the complaint. Take a look at our section on children’s feet for more details.

Source:
The Society Of Chiropodists And Podiatrists

 

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Callus

Callus

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 excessive, some areas of the skin thicken, in the form of corns and callus, as a protective response.

A callus, or callosity, is an extended area of thickened skin on the soles of the feet, and occurs on areas of pressure. It is the body’s reaction to pressure or friction, and can appear anywhere the skin rubs against a bone, a shoe, or the ground.

Walking on stones?

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.

What to do

You can control a small amount of hard skin by gently rubbing with a pumice stone, or chiropody sponge occasionally when you are in the bath. Use a moisturising cream daily. If this does not appear to be working, seek advice from a registered chiropodist (also known as podiatrist) or pharmacist.

If the callus is painful and feels as if you are “walking on stones”, consult a registered chiropodist/podiatrist who will be able to advise you why this has occurred and, where possible, how to prevent it happening again. Your chiropodist/podiatrist can also remove hard skin, relieve pain, and redistribute pressure with soft padding, strapping, or corrective appliances which fit easily into your shoes. The skin should then return to its normal state.

The elderly can benefit from padding to the ball of the foot, to compensate for any loss of natural padding. Emollient creams delay callus building up, and help improve the skin’s natural elasticity. Your chiropodist/podiatrist will be able to advise you on the most appropriate skin preparations for your needs.

Source:
The Society Of Chiropodists And Podiatrists

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Corns

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.

Under pressure

There are five different types of corns. The two most common are hard and soft corns.

Hard Corns

These are the most common and appears as small, concentrated areas of hard skin up to the size of a small pea, usually within a wider area of thickened skin or callous, and can be symptoms of feet or toes not functioning properly.

Soft Corns

These develop in a similar way to hard corns. They are whitish and rubbery in texture, and appear between toes, where the skin is moist from sweat, or from inadequate drying. A registered podiatrist/chiropodist will be able to reduce the bulk of the corn, and apply astringents to cut down on sweat retention between the toes.

Seed Corns

These are tiny corns that tend to occur either singly or in clusters on the bottom of the foot. They are usually painless.

Vascular Corns

These corns will bleed profusely if they are cut and can be very painful.

Fibrous Corns

These arise from corns that have been present for a long time. They appear to be more firmly attached to the deeper tissues than any other corn. They may also be painful.

What To Do

Don’t cut corns yourself, especially if you are elderly or diabetic, and don’t use corn plasters or paints which can burn the healthy tissue around the corns. Home remedies, like lambswool around toes, are potentially dangerous. Commercially available ‘cures’ should be used only following professional advice.

You could use a pumice stone to remove the thickened skin a little at a time, or relieve pressure between the toes with a foam wedge, but if you are unsure of what to do, or need special attention, consult a registered podiatrist/chiropodist who will be able to remove corns painlessly, apply padding or insoles to relieve pressure, or fit corrective appliances for long-term relief.

Source:
The Society Of Chiropodists And Podiatrists

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