Common Foot Problems

We often don't realize that even a small corn, callus, thick toenail, etc., can cause such  discomfort that it can interfere with our everyday lives. In many cases, a nursing foot care  professional can quickly treat the most common foot problems.

CORNS

Corns like calluses develop from an accumulation of dead skin cells on foot, forming  thick, hardened areas. They contain a cone-shaped core with a point that can press on a nerve below, causing pain. Corns are a widespread ailment that usually forms on the  tops, sides and tips of the toes. Corns can become inflamed due to constant friction and pressure from footwear. Corns that form between the toes are sometimes referred to as soft corns.

Cause

Some of the common causes of corn development are tight-fitting footwear, high heeled footwear, tight-fitting stockings and socks, deformed toes, or the foot sliding forward in a shoe that fits too loosely. Soft corns result from bony prominences and are located between the toes. They become soft due to  perspiration in the forefoot area. Complications that can arise from corns include bursitis and the development of an ulcer.

Treatment and Prevention

There are simple ways to prevent and treat the corns. You should wear properly  fitted footwear with extra room in the toe box (toe area). Avoid shoes that are too  tight or too loose. Use an orthotic or shoe insert made with materials that will  absorb shock and shear forces. Also, avoid tight socks and stockings to provide a  healthier environment for the foot. Try to steer away from corn removing solutions  and medicated pads. These solutions can sometimes increase irritation and discomfort. People with diabetes and all other individuals with poor circulation  should never use chemical agents to remove corns.

CLAW TOE

A claw toe is a toe contracted at the PIP and DIP joints (middle and end joints in the toe)  and can lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe's joints to curl downwards. Claw toes may occur in any toe, except the big  toe. There is often discomfort at the top part of the toe that is rubbing against the shoe and at the end of the toe pressed against the bottom of the shoe. Claw toes are  classified based on the mobility of the toe joints. There are two types: flexible and rigid.  In a flexible claw toe, the joint can move. This type of claw toe can be straightened  manually. A rigid claw toe does not have that same ability to move. Movement is minimal and can be extremely painful. This sometimes causes foot movement to become restricted, leading to extra stress at the ball-of-the-foot and possibly causing pain and the development of corns and calluses.

Cause

Claw toes result from a muscle imbalance, which causes the ligaments and  tendons to become unnaturally tight. This results in the joints curling downwards. Arthritis can also lead to many different forefoot deformities, including claw toes.

Treatment and Prevention

Changing the type of footwear worn is a crucial step in the treatment of claw  toes. When choosing a shoe, make sure the toe box (toe area) is high and broad  and can accommodate the claw toes. A shoe with a high, broad toe box will  provide enough room in the forefoot area to less friction against the toes. Other conservative treatments include using forefoot products designed to relieve claw  toes, such as toe crests and hammer toe splints. These devices will help hold  down the claw toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe  while providing comfort and lubrication.

CALLUS

The formation of calluses is caused by an accumulation of dead skin cells that harden  and thicken over the foot's area. This callus formation is the body's defence mechanism  to protect the foot against excessive pressure and friction. Calluses are generally found  on the ball-of-the-foot, the heel, and the inside of the big toe. Some calluses have a deep-seated core known as a nucleation. This particular type of callus can be excruciating to pressure. This condition is often referred to as Intractable Plantar Keratosis.

Cause

Calluses develop because of excessive pressure at a specific area of the foot.  Some common causes of callus formation are high-heeled dress shoes, too small shoes, obesity, abnormalities in the gait cycle (walking motion), flat feet, high arched feet, bony prominences, and the loss of the fat pad on the bottom of the foot.

Treatment and Prevention

Many people try to alleviate the pain caused by calluses by cutting or trimming  them with a razor blade or knife. This is not the way to properly treat calluses.  This is very dangerous and can worsen the condition resulting in unnecessary injuries. People with diabetes especially should never try this type of treatment.  To relieve the excessive pressure that leads to callus formation, weight should be  redistributed equally using an orthotic. An effective orthotic transfers pressure  away from the "hot spots" or high pressured areas to allow the callus to heal. The  orthotic should be made with materials that absorb shock and shear (friction)  forces. Women should also steer away from wearing high-heeled shoes. As  always, surgery should be the very last resort.

BUNIONS

Bunions, referred to in the medical community as Hallux Valgus, are among the most common forefoot problems. A bunion is a prominent bump on the inside of the foot around the big toe joint. This bump is a bone protruding towards the inside of the foot. With the big toe's continued movement towards the smaller toes, it is common to find the  big toe resting under or over the second toe. This causes a common forefoot condition called overlapping toes. Some of the symptoms of bunions include inflammation, swelling, and soreness on the big toe's side surface. The discomfort commonly causes a patient to walk improperly.  

Another type of bunion that some individuals experience is called a Tailor's Bunion, also known as a Bunionette. This forms on the outside of the foot towards the joint at the little toe. It is a smaller bump that forms due to the little toe moving inwards, towards the big toe.

Cause

Bunions are a common problem experienced mostly by women. The deformity  can develop from an abnormality in foot function or arthritis but is more  commonly caused by wearing improper fitting footwear. Tight, narrow dress  shoes with a constrictive toe box (toe area) can cause the foot to begin to take  the shoe’s shape, leading to a bunion formation. Women who have bunions  usually wear dress shoes that are too small for their feet. Their toes squeeze  together in their shoes, causing the first metatarsal bone to protrude on the side  of the foot. 

Men and women need to realize that wearing dress shoes and boots, which are  tapered in the toe area, can cause the bunion to worsen to where surgery is  necessary.

Treatment and Prevention

In the early stages of forming a bunion, soaking feet in warm water can provide  temporary relief. The best way to alleviate the pain associated with bunions is to  wear properly fitting shoes. Shoes designed with a high, wide toe box (toe area)  are recommended for people suffering from forefoot disorders, such as bunions.  

Shoes with rocker soles will unload pressure to the bunion area. Orthotics are  also recommended for this condition to provide extra comfort, support, and  protection.  

Other conservative treatments include using forefoot products to accommodate  and relieve bunions, such as bunion shields, bunion night splints, and bunion  bandages. These conservative treatments can limit the bunion formation  progression, relieve pain and provide a healthy environment for the foot.

INGROWN NAILS

Known to foot care providers as onychocryptosis, ingrown toenails are a common, painful condition that occurs when the skin on one or both sides of a nail grows over the  edges of the nail itself grows into the skin. This condition is usually excruciating and can  be associated with infection of the toe. Some ingrown toenails are chronic, with repeated episodes of pain and infection. Irritation, redness, an uncomfortable sensation of  warmth, and swelling can result from an ingrown toenail.

Cause

Ingrown toenails develop for many reasons. In some cases, the condition is  congenital, such as toenails that are too large. People whose toes curl, either  congenitally or from diseases like arthritis, are prone to ingrown toenails. Often  trauma, like stubbing a toe or having a toe stepped on, can cause a piece of the  nail to be jammed into the skin. Repeated trauma, such as the pounding to which  runners typically subject their feet, also can cause ingrown nails.  

The most common cause is cutting your toenails incorrectly, causing them to re grow into the skin. Tight hosiery or shoes with narrow toe boxes only make  matters worse. If the skin is red, painful or swollen on the sides of the nail, an  infection may be present. This occurs because the ingrown nail is often in a  warm, moist and bacteria-rich environment. When the nail penetrates the skin, it  provides a convenient entry for germs that can cause infection. Untreated, the  nail can go under the skin, causing a more severe infection. In either case, the  infection needs to be cured with sterile instruments and antibiotics.

Treatment and Prevention

Ingrown toenails should be treated by a foot care professional as soon as they  are recognized.  

If excessive inflammation, swelling, pain or discharge is present, the toenail  probably is infected and should be treated by a physician. A podiatrist can trim or  remove the infected nail with a minor in-office surgical procedure. They can remove the offending portion of the nail or overgrown skin with a scalpel and treat the infection. Unless the problem is congenital, the best way to prevent  ingrown toenails is to protect the feet from trauma and wear shoes with adequate  room for the toes.  

Cutting toenails correctly goes a long way toward the prevention of ingrown  toenails. Using a safety nail clipper, cut the nails straight across so that the nail  corner is visible. If you cut the nail too short, you invite the nail corner to grow  into the skin. When the edge of the nail starts to grow in, it is the natural  tendency to cut down at an angle at the nail edge to relieve the pain. This does relieve the pain temporarily, but it can also start a downward spiral, training the  nail to become more ingrown.

FUNGUS

Toenail fungus, also known as Onychomycosis, affects about half of Canadians by the  age of 70. It is relatively rare in children, but the incidence increases with age. Fungus  infections occur when microscopic fungi gain entry through a small trauma in the nail, then grow and spread in the warm, moist environment inside the patient's socks and  shoes. Symptoms of toenail fungus, which several types of fungi can cause, include swelling, yellowing, thickening or crumbling of the nail, streaks or spots down the side of  the nail, and even complete loss of the nail. Toenail colour can vary from brown or yellow  to white with this condition. Fungal infections can affect the fingernails and the toenails, but toenail fungus is more difficult to treat because toenails grow more slowly. It occurs  most often on the big toe.

Cause

Toenail fungus can be picked up in damp areas such as public gyms, shower  stalls or swimming pools and can be passed among family members. Athletes  and people who wear tight-fitting shoes or tight hosiery that cause trauma to the  toes or keep the feet from drying out are at higher risk. The condition can also  spread from one toe to another or other parts of the body. Other risk factors  include:  

• Abnormal PH level of the skin. 
• Not drying off the feet thoroughly after bathing or exercise. 
• A compromised immune system in someone exposed to a fungus.

People with diabetes have an increased risk of contracting a toenail fungus  because their immune system is compromised. They should have their nails cut  and debrided by a podiatrist.

Treatment and Prevention

Because it is difficult to treat or eradicate toenail fungus, it is a good idea to try to  prevent it. It helps to wear protective shoes or sandals in public showers, pool  areas and gyms, and avoid borrowing someone else's shoes or sharing socks or  towels with someone who has toenail fungus. An orthotic device can add  cushioning and control over-pronation, support the longitudinal arch, and reduce  stress on the lower leg muscles. Wash your feet regularly, and dry them  thoroughly when they get wet. Wearing nail polish on the toes is not advised  because it can seal in fungus and allow it to grow. Keep toenails trimmed, and be  sure to disinfect any pedicure tools before using them. If you do develop toenail  fungus, see your foot care professional or doctor. Medicated nail polish might be  prescribed for a localized infection, but a severe infection will likely be treated  with a prescription oral antifungal medication. These medications can have side  effects, so be sure to work closely with your doctor on your treatment plan. Only  in severe cases will surgical removal of the nail be recommended.

HAMMER TOE

A hammertoe is a toe that is contracted at the PIP joint (middle joint in the toe),  potentially leading to severe pressure and pain. Ligaments and tendons that have  tightened cause the toe's joints to curl downwards. Hammertoes may occur in any toe except the big toe. There is often discomfort at the top part of the toe due to rubbing  against the shoe. Hammertoes are classified based on the mobility of the toe joints. There are two types - flexible and rigid. In a flexible hammertoe, the joint can move. This  type of hammertoe can be straightened manually. A rigid hammer toe does not have the  same ability to move. Movement is minimal and can be extremely painful. This sometimes causes foot movement to become restricted, leading to extra stress at the  ball-of-the-foot and possibly causing pain and the development of corns and calluses.

Cause

Hammertoes result from a muscle imbalance, which causes the ligaments and  tendons to become unnaturally tight. This results in the joint curling downward.  Arthritis can also lead to many different forefoot deformities, including  hammertoes.

Treatment and Prevention

Changing the type of footwear worn is a crucial step in the treatment of  hammertoes. When choosing a shoe, make sure the toe box (toe area) is high and broad and can accommodate the hammertoes. A shoe with a high, broad toe  box will provide enough room in the forefoot area to permit less friction against  the toes. Other conservative treatments include using forefoot products designed  to relieve hammer toes, such as hammertoe crests and hammer toe splints. These devices will help hold down the hammer toe and provide relief to the forefoot. Gel toe shields and gel toe caps are also recommended to eliminate friction between the shoe and the toe while providing comfort and lubrication. 

HEEL FISSURES

Heel fissures, also known as cracked heels, can be a simple cosmetic problem and a nuisance and lead to serious medical problems. Heel fissures occur when the skin on the bottom, the heel's outer edge becomes hard, dry and flaky, sometimes causing deep fissures that can be painful or bleed.

Cause

Heel fissures can affect anyone, but risk factors include:  

• Living in a dry climate. 
• Obesity. 
• Consistently walking barefoot or wearing sandals or open-backed shoes.
• Inactive sweat glands. 

Like many foot conditions, heel fissures can become more dangerous if they go  untreated and become deep or infected. This is especially dangerous for people  with diabetes or compromised immune systems.

Treatment and Prevention

Moisturizing the feet regularly can prevent heel fissures. Once they occur, you  can use a pumice stone or foot file every other day to gently decrease the thick  and flaky layer of skin. Avoid going barefoot or wearing open-backed shoes,  sandals or shoes with thin soles. Shoes with substantial shock absorption can  help to improve the condition. Moisturizing the feet at least twice a day and  wearing socks over moisturizer while sleeping can also help.