Treatments

A fungal infection of the nail is referred to as onychomycosis in medical terms. It generally only affects toenails. Fungal bacteria can enter the nail at the edges and gradually make its way towards the middle of the nail. It is usual to observe a yellowish/brownish discolouration of the nail and the texture of the nail will change to a brittle state, possibly leading to segments of the nail falling away. The skin surrounding the nail can also become swollen and painful.

Antifungal medicaments can be obtained and these can be topically administered to the toenail, or taken as a tablet. A nail softening cream can be used to bring back a suppleness to the nail in order for the infection to be disposed of by scraping it away. For more extreme circumstances, the nail will need to be removed under a local anaesthetic. Wearing clean socks, washing/drying feet everyday and wearing flip flops in communal showering and changing areas can help to reduce fungal nail infections.

Thickened nails usually occur on the big toe and for a number of reasons; one could be from a constant or past trauma, another could be from repetitive activity that bares pressure on the nail. Neglect due to immobility, or a person’s age can also be a reason for thickened nails. Repetitive tension on a nail can cause the nail to become loosened and separated from the nail bed. Cutting a thickened nail can be painful and hard to carry out. A foot health practitioner can carefully cut thickened nails using special nippers and reduce the thickness using a Burrs drill. The medical term for thickened nail is Onychauxis. Regular maintenance of the thickened nail will help to reduce any discomfort or pain and any debris under the nail that could cause infection. A GP referral would be needed in order to ascertain the exact cause of nail thickening, especially if symptoms become worse.

Ram’s Horn (medically referred to as onychogryphosis) is not just an extreme thickening of the nails but also a curvature of the nail, starting at the nail’s edge and curving over the apex of the toe or finger and sometimes wrapping around it. The causes can range from repetitive trauma to neglect due to possible immobility. With regular maintenance from a foot health practitioner, the ram’s horn nail can be managed. Removal would require the whole nail to be taken away and the nail matrix (where the nail originates) to be permanently deactivated to prevent regrowth.

Athlete’s foot is also known as Tinea Pedis. It is a fungal infection that develops between the small toes of the feet. Fungal germs can be found anywhere on the skin and usually they cause no harm. However, the warm, moist and air free conditions between the small toes are perfect for these fungal germs to multiply, invade the skin and cause infections. Symptoms include rashes that become itchy and causes the skin to flake, this can progress to splits (fissures) in the skin between the toes that can become painful. Athlete’s foot is very common, especially in feet that experience a lot of sweat through physical exertion and/or shoes and socks that promote sweating. It is usually easy to treat with the use of a topical antifungal treatment.

The medical term for an ingrown toenail is referred to as onychocryptosis. It occurs when the nail of the big toe starts to grow into the skin that surrounds it (known as the sulci). Sometimes physical trauma such as incorrect toenail cutting can leave behind a small spike of nail that penetrates the surrounding skin, causing inflammation and possible infection. On observation, the skin will be swollen, red and extremely painful to the touch, especially if pressure is applied to the affected area. There could also be an abundance of skin cells, this is known as hyper-granulation; a forming of safety tissue around a wound. If the skin is infected, pus could also be present. Another cause of ingrown toenails is when the skin along the side of the nail has engulfed the nail plate and excess friction from walking or running in tight fitting shoes has caused irritation. The thickening and splitting of the nail from a fungal infection (known medically as onychomycosis) can also contribute to the development of an ingrown toenail.

To manage an ingrown toenail on a daily basis, keep feet clean, wear clean socks everyday along with comfortable shoes. Treatment can involve precision nail clipping by a foot health professional, or for more serious cases a partial nail avulsion (where part of the toenail is removed) would need to be carried out. For extreme cases a total nail avulsion (where the whole toenail is removed) would be needed. In the case of infection, a course in antibiotics would be administered along with the drainage of pus.

Corns are an area of callused (hardened) skin that can occur anywhere on the toes and the soles of the feet where excess friction occurs. Due to the corn’s deep mass of cornified cells, known as the nucleus (made up of hyperkeratotic cells), they can cause a lot of pain when the pressure of standing up and walking is applied. This is due to the nucleus (a hard, inverted cone-like mass of cells at the centre of the corn) pushing into the underlying skin. They can be healed very easily through having the overlying callused skin and nucleus removed with the gentle painless use of a scalpe

Callus is an area of harden skin that forms primarily over the balls of the feet and the heels, as these are weight baring areas of the feet. They are usually much bigger than corns and have no defining outline. They can be yellowish in colour and generally they are not sensitive to the touch. The causing of a callus is the rubbing of the skin against something, usually an ill-fitting shoe. Using an appropriate insole can reduce the formation of a callus and they can also be removed with the gentle, painless use of a scalpel.

A verruca is also referred to as a plantar wart. These warts develop on the soles of the feet and are highly contagious. They are caused by a strain of the human papilloma virus (HPV) that invades the skin. The virus can be picked up in environments such as swimming pools and communal changing room floors, they commonly affect children and teenagers. Sometimes it can take weeks or months for a verruca to form after the initial contracting of HPV. Their appearance is that of a small black dot, or for mosaic verrucae; a cluster of small back dots, these dots are blocked blood vessels underneath the hardened skin. They can be incredibly painful due to the weight of the body pushing the verruca into the skin on the soles of the foot and the skin on and around the toes. Verrucae can take a long time to heal and can sometimes heal without any intervention, however due to the discomfort and pain aspect, they normally require treatment. These treatments can include the paring away of the hardened skin surrounding the black dots with the gentle use of a scalpel. Along with regular reduction of the hardened skin, the administering of a medicament such as salicylic acid will aid gradual healing.

Bunions, also known as Hallux Abducto Valgus, are a bulbous deformity of the joint at the base of the big toe. They are very prominent and as a result of this deformity the big toe’s position alters to point inwards towards the toes. The causes of bunions can include an inherited predisposition to the condition, also wearing shoes with raised heels and a narrow toe box can be a cause. Due to the location of the deformity (on the big toe joint), where the weight of the body is supported during walking, bunions can become incredibly painful. They are also vulnerable to significant amounts of friction when walking, so callusing can occur on a bunion too. They are surprisingly common and can be managed through the administering of bunion pads, wearing appropriate footwear such as flat shoes with soft soles and when painful, an analgesic can be taken. Bunions can be corrected with surgery.

This is the breaking apart or splitting of hardened, callused skin on the heel of the foot due to pressures such as standing and walking being applied. The hardened skin loses its elasticity and causes splits (fissures) to occur. These splits can become painful as they expose deeper, softer and more tender skin. As a result, bleeding can sometimes occur which could also lead to infection. The worst of the hardened cracked skin can be removed using a scalpel, followed by a nail file to reduce the remaining hardness even further. The daily use of either an oil-based moisturiser or a heel balm can greatly reduce cracked heels.