VERRUCAE

A verruca is the manifestation and growth of a contagious virus (HPV, The Human Papilloma Virus) that invades the skin through small cuts or abrasions on its surface, even through openings that are too small to be seen with the naked eye. Once inside the skin, the virus can grow and spread, stimulating the rapid generation of cells on the surface of your skin. There are over 60 different strains of HPV. Technically, verruca may appear anywhere on the skin, but only those that appear on the soles of the feet are known as plantar verruca.

Only people can pass verruca to other people – either from direct skin-to-skin contact or inadvertently leaving the virus somewhere where others can pick it up. For example, the virus can be spread when one person with plantar verruca walks barefoot on ground where others do the same. The virus can also be spread if a patient with a plantar verruca loans shoes or socks, which have not been washed, to an infected person.

Verrucae can easily be spread to areas around the body other than the feet, such as when the patient touches the plantar verruca, and then touches another area of his or her body, such as hands, face, genitals, scalp, arms, legs, ears – you name it. If the wart bleeds, (such as when it is nicked or cut accidentally), this creates an ideal avenue for infection of another part of the body, or another person.

Verrucae are also stubborn and frustrating. They may disappear for a while, and then recur in the same place. They may go away with treatment and then come back – or they recur in the same place. Children seem to be more prone to verruca than adults, leading some medical experts to theorise that as they age, some people can develop immunities to the virus that causes verruca. Plantar verruca (and all warts) are often unsightly and sometimes painful, but not life threatening. That said, however, it is important to note that there are various lesions of the skin on the foot, including heloma, tyloma, moles – and even a few rare cancerous growths – that have similar or identical characteristics, therefore the correct diagnosis is vital before treatment can commence.

The correct name for a verruca when found on the feet or toes is Verruca Pedis. Verrucas are slightly raised and circular in shape, with a thickened rim of surrounding skin. The surface may have black dots (pepper-pot appearance). There may be several verrucas or just one.

Sometimes verrucas form clusters of small warts, called “mosaic warts” – these are usually painless. In children, verrucas tend to come and go quite quickly, but in adults they can persist for several years if not treated.

TREATMENT
Following assessment we will diagnose the verruca and give you the most appropriate treatment with agreement with you, this may involve cutting away the dead tissue and following up with acid treatment which can be effective or alternately in more difficult cases Cryotherapy may be used, this involves freezing the area, with all treatments there will need to be follow up visits. It is important that when receiving treatment that the area is kept dry. The chiropodist/podiatrist will advise you how to look after the area depending on which treatment is chosen.

With some patients it may be better to do nothing and just to keep it covered with a plaster for the following reasons:-

• Verrucas can disappear on their own, and treatment can be inconvenient and uncomfortable.

• The body can build up immunity if the verruca is left to disappear naturally.

All you need to know about Verrucae

 

CRACKED HEELS

Cracked heels can be very painful, the symptoms are pain on weight bearing and thickening of the skin around the heel, this is called callous. Shoes that are open such as sandals and thin soled shoes can make the symptoms worse. Thick dry skin (callus) can be due to the way you walk.

Some patients may have cracked heels through other factors such as:-

• Having to stand for prolonged periods
• Wearing open back shoes
• Obesity
• Medical conditions such as diabetes, underactive thyroid.
• Dry skin conditions such as eczema and psoriasis

TREATMENT
Self treatment can be carried out with creams and emollients, however if callous is present this will need to be reduced with a pumice stone.

A chiropodist/podiatrist will reduce the callous using a drill or by reducing down with a foot file, the foot will then treated with the appropriate emollient.

Diabetic patients should never attempt to reduce callous and cracked heels as this may cause infection. Diabetic patients should pay attention to the footwear such as socks and shoes as these may be causing the problems. A chiropodist/podiatrist will be able to advise you about appropriate footwear and may advise you to wear an orthowedge or appropriate insoles to reduce the pressure on the heel area.
 

INGROWN TOENAILS

An ingrown toenail (onychocryptosis) is often caused by cutting the nails incorrectly. Although other factors may be involved, such as the shape of the nail, for example if the nail is more curved from side to side rather than being flat this may be cause an incurved nail, which is prone to becoming ingrown. Inheritory factors can also be considered as the shape of the nail may be congenital, or may have occurred due to trauma or pressure from shoes. Trimming too far down the sides and poor cutting of nails, can cause a spike, which will cause pressure and could later penetrate the skin and cause an ingrown toenail.

Tight shoes may cause pressure between the skin in the nail fold and this will increase the risk of ingrown toenail. An injury that may cause trauma to the nail may alter the shape of the making it more prone to becoming an ingrown toenail. Pressure from the toe next to the nail that has ingrown can be a factor. A ‘chubby’ or fleshy toe is more likely to have a nail grow into this, as are individuals whose feet swell as they are more prone for this to happen.

TREATMENT
Ingrown toenails can become infected, antibiotics are often used to treat this, however the ingrown nail will still be there, so it is important to have a skilled chiropodist/podiatrist to remove the spike or corner that has penetrated the skin. The chiropodist/podiatrist will carry out a full assessment to ensure that the pain is alleviated by the removal of the spike and will apply an antiseptic dressing to clear up any infection present and will further advise you if a follow up appointment is necessary.

Ingrown toenails often reoccur, due to the shape of the nail. Regular treatment may be required.

In some patients the ingrown toenail does not always respond to conservative care and the ingrown nail may be severe. The Chiropodist/Podiatrist will in these cases opt for surgical removal under local aesthetic.

The cornerstone to self treatment and prevention of ingrown toenails is to cut nails straight across to allow the corners to protrude and to wear shoes and socks that are not too tight.
 

BUNIONS

Bunions can develop when the great toe is pushed from its normal alignment and forced by pressure into an abnormal position. This is usually caused by wearing shoes that are too tight.

The joint is usually subjected to further pressure and develops a bursa, (a sack which is hollow lined with fluid) which becomes inflamed. This is common in certain occupations, such as hairdressers, waiters and the police, as they are on their feet for many hours so allowing the anterior metatarsal arch to fall or weaken and the foot becomes flattened and the joint of the big toe becomes projected.

Symptoms include redness, swelling and pain, the bigger the bunion gets, the more it hurts to walk.

TREATMENT
This depends largely on how long the bunion has been in existence. It is rare that a radical cure for a fully developed bunion can be attained. It is important to reduce inflammation and to remove coarsened skin; massage can assist as it has a part to play in helping to keep the joint mobile. If the great toe is out of alignment orthotics may redress the balance, as are shoes that do not restrict the joint. Shoes with wide insteps, broad toes and soft soles are the best also recommended is a cushioned pad to alleviate the pressure. Your chiropodist/podiatrist will be able to advise you.

Some bunions may need surgery to realign bone, ligaments, tendons and nerves to bring the great toe back to its correct position.
 

CORNS AND CALLUSES

A Callus is a yellowish plaque of hard skin and a corn is an inverted cone of similarly hard skin which is pushed into the skin. Both conditions are associated with excess intermittent mechanical stress (shear, friction, pressure, torsion and tension) which results in abnormal keratization. Corns and Callus are rarely seen in people less than 16 years old. This can be caused by ill -fitting shoes or flat or high arched feet or abnormalities of the mechanics of the lower limb.

TREATMENT
Successful management requires removal of the cause followed by treatment aimed at reducing pain and restoring normal skin function. The chiropodist/podiatrist will reduce callus and enucleate (remove) the corn with a scalpel to reduce pain, pads may be advised to alleviate further friction and reduce pain. To absorb shear a toe pad of polymer gel or tubifoam may be used. It may be necessary to change shoes if they are not suitable for example; a smooth inside to footwear and well fitting shoes may avoid some of the associated problems.