TOENAIL & SKIN CONDITIONS

Blisters

A blister is a pocket of fluid protected by the overlying layer of skin. Blisters on the feet are usually caused by friction and can make wearing shoes and most activities painful. Blisters can also be caused by an insect bite, a skin burn, infection, sunburn, an allergic reaction or trauma.

Often, blisters on the feet result from wearing shoes that fit poorly. If the footwear is too tight or too loose, your feet can rub against the shoes causing friction. In this case, fluid will build up beneath the skin. Excessive moisture such as perspiration can also cause blisters, especially for runners in warm weather.

Symptoms

If you are experiencing skin irritation when wearing shoes, look for raised bumps of skin where the foot is in contact with the shoes. These will be fairly soft because they are filled with liquid.

Treating Blisters

The best treatment for a blister is to leave it intact to let new skin grow underneath. Even if it bursts, leave the covering skin in place as it will help protect the area from infection. Just cover the blister with an adhesive bandage and avoid shoes that rub against the area.

If your blister does not heal within a few days or if you observe any signs of infection, visit your podiatrist for expert care. The doctor will use a sterile needle to drain the blister and then apply antibiotic ointment. If the area is infected, oral antibiotics may also be prescribed.

Preventing Blisters

If friction against your shoes has caused a blister, invest in shoes that are the right size and that fit well. Adding an insole to the shoe can reduce friction with extra padding.

Athletes should focus on keeping the feet dry with foot powder or with moisture-wicking socks.

Corns and Calluses

Calluses and corns are skin problems often found on the feet. A callus is a thick, hardened skin on the bottom of the foot that protects the skin from too much friction. They are often found on the ball of the foot, the heel and under the big toe.

A corn forms when two toes rub together, causing thicker skin with inflamed tissue underneath. Corns between the toes have soft cores, while those on the top of a toe are hard corns.

Both of these skin growths are caused by excess pressure and friction and can result from overuse, from an abnormal gait, and by wearing shoes that are either too tight or too loose

Calluses and corns are skin problems often found on the feet. A callus is a thick, hardened skin on the bottom of the foot that protects the skin from too much friction. They are often found on the ball of the foot, the heel and under the big toe.

A corn forms when two toes rub together, causing thicker skin with inflamed tissue underneath. Corns between the toes have soft cores, while those on the top of a toe are hard corns.

Both of these skin growths are caused by excess pressure and friction and can result from overuse, from an abnormal gait, and by wearing shoes that are either too tight or too loose

Symptoms

A callus will show hardened, thickened skin and may appear as a bump. The skin can be dry, flaky or scaly. Walking on a callus can be painful as they grow large.

Whether a hard or soft corn, you will notice hardened, raised bumps that can be painful when pressed.

Treating

Home treatment can be effective for corns and calluses that are not painful:

  • Soak feet in warm, soapy water and then rub the thickened areas with a pumice stone or foot file.
  • Apply a moisturizing lotion or cream every night and cover with a loose sock.
  • Add over-the-counter moleskin or pads – not with salicylic acid – directly to the callus or corn to ease pressure.

Professional podiatric treatment can help ease the symptoms and eliminate the skin growth. We will shave the surface of a callus to relieve pressure. An exfoliant such as a cream with urea can remove dead skin. An oral antibiotic can clear up any sign of infection.

If we determine that your callus or corn is caused by your gait or foot structure, custom-fitted orthotics can greatly ease the friction and pressure

Prevention

Custom-fitted orthotics and metatarsal pads can help eliminate the abnormal pressure or friction that caused the metatarsalgia.

Athletes or anyone who runs or works out must wear the proper footwear for their chosen activities. New shoes must have adequate cushioning and, for those who run or repeatedly jump on hard surfaces, choose rubber heels and soles for better shock absorption.

Fungal Toenails

A toenail fungus will get under the surface of the nail where it takes hold and may even spread to other toenails. Left untreated, the infection may make it difficult to walk and work. The thicker toenails are hard to trim and make it painful to wear shoes.

Fungal nail is contagious and you are vulnerable in public areas like swimming pools, showers, spas and locker rooms. People with diabetes or who suffer from circulatory problems or immune deficiency are prone to toenail fungus.

Symptoms

Toenail fungus causes many unpleasant symptoms including:

  • Change in toenail appearance, texture and color
  • Nail thickening
  • Unpleasant odor
  • Debris noticeable under the nail plate
  • White marks on the nail plate

Treatment

Home treatments including over-the-counter antifungal creams may ease the symptoms of toenail fungus, but full healing can only be obtained through a podiatrist’s care.

After taking a culture from the nail to determine the cause of the problem, we will treat it with topical and/or oral medication. Debridement, or removal of the diseased nail matter and its degree, is an effective treatment. Surgery may even be required to remove the nail permanently and prevent the regrowth of a deformed nail.

Prevention

Toenail fungus can be prevented with these commonsense tips:

  • Wash your feet with warm soapy water every day, and dry thoroughly.
  • Always protect your feet in public areas with shower shoes or flip-flops
  • Wear clean socks every day and change more often if they become sweaty
  • Trim nails straight across and short enough so that they don’t extend beyond the toe tip
  • Choose socks made of synthetic fiber to wick moisture away from the skin
  • Don’t use polish on those nails that may have an infection

Ingrown Toenail

Ingrown toenails are nails where the corners or sides grow into the nearby soft tissue. The big toe is the most common location, but any toenail may become ingrown.

An ingrown toenail may be caused by improper trimming of the nail where the corners are curved. Heredity may play a part as can pressure on the toes from crowding or tight shoes.

Symptoms

  • Pain
  • Swelling
  • Redness
  • Drainage
  • Odor

Treatment

If you suspect an ingrown toenail, soak the foot in soapy water or a warm saltwater bath, then smooth on antiseptic lotion and bandage. If there is no improvement in a day or so, visit your podiatrist. Over-the-counter medications are ineffective, and don’t try to remove any part of the nail yourself.

For those with diabetes, peripheral vascular disease or another circulatory disorder, do not attempt to self-treat an ingrown nail. Get help from a podiatrist as soon as possible.

See your foot doctor if there is any sign of infection around the toenail such as drainage or excessive redness. To eliminate an ingrown toenail, the doctor will remove the ingrown portion and treat the infection with oral or topical medication. For chronic problems, the corner of the nail along with its root will be removed.

Prevention

  • Wear comfortable shoes with a wide toe box.
  • Avoid wearing high heels.
  • Trim toenails straight across with toenail clippers and don’t round or dig into the corners.
  • Don’t tear or rip the nail edges.

Neuroma

A neuroma is a nerve tissue growth often located between the third and fourth toes. Although benign, a neuroma can be painful with a burning sensation or numbness.

These factors can contribute to a neuroma:

  • Biomechanical deformities like a flat foot or high arch.
  • Improper shoes that squeeze the toe area. High heels can also apply excess pressure to the toes.
  • Repeated stress to the toes and ball of the foot.
  • Trauma.

Symptoms

Neuroma symptoms include:

  • Pain between the toes when walking
  • Feeling like there is a stone in the shoe.
  • Numbness or tingling in the ball of the foot.
  • Pain in the ball of the foot with weight-bearing.
  • Swelling between the toes.

Treatment

If you suspect a neuroma, try some home treatment. Switch to shoes with plenty of toe room and low heels. Proper shoes will have shock-absorbent soles and insoles to keep excessive pressure off your foot.

Rest your foot as much as possible and ice to relieve discomfort. Massaging the area can temporarily ease neuroma pain.

When these methods don’t work, it’s time to visit your podiatrist. Left untreated, neuromas may worsen. The earlier it is treated, the sooner the neuroma will heal.

We will relieve the pressure from the area. Padding the ball of the foot can relieve neuroma symptoms. Anti-inflammatory medications and cortisone injections can ease pain and inflammation.

Custom-fitted orthotics can help control foot function while they relieve symptoms and prevent worsening.

For more severe neuromas, we will discuss surgery with you. The outpatient surgery removes the enlarged nerve.

Prevention

These preventive steps can help:

  • Make sure that your shoes, especially workout footwear, have plenty of room in the front so your toes are not squeezed.
  • Limit wearing shoes with heel height greater than two inches or those with a narrow toe box.
  • Choose shoes with adequate padding for the ball of the foot.

Shockwave Therapy

Extracorporeal Shock Wave Therapy (ESWT) is used to treat chronic heel pain (plantar fasciitis). “Extracorporeal” means “outside of the body.” During this noninvasive procedure, sonic waves are directed at the area of pain using a device similar to that currently used in nonsurgical treatment of kidney stones.

Extracorporeal Shock Wave Therapy is prescribed for patients who have experienced plantar fasciitis for an extended period of time — six months or more — and have not benefited from other conservative treatments. The brief procedure lasts about 15 minutes and is performed without need for anesthesia. Strong sound waves are directed at and penetrate the heel area to stimulate a healing response by the body. ESWT is performed in our office.

People who are not candidates for ESWT include pregnant women and individuals with neurological foot disease, vascular foot disease, pacemakers, or people taking medications that interfere with blood clotting (such as Coumadin).

This therapy is a safe and effective alternative treatment for heel pain. Clinical studies show a 70 percent success rate for treatment of plantar fasciitis using Extracorporeal Shock Wave Therapy.

Warts

Warts can appear anywhere on the body. When they are on the bottom of your foot, they are called plantar warts because they occur on the sole of your foot.

Because the bottom of the foot has a lot of pressure, the warts grow inward into the tissue of your foot. Sometimes they are covered by a callus that you can see on the surface of the skin.

Plantar warts are caused by the human papillomavirus which enters the body through a break in the skin. This virus is very contagious and can be picked up in public areas such as swimming pools, showers and locker rooms. Teenagers and children are prone to getting this virus as are those with weakened immune systems.

Symptoms

  • A rough, grainy growth on the bottom of the foot
  • A callus that may have covered the wart
  • Black pinpoints on the surface of the wart
  • Pain or tenderness when walking or standing

It’s essential to seek out a podiatrist’s help immediately if you notice an ulcer.

Treatment

Over-the-counter wart treatments are not effective in eradicating the wart. Our professional treatments include:

  • Prescription salicylic acid treatments to peel away the wart.
  • Using liquid nitrogen to freeze the wart. This is also called cryotherapy. The area will be numbed to reduce pain. The dead tissue will come off in a few weeks.
  • Laser treatment to destroy the wart by closing off the blood vessels.
  • Surgical removal of the wart.

Prevention

  • Always cover feet with shower shoes or flip-flops in public areas.
  • Keep your feet clean and dry.
  • Change socks and shoes daily.
  • Don’t touch any warts that you have as they can spread.
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