Ingrown Toenail

An ingrown toenail is curving of corner or edge of your toenail which grows inside surrounding skin. Ingrown toenail can be painful.

It starts out hard, swollen and tender, and later, may become sore, red and infected.

Your skin may start to grow over the ingrown toenail. This condition is seen in both men and women. Big toe is most likely affected.

Ingrown toenails often are the result of trimming your toenails too short, particularly on the sides of your big toes.

When trimming your nails, avoid tapering the corners so that the nail curves with the shape of your toe. The sides of the nail will curl down and dig into your skin. Shoes that are too tight or short also may cause ingrown toenails.

You can prevent ingrown toenails by :

• Trimming your toenails straight across with no rounded corners.
• Ensuring that your shoes and socks are not too tight.
• Keeping your feet clean at all time.

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Athlete's foot

Athlete's foot and fungal toenails are the most common types of foot fungus.

Athlete's foot is a skin disease caused by a fungus, usually occurring between the toes. The fungus usually attacks the feet because shoes create a warm, dark, and humid environment which encourages fungus growth.

The warmth and dampness of areas around swimming pools, showers, and poorly maintained Public toilets, are also breeding grounds for fungi.

Not all fungus conditions lead to Athlete's foot, however. Other conditions, such as malfunctions of the sweat mechanism, reaction to dyes or adhesives in shoes, eczema, and psoriasis, also may mimic Athlete's foot.

Symptoms of athlete's feet include drying skin, itching scaling, inflammation, and blisters. Athlete's foot may spread to the soles of the feet and to the toenails, and can spread to other parts of the body, including the groin and underarms.

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You can prevent Athlete's foot by

• Avoiding prolonged & frequent wetting of feet.
• Avoiding walking barefoot. Use shower shoes.
• Reducing perspiration by using talcum powder.
• Wearing light and airy shoes.
• Wearing socks that keep your feet dry, and changing them frequently if you perspire heavily.
• While fungicidal and fungi static chemicals are usually used to treat Athlete`s foot problems, they often fail to contact the fungi in the horny layers of the skin. Instead, topical or oral antifungal drugs may need to be prescribed.

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Fungal toenail infections

Fungal toenail infections are a common foot health problem and can persist for years without ever causing pain. The disease, characterized by a change in a toenail's color, is often considered nothing more than a mere blemish, but it can present serious problems if left untreated.

Many people don't realize they have a fungal nail problem. Moreover, many don’t seek treatment. Still, fungal toenail infections are a common foot health problem.

Also referred to as Onychomycosis, fungal nail infections are an infection underneath the surface of the nail, which can also penetrate the nail. In addition to causing difficulty and pain when walking or running, fungal nail infections are often accompanied by a secondary bacterial and/or yeast infection in or about the nail plate.

A group of fungi called dermophytes easily attack the nail, thriving off keratin, the nail`s protein substance. When the tiny organisms take hold, the nail may become thicker, yellowish-brown or darker in color, and foul smelling. Debris may collect beneath the nail plate, white marks frequently appear on the nail plate, and the infection is capable of spreading to other toenails, the skin, or even the fingernails.

Those who suffer chronic diseases with poor body resistence, such as diabetes, circulatory problems, or immune-deficiency conditions, are especially prone to fungal nails. Other contributory factors may be a history of Athlete`s foot and excessive perspiration.

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How to prevent Fungal toe nail infection ?

• Keep your feet clean and dry. Avoid prolonged & recurrent wetting of toes.
• Clip your nails straight across so that the nail does not extend beyond the tip of the toe.
• Use a quality foot talcum powder in conjunction with shoes that fit well and are made of materials that breathe.
• Avoid wearing excessively tight hosiery, which promotes moisture. Socks made of synthetic fiber tend to "wick" away moisture faster than cotton or wool socks, especially for those with more active life styles.
• Don`t apply polish to nails suspected of infection.
• Exercise daily & inspect your feet and toes regularly.

Depending on the type of infection you have, over-the-counter liquid antifungal agents, while sometimes effective, may not prevent a fungal infection from recurring. A topical or oral medication may need to be prescribed, and the diseased nail matter and debris removed by a process called debridement.

In some cases, surgical treatment is prescribed, during which the infected nail is removed. Permanent removal of a chronically painful nail, which has not responded to any other treatment, permits the fungal infection to be cured, and prevents the return of a deformed nail.

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Black Toenails

VVariety of things can cause Black toenails. Darkened nails often occur from the toe hitting the end or the top of the shoe toe area. Wearing tight or ill-fitting shoe is very important cause.The darkened nail is essentially a bruised nail. Sometimes fungal nail infection can be the cause of black toenail.

If you are a diabetic, any change in the color of your toenail should be evaluated. The pressure, which caused the bruising of the nail, can cause a small sore under the toenail, and the sore can become infected. Patients with diabetes should not treat this condition themselves and should Contact Us

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Corns

Corns are circumscribed & small thickness of skin which occur at high & abnormal pressure areas of feet. The surface layer of the skin thickens and builds up, irritating the tissues underneath .Corns are usually located at bottom of foot (Metatarsal area) or top of toes. Hard corns are usually located on the top of the toe or on the side of the small toe. Soft corns resemble open sores and develop between the toes as they rub against each other.

Ill - fitting shoes, toe deformities, such as hammertoe or claw toe and Flat feet can lead to corns.

At our centre your corns can be removed without any pain or injection or any cut in skin or blood loss & you will be able to walk down normally to your home or office ( No dressing required ), Contact Us.

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Calluses

A callus is a flat & slightly larger area of hard, thickened skin that can occur across the ball of the foot, on the heel, or on the outer side of the big toe.

Calluses have painful nerves and bursal sacs (fluid-filled balloons that act as shock absorbers) beneath them, causing symptoms ranging from sharp, shooting pain to dull, aching soreness.

Calluses are due to repeated friction and pressure, as the shoe (or ground) rubs against a bony prominence on the toe or foot. The skin thickens in response to this pressure. Small amounts of friction or pressure over long periods of time cause a corn or callus. Calluses typically develop under the ball of the foot that is carrying more than its fair share of the body weight.

Calluses can be treated with over-the-counter callus removers that have strong acids that peel this excess skin away after repeated application. You should be careful with these products as they can cause chemical burns when not used correctly. Their use in diabetics is more dangerous because of the chances of developing of Non healing Diabetic Foot Ulcer.

If you need assistance removing calluses, Contact Us. Calluses can be trimmed and comfortable padding applied to these painful areas. In addition to medication to relieve inflammation, cortisone may be injected into the underlying bursal sac to rapidly reduce pain and swelling.

Plantar calluses that are recurring are sometimes removed surgically in a procedure called an osteotomy, which relieves pressure on the bone.

How to prevent calluses :

• Switch to better shoes, or even an orthotic device.
• Buy socks with double-thick toes and heels.

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Swelling Of Legs And Ankle

Different cause of swollen feet & legs are :

Venous stasis - It is a loss of proper vein function of the legs that would normally carry blood back toward the heart. This may occur following injury to the veins, which can result in blood clots in the superficial veins known as superficial phlebitis, or following blood clots in the deep veins known as deep venous thrombosis. The superficial veins in the legs may be varicose, causing the veins to be enlarged and appear as a cord or a bunch of grapes. Patients often complain of a feeling of fullness, aching, or tiredness in their legs.

Swelling in the lower legs and ankle can also occur as a result of chronic congestive heart failure and kidney disease. In some instances the cause of the swelling may not be easily identified ( Idiopathic ).

Swelling feet is more so in the evening hours or after prolonged sitting with legs hanging e.g. Long Train or Aeroplane journey.These symptoms are worse with standing, and are relieved when the legs are elevated. As the condition progresses the blood continues to collect in the feet, ankles, and legs.

Treatment is by taking care of cause & certain other modalities, Contact Us.

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Spasms of legs

Leg spasms are contractions of the Calf Muscles,feet, or toes and are sometimes seen with muscle cramps, twitching, and convulsions. These contractions of the muscles can be violent.

Spasms of the hands or feet are an important early sign of tetany, a potentially life-threatening condition. Tetany is a manifestation of an abnormality in calcium level, which can be linked to a lack of Vitamin D, lessened function of the parathyroid glands, alkalosis in the body, or the ingestion of alkaline salts.

Carpopedal spasms are usually accompanied by numbness, tingling, or a "pins-and-needles" feeling in the fingers, toes, and around the mouth; muscle weakness; fatigue; cramping; twitching; and uncontrolled, purposeless, rapid motions.

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Burning Feet

Burning feet is a common complaint, especially among people over 50 and those who are diabetic.

Thyroid dysfunction, gastric restriction in morbidly obese people, and heavy use of alcohol also have been linked with burning feet.

Neuroma and tarsal tunnel syndrome, which causes a pinched nerve, also can result in burning feet.

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Smelly Feet and Foot Odor

The feet and hands contain more sweat glands than any other part of the body (about 3,000 glands per square inch). Smelly feet can be not only embarrassing but uncomfortable as well.

Feet smell for two reasons, your feet sweat a lot & you wear shoes for prolong period. The interaction between your perspiration and the bacteria that thrive in your shoes and socks generates the odor. Therefore, any attempt to reduce foot odor has to address both your sweating and your footwear.

Smelly feet can also be caused by an inherited condition called hyperhidrosis, or excessive sweating, which primarily affects men. Stress, some medications, fluid intake and hormonal changes also can increase the amount of perspiration your body produces.

Prevention

Smelly feet generally can be controlled with a few preventive measures :

• Wear shoes made of leather, canvas, mesh or other materials that let your feet breathe. Never wear nylon socks or plastic shoes.
• Bathe your feet daily in lukewarm water, using a mild soap. Dry thoroughly.
• Change your socks and shoes at least once a day.
• Check for fungal infections between your toes and on the bottoms of your feet. If you spot redness or dry, patchy skin, Contact Us.
• Don’t wear the same pair of shoes two days in a row. If you frequently wear athletic shoes, alternate pairs so that the shoes can dry out. Give your shoes at least 24 hours to air out between wearings; if the odor doesn’t go away, discard the shoes.
• Dust your feet frequently with a good talcum powder or foot powder. Practice good foot hygiene to keep bacteria levels at a minimum.
• Wear thick, soft socks to help draw moisture away from the feet. Cotton and other absorbent materials are best.

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Foot Ulcers

Ulcers are skin wounds that are slow to heal and are classified in four stages, according to which layers of skin are broken through.

Stage 1 - Characterised by a reddening over bony areas.

Stage 2 - Characterised by blisters, peeling or cracked skin. There is a partial thickness skin loss involving the top two layers of the skin.

Stage 3 - Characterised by broken skin and sometimes bloody or purulent discharge. There is a full thickness skin loss involving subcutaneous tissue ( the tissue between the skin and the muscle. )

Stage 4 - Characterised by breaks in the skin involving skin, muscle, tendon and bone and are often associated with a bone infection called osteomyelitis.

There are 4 major reasons of Foot Ulcers :

Venous - This type of ulcer is due to compromised veins. It is commonly seen in the 'Garter area' ( around the ) ankle and are slow to heal.

Neuropathic - Loss of sensation in the feet. Diabetes is the usual cause.

Arterial - Due to poor blood flow to the lower extremity. This type of ulcer can be very painful and is usually found on the margins of foot e.g. tips of toes, heels etc. They can be easily infected. They usually lead to gangrene which usually requires amputation of Toes, foot or leg.To avoid amputation Contact Us.

Decubitus - This type of ulcer is caused by excessive prolonged pressure on one area of the foot. They are known as “bed sores” or “pressure ulcers” too.The most common place to see this type of ulcer is in a person who is confined to bed and they usually occur on the backs of the heels.

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Bunions

Bunions are usually hereditary but they may be because of wearing tight, narrow shoes. Bunions cause the base of your big toe to enlarge and protrude. The skin over it may be red and tender. Wearing any type of shoe may be painful. The bigger your bunion gets, the more it hurts to walk. Your big toe may angle toward your second toe, or even move all the way under it. The skin on the bottom of your foot may become thicker and painful.

If your bunion gets too severe, it may be difficult to walk. Your pain may become chronic and you may develop arthritis.

Treatment is by Orthotics or surgery.

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Claw Toes

Claw toe means your toes "claw," digging down into the soles of your shoes and creating painful calluses. Claw toe normally is caused by weakened muscles due to nerve damage from diseases like diabetes or alcoholism,. Claw toe gets worse without treatment and may become a permanent deformity over time.

Claw toe deformities are easier to repair when detected early, but they harden into place over time. Splint or tape is used to hold your toes in correct position.

Hammer Toe :

Intro :
A hammer toe is a term that is commonly used to describe any type of toe deformity. In a hammertoe the deformity usually exists in one toe, the base of the toe points upward and the end of the toe points down like an L.

Causes :
Increasing factors of developing hammer toes :

• Some people are just structurally prone to develop hammer toes ( hereditary ).
• Tight footwear is an important factor in the cause of hammer toes as well as providing the pressure that causes the symptoms.
• Weaker small muscles in the foot may also play a role.

Symptoms :
The symptoms of a hammer toe are usually first noticed when a corn develops on the top of the toe and becomes painful, usually when wearing tight shoes. Most of the symptoms are due to pressure from footwear on the toe. There may be a callus under the metatarsal head at the base of the toe. Initially a hammer toe is usually flexible, but when longstanding it becomes more rigid.

Prevention & Treatment :
Prevention of a hammer toe can be difficult as the problem doesn't has any symptoms until the problem is well established. Wearing shoes that have extra room in the toes may help the problem or slow down its development.

Treating Hammer toe :

• It´s important that any footwear advice is followed. The correct amount of space in the toe box will allow room for the toes to function without excessive pressure. We recommend you to ask for a proper fitting chart in your shoe store or to check online.
• If a corn is present, this will need to be treated.
• If the toe is still flexible, it may be possible to use splints or tape to try and correct the toe. Without correct fitting footwear, this is often unsuccessful.
• Padding is often used to get pressure off the toe to help the symptoms.
• If conservative treatment is unsuccessful at helping the symptoms, surgery is often a good option.

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Heel Fissures

Heel fissures, or cracking of the skin of the heels, is an often painful condition. Skin lotions can help with reducing the dryness associated with the condition.

Open-backed sandals or shoes without heel counter, which allow more slippage around the heel while walking, are often the culprits. Bare foot walking (common in Indian population) is also very important cause. The skin thickens as a result of the friction.

Deep fissure may need debridement because it can be invaded by pathogenic bacterias causing bleeding with ulcer formation. Contact Us.

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Mosaic Warts

Intro :
Warts are caused by a viral infection,Human Papilloma Virus(HPV). The virus penetrates through the skin and may often enter through traumatised or damaged skin. Warts are often spread in moist areas and can appear on any skin surface. On the sole of the foot they are called "plantar warts", which are one of the most common surfaces to appear.

Causes :
The Wart Virus is spread by direct contact. Quite often a moist area that has "skin residue" is an area at risk for spreading warts. This includes gym locker rooms, showers and swimming pools. Plantar warts can occur when HPV (Wart virus) invades the body through tiny cuts or breaks in the skin on the bottom of the feet.

Symptoms :
Plantar warts usually are rough and spongy, and most are grey, brown, or yellow with dark pinpoints, scraping a wart may cause it to bleed. Many corns or calluses on the foot are mistaken for warts and the converse is also true. A plantar wart is similar in structure to an iceberg, the part on the surface of the skin is a small part of the entire problem. If left untreated, plantar warts can grow up to 1 inch in circumference and may spread into clusters (called mosaic warts).

Prevention & Treatment :
Tips For Prevention :

• Avoid walking barefoot in locker rooms, pools, gyms, and most other public areas.
• Use protective slippers or sandals in public areas.
• Avoid direct contact with warts from yourself with other body parts or from other people.
• Keep your feet clean and dry.
• Self treatment in not recommended.

In some cases, podiatrists apply mild acid to treat plantar warts. This treatment often requires multiple applications over the course of several weeks, disintegrates viral cells and allows healthy skin cells to replace them. Laser treatment: Lasers produce little scarring and are effective in most cases.

Wart Tips :

• Seek professional evaluation and assistance with the treatment of your warts if they have persisted, cause pain, or spread.
• Diabetics and other patients with circulatory, immunological or neurological problems should not self-treat their warts.
• Warts may spread and are catching. Make sure you have your warts evaluated to protect yourself and those close to you.
• For permanent cure of Warts - Contact Us.

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Morton's Neuroma

Morton's neuroma shown in circled area.

Morton's neuroma is caused by a nerve being pinched. This pinching usually results in pain between the third and fourth toes. Tight shoes can squeeze foot bones together. The nerve responds by forming a neuroma, a build up of extra tissue in the nerve. The neuroma results in pain, that may radiate into the toes.

Treatment usually involves wearing wider shoes and taking oral medications to decrease the swelling around the nerve. A pad on the sole of the foot to spread the bones is often helpful. Your doctor may also inject cortisone around the nerve. If your difficulty continues, surgery to remove the neuroma may be suggested.

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Varicose veins

Definition

Varicose veins are enlarged, twisted, painful superficial veins resulting from poorly functioning valves. Varicose veins usually occur in the veins of the legs, although it may occur elsewhere. It is a common condition, affecting mostly women.

Alternative Names

Varicosity; Varicosis

Causes

In normal veins, valves in the vein keep blood moving forward toward the heart. With varicose veins, the valves do not function properly, allowing blood to remain in the vein. Pooling of blood in a vein causes it to enlarge.

This process usually occurs in the veins of the legs, although it may occur elsewhere. Varicose veins are common, affecting mostly women.

Causes include congenitally defective valves, thrombophlebitis, and pregnancy. Prolonged standing and increased pressure within the abdomen may increase susceptibility to the development of varicose veins or aggravate the condition.

Primary varicose veins occur because of congenitally defective valves, or without a known cause. Secondary varicose veins occur because of another condition, such as occurs when a pregnant woman develops varicose veins.

Symptoms

• Pain in the legs : fullness, heaviness, aching
• Visible, enlarged veins
• Mild swelling of ankles
• Skin at the ankle discoloured brown
• Skin ulcers near the ankle

Exams and Tests

The diagnosis is based primarily on the characteristic appearance of the legs when the patient is standing or is seated with the legs dangling. At times a physician may order a duplex ultrasound exam of extremity to see blood flow and characterise the vessels, and to rule out other disorders of the legs. Rarely, an angiography of the legs may be performed to rule out other disorders.

Treatment

Treatment is usually conservative. The patient will be asked to avoid excess standing, elevate the legs when resting or sleeping, and to wear elastic support hose.

Surgery such as vein stripping and ligation (removal of the varicose vein), or sclerotherapy of veins (injecting with a solution that causes scarring, which closes the vein) may be recommended. Vein stripping is a very extensive procedure, and it is usually reserved for patients who are experiencing a lot of pain or who have skin ulcers.

FDA approved & most effective latest treatment for varicose veins is Laser treatment which can treat larger varicose veins in the legs. In this technique a laser fibre is passed into the vein under the guidance of duplex ultrasound screen. This is less painful than vein ligation and stripping & another advantage is patient can return to his work within two-three days.

Possible Complications

• Phlebitis ( chronic inflammation of the vein )
• Formation of leg ulcers
• Rupture of a varicose vein

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Gangrene-Peripheral Vascular Disease (PVD)

Diabetics are more prone to develop peripheral vascular disease than the non-diabetic. However, one certainly does not have to be diabetic to develop vascular disease. One who smokes is also prone to get smoking. With peripheral vascular disease, arteries in the leg that carry blood to the foot become clogged. The earliest sign of PVD may be intermittent claudication which is a severe cramping of the leg or thigh that occurs while walking, usually at a predictable distance measured in blocks, and which may resolve after a period of rest. As the vascular disease worsens with time, the distance one can walk prior to feeling claudication pain becomes shorter.

A later sign of PVD is rest pain. This is pain that is often felt at rest when laying in bed. Typically, the pain is relieved by putting the feet down on the floor which allows the blood to flow down to the feet more easily.

PVD may also result in ischemic ulcers or gangrene. These develop when the tissues of the feet do not get enough blood flow. Without enough blood, the tissues do not get enough oxygen and they die.Once gangrene develops, the tissue death is not reversible and an amputation is often required.

Many limbs can be saved with procedures to restore blood flow to the feet. This may be accomplished in some cases with angioplasty, where a balloon is fed through the arteries and used to open the blockage. Sometimes a stent, a cylindrical piece of metal, is used to keep the area open. Other cases may benefit from the performance of a bypass procedure by a vascular surgeon. In a bypass, a vein or synthetic tube is used to bring blood around the blockage. A "Fem-Pop" bypass refers to a bypass connection the Femoral Artery in the thigh to the Popliteal artery near the knee. Blockages in diabetics may occur further down the leg and may require a bypass to an artery such as the posterior tibial or dorsalis pedis.

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