Foot problems

COMMON FOOT DISEASES

The problems in the foot, is one of the fields of action of the Podiatrist; but it also covers:

• Chiropodology
• Orthopodology
• Biomechanics of the foot and ankle
• Foot surgery
• Sports podiatry

There are many foot problems and injuries that can develop in the feet that should be evaluated and treated by a podiatric specialist. We will mention the most important and frequent ones:

 

Skin lesions

 

• Helomas or calluses

 

They are well circumscribed lesions of thickening of the superficial layer of the skin. They are usually rounded, very painful and located mainly in the plantar region of the forefoot.

They are caused by excessive rubbing, either by the use of inappropriate footwear or by some deformity or prominence of the bone that generates pressure in a specific area of the foot.

Helomas, commonly known as calluses or thymomas, can be soft if they are of recent appearance or hard if they have evolved for a long time. As they become harder, they are more difficult for the podiatrist to remove.

 

Can I treat a callus at home with a commercially available product?

 

Topical treatments available in pharmacies for corns may have an effect in a few cases, especially if they are soft or recent corns and on some types of skin in particular. Some products are very abrasive or if used improperly can cause burns or other injuries.

Therefore, it is important to visit a podiatrist who will be able to remove the callus and also evaluate the causes to prevent it from recurring.

 

 

• Interdigital helomas

 

It is a callus that comes out between the toes, in these cases occurs by prominences of the bones of the phalanges or by the use of narrow-toed shoes that compress the toes.

They are extremely painful, and a visit to a podiatrist is always recommended to remove the callus and evaluate possible associated deformities or bony prominences.

It is important to evaluate the footprint and type of footwear, in addition to the use of custom-made silicone interdigital separators to solve the problem definitively.

 

Can I use any separator purchased at the pharmacy to treat corns?

 

The recommendation is to consult a podiatrist, who will be able to evaluate and indicate whether or not you need some type of device. The use of separators must always be individualized.

 

• Distal helomas (distal calluses)

Distal calluses are those that occur on the fingertips. This is basically caused by the length of the toes and the use of inadequate footwear.

It is important to remember that helomas can be treated definitively with minimally invasive foot surgery. These techniques allow correction of finger deformities through 2-3 millimeter incisions with a fast and comfortable recovery.

• Plantar warts or papillomas

Warts are lesions of viral origin ( human papilloma virus), which frequently appear in children and young people, especially if they frequent swimming pools. They are often mistaken for corns. They are also very painful. Consultation with a podiatrist is recommended to establish a good diagnosis and to remove the wart completely. The products that can be used for these cases vary according to the age of the patient, the size of the wart, the exact location, whether they are single or multiple, and the skin type of each person.

 

Are plantar warts contagious?

They are contagious due to their viral origin, so it is advisable to have them removed by a professional who guarantees the complete elimination of plantar warts.

• Hyperkeratosis

It is the thickening of the superficial layer of the skin, in areas of friction, such as heels and edges of the foot. They are a frequent reason for consultation, for aesthetic reasons.. At the podiatrist’s office, in addition to removing the areas of thickened skin, you will receive recommendations for footwear, hydration and hygiene care necessary to prevent the reappearance of these lesions.

• Bromhidrosis

It is the medical name for foot odor. This occurs due to excessive sweating, poor hygiene and bacterial proliferation .

 

Can foot odor be treated?

Yes, in the podiatrist’s consultation, after the evaluation to explore causes and associated medical problems, measures will be indicated to solve this problem.

• Hyperhidrosis of the foot

It is excessive sweating, it can be a general disease, affecting many areas of the body or present hyperhidrosis localized in the feet.

There are medical treatments to improve excessive sweating and hygiene and footwear recommendations to avoid the consequences of this problem.

• Tinea pedis (athlete’s foot)

It is a fungal infection of the skin of the foot. It is also called athlete’s foot because of the frequency of this infection in athletes, due to the humidity caused by the prolonged use of sports shoes.

Hygiene measures and avoiding humidity are the way to prevent this type of infection. In many cases they are difficult to treat.

Can I use any antifungal ointment for foot fungus?

There are different commercial formulations of antifungal creams, solutions and ointments. Not all antifungals work for tinea pedis. In addition, inappropriate use can generate resistance, which makes future treatment more difficult. There are also creams with drug combinations that are even contraindicated.

 

 

Nail injuries

• Onychogryphosis or onychodystrophy

Onychogryphosis is the thickening of the nails, which can be congenital or traumatic.

The podiatrist’s care is very important to improve the thickening and to take measures to prevent the appearance of other associated nail problems.

• Onychomycosis

It is a fungal infection of the nails. They are usually difficult to treat, so it is always recommended to consult before self-medicating with topical solutions.

Each case should be evaluated on a case-by-case basis to establish the best treatment scheme. These can be oral, topical, or combination treatments. Preventive and hygienic measures are essential. For this reason, we insist on not taking any medication beforehand until your podiatrist recommends the appropriate medication and dosage, which is usually for long periods of time.

• Onychocryptosis

It is one of the most frequent reasons for consultation for nail problems. Onychocryptosis or ingrown toenails occur when the edge of the nail digs into the surrounding skin of the toe. This generates pain and conditions bacterial infections. These infections are particularly dangerous in diabetic patients or those with circulatory disorders. It can be resolved in all cases, with minimal surgery, performed under local anesthesia, which usually relieves pain quickly and decreases the degree of inflammation or infection. In these cases, it is necessary to make controls with the podiatrist until the complete improvement of the problem.

What should I do if I have an ingrown toenail?

It is advisable to consult a podiatrist who will solve the problem in the office. The more advanced the ingrown toenail problem is, the more difficult the treatment becomes.

The nail should not be trimmed any further, nor should sharp or cutting objects be introduced into the edge of the nail. This inadequate practice may favor local infections and accelerate inflammation.

Exercise or physical activity should also be avoided until the inflammation and infection resolve.

The definitive treatment is ingrown toenail corrective surgery.

 

 

Common foot deformities

• Hallux valgus or bunions

It is a frequent reason for consulting a podiatrist, both for reasons of gait limitation, difficulty with footwear and pain, as well as for esthetic reasons.

It is much more frequent in women (90% of cases) and there are genetic or hereditary aspects involved, especially when it occurs in young individuals.

Often the deformity is bilateral, although it can be seen more accentuated in one foot than the other. For this reason, each foot must be evaluated individually.

Careful evaluation by a podiatrist is necessary, including physical examination and radiological studies to determine the degree of angulations or deviations of the first toe. It is also very important to examine associated deformities, which must be treated simultaneously to ensure the success of any surgical treatment.

The resolution of these cases is usually surgical and can now be resolved by minimally invasive surgery or percutaneous foot surgery, with rapid recovery and minimal pain.

 

If I have surgery, can my bunions come back?

 

The surgical resolution of hallux valgus or bunions generates definitive results. Provided that the problem has been properly assessed and corrected and appropriate techniques have been used.

Therefore, we insist that the selection of the institution and the surgeon are fundamental. In the San Roman ClinicWe have 40 years of experience at the forefront of technology and academic updating of our surgeons.

 

• Hallux rigidus

It is an inability to mobilize the base of the first toe, without the deformity of bunions or hallux valgus. It is usually caused by inflammatory and degenerative processes of osteoarthritis or may be secondary to trauma.

There are medical treatments that can be implemented by the podiatrist in mild or moderate cases or choose in more severe cases the surgical option.

 

• Tailor’s bunion or fifth varus

It is an acquired foot deformity, which affects the fifth toe and the fifth metatarsal. It is the equivalent to hallux valgus but in the fifth toe.

It is commonly called Tailor’s bunion because in ancient times tailors sat on the floor with their legs crossed to sew for hours and in that position the fifth toe and the head of the fifth metatarsal rests on the floor.

It may appear in a mild form in youth and the deformity becomes more pronounced throughout life. In advanced stages there is a lot of pain and difficulty in walking that forces podiatric consultation and surgical resolution.

Nowadays, minimally invasive surgery is available, which is ambulatory, without using general anesthesia and with minimal complications. It also has the particularity that the patient can walk with the postoperative footwear after surgery.

• Metatarsalgia

It is a condition characterized by pain in the metatarsal, plantar region near the toes. It is usually associated with certain sports practices with repeated rebound in that area of the foot, or by the use of inadequate footwear or other associated deformities, which change the tread pattern such as hallux valgus. Excess weight and traumatic antecedents of the foot also play a role.

• Feet: cavus – club – equinus – flat

  • Mapis the most common deformity in children. As its name indicates, there is no normal plantar arch, so the entire plantar surface is in contact with the floor at the moment of walking. Flat feet can trigger pain or plantar fasciitis, as well as alterations in the knee and ankle joints. Consultation with the podiatrist allows to establish the degree of the condition and to implement the appropriate orthopedic treatment with gait recommendations according to each case.
  • Cavois the accentuation of the normal arch of the foot, it is less common than flat feet. They often cause pain due to the pressure exerted on the heels and metatarsals during walking. Orthopedic treatment of this condition is possible.
  • ZamboVarus equinus (equinus varus): is a congenital deformity, more frequent in males. It has orthopedic resolution when it occurs in young children or newborns.
  • EquinusEquine: there is a permanent plantar flexion (invisible heels), causing the gait to be done on tiptoe, supporting the anterior region of the foot.

It may be a congenital disorder or secondary to neurological pathologies such as stroke, poliomyelitis, multiple sclerosis and muscular dystrophies. It can be treated with orthopedics and in more severe cases surgery is needed.

 

 

• Digital claw

It is a deformity of the toes, which is usually associated with other foot deformities. Special orthoses with silicone rings are available to correct these defects before undergoing surgery.

• Hammertoes

It is also a deformity of the fingers, more complex than the claw, it has orthotic and surgical treatment.

• Clinodactyly

It is the transverse deformity of one or more toes. Certain insoles with silicone rings can be used to correct the problem, without the need for surgery. This deformity is common in children

• Open foot

It is a widening of the forefoot that occurs due to weakness of ligaments in the area and causes accentuated pain in the forefoot region.

 

Painful disorders

• Calcaneal and subcalcaneal spur

It is a prominence of the main bone of the heel (calcaneus), that prominence by itself does not generate symptoms, unless it compresses or injures some surrounding structure.

• Plantar fasciitis

It is the inflammation of the plantar fascia, which is a thin membrane located in the plantar region from the heel to the forefoot. Inflammation of this fascia often results in pain and inability to walk. It is common in athletes and people over 45 years of age.

• Morton’s neuroma

It is a small benign tumor originating in nerve structures and is located in the interdigital region of the foot and is a major cause of pain. It is more frequent between the third and fourth fingers. The use of high heels and some sports can lead to the appearance of these injuries.

 

Diabetes

In the case of diabetics, regular and preventive consultation with a specialist in podiatry is very important to achieve a good quality of life.

It is considered that 25% of diabetic patients develop some medical problem in their feet.

There are two major groups of conditions in diabetics:

1. Consequence of susceptibility to infections.
2. Derived from neurological and vascular alterations typical of diabetes.

The most frequent diseases are:

• Mycosis of the foot (Tinea pedis)
• Mycosis of the nails (Tinea unguis)
• Onychocryptosis: infections in diabetic patients are more important than in the rest of the population. A small injury or infection can spread quickly, and treatment is more complex and recovery slower, due to the usual disturbances in circulation and wound healing.
• Hyperkeratosis.
• Neuropathic ulcers or plantar perforating disease: they occur as a consequence of the decrease in blood flow and nutrients. In addition, sensitivity problems mean that diabetics do not easily notice small injuries and trauma to their feet.

For all these reasons, podiatric consultation in diabetics should be scheduled on a regular basis, in order to detect small problems and correct them, in addition to providing guidance on foot hygiene measures for diabetics and special care.

 

Article prepared by Clínica San Román

Date of Publication: 27-11-2018

Date of revision: 7-02-2020