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InStep Foot Clinic offers free advice on a number of foot conditions and care.  To view, please click on one of the following links.  All information given is advice and if you have any issues or concerns please contact InStep Foot Clinic to discuss.
Flat Feet

Verrucae

Ingrowing Toenail (Onychocryptosis)

Fungal Infections

Chilblains

Athlete’s Foot

Sweaty Feet

Corns and Calluses

Flat Feet
Definition
Pes planus or Pronation is a condition where the arch or instep of the foot collapses and comes in contact with the ground. In some individuals, this arch never develops.
Cause
Flat feet are a common condition. In infants and toddlers, the longitudinal arch is not developed and flat feet are normal. The arch develops in childhood and by adulthood most people have developed normal arches. When flat feet persist, the majority are considered variations of the normal. Most feet are flexible and an arch appears when the person stands up. Stiff, inflexible, or painful flat feet may be associated with other conditions and require attention.
Most flat feet do not cause pain or other problems. Flat feet may be associated with pronation, a leaning inward of the ankle bones toward the centre line. Shoes of children who pronate, when placed side by side, will lean towards each other. Foot pain, ankle pain, or lower leg pain (especially in children) may be a sign of flat feet and should be evaluated by a Podiatrist.
Symptoms

  • Absence of longitudinal arch of foot when standing
  • Foot pain. knee, hip or lower back pain.
  • Heel tilts away from the midline of the body more than usual
Signs and Tests
Examination of the foot is sufficient for us to make the diagnosis flat foot. However, the underlying cause must be determined. This involves examination of the lower limbs bony and muscular alignments as well as the Gait (Walking motion).
Treatment
Orthotic (arch supporting insert in the shoe) can bring relief. Sometimes exercise programs are issued and maybe the only treatment necessary.
Expectations (prognosis)
Most cases of flat feet are painless and no problems are to be expected. The prognosis of painful flat feet again depends on the cause of the condition. Usually treatment is successful, regardless of the cause.
Complications
Flat feet are not really associated with any complications except pain. But can also cause knee, hip and lower back pain and wear in the joints.
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Verrucae
What is a verruca?
A verruca is simply a wart that is usually found on the soles of your feet, though they can also appear around the toes. In the early stages, a verruca looks like a small, dark, puncture mark but later turns grey or brown. It may become rough and bumpy with a cauliflower-like appearance and may develop a black spot in the middle, which is caused by bleeding. A verruca can grow to half an inch in diameter and may spread into a cluster of small warts.
What causes them?
Verrucae are caused by the human papiloma virus (HPV). This virus is very contagious, but can only be caught by direct contact. It thrives in warm, moist environments such as swimming pools, changing room floors and bathrooms. So if an infected bare foot walks across the poolside, it may release virus-infected cells onto the floor. If you walk on the same floor, you can pick the virus up, especially if you have any small or invisible cuts and abrasions that make it even easier for the virus to penetrate. You could also catch the virus from an infected towel.
Is it serious?
They are harmless. However, they can cause a sharp, burning pain if you get one on a weight-bearing area such as the ball or the heel of the foot. Because you are constantly pressing on the area when walking, they can protrude into the skin and become more painful.
When you have verrucae on a non-weight bearing surface (such as on the top of the foot or in the toes), they protrude above skin level, tend to be fleshier and cause less pain.
Who gets them?
They tend to be common in children, especially teenagers. However for unknown reasons, some people seem to be more susceptible to the virus, whereas others are immune.
What’s the difference between a corn and a verruca?
A verruca is a viral infection, whereas a corn or callus is simply layers of dead skin. Verrucae tend to be painful to pinch, but if you’re unsure your podiatrist will know.
What can I do?
Minimise your chances of catching a verruca by keeping your feet clean and dry and covering up any cuts or scratches. Avoid walking barefoot in communal showers or changing rooms (wear flip-flops) and don’t share towels. Though you should wear verruca socks when swimming to avoid passing on the virus, they can also be worn as a preventive measure.
If a verruca does appear, avoid touching or scratching it as it may spread into a cluster of several warts. Instead, cover it up with plaster. In some cases, this may cure it.
Do not self-treat if you have diabetes or circulation problems. However, if you are fit and healthy, it’s fine to treat yourself with over-the-counter gels and ointments. Ask your pharmacist for advice or look for products containing salicyclic acid, such as Verrugon. Ensure, however, that you follow the instructions carefully. If, at any stage, your verruca becomes painful or the surrounding skin goes red, stop treatment and telephone InStep Foot Clinic. If you damage the healthy tissue that surrounds the wart tissue you could hamper further treatment.
What can a podiatrist do?
Because verrucae usually disappear in time (fought off by your immune system), the general policy in the UK is to only treat them when they are causing pain. Verrucae generally resolve spontaneously within six months in children. But in adults, they can persist for years.
If yours is causing pain, there are a number of treatment options available – though no one particular treatment can guarantee a cure. A recent review of treatments in the British Medical Journal (August 2002) concluded that the safest and most effective treatments were those containing salicyclic acid. The acid is applied to the wart to disintegrate the viral cells and has a cure rate of 75%. It may need to be applied at weekly intervals over a set period of time.
Other treatments include :
Cryotherapy
This involves freezing warts off with liquid nitrogen or nitrous oxide gas. This needs to be done every 2 or 3 weeks for a few months before the verruca is fully removed. However, it can lead to soreness and blistering in some people. You can still swim after this treatment, but it’s not advised for sensitive or anxious children.
Electrosurgery
After a local anaesthetic, the verruca is pared down. An electric needle is then placed in the middle of the wart for a few seconds until the wart boils – the verruca is the scooped out.
Alternative therapies
Banana skin, Tea tree oil and Thuja tincture may also be applied to good effect.
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Ingrowing Toenail (Onychocryptosis)
What is it?
An ingrowing toenail is one that pierces the flesh of the toe. It can feel as if you have a splinter, and can be extremely painful. In more severe cases, it can cause pus and bleeding. Ingrowing toenails most commonly affect the big toenail, but can effect the other toes too.
A nail that is curling (involuted or convoluted) into the flesh, but isn’t actually piercing the skin isn’t an ingrowing toenail, but can feel very painful and also appear red and inflamed as well.
Who gets it?
Active, sporty people are particularly prone, because they sweat more. Younger people are more likely to get it (as they pick their nails more, compared to older people who may not reach their toes!). Women often develop them as a result of cutting nails too low in order to relieve the pressure and discomfort of an involuted nail.
Is it serious?
If left untreated, the infection can spread to the rest of the toe. The quicker you treat it, the less painful the treatment.
What causes it?
There are many genetic factors that can make you prone to ingrowing toenails, such as your posture (the way you stand), your gait (the way you walk), a foot deformity such as a bunion, hammer toes or excessive pronation of the feet (when your foot rolls excessively). Your nails may also naturally splay or curl out instead of growing straight, encouraging your nail to grow outwards or inwards into the flesh.
Tight footwear, tight hosiery and tight socks can also push your toe flesh onto the nail so that it pierces the skin. Also if you sweat excessively or don’t rotate your footwear, this makes the skin moist, so that it welcomes the nail like a soft sponge. If you have brittle nails with sharp edges or are in the habit of breaking off bits of nails that are sticking out, you’re more likely to get an ingrowing toenail. However, one of the most common causes is not cutting your toenails properly.
What can I do?
Firstly, learn to cut your nails properly. Nails cutters aren’t a good idea because the curved cutting edge can cut the flesh and nail scissors can slip. It’s best to use nail nippers (available from chemists) because they have a smaller cutting blade but a longer handle. Cut your nails straight across and don’t cut too low at the edge or down the side. The corner of the nail should be visible above the skin. Also, cut them after a bath or shower when they are soft. Contact us and we’ll show you the right way.
Good hygiene can go a long way to preventing ingrowing toenails. Avoid moist, soggy feet by rotating your footwear so each pair has a chance to dry out thoroughly. Avoid man-made materials and choose socks and shoes of natural fibre. In the summer, wear open-toed sandals where possible.
If you’ve booked an appointment with a podiatrist at InStep Foot Clinic, relieve the discomfort in the meantime by bathing your feet in a salty footbath. This prevents infection and reduces inflammation. Then apply a clean sterile dressing, especially if you have a discharge. Rest your foot as much as possible.
If you have diabetes, are taking steroids or are on anti-coagulants, don’t attempt to cut your nails or remove the ingrowing spike of nails yourself.
What can a podiatrist do?
It depends on the severity of your condition. For the most basic painful and irritable ingrowing toenail, we will remove the offending spike of nail and cover with an antiseptic dressing.
If your toes are too painful to touch, your podiatrist may use a spray, gel or inject a local anaesthetic before removing the offending portion of the nail.
If you have involuted nails, your podiatrist may remove the bit that’s curling into the flesh and file the edges of the nail to a smooth surface.
If you have bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, you’ll need antibiotics to beat the infection as well as having the offending spike removed.
Please be aware that not everyone coming to us with an ingrowing toenail actually has an ingrowing toenails. Sometimes they have a curly nail which has a lot of debris (dirt or fluff) underneath it or a corn or callus down the side of the nail, which can be nearly as painful. However, if it’s a corn, the pain tends to be throbbing as opposed to the sharp pain you get with an ingrowing toenail. If this is the case, we will remove the debris, and if necessary thin the nail.
If you are particularly prone to ingrowing toenails from underlying problems such as poor gait, we may recommend correction of the underlying problem as well as a more permanent solution to the nail itself, such as partial nail avulsion (PNA). This is done under a local anaesthetic, where 8-10% of the nail is removed (including the root) so that the nail permanently becomes slightly narrower. The chemical phenol cauterises the nail and prevents it regrowing in the corners. This is 97-98% successful. You will, however, have to go back to your podiatrist for a number of re-dressings. After surgery, the overall appearance of the nails looks normal – to the extent that some people even forget which nail they’ve had done!
What can your GP do?
Your GP can prescribe a course of antibiotics if you have an infection but is more likely to refer you to a podiatrist.
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Fungal Infections
The most common fungal infections of skin are those which occur on the feet. Footwear creates the necessary conditions of moisture and warmth between the toes and communal activity permits the spread of infection.
What causes it?
Fungal infections can affect people of all ages. However, children are more likely to pick up the most common type Athlete’s foot (Tinea pedis).
Symptoms of Athlete’s Foot
  • Itching between the fourth and fifth toes
  • Red, raw looking skin, which is often itchy
  • Skin that flakes, peels or cracks
  • Sore, pus-filled, weeping rash

Other fungal infections of the skin may appear as:

  • Small spot-like blisters on one or both feet, appearing as a rash
  • Dry redness and scaly skin all over the soles called ‘moccasin’ type.

Toenails can also be infected, with the nail becoming thickened, brittle, and yellowish-brown in colour, eventually developing a ‘worm-eaten’ or porous appearance.

  1. Wash feet at least once a day with soap and tepid water, drying thoroughly and gently in between the toes.
  2. Choose hosiery made from natural fibres, preferably cotton.
  3. Wear well-fitting shoes or sandals wherever possible, which allow the air to circulate. Avoid footwear with rubber soles or man-made materials.
  4. Change socks or stockings every day.
  5. Use an antifungal powder and spray sparingly between the toes, wipe away excess powder with cotton wool.

If you have a fungal infection don’t spread it

  1. Never wear shoes or slippers belonging to others.
  2. Use your own towel.
  3. Wear flip-flops when changing in communal places.
  4. Thoroughly rinse the bath or shower after use.

Most creams and powders should be applied twice daily.
Nails
Toenail infections are more difficult to clear totally than skin infections. Because the nail thickens with fungal infection we will thin the nail down as far as possible before using a treatment such as a paint or cream. This enables the treatment to reach the affected area in the most effective way.
Tablets are available on prescription only. The InStep Foot Clinic Chiropodist will advise you. Always read the label. For information about other foot problems and conditions, contact us. Back to the Top

Chilblains
Many people suffer from cold feet in winter, but not all of them develop chilblains. Whether they do or not depends to a large extent on the efficiency of the circulation.
Chilblains are small itchy red swellings on the skin, which can become increasingly painful, can swell and then dry out leaving cracks in the skin which expose the foot to the risk of infection. They occur on the toes, particularly the smaller ones, fingers, the face, especially on the nose, and the lobes of ears. They can also occur on areas of the feet exposed to pressure, for instance, on a bunion or where the second toe is squeezed by tight shoes.
Cold feet
Chilblains are caused by the skin’s abnormal reaction to cold. Damp or draughty conditions, dietary factors and hormonal imbalance can be contributory factors. If the skins is chilled, and is followed by too rapid warming next to a fire or hot water bottle, chilblains may result.
Who is most at risk?
The condition mainly affects young adults working outdoors in cold places or people who do not wear socks or tights in winter. Elderly people, whose circulation is less efficient than it used to be, people who don’t take enough exercise, and those suffering from anaemia, are also susceptible.
What are the symptoms?
With the onset of cold weather, susceptible people will experience a burning and itching on their hands and feet. On going into a warm room, the itching and burning is intensified. There may be some swelling or redness, and in extreme cases, the surface of the skin may break, and sores (ulcers) may develop.
What can you do?
To prevent chilblains, keep your body, feet and legs warm especially if your circulation is poor and your mobility is limited. The whole body, rather than just the feet, needs to be kept warm. Trousers, long boots, tights and leg warmers or long socks will help.
You can also prevent chilblains if you follow a regular foot health routine.
If chilblains have developed
Don’t scratch them; soothing lotions such as witch hazel or calamine will take away most of the discomfort.
If the chilblain has ulcerated, apply an antiseptic dressing. If you have diabetes or undergoing medical treatment, have the ulcer assessed by your GP or we can do it at InStep Foot Clinic.
If the chilblain hasn’t broken you can paint them with a mixture of friar’s balsam and a weak solution of iodine, which your pharmacist may make up for you, or an over-the-counter preparation. At night, rub some lanolin ointment well into the feet to help retain heat.
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Athlete’s Foot
What is it?
Athlete’s foot is a fungal infection. It can lead to intense itching, cracked, blistered or peeling areas of skin, redness and scaling. It can occur on moist, waterlogged skin especially between the fourth and fifth toes, or on dry, flaky skin around the heels or elsewhere on the foot.
What causes it?
It’s caused by a number of fungal species which you can pick up from anywhere (typically communal areas such as pools, showers and changing rooms) or anywhere you may walk around barefooted. The fungus on each bit of skin that falls away from someone else’s feet can be picked up by you if you’re prone.
Once your feet have been contaminated, the warm, dark and sweaty environment of feet cramped in shoes or trainers provides the ideal breeding ground for the fungus. However, athlete’s foot also occurs in dry, flaky areas. It’s quite common in summer sandal-wearers. The sun combined with the constant trauma from sandals makes them more prone to infection.
Who gets it?
Well, it’s not called athlete’s foot for nothing. Walking around barefoot around swimming pools and spending your life in trainers make you more likely to suffer. But obviously, you don’t need to be an athlete to suffer.
What can I do?
There are many things you can do to make your feet less hospitable to fungal infections.
Re-think your footwear
Firstly, change your footwear on a regular basis. There’s no point sorting your feet out if you constantly re-infect them by putting them into damp, fungally infected shoes. It takes 24-48 hours for shoes to dry out properly, so alternate your shoes daily.
To help shoes dry out more quickly, take any insoles out. Also, loosen any laces and open your shoes out fully so that air can circulate. Go for trainers with ventilation holes.
If your shoes are so tight that they squeeze your toes together, this encourages fungus. Let air circulate between the toes by going for wider, deeper toebox instead and choose shoes made from natural materials. Of course, you should also change your socks every day too.
Wear flip-flops in the bathroom and public showers. This will not only ensure that you don’t leave your dead skin around for others to pick up, but will stop you picking up another species of fungus! And never wear anyone else’s shoes, trainers or slippers.
Re-think your footcare
Treatment depends on what type of athlete’s foot you have :
For athlete’s foot where the skin conditions are dry
If your athlete’s foot occurs in a dry area such as your heel, you need to restore moisture by rubbing in an anti-fungal cream or ointment. However, don’t forget to wash your hand’s thoroughly afterwards. Even better, use disposable gloves so you don’t get the fungus on your hands at all.
For athlete’s foot where the skin conditions have been moist
This requires altogether different treatment. Wash your feet in as cold water as you can bear, as hot water only makes your feet fungus-friendly. Then dry them thoroughly after washing – preferably with a separate towel or even kitchen roll. Dab dry, don’t run as running tends to take away the healing skin. As the aim is to get rid of the moisture – although skin may appear flaky and dry – never use moisturiser between your toes. Avoid powder too as it can cake up and irritate the skin. A spirit-based preparation can help, such as surgical spirit (it’s cooling, soothing and antiseptic)
If your athlete’s foot is mild or you’ve only just started to suffer, rethinking your foot hygiene may help. Surgical spirit may be enough to see it off. However, if an antifungal medication is required, your pharmacist can recommend one.
Don’t stop the hygiene regime, shoes rotation and/or medication once symptoms have gone. Even though your symptoms may disappear after several days or weeks, the fungus can lie dormant and could eventually reappear if the environment is right. Some products require continued treatment for many weeks – always follow instructions. Also, be alert to symptoms so that you can deal with any problems straight away.
Though you should avoid using anti-fungal powders between the toes, they’re good for dusting inside shoes and trainers.
What can a podiatrist do?
You should be able to get rid of athlete’s foot on your own, but a podiatrist may help you pinpoint the best treatment for your particular type of athlete’s foot. Your podiatrist can also help if the fungal infection has spread to your nails, by reducing the thickness and cutting back the nails, thereby exposing the infected nailbed to a lighter, cooler environment.
Nail infections may not respond to topical treatments. You might need oral medication (i.e tablets) to kill the fungus in nails. If the fungus is only in the nail and not elsewhere, it is probably caused by an injury. An injury allows the fungus to creep in and multiply under the nail. This can affect the substance of the nail which may become crusty, discoloured and deformed. This oral medication needed, however, can have side effects. So if you have other medical conditions or are on other medication, your GP or podiatrist may recommend that you don’t take it.
What your GP can do
Your GP can prescribe a broad-spectrum anti-fungal medication to eliminate the fungus if local treatment or your prevention regime has failed.
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Sweaty Feet
Most of us have suffered from foot perspiration and odour from time to time, yet for some people sweaty feet are a persistent problem which can be embarrassing and uncomfortable.
Sweaty feet is a complaint known as Hyperhidrosis, or excessive sweating, and has a lot to do with how the sweat glands in this part of the body work. With 250,000 sweat glands, feet do not tend to sweat more than other parts of the body. But with a daily hygiene routine, few people should suffer from the embarrassment that it may cause.
Sweat glands in the feet
There are more sweat glands per inch in our feet than anywhere else in the body, and their function is to keep the skin moist and therefore supple. They secrete all the time, not just in response to heat or exercise in the body.
Possible causes
Sweaty feet can be caused by stress on the foot. This may be due to a structural problem, or because the foot is under strain or tired, for example, when you’ve been standing on your feet all day.
Hot weather can make matters worse, although sweaty feet is a winter, as well as a summer, problem. It can also be an inherited condition.
In adolescents, sweaty feet are probably caused by over-active sweat glands triggered by changing hormonal levels in the body. As the sweat glands on the soles of the feet (and the palms of the hand) respond mostly to emotion, mental or emotional stress is a common cause.
What to do
Simple hygiene is usually effective in dealing with sweaty feet. Try following our recommended daily foot hygiene routine.
Footwear
Careful consideration of footwear and socks is essential. Well-fitting shoes made of leather, which allow your feet to ‘breathe’, are best. As a lot of sweat is absorbed by insoles or the uppers of shoes, don’t wear the same pair every day, and allow them to dry out before wearing them again. Detachable insoles are also a good idea. Socks that absorb moisture well, like wool, cotton or wool/cotton mixture, will also help. Always wash your socks before using them again.
Other problems
An added problem that often accompanies sweaty feet is foot odour. This is caused by bacteria on the skin breaking the sweat down, which releases an offensive smell. This can usually be prevented with careful hygiene, or medicated insoles which can have a deodorising effect. Wash your feet with an anti-bacterial soap such as Hibiscrub. There is also a greater risk of minor skin infections, through athlete’s foot, or blisters.
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Corns and Calluses
When we walk or stand, our body weight is carried first on the heel and then on the ball of the foot, where the skin is thicker to withstand the pressure. When this pressure becomes intense, growths, in the form of corns and callus, may appear, as a protective response.
Corns always occur over a bony prominence, such as a joint. A callus is an extended area of thickened skin on the soles of the feet, and occurs on areas of pressure. It is the body’s reaction to pressure or friction, and can appear anywhere the skin rubs against a bone, a shoe, or the ground. Walking on stones? Most calluses are symptoms of an underlying problem like a bony deformity, a particular style of walking, or inappropriate footwear. Some people have a natural tendency to form callus because of skin type. Elderly people have less fatty tissue in their skin and this can lead to callus forming on the ball of the foot.
WHAT TO DO.
You can control a small amount of hard skin by gently rubbing with a pumice stone, or chiropody sponge occasionally when you are in the bath. Use a moisturising cream daily. If this does not appear to be working, contact InStep Foot Clinic for advice on why this has occurred and where possible, how to prevent it happening again. We can also remove hard skin, relieve pain, and redistribute pressure with soft padding, strapping, or corrective appliances which fit easily into your shoes. The skin should then return to its normal state. The elderly can benefit from padding to the ball of the foot, to compensate for any loss of natural padding. Emollient creams delay callus building up, and help improve the skin’s natural elasticity. At InStep Foot Clinic, we will advise you on the most appropriate skin preparations for your needs.

 
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