Your feet hurt and you don’t know what to do about it? Here is a list of the podiatric pathologies observed most frequently in the clinic and the various treatments possible.
- Plantar fasciitis or heal spur syndrome
- Bunions (hallux valgus)
- Ingrown toenails
- Plantar warts
- Athlete’s foot (Tinea pedis)
- Fungal infection of the nail (onychomycosis)
- Diabetic foot
- Morton’s neuroma
- Children’s problems
Plantar fasciitis or heal spur syndrome
Plantar fasciitis or heal spur syndrome is an inflammation of the plantar fascia which is primarily characterized by heal pain that is secondary to stretching or micro tears in the plantar fascia. The plantar fascia is a fibrous membrane that is attached to the heal and runs to the base of the toes; it helps shape the arch of the foot. Usually, the patient will experience a sharp pain when taking his first steps in the morning or following rest or physical activity.
There are many causes for plantar fasciitis. They include, among others, practising sports without preparation or without wearing adequate equipment, repetitive movements, over-use, flat or hollow feet, a lack of flexibility in the calves, rapid weight gain, wearing inadequate shoes, and walking or standing for prolonged periods of time on a hard surface. It should be noted that normal aging increases the fragility of the fascia, as does a past episode of plantar fasciitis.
It is important to correct this problem as quickly as possible since the foot is used throughout the day, when standing or walking, which prevents the complete elimination of the symptoms in most people and can even cause the situation to degenerate rapidly. Therefore, it is important to consult your podiatrist as soon as the symptoms appear, since an injury takes longer to heal completely when it has lasted weeks and even months. Your podiatrist will make the right diagnosis, will find the cause of your fasciitis and will suggest an appropriate treatment plan for you.
When you visit the podiatrist, she will examine you and determine the treatment you need. She will be able to give you advice about footwear, prescribe non-steroid anti-inflammatory medication, provide taping, prescribe plantar orthotics or even propose a cortisone injection.
Bunions (hallux valgus)
A hallux abductovalgus, commonly called a bunion, is a deviation of the bones in the big toe (metatarsus and phalanx) secondary to various etiologies. In fact, there are many causes.
The origin may be:
- Biomechanical (hypermobility of the bones in the foot, flat foot, hollow foot, lack of flexibility in the calf);
- Arthritic change (osteoarthritis, rheumatoid arthritis, psoriatic arthritis);
- Neuromuscular (cerebral palsy, Guillain-Barré);
- Genetic (Marfan syndrome, Ehlers-Danlos syndrome, Down syndrome);
- Congenital (family history in 65% of the cases);
- Secondary to a surgical complication;
- Pressure from shoes can accelerate the process, but does not generally cause the deformation on its own.
Your podiatrist will examine your bunion and determine the severity of the deformation Thus, she will verify the quality of the movement of the large toe and make the examinations needed to verify the alignment of the foot. X-rays may be necessary. Possible treatments include: plantar orthotics, changing shoes, cushions and, ultimately, surgery. Conservative treatments are always given priority before surgery is considered. They involve controlling or limiting the progress of the deviation and are generally sufficient to control pain.
N.B. : There is also a juvenile form of bunion which typically occurs between the ages of 10 and 16. For such cases, orthotic treatment is strongly recommended as soon as the deviation appears.
Ingrown toenails (onychocryptosis)
Ingrown toenails are a problem that is frequently observed in the clinic For the patient, it is difficult to treat an ingrown toenail since home remedies often make the problem worse. For this reason, a visit to the podiatrist may be a good idea in order to prevent any risk of infection and any recurrence.
At the outset, the toe will look red. Then, over time, an infection may set in; finally a very sensitive granuloma may form. Don’t let your ingrown toenail degenerate and ruin your quality of life!
During the consultation, your podiatrist will start by identifying the source of the ingrown toenail (poor nail trimming, excessive trimming, shoes, exostosis under the nail, etc.) and will recommend the best treatment. Occasionally, simply trimming the nail with a nail clipper will be enough to clear the nail, release the pressure and allow your toe to heal. However, we have noted that the ingrown toenail returns after a few weeks in the case of most patients for whom we merely trimmed the nail without burning the root.
For this reason a partial, permanent excision of the nail may be a solution in cases that have lasted months or even years. This technique involves simply cutting a strip of the nail (only the area that is covered by skin) to the base then burning the root of that portion of the nail. This procedure is well tolerated and provides good results.
The plantar wart is a benign papilloma produced by the human papilloma virus (HPV). Patients want to have their plantar wart treated for various reasons: to prevent the wart from spreading on their own body or to others or to prevent pain (some warts are painless at the outset but can be a source of pain over time).
The people who are most at risk are: children, adolescents, elderly people and individuals with a weakened immune system. The virus is transmitted by contact between unprotected skin with contaminated clothing or surfaces, such as shower floors and swimming pools.
Since the virus is limited to the upper layers of the skin, it has little contact with the immune system and even less chance of stimulating the production of antibodies, which accounts for the high recurrence rate and the tenacity of plantar warts. The best way to prevent the appearance of these lesions is to avoid walking barefoot in public showers and to wear socks at all times.
It is important to treat a plantar wart as soon as it appears. After diagnosing a plantar wart, your podiatrist will suggest the right treatment for you.
Plantar warts are, unfortunately, often confused with corns. An incorrect diagnosis inevitably results in an incorrect treatment and poor results. Consult your podiatrist to treat the right problem.
Athlete’s foot (tinea pedis)
Athlete’s foot is a fungal infection affecting the skin. It occurs rather frequently and will affect 30% of the population at one time in their lives. Heat, darkness and dampness are ideal conditions for allowing a fungus to multiply quickly.
The infection is transmitted easily in sports locker rooms, and by shower floors, bathroom ceramic tiles, slippers, shoes and towels.
There are four types of athlete’s foot :
- Vesicular: very small blisters;
- Intertriginous: between the toes;
- Hyperkeratotic: with chronic and resistant calluses (corns);
- Severe flaking with inflammation.
It is important to consult your podiatrist since several other conditions can be confused with athlete’s foot: inflammatory and auto-immune reaction (contact dermatitis, eczema, psoriasis, lichen planus), warts, parasites, erythrasm, and genetic conditions (keratoderma).
Fungal infection of the nail (onychomycosis)
Onychomycosis is a fungal infection of the toenail. Although the big toe is the one most frequently affected, the infection can affect any toenail. Fungus infections spread in a warm, damp and dark environment, such as inside shoes. For this reason, onychomycosis rarely heals without treatment and tends to spread to several toenails over time.
In addition to the risk of permanent damage to the toenails, individuals with a weakened immune system (diabetic patients, elderly people, etc.) who neglect this problem are exposed to the risk, among others, of contracting severe athlete’s foot, cellulitis or medical problems that are much more serious.
Onychomycosis can appear in several different ways since several types of fungus can cause it.
Do not hesitate to consult a health profession at the first signs of infection: a change in colour or texture, a nail that lifts off or has grown thicker. Your podiatrist will be able to guide you to the right diagnosis and the appropriate treatment and will show you how to prevent this type of problem.
For diabetic patients, it is a very good idea to consult the Clinique podiatrique Vaudreuil for a neurological and vascular assessment.
A visit to the clinic will serve to reduce the risk of ulcers by the treatment of calluses, give the patient good advice about shoes, treat ulcers through debridement, bandages, adapted orthotics or diabetic walking boots. People with diabetes are more at risk of developing pressure ulcers, for several reasons.
On a long-term basis, diabetes can cause:
- Loss of sensitivity in the feet (neuropathy) which hides the pain caused by pressure and injuries;
- Vascular insufficiency;
- Motor changes: the small, intrinsic muscles in the foot can be affected and cause hammer toes which increase pressure points at the front of the foot, thereby increasing the risk of ulcers.
A few interesting facts:
- Poorly controlled blood sugar levels (glycemia) increase the chances of developing a neuropathy;
- 40% to 50% of people with diabetes will become neuropathic within the first 10 years they have the disease;
- Neuropathy can cause burning sensations, tingling, or numbness in the feet;
- Almost 45% of leg amputations involve diabetic patients;
- It is estimated that 85% of leg amputations could be prevented using an interdisciplinary approach.
What will a podiatrist do for you?
- Sensory evaluation: tests to determine if you have lost a protective sensation;
- Dermatological evaluation: careful examination of the foot, nails and between the toes for potential sites for ulcers: injury, dryness/dampness, calluses, fungal infection, wart;
- Vascular evaluation: verification of the peripheral pulse, temperature of the foot, time required to fill capillaries, etc.;
- Motor evaluation: analysis of gait, verification of the range of the movement, evaluation of bone and joint deformations (hammer toes or claw toes, Charcot’s foot, etc.);
- Verification of your shoes:
- Is the heel reinforcement adequate?
- Is the width of the shoe adequate for your feet?
- Are there seams inside?
- Is the supple material supple enough?
We strongly recommend that diabetic individuals wear good shoes at all times, even in the house.
- Complete foot care: debridement of corns and calluses, trimming and thinning of nails, application of moisturizing cream. Your podiatrist will take the time to explain the appropriate care to be given to your feet and will help you prevent the podiatric complications associated with diabetes.
Did you know that removing a corn with a surgical blade can reduce the pressure applied to the skin by 30% and considerably reduces the risk of ulcers?
Morton’s neuroma is a perineural fibrosis caused by the repeated irritation of the nerve and it results in a burning sensation, numbness or electric discharges at the front of the foot that can irradiate to the toes. Occasionally, this results in the impression that your sock is on wrong or that you have a mass under the front of your foot.
The pain appears when you walk and is generally relieved by rest. It re-appears with the slightest activity.
Various causes of Morton’s neuroma:
- Poor shoe type (narrow shoes increase the compressive forces considerably);
- Repeated trauma (pressure);
- Incorrect biomechanics (pronation of the foot, hypermobile feet, etc.).
Treatment: After making a complete evaluation, your podiatrist will recommend the most appropriate treatment based on your needs.
The most common treatments:
- Change in shoe style;
- Detection and elimination of sources of repeated pressure;
- Oral ant-inflammatory medication;
- Cortisone injections;
- Biomechanical control using Cryos plantar orthotics;
- In rare cases, your podiatrist will recommend surgery if all of the possible treatments have been tried without success.
Problems affecting children
- Pieds plats
- Flat feet
- Growing pains
- Knock knee (genu valgum)
- Lower limb discrepancy
- Juvenile bunions
- Repeated sprains