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• Discolouration starting at the free edge of the nail moving down the side towards the cuticle
• A white/yellow/brown crumbly appearance of the nail
• The whole of the nail may be involved
• Thickening of the nail
• Separation of the nail from the nail bed
• Pain under the nail
• Inflammation around the nail

Signs and symptoms of nail discolouration or deformity may not always be clear and should never be ignored. If you are concerned it is best to consult a Podiatrist or Doctor for a proper diagnosis. How did this happen? The most common cause of toenail fungus is cross-infection with Tinea Pedis better known as Athlete’s Foot! A common fungal infection of the skin. Other causes include:

• Keeping feet in a closed, warm, moist environment
• Ill-fitting footwear or hosiery
• Wearing synthetic fibres or nylons in footwear and hosiery
• Occluding nails with nail polish for long periods of time
• Cross infection in communal areas

Fungal organisms are opportunistic, which means they often affect people whose immune defences are running low. Treatments The type of treatment advised very much depends on the organism, the area of nail affected and how severe the infection is. If there are mild to no symptoms and the cosmetic appearance is not causing concern, treatment may not be necessary. For mild to moderate fungal infections or if you are unable to take systemic medication, the recommendation may be to start treatment with an anti-fungal nail lacquer as a home treatment. This works well in conjunction with regular reduction and filing of the affected nails by your Podiatrist throughout the treatment period. If the infection is more severe, the recommended treatment may involve a combination of oral medication, anti-fungal nail lacquer application and nail reduction and filing by your Podiatrist. Fungal infections of the toenails can be a real challenge to treat but not impossible!  Working as a team with your Podiatrist will give you a better chance of cure.   Prevention is better than cure when it comes to fungal infection of the nails. The following tips will help you keep your nails fungus free:

• Look after your nails keep them short and filed. Use your own nail care equipment
• Treat any fungal infections of your feet as soon as possible to prevent cross infection to your nails
• Let your feet and nails breathe! Wear cotton hosiery and well fitting shoes. Dispose of old contaminated footwear
• Take nail polish off, avoid leaving on your nails for long periods
• Wear protective footwear in communal areas such as swimming pool sides and changing areas
• Keeping your immune system healthy!
• Visit your podiatrist regularly for a foot health check

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You may have heard of or experienced this debilitating heel condition. Plantar fasciitis is an inflammation of the Plantar fascia and is the commonest cause of heel pain.

The plantar fascia is a fibrous band of tissue that supports many structures in the foot. Inflammation results from acute micro-tears commonly occurring at its point of origin on the heel bone. With constant use of the feet during daily activities, the micro-tears have little chance of healing and so the condition becomes increasingly painful particularly first thing in the morning and after long periods of inactivity.

Common signs and symptoms to watch out for are:

• Bruise like pain or ache around the inner region of your heel.
• Pain on weight bearing, usually worse in the morning or after any period of inactivity.
• There may be redness and swelling of the affected area
• Limping due to pain. Aches and pains on the supporting limb and foot.

What has caused this? It could be a number of things which we will discuss, but often patients recall a particular activity or moment they first felt the pain.  You may recall your heel landing heavily on the ground perhaps.

Causes of injury to the plantar fascia include:

• Tightness of the plantar fascia
• Excessive Pronation
• A tight Achilles tendon
• Being overweight
• Wearing shoes that lack cushioning, support or stiffness
• Occupational

These may produce excessive tension and stress on the plantar fascia leading to micro-tears.

Plantar fasciitis is self-limiting. However, it is likely to be a real killjoy in the meantime! Perhaps you are a dancer, a runner, a teacher or a chef standing on your feet all day, if you are suffering from Plantar fasciitis you will want to manage this problem fast.

Treatments you can do at home:

• Rest your foot and reduce any pounding exercises.
• Stretches – In a sitting position, bring your toes towards you and hold for 30 secs and repeat 3 times before getting up to walk. These exercises can work wonders if you do them daily, especially first thing in the morning!
• Roll your foot on a cold tennis ball, a drink can or a Pediroller
• If you are overweight start a healthy diet and try a non-weight bearing exercise such as swimming for example.
• Try a gel heel cup and change to cushioning footwear like trainers.

Recovery from Plantar fasciitis can be a lot faster after starting a course of conservative treatment, so come and see us! Your Podiatrist will have vast experience in the treatment of heel conditions. We can work with you not only to treat the plantar fasciitis but can also prevent it from happening again!

Sources:

Plantar fasciitis, Medscape January 2019 Craig C. Young

CKS NICE.org.uk Scenario, Management of Plantar fasciitis

Mayo Clinic Website, Plantar fasciitis

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This is a  common cause of metatarsalgia, (pain in the ball of the foot!) a common presentation in the clinic with common symptoms such as:

• Mild to severe pain in the ball of the foot or on top sometimes radiating to toes
• Sharp, Shooting pain
• Bruise like pain
• Burning sensation, Numbness and tingling
• Swelling and inflammation

So what’s going on?  – A neuroma is an inflammation and a thickening around the nerves that are present between the metatarsals of your foot. The thickening around the nerves is believed to be the result of irritation caused by the nerves being compressed by the metatarsals on either side. This could be due to poor foot mechanics during gait, excessive pronation or footwear that is too tight.

Pronation? This is a word that is no longer unfamiliar to the general public.  Pronation in lay-terms is the action of your feet ‘rolling in’ particularly in reference to the way you are walking. It is a normal occurrence but in excess may lead to unwanted stresses in the foot and lower limb. Excessive pronation is a common cause of Morton’s Neuroma. In its early stages, treatment with orthotic insoles can be very successful. Foot orthotics can be made to fit most shoes. They are discreet, comfortable and can be modified and adapted to your specific need.

Treatments for Morton’s Neuroma may include:

• Foot orthotics
• Dome pads
• Silicone orthoses for toes
• Anti-inflammatory medication
• Steroid injections
• Surgery

If you are experiencing symptoms of Morton’s neuroma and it is affecting your daily activities. We strongly recommend you see your Podiatrist as soon as you can for a full assessment and treatment plan. If you want to get back to doing the activities you love foot pain free, a Podiatrist can definitely help.

Sources:

The College of Podiatry website /Foot problems.

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Having one leg shorter than the other you may be surprised to read, is quite a common feature in many of us!  However, it often goes completely unnoticed and doesn’t cause a problem unless the difference is quite significant usually more than 1 cm.

Differences in length can be structural in origin, for example, your long leg bones may naturally be shorter on one leg or shortened as a consequence of surgery, illness or injury.  Leg length can also be affected by functional or environmental issues. For instance, if you are used to camber running more on one side than the other or if you are used to carrying a heavy load but favour one side of your body more.

Signs and symptoms you may notice if you have a leg length discrepancy include Low back pain – usually more on one side. You may also have pain or discomfort in your hips, knees and feet this is because the body naturally wants to correct itself and so compensates for the difference!

You may notice that your shoes are wearing more on one side of the sole than the other….and it’s not been long since you’ve bought them! Or you may be building callus or a corn keeps forming on one foot but not the other. These are common presentations we see in the clinic from people affected by a difference in leg length.

The foot on the shorter leg is often seen to ‘roll outwards’  causing excessive loading on the outer margins of the foot leading to heavy callus formation and soft tissue strain. The foot on the longer leg is often seen to ‘roll inwards’ in an attempt to shorten causing excessive loads to the inner part of the foot. The result? aches, pains and tiredness that can limit the activities you love to do.

It’s natural that you’ll want to get back to doing the things you love so this is where we can help you.  As Podiatrists, we can assess and treat leg length difference and its associated problems. We can provide general foot care to keep you comfortable and reduce any hard skin, corns or nail problems, offer long term management solutions with Orthotics and/ or stretches or a referral to Physiotherapy if we feel you would benefit from further evaluation or a full exercise program. Orthotics can provide long term solutions for structural and functional causes of leg length discrepancy.

References used: Joseph D’amico, DPMPodiatry today 22/4/14 Vol 27 issue 5

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