General Information

Some foot conditions can affect anyone. Here we outline some common foot conditions for you to understand a little more about them. On this page, we discuss:

• Fungal infection
• Plantar heel pain
• Warts
• Orthotics
• Bunions

Fungal Toenail infections “Onychomycosis” Fungal toenail infections infect up to 8% of the general population. It is 30 times more likely in adults than children. Can be found in up to 90% of people over 70 years of age . They are more common in people with an immuno-suppression illness or therapy and is also found commonly in diabetics and other conditions that affect the body’s response to infections. Other risk factors are living in warm humid environment and a previously been injured a toe nail and having tinea of the feet. Nail infections can be caught by using nail files and nail clippers that have not been thoroughly sterilised. It is then passed onto other people by using this equipment It is also increasingly common now to see an infection from pedicures, both and overseas. It is important to remember that many countries do not have the same hygiene standards as we do in Australia. A luxury spa treatment whilst on holiday may prove to have long lasting problems, if you catch a fungal nail infection from the pedicure.

EFFECTS
Fungal infections of the toenail are unsightly. The nail changes colour (white/yellow/ brown, spot and lines). The nail can thicken, become brittle and break away. People with fungal nail infections don’t like to expose their toes because of their appearance. They fear people will see the nail, judge the person for having an infection. People commonly cover up the toenails with enclosed shoes to hide them. In hot weather this can be uncomfortable, and promote the growth of the fungus with the hot humid environment. Fungal toenails can be painful, as the nail becomes uneven and it creates pressure on the nail bed. Sometimes the infection invades the skin of the toe, which will cause local inflammation and pain. Although covering the nail with polish may improve the appearance in the short term, it results in sealing the infection in. This can promote the growth of the fungus. It is difficult of care for your own fungal nails, due the thickness of the nail, the brittleness and the splitting. If a nail cannot be cut properly, an ingrown toe nail may result. Resolving a nail infection can improve a person’s confidence and sense of wellbeing. They can return to wearing open shoes and be free of discomfort and pain.

TREATMENT
Fungal toenail infections can be caused by a number of different strains of fungus and yeasts. Medical conditions such as psoriasis, eczema, circulation problems and injury to the nail can look like a fungal infection. It is important to correctly identify that there is an infection in the nail prior to treatment. Podiatrists are experienced at examining nails and assessing if a nail infection is present. If necessary, scrapings can be sent to a laboratory for testing.

QUICK FIXES
If the nail infection is found very early on, a podiatrist can cut back the infected nail and advise a treatment to keep the rest of the nail becoming infected. In most cases nail the infected part of the nail is trimmed and filed away. This improves appearances immediately.

LONG TERM TREATMENT
In most cases the podiatrist does not see the nail until the infection is entrenched. In these cases the podiatrist will still need to cut and file away as much of the infected nail as possible. This will allow a treatment to be applied and to reach the active areas. Topical treatment will take 3- 12months. This is because the infected and damaged nail does not heal, but instead needs grow out. Oral medicines are also used for the treatment of fungal nails. It is important that they are correctly diagnosed before taking the treatment, and the patient is monitored for side effects.

END RESULTS
The nails do not always return to normal appearance after treatment, this because of permanent damage to the nail cells may have occurred while the infection was present. Once the infection is cured, the appearance can be enhanced with regular care of the nails.

PREVENTION
Prevention of nail infection is certainly much better than treatment.

• Skin and nail fungal infections should treated promptly.
• Replace old shoes and socks that may contain spores
• Avoid pedicures where the nail clipper and files etc. are not sterilised between use.
• If you think you have a fungal infection of the toe nails, don’t share nail clippers and files, or attend pedicures, as you could pass it on. Instead see your Podiatrist.

Plantar Heel Pain

Plantar heel pain occur at the bottom of the heel. Often plantar heel pain is the result of damage to the plantar fascia. The plantar fascia is a broad fan shaped strap of strong body tissue which stretches from the bottom of the heel bone to the ball of the foot. It helps to hold the foot bones and joints in place. When it is over stressed (over stretched) typical symptoms occur. The heels hurt most of all first thing in the morning or after a period of rest. The heels are also very sore after standing for a long time.

CAUSES
There are many medical causes of heel pain but by far the most common cause is associated with damage and inflammation of the plantar fascia, and its insertion into the heel bone. A foot x-ray often reveals the presence of heel spurs, which are sharp spikes of bony over growth on the bottom of the heel bone. Heel spurs may or may not be present with plantar heel pain and are unlikely to be contributing to the pain. Examination of the joints and muscles in the foot and leg, and checking of foot and leg mechanics will show that individuals will have a unique structure that affects the walking pattern. Plantar heel pain is also linked to long standing work, being overweight and poor footwear.

TREATMENT
The aim of treatment is to give relief from the pain in the short term , and address mechanical imbalances in the long term. Initial treatments may include strapping, padding, stretching, trigger-point therapy, mobilisations, and footwear changes. In the longer term your podiatrist may advise an orthotic to control the foot mechanics. Orthotics are in-shoe devices which reduce the abnormal forces on the foot. It is important to discuss your mobility and foot care problems with a podiatrist who can advise which service or professional support is most appropriate to your needs.

Warts

Warts (or verrucae) are lesions caused by a virus that grows within the skin (the epidermis). This virus is the human papilloma virus which can exist in a dormant yet infectious state outside the body, so it doesn’t require skin to skin contact to be spread. For the infection to occur, and for the wart to grow, there must be a break in the skin. Warts often appear as a small lump of hard skin with black dots. It is mostly occurs on the bottom of the foot. It is easily confused with a corn, but there are some simple differences:

• A wart is painful when squeezed
• A corn is painful when pushed
• A wart can occur anywhere on the foot
• A corn occurs over areas of pressure

CAUSES
This is one reason why warts are common in children: they have finer skin that is more easily damaged; and other reasons include they have not yet built up a resistance to warts and more commonly use pools and shared showers. Warts on the bottom of the foot often can be quite painful as pressure from standing forces the wart back into the foot. On other areas of the foot a wart can grow outwards and be painless.

TREATMENT
Treatment involves the destruction of the infected wart tissue . This can be done by a variety of ways, including:

• Cryotherapy – freezing the wart off with liquid nitrogen
• Chemical or medicated application
• Cautery – bruning the wart off
• Surgical removal for more serious warts
• Consultation with your podiatrist will enable you to decide whether the wart needs treatment and what is the most appropriate means of treatment for you.

Orthoses (Orthotic devices)

Orthotic devices can be used to maintain proper foot support. They are made of plastic and must be regularly checked (at least once every three years) to ensure they are still doing the job they were designed and fitted to do. Orthoses help to realign the foot and distribute body weight evenly. They can be used for all for a variety of problems including pain, poor stability and gross motor problems. These devices are not simple arch supports and need to be custom-made for each individual. The Podiatrist, after assessing your foot function may recommend orthoses or insoles to help relieve foot pain and discomfort.