Reddened, cracked, and peeling skin

Some bleeding

Itching, burning

Stinging sensation

On the toe nail:

Nail gets thicker

Bad odor

Debris collects beneath the nail

White marks on the nail, change in color (yellow or brown)

Treatment may include

There are a variety of products that can be used on the foot and toe nails that kill the fungus.

Self-care treatments:

Bathe your feet at least once a day with soap and warm water. Dry thoroughly after bathing and keep your feet dry. Change socks frequently and buy socks that absorb moisture, such as cotton and wool. Expose your feet to the air for short periods of time throughout the day (do not walk barefoot, however). Wear sandals with open toes whenever possible.

Prevention:

Wear sandals or shoes when walking on moist or wet floors

Don't share shoes or personal care items such as towels

Wear socks made of absorbent materials such as cotton or wool

Change socks frequently if you perspire heavily

Choose footwear that allows for the circulation of air

Keep the floors in shared facilities clean and dry

Keep your feet clean and dry by dusting Talc Powder in shoes and hose and feet

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Achilles Tendonitis

Achilles tendonitis causes inflammation and degeneration of the achilles tendon. The achilles tendon is the large tendon located in the back of the leg that inserts into the heel. The pain caused by achilles tendonitis can develop gradually without a history of trauma. The pain can be a shooting pain, burning pain, or even an extremely piercing pain. Achilles tendonitis should not be left untreated due to the danger that the tendon can become weak and ruptured.

Achilles Tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. In some cases even prolonged periods of standing can cause symptoms. It is a common problem often experienced by athletes, particularly distance runners. Achilles Tendonitis is a difficult injury to treat in athletes due to their high level of activity and reluctance to stop or slow down their training.

Individuals who suffer from achilles tendonitis often complain that their first steps out of bed in the morning are extremely painful. Another common complaint is pain after steps are taken after long periods of sitting. This pain often lessens with activity.

Causes of Achilles Tendonitis

There are several factors that can cause achilles tendonitis. The most common cause is over-pronation. Over-pronation occurs in the walking process, when the arch collapses upon weight bearing, adding stress on the achilles tendon.

Other factors that lead to achilles tendonitis are improper shoe selection, inadequate stretching prior to engaging in athletics, a short achilles tendon, direct trauma (injury) to the tendon, and heel bone deformity.

Athletes, particularly runners, should incorporate a thorough stretching program to properly warm-up the muscles. They should decrease the distance of their walk or run, apply ice after the activity and avoid any uphill climbs. Athletes should use an orthotic device, heel cup, or heel cradle for extra support.

A heel cup or heel cradle elevates the heel to reduce stress and pressure on the achilles tendon. The device should be made with light-weight, shock absorbing materials. An orthotic device can be used to control over-pronation, support the longitudinal arch, and reduce stress on the achilles tendon.

If the problem persists, consult your Chiropodist.

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Bunions

Bunions are a very common deformity of the forefoot. A bunion is the displacement of the first metatarsal bone toward the mid-line of the body and a simultaneous displacement of the great toe away from the mid-line (and toward the smaller toes). This causes a prominence of bone on the inside (medial) margin of the forefoot and this is termed a bunion. With continued drifting of the great toe (hallux) toward the smaller toes, it may come to rest under (occasionally over) the second toe. The incidence of bunions is much higher in women than men. Bunions are hereditary and narrow toed and high-heeled shoes can accelerate the formation of a bunion.

Symptoms

Redness, swelling, or pain along the inside margin of the foot just behind the great toe

Moderate to severe discomfort at the bunion when wearing shoes, particularly if tight fitting

A painful callus may develop over the bunion

There may be a painful corn on the adjacent sides of the first and second toes.

There may be irritation caused by overlapping of the first and second toes.

There may be stiffness and discomfort in the joint between the great toe and the first metatarsal.

Skin over the bunion may break down causing an ulceration, which can become infected.

Causes

Abnormality in foot function, particularly a pronated foot. This is probably the most important and common causative factor.

Family history of bunions.

Narrow toed dress shoes and high heels may contribute to the formation of a bunion.

Genetic and neuromuscular disease resulting in muscle imbalance.

Limb length inequality can cause a bunion on the longer limb.

What You Can Do

Apply a commercial bunion pad around the bony prominence, use only non-medicated pads.

Wear shoes with a wide and deep toe box.

Avoid all high-heeled shoes.

If symptoms persist, consult your Chiropodist or physician.

What the Chiropodist may do

Apply special pads and dressings to protect the bunion from shoe pressure.

Apply various splints or digital orthotics to reposition the great toe joint.

Recommend commercially available or custom made shoes.

Prescribe functional orthotics to correct faulty foot function, and help prevent worsening of the deformity.

Recommend bunion surgery to correct the deformity.

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Calluses

Calluses are hyperkeratoses of the skin. This is a thickening of the surface layer of the skin, usually in response to pressure. Calluses usually form on the ball of the foot, the heel, and the underside of the big toe. They may, however, form over any bony prominence.

Symptoms:

A hard growth usually on the ball of the foot

Pain on weight bearing, relieved by rest

Increased discomfort in thin soled and high heeled shoes

More common in women than men

Causes

High heeled shoes

Mal-allignment of the metatarsal bones

Abnormalities of gait

Flat feet and High arched feet

Excessively long metatarsal bone

Obesity

Bony prominence

Loss (atrophy) of fat pad on the underside of the foot

Short Achilles tendon

What you can do

Avoid high heeled shoes

Keep skin moist and supple with regular application of a moisturizer

Use a pumice stone or other abrasive to reduce the thickness of the callus

Apply non-medicated pads around the callus to relieve pressure

What the Chiropodist may do

Carefully debride (pare down) the callus and any deep seated core it may have.

Apply various pads to relieve pressure

Recommend appropriate shoes

Prescribe orhtotics to correct functional problems

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Corns

Corns are hyperkeratoses of the skin and usually form on the toes. This is a thickening of the surface layer of the skin in response to pressure. As the corn thickens, the tissues under the corn are subject to increased irritation. There may be a deep seated nucleation, this is like a core where the corn is thickest and most painful. As corns become inflamed, there is pain and sometimes swelling and redness. Common places where corns form are; the top surface of the toe, between the toes and at the tip of the toe.

Symptoms

A hard growth on the skin of the toes

Pain on direct pressure against the corn

Sometimes redness and swelling around the corn, with severe discomfort

Increased discomfort in tight fitting shoes

More common in women than men

Causes

Tight fitting shoes

Deformed and crooked toes

Tight socks and stockings

Seam or stitch inside the shoe which rubs against the toe

Sometimes a shoe which is too loose, with the foot sliding forward with each step.

Prolonged walking on a downward slope

What you can do?

Avoid shoes which are to tight or too loose

Buy shoes with an extra depth toe box (the part of the shoe over the toes)

Use a pumice stone or other abrasive to reduce the thickness of the corn

Apply non-medicated pads around the corn to relieve pressure

What the Chiropodist may do?

Carefully debride (pare down) the corn and any deep seated core it may have.

Recommend appropriate shoes.

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Diabetes

Diabetes is probably the most damaging disease that a patient can encounter with regards to their feet. Diabetes comes in two basic types; type 1 and type 2. Type 1 is usually associated with juvenile diabetes and is usually a hereditary type of disease. Type 2, commonly referred to as adult onset diabetes, is usually characterized by elevated blood sugars by people who are overweight and have not attended to their diet as they should.

Diabetes can be controlled with medications, diet and exercise. But a serious condition occurs if the sugars are out of control and a lesion (sore or ulcer) develops on the plantar (bottom) of the foot. The goal and treatment of diabetics with foot ulcers is to relieve the pressure, prevent infection and ultimately ensure the patient does not lose their limb. It is important that a patient with a foot ulcer consult their Chiropodist, vascular surgeon, orthopedist or family doctor.

Many tests are employed to maintain diabetic good health, including blood tests, MRI's, x-rays, and constant supervision of the patient. Neuropathy is the number one disease that affects a diabetic that leads to loss of limb. Neuropathy is the loss of sensation, and the patient is not aware that he/she is developing sores on the bottom of his/her foot. It is the Chiropodist who usually treats these lesions. He will treat the lesions by debridement (peeling away of the ulceration), padding to relieve pressures of the ulceration, fabrication of orthotics, a diabetic shoe, antibiotic medications, foot soaks and good diabetic hygiene.

Why do I have to worry more about my feet?

People with diabetes often have trouble with their feet. Part of the problem is that the loss of feeling in your feet makes it hard for you to tell if you have a blister or sore. If little sores aren't taken care of, they can get worse and turn into ulcers (serious, deep sores). If these ulcers become infected, you may have to go to the hospital or, in very serious cases, have a foot amputated (removed). This handout will give you some tips on how to care for your feet.

How can I avoid problems with my feet?

Keep your blood sugar level as close to normal as possible. Also, follow your doctor's advice on diet, exercise and medicine. Here are some other ways to protect your feet:

Wash your feet every day with lukewarm (not hot) water and mild soap.

Dry your feet well, especially between the toes. Use a soft towel and pat gently; don't rub.

Keep the skin of your feet smooth by applying a cream or lanolin lotion, especially on the heels. If the skin is cracked, talk to your doctor about how to treat it.

Keep your feet dry by dusting them with nonmedicated powder before putting on shoes, socks or stockings.

Check your feet every day. You may need a mirror to look at the bottoms of your feet. Call your doctor at the very first sign of redness, swelling, pain that doesn't go away, or numbness or tingling in any part of your foot.

Don't treat calluses, corns or bunions without talking to your doctor first.

Cut toenails straight across to avoid ingrown toenails. It might help to soak your toenails in warm water to soften them before you cut them.

Don't let your feet get too hot or too cold.

Don't go barefoot.

If you suspect that you may have a diabetic ulcer, immediate medical attention is necessary.

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Fungus Problems

Fungal infection of toenails is a common foot health problem that many people do not recognize. Fungi are simple parasitic plant organisms, such as molds and mildew, that do not require sunlight for growth. They easily attack the nail, thriving off keratin, the nail's protein substance.

Fungal nail infection is an infection underneath the nail that can also penetrate the nail. If it is ignored, it could impair one's ability to work or even walk because it is frequently accompanied by thickening of the nails, which then cannot be easily trimmed, and may cause pain while wearing shoes.

Symptoms:

Change in color (yellow or brown)

Nail gets thicker

Bad odor

Debris collects beneath the nail

White marks on the nail

This infection is capable of spreading to other toenails, the skin or even the fingernails.

Toenails are especially vulnerable around damp areas where people are likely to be walking barefoot - swimming pools, locker rooms, and showers. Injury to the nail bed may make it more susceptible to all types of infection, including fungal infection. Those who suffer chronic diseases, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails.

There are a variety of products that can be used on the foot and toe nails that kill the tinea pedis fungus.

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Gout

Gout (hyperuricemia or elevated uric acid) is a systematic disorder that affects the big toe joint. Gout is the end result of a build-up of uric acid in the blood. The uric acid crystallizes and settles in the joints in the body, most often in the big-toe joint. When it does so, it produces an excruciating pain. The onset of an attack of gout can be sudden and vicious. It is not uncommon for the victim to be awakened by this excruciating pain in the middle of the night. (Gout is often confused with Osteoarthritis, a condition that is characterized by a much slower onset of pain, and seems worse after a person has been walking or running.)

Gout is generally thought to be a hereditary disease, but there are many causes: increased purine intake, sudden weight loss due to dieting, and/or diuretics can cause elevated uric acid and mimic the symptoms of gout. In rare cases, leukemia's and/or blood dyscrasias can cause elevated uric acid. Gout can be a serious disease and needs medical i ntervention, generally by an Internist.

If gout is not treated properly, it will eventually cause permanent changes in the big-toe joint. It is important to seek medical attention if you suspect the existence of gout. It is encouraging to note that drugs can be prescribed that will control the uric-acid level in the blood. You need not suffer from gout in this day and age.

Diet:

Common foods that cause gout, such as alcohol, red meat, lobster, shell fish, etc., should be eliminated from the diet. Cranberry juice has been used as a uricosuric (a substance which helps to eliminate uric acid through the urine).

If the problem persists, consult your Chiropodist.

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Heel Pain

Heel pain is a common condition in which weight bearing on the heel causes extreme discomfort.

Causes of Heel Pain:

There are two different categories of heel pain. The first is caused by over-use repetitive stress which refers to a soreness resulting from too much impact on a specific area of the foot. This condition, often referred to as "heel pain syndrome," can be caused by shoes with heels that are too low, a thinned out fat pad in the heel area, or from a sudden increase in activity.

Plantar fasciitis, a very common diagnosis of heel pain, is usually caused from a biomechancial problem, such as over-pronation (flat feet). The plantar fascia is a broad band of fibrous tissue that runs along the bottom surface of the foot, from the heel through the midfoot and into the forefoot. Over-pronation can cause the plantar fascia to be excessively stretched and inflamed, resulting in pain in the heel and arch areas of the foot. Often the pain will be most intense first thing in the morning or after a prolonged period of rest. The pain will gradually subside as the day progresses.

To properly treat heel pain, you must absorb shock, provide cushioning and elevate the heel to transfer pressure. This can be accomplished with a heel cup, heel cradle, or an orthotic designed with materials that will absorb shock and shear forces.

When the condition is pronation related (usually plantar fasciitis), an orthotic with medial posting and good arch support will control the pronation and prevent the inflammation of the plantar fascia.

Footwear selection is also an important criteria when treating heel pain. Shoes with a firm heel counter, good arch support, and appropriate heel height are the ideal choice.

If the problem persists, consult your Chiropodist.

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Heel Spurs

The heel bone is the largest bone in the foot and absorbs the most amounts of shock and pressure. A heel spur develops as an abnormal growth of the heel bone. Calcium deposits form when the plantar fascia pulls away from the heel area, causing a bony protrusion, or heel spur to develop. The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Heel spurs can cause extreme pain in the rearfoot, especially w hile standing or walking.

Heel spurs develop as an abnormal growth in the heel bone due to calcium deposits that form when the plantar fascia pulls away from the heel. This stretching of the plantar fascia is usually the result of over-pronation (flat feet), but people with unusually high arches (pes cavus) can also develop heel spurs. Women have a significantly higher incidence of heel spurs due to the types of footwear often worn on a regular basis.

The key for the proper treatment of heel spurs is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rearfoot posting and longitudinal arch support is an effective device to reduce the over-pronation, and allow the condition to heal.

Other common treatments include stretching exercises, losing weight, wearing shoes that have a cushioned heel that absorbs shock, and elevating the heel with the use of a heel cradle, heel cup, or orthotic. Heel cradles and heel cups provide extra comfort and cushion to the heel, and reduce the amount of shock and shear forces experienced from everyday activities.

If the problem persists, consult your Chiropodist.

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Ingrown Toenails

Ingrown toenails can be very painful. Ingrown toenails are caused by impingement of the skin along the margins of the nail by the nail plate. Some ingrown toenails are chronic, with repeated episodes of pain and infection. Pain can be present without infection, and occasionally infection is present without pain. The usual signs of infection include; redness, swelling, increased warmth, and pain.

Symptoms

Pain along the margin(s) of the toenail

Aggravated by wearing shoes, particularly those with narrow toes.

May be sensitive to any pressure, even the weight of the bed clothes.

There may be signs of infection.

There may be drainage of pus, or a watery discharge tinged with blood.

Causes

Improper trimming of toenails

Tight fitting shoes which compress the toes together

Hose or socks that are too tight

Abnormally shaped nail plate

Other toenail deformities (eg. excessively thick nail plate)

Trauma to the nail plate or toe

What you can do

Cut toenails straight across, and leave slightly longer then the end of the toe

Avoid tight fitting foot wear

If discomfort develops try soaking the foot in a basin of warm water two or three times a day.

An infected ingrown nail requires prompt professional attention.

What the Chiropodist may do

Trim a small spicule of nail to relieve the pressure. Callus (dead skin) may have accumulated in the nail groove, which needs to be removed. Routine ingrown toenail care may need to be done periodically.

Elevate the end of the nail plate to prevent impingement on the soft tissues

Prescribe special soaks and/or antibiotics

Surgically correct a chronic ingrown toenail

Completely remove a deformed toenail so it will not grow back.

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Morton's Neuroma

Morton's Neuroma is a common foot problem associated with pain, swelling and/or an inflammation of a nerve, usually at the ball-of-the-foot between the 3rd and 4th toes. Symptoms of this condition include sharp pain, burning, and even a lack of feeling in the affected area. Morton's Neuroma may also cause numbness, tingling, or cramping in the forefoot.

Morton's Neuroma is a foot condition caused from an abnormal function of the foot that leads to bones squeezing a nerve usually between the 3rd and 4th metatarsal heads. Symptoms of Morton's Neuroma often occur during or after you have been placing significant pressure on the forefoot area, while walking, standing, jumping, or sprinting. This condition can also be caused by footwear selection. Footwear with pointed toes and/or high heels can often lead to a neuroma. Constricting shoes can pinch the nerve between the toes, causing discomfort and extreme pain.

The first step in treating Morton's Neuroma is to select proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating and relieving the pain. The next step in treatment is to use an orthotic designed with a metatarsal pad. This pad is located behind the ball-of-the-foot to unload pressure, and relieve the pain caused by the neuroma.

If problem persists, consult your Chiropodist.

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Plantar Fasciitis

Plantar Fasciitis is an inflammation caused by excessive stretching of the plantar fascia. The plantar fascia is a broad band of fibrous tissue that runs along the bottom surface of the foot, attaching at the bottom of the heel bone and extending to the forefoot. When the plantar fascia is excessively stretched, this can cause plantar fasciitis, which can also lead to heel pain, arch pain, and heel spurs.

Plantar Fasciitis often leads to heel pain, heel spurs, and/or arch pain. The excessive stretching of the plantar fascia that leads to the inflammation and discomfort can be caused by the following:

Over-pronation (flat feet) which results in the arch collapsing upon weight bearing

A foot with an unusually high arch

A sudden increase in physical activity

Excessive weight on the foot, usually attributed to obesity or pregnancy

Improperly fitting footwear

Over-pronation (flat feet) is the leading cause of plantar faciitis. Over-pronation occurs in the walking process, when a person's arch collapses upon weight bearing, causing the plantar fascia to be stretched away from the heel bone.

With Plantar Fasciitis, the bottom of your foot usually hurts near the inside of the foot where the heel and arch meet. The pain is often acute either first thing in the morning or after a long rest, because while resting the plantar fascia contracts back to its original shape. As the day progresses and the plantar fascia continues to be stretched, the pain often subsides.

The key for the proper treatment of plantar fasciitis is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rearfoot posting and longitudinal arch support is an effective device to reduce the over-pronation and allow the condition to heel.

If you have usually high arches, which can also lead to plantar fasciitis, cushion the heel, absorb shock and wear proper footwear that will accommodate and comfort the foot.

Other common treatments include stretching exercises, plantar fasciitis night splints, wearing shoes that have a cushioned heel to absorb shock, and elevating the heel with the use of a heel cradle or heel cup. Heel cradles, heel cups and orthotics provide extra comfort, cushion the heel, and reduce the amount of shock and shear forces placed during everyday activities.

If the problem persists, consult your Chiropodist.

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Sweaty Feet / Foot Odor

Sweaty feet (hyperhydrosis) and smelly feet (bromohydrosis) are two very common, annoying conditions of the feet. While some cases of excessive smelling or sweating of the feet are systemic (throughout the whole body) in nature, such as anemia (low blood count) or hyperthyroidism (overactive thyroid), these conditions are usually of a local cause.

The wearing of shoes that have synthetic materials, which most shoes have, especially tennis shoes, and socks that are of man made fabric are contributing factors of the production of excessive perspiration and the bacteria growth that causes this condition. These two conditions set up a condition called athletes foot (tinea pedis).

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