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Athlete's Foot
Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes.
The fungus most commonly attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth.
The warmth and dampness of areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi. Because the infection was common among athletes who used these facilities frequently, the term "athlete's foot" became popular.
Not all fungus conditions are athlete's foot. Other conditions, such as disturbances of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete's foot.
Symptoms
The signs of athlete's foot, singly or combined, are dry skin, itching, scaling, inflammation, and blisters. Blisters often lead to cracking of the skin. When blisters break, small raw areas of tissue are exposed, causing pain and swelling. Itching and burning may increase as the infection spreads.
Athlete's foot may spread to the soles of the feet and to the toenails. It can be spread to other parts of the body, notably the groin and underarms, by those who scratch the infection and then touch themselves elsewhere. The organisms causing athlete's foot may persist for long periods. Consequently, the infection may be spread by contaminated bed sheets or clothing to other parts of the body.
Prevention
It is not easy to prevent athlete's foot because it is usually contracted in dressing rooms, showers, and swimming pool locker rooms where bare feet come in contact with the fungus. However, you can do much to prevent infection by practicing good foot hygiene. Daily washing of the feet with soap and water; drying carefully, especially between the toes; and changing shoes and hose regularly to decrease moisture, help prevent the fungus from infecting the feet. Also helpful is daily use of a quality foot powder.
Foot Odor and Smelly Feet
The feet and hands contain more sweat glands than any other part of the body (about 3,000 glands per square inch). Feet smell for two reasons: you wear shoes and your feet sweat. The interaction between your perspiration and the bacteria that thrive in your shoes and socks generates the odor. Any attempt to reduce foot odor has to address both your sweating and your footwear.
Smelly feet can also be caused by an inherited condition called hyperhidrosis, or excessive sweating, which primarily affects males. Stress, some medications, fluid intake and hormonal changes also can increase the amount of perspiration your body produces.
Ingrown Nails
Ingrown nails are nails whose corners or sides dig painfully into the skin, often causing infection. They are frequently caused by improper nail trimming, but also by shoe pressure, injury, fungus infection, heredity, and poor foot structure.
Toenails should be trimmed straight across, slightly longer than the end of the toe, with toenail clippers.
If they become painful or infected, contact our office. We may remove the ingrown portion of the nail and if the condition reoccurs frequently, may permanently remove the nail.
Bunion Prevention
Because bunions develop slowly, taking care of your feet during childhood and early adulthood can pay off later in life. Keep track of the shape of your feet as they develop over time, especially if foot problems run in your family.
Exercising your feet can strengthen them. Learn to pick up small objects with your toes. Wear shoes that fit properly and that do not cramp or pinch your toes. Women should avoid shoes with high heels or pointed toes.
Corns and Calluses
Corns and calluses are protective layers of compacted, dead skin cells. They are caused by repeated friction from skin rubbing against bony areas or against an irregularity in a shoe. Corns ordinarily form on the toes and calluses on the soles of the feet. The friction and pressure can burn or otherwise be painful and may be relieved by moleskin or padding on the affected areas.
Never cut corns or calluses with any instrument, and never apply home remedies, except under a podiatrist`s instructions.
Fungal Nails
Since fungal nails are usually more resistant and more difficult to treat than Athlete's foot, topical or oral antifungal medications may be prescribed. Permanent nail removal is another possible form of treatment for fungal nails.
After a fungal nail infection has cleared up, you can take steps to prevent the infection from coming back.
Keeping the fungus under control will help prevent a fungal infection of the skin from reinfecting the nail. Before bed, thoroughly wash and dry your feet, and apply a non-prescription anti-fungal cream to the entire foot from the ankle down. Use the cream every night, then gradually apply it less often. Keep your feet dry. Dry feet are less likely to become infected. Apply powder to your dry feet after you take a shower or bath.
Diabetic Foot Care
Symptoms.
People with diabetes can have several problems ranging from poor healing, decreased immune system, poor circulation to loss of feeling. Diabetics often get infections and complications which may lead to amputation. If you experience any burning, excessive pain, numbness, or tingling then inform your doctor. You should also inform your doctor of any arch or calf cramps or pain.
Maintain and Regulate Blood Sugars.
It is very important diabetics monitor their daily blood sugar levels. If your levels are fluctuating or staying high then keep a record of levels, time of day of meals, and medications to review with your diabetes doctor. Regulate your blood sugar by proper diet and exercising. Talk to your doctors about diet, weight, and exercising programs.
Lose weight.
People with diabetes are commonly overweight, which nearly doubles the risk of complications. Ask your doctor about exercise and diet programs which will help you lose and control your weight.
Exercise.
Exercising will help improve your blood sugar levels, reduce and control weight, improve circulation, and condition your feet. Walking is one of the best all-around exercises for the diabetic patient. Walking at minimum for 20 minutes is beneficial. Ask your doctor about other stretching exercises or alternative exercises if you are unable to walk or need assistance. Be sure to wear appropriate shoes when exercising. Ask your podiatric physician what’s best for you.
Stop smoking.
Diabetics are already at risk for poor circulation. Cigarette smoking accelerates blood circulation damage by affecting the blood and vessels at an increased rate of 3-4 times. If you currently do smoke you need to quit smoking. Talk to your primary care doctor about different options to quit smoking.
Inspect feet and toes daily.
Check your feet every day. If you are unable to see the bottom of your feet, then put your foot on a chair or stand and use a mirror with a long handle. Look for openings in the skin, cuts, discoloration including redness, bruises, sores, swelling, or changes. Remember to look at the toenails and surrounding area for any changes such as discoloration or drainage. Call your doctor immediately if you notice any changes.
Wash feet daily.
You may shower and take daily baths. Clean your feet everyday with soap and water. Diabetics can lose feeling in their feet which prevents you from distinguishing water temperatures. Do not use your foot to check water temperatures. Use a thermometer check water temperatures before stepping into the shower or bath. If you have good feeling in your hands then you can use your hands. Do not soak your feet unless you are advised by your doctor.
Moisturize your feet.
Use a good moisturizing cream daily but avoid excessive amounts between the toes. Rub thoroughly between toes.
Do Not Go Barefoot.
Diabetics tend to lose feeling as well as joint perception and accommodation on different terrain. It is recommended not to walk barefoot. This will protect your joints and bones and help prevent wounds and infection. You should wear shoes or slippers at all times even in the house. Wear comfortable well fitted shoes which do rub on your feet and provide adequate cushioning for protection. Before wearing any shoes or slippers look and check the inside for any objects.
Be properly measured and fitted every time you buy new shoes.
It is very important to have well fitted shoes to prevent any rubbing or pressure on your feet. Diabetics often suffer problems from poor fitted shoes. Talk to your doctor about the proper shoe for your feet and needs. Have your feet measured each time you buy shoes. When purchasing shoes always consider the length, width, shape, depth, and insole or cushioning. You may require additional inserts. Talk to your doctor about what is the best shoe for your needs.
Cut toenails only as directed.
Only cut nails when instructed or advised by your podiatrist. Do not cut into the corners or too far back where the nail is attached. Toenails need to be cut to the shape of the nail. If you have any problems call your podiatrist.
See your podiatric physician.
Regular check ups by your podiatric physician is very important to monitor your circulation and sensation status. Your podiatric physician will also check for any wounds or infection. Your podiatric physician will determine how often you need to be checked based on the health of your feet. Patients may be checked annually, six months, 3 months or more frequently if having treatment or monitoring for a specific condition.
Burning Feet
Burning feet are a common complaint among many groups of people, most commonly those over 50 years of age and in diabetics. There are many causes. Heavy alcohol use may lead to the condition. Neuropathy and loss of sensation often are contributors as well. Other causes include thyroid dysfunction and gastric restriction in obesity. Some infectious diseases, such as leishmaniasis, a rarely reported neurologic change secondary to a bacteria, also may cause burning feet.
Treatment
Treatments vary, depending on the cause of the burning foot syndrome. Diagnostic tests often are performed before a diagnosis is made.
Warts
Warts are one of several soft tissue conditions of the foot that can be quite painful. They are caused by a virus, which generally invades the skin through small or invisible cuts and abrasions. They can appear anywhere on the skin, but technically only those on the sole are properly called plantar warts.
Children, especially teenagers, tend to be more susceptible to warts than adults; some people seem to be immune.
Identification Problems
Most warts are harmless, even though they may be painful. They are often mistaken for corns or calluses—which are layers of dead skin that build up to protect an area which is being continuously irritated. The wart, however, is a viral infection.
It is also possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart. It is wise to consult a podiatric physician when any suspicious growth or eruption is detected on the skin of the foot in order to ensure a correct diagnosis.
Plantar warts tend to be hard and flat, with a rough surface and well-defined boundaries; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are often gray or brown (but the color may vary), with a center that appears as one or more pinpoints of black. It is important to note that warts can be very resistant to treatment and have a tendency to reoccur.
Source of the Virus
The plantar wart is often contracted by walking barefoot on dirty surfaces or littered ground where the virus is lurking. The causative virus thrives in warm, moist environments, making infection a common occurrence in communal bathing facilities.
If left untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading.
Occasionally, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.
When plantar warts develop on the weight-bearing areas of the foot—the ball of the foot, or the heel, for example—they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain.
Tips for Prevention
- Avoid walking barefoot, except on sandy beaches.
- Change shoes and socks daily.
- Keep feet clean and dry.
- Check children's feet periodically.
- Avoid direct contact with warts—from other persons or from other parts of the body.
- Do not ignore growths on, or changes in, your skin.
- Visit your podiatric physician as part of your annual health checkup.
Self Treatment
Self treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self treatment with such medications especially should be avoided by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.
Professional Treatment
It is possible that your podiatric physician will prescribe and supervise your use of a wart-removal preparation. More likely, however, removal of warts by a simple surgical procedure, performed under local anesthetic, may be indicated.
Lasers have become a common and effective treatment. A procedure known as CO2 laser cautery is performed under local anesthesia either in your podiatrist’s office surgical setting or an outpatient surgery facility. The laser reduces post-treatment scarring and is a safe form for eliminating wart lesions.
Tips for Individuals with Warts
· Avoid self treatment with over-the-counter preparations.
· Seek professional podiatric evaluation and assistance with the treatment of your warts.
· Diabetics and other patients with circulatory, immunological, or neurological problems should be especially careful with the treatment of their warts.
· Warts may spread and are catching. Make sure you have your warts evaluated to protect yourself and those close to you.
Heel Pain
Heel Pain Has Many Causes
In our pursuit of healthy bodies, pain can be an enemy. In some instances, however, it is of biological benefit. Pain that occurs right after an injury or early in an illness may play a protective role, often warning us about the damage we've suffered. When we sprain an ankle, for example, the pain warns us that the ligament and soft tissues may be frayed and bruised, and that further activity may cause additional injury. Pain, such as may occur in our heels, also alerts us to seek medical attention. This alert is of utmost importance because of the many afflictions that contribute to heel pain.
Heel Pain
Heel pain is generally the result of faulty biomechanics (walking gait abnormalities) that place too much stress on the heel bone and the soft tissues that attach to it. The stress may also result from injury, or a bruise incurred while walking, running, or jumping on hard surfaces; wearing poorly constructed footwear; or being overweight. The heel bone is the largest of the 26 bones in the human foot, which also has 33 joints and a network of more than 100 tendons, muscles, and ligaments. Like all bones, it is subject to outside influences that can affect its integrity and its ability to keep us on our feet. Heel pain, sometimes disabling, can occur in the front, back, or bottom of the heel.
Heel Spurs
A common cause of heel pain is the heel spur, a bony growth on the underside of the heel bone. The spur, visible by X-ray, appears as a protrusion that can extend forward as much as half an inch. When there is no indication of bone enlargement, the condition is sometimes referred to as "heel spur syndrome." Heel spurs result from strain on the muscles and ligaments of the foot, by stretching of the long band of tissue that connects the heel and the ball of the foot, and by repeated tearing away of the lining or membrane that covers the heel bone. These conditions may result from biomechanical imbalance, running or jogging, improperly fitted or excessively worn shoes, or obesity.
Plantar Fasciitis
Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and it can be quite painful. The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.
The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle. Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear, but that may be just a false sense of relief. The pain often returns after prolonged rest or extensive walking.
Excessive Pronation
Heel pain sometimes results from excessive pronation. Pronation is the normal flexible motion and flattening of the arch of the foot that allows it to adapt to ground surfaces and absorb shock in the normal walking pattern. As you walk, the heel contacts the ground first; the weight shifts first to the outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls upward and outward, becoming rigid and stable in order to lift the body and move it forward. Excessive pronation—excessive inward motion—can create an abnormal amount of stretching and pulling on the ligaments and tendons attaching to the bottom back of the heel bone. Excessive pronation may also contribute to injury to the hip, knee, and lower back.
Disease and Heel Pain
Some general health conditions can also bring about heel pain.
- Rheumatoid arthritis and other forms of arthritis, including gout, which usually manifests itself in the big toe joint, can cause heel discomfort in some cases.
- Heel pain may also be the result of an inflamed bursa (bursitis), a small, irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue growth. Such heel pain may be associated with a heel spur or may mimic the pain of a heel spur.
- Haglund's deformity ("pump bump") is a bone enlargement at the back of the heel bone, in the area where the achilles tendon attaches to the bone. This sometimes painful deformity generally is the result of bursitis caused by pressure against the shoe and can be aggravated by the height or stitching of a heel counter of a particular shoe.
- Pain at the back of the heel is associated with inflammation of the achilles tendon as it runs behind the ankle and inserts on the back surface of the heel bone. The inflammation is called achilles tendinitis. It is common among people who run and walk a lot and have tight tendons. The condition occurs when the tendon is strained over time, causing the fibers to tear or stretch along its length, or at its insertion on to the heel bone. This leads to inflammation, pain, and the possible growth of a bone spur on the back of the heel bone. The inflammation is aggravated by the chronic irritation that sometimes accompanies an active lifestyle and certain activities that strain an already tight tendon.
- Bone bruises are common heel injuries. A bone bruise or contusion is an inflammation of the tissues that cover the heel bone. A bone bruise is a sharply painful injury caused by the direct impact of a hard object or surface on the foot.
Stress fractures of the heel bone also can occur, although infrequently.
Children’s Heel Pain
Heel pain can also occur in children, most commonly between ages 8 and 13, as they become increasingly active in sports activity in and out of school. This physical activity, particularly jumping, inflames the growth centers of the heels; the more active the child, the more likely the condition will occur. When the bones mature, the problems disappear and are not likely to recur. If heel pain occurs in this age group, podiatric care is necessary to protect the growing bone and to provide pain relief. Other good news is that heel spurs do not often develop in children.
Prevention
A variety of steps can be taken to avoid heel pain and accompanying afflictions:
- Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, rigid shanks, and supportive heel counters.
- Wear the proper shoes for each activity.
- Do not wear shoes with excessive wear on heels or soles.
- Prepare properly before exercising. Warm up and do stretching exercises before and after running.
- Pace yourself when you participate in athletic activities.
- Don’t underestimate your body's need for rest and good nutrition.
- If obese, lose weight.
Treatment
Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use of shoe inserts or orthotic devices. Taping or strapping supports the foot, placing stressed muscles and tendons in a physiologically restful state. Physical therapy may be used in conjunction with such treatments.
A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting of the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.
Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.
Heel Pain Tips
- If you have experienced painful heels try wearing your shoes around your house in the evening. Don't wear slippers or socks or go barefoot. You may also try gentle calf stretches for 20 to 30 seconds on each leg. This is best done barefoot, leaning forward towards a wall with one foot forward and one foot back.
- If the pain persists longer than one month, you should visit a podiatrist for evaluation and treatment. Your feet should not hurt, and professional podiatric care may be required to help relieve your discomfort.
- If you have not exercised in a long time, consult your podiatric physician before starting a new exercise program.
- Begin an exercise program slowly. Don't go too far or too fast.
- Purchase and maintain good shoes and replace them regularly.
- Stretch each foot and achilles tendon before and after exercise.
- Avoid uneven walking surfaces or stepping on rocks as much as possible.
- Avoid going barefoot on hard surfaces.
- Vary the incline on a treadmill during exercise. Nobody walks uphill all the time.
- If it hurts, stop. Don't try to "work through the pain."
The above information may be found in further detail at www.apma.org
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