As the summer draws to a close, podiatrists and pharmacies alike are inundated with patients. From a podiatrist’s perspective, it essential to maintain a good working relationship with our local pharmacies. By working with each other as health care professionals, we can ensure the highest quality care possible is delivered to our patients. The warmer weather of the latter months of summer mixed with the back-to-school rush, brings an array of ailments to surface, some of which I discuss below.
Corns vs. Verrucae
The reason I have categorised these different complaints together is because corns and verrucae are often misdiagnosed as one another. Most days in clinic, a patient comes in with what they suspect to be a corn but on examination is a verruca or vice versa. Corns are hard skin built up at a point of pressure; often due to an external source such as a tight shoe or due to the way a person is walking (their gait pattern). Verrucae contrastingly are a viral infection – often transferred from one person to another in areas of shallow water or wet surfaces. This could be the floor surface of swimming pool changing rooms or communal showers. Verrucae can appear with small superficial black dots which are tiny blood capillaries. Unfortunately, not all verrucae have these marks.
The demographics of a patient can also be used as a clue to distinguish between corns and verrucae. Verrucae are classically seen in younger patients. Young adults and children are more susceptible to such viruses, especially with exposure during swimming lessons and a stilldeveloping immune system. Corns often have an external cause, as mentioned above. Corns and verrucae can be very similar in appearance, and if there is uncertainty, a podiatrist opinion may be indicated. We must remember more sinister lesions, such as malignant melanoma.
If a patient has a lesion or spot that is changing in nature, it is important to get it checked out by a podiatrist or G.P.
Corn plasters: A no from me!
As a podiatrist, I can see why people use them; however, I am strictly against the use of corn plasters. Many corn plasters contain salicylic acid, which is caustic to healthy skin tissue. These corn plasters usually have a standard shape and size; however, corns can vary. Therefore, there can be a discrepancy between the size of the plaster and the size and shape of the offending lesion. As a result, surrounding healthy skin may be damaged by the application of this caustic plaster, resulting in a bigger problem for the patient. When a corn plaster is applied and the patient starts walking around with a shoe and sock on, the corn plaster can move and burn surrounding healthy tissue. When a patient has vulnerable skin, these problems can escalate, skin can break and ulcers can form.
The solution to a corn is to treat the source of the pressure. This may be achieved by altering footwear, using a urea-based emollient to soften the hardened skin, or by the removal of the corn by a trained health care professional, i.e., a podiatrist.
Verruca Treatment:
Verrucae are commonly seen at this time of year, after summer holidays spent swimming by a pool. In my opinion, the best solution to this common problem is prevention. Prevention against verrucae can include swimming socks for children. It can be as simple as wearing flip-flops in communal showers and changing areas rather than going barefoot. Although children are more susceptible to catching verrucae as their immune system is still developing, this also means that it can be easy for the virus to be eradicated from a child’s foot. Low percentages of salicylic acid and cryo treatments can be found over the counter. Care must be taken not to spread the verrucae and to not cause any harm to the healthy tissue surrounding the verruca. My best piece of advice is to keep the verrucae covered with an occlusive tape that is hypoallergenic if possible. This can stop the verruca from spreading and can be found to eradicate the verruca completely in some patients’. For more resistant cases in older patients, a podiatrist may be consulted, and the use of swift microwave therapy may be indicated, which can be very successful.
Back-to-school
As children go back to school, there are a few points to keep in mind about their feet and footwear. If children are not wearing appropriate shoes, we can see a range of ailments, from ingrown toenails and corns to blisters and chilblains. When children are still growing, it is important to get a good shoe that fits well on their foot and will last the winter. Shops such as Clarke’s and Cripps have a selection of shoes and well-trained fitters on hand to ensure shoes are long and wide enough for the child. Although shoes that are too big can cause friction, a shoe half a size bigger allows the young foot enough room to grow within it. When shoes are too short or too narrow, ingrown toenails are a common occurrence in young children. A wide and deep toe box are characteristics of a good shoe, with lace or strong velcro ideal for keeping the shoe secure on a child. Laces and good velcro straps can prevent excessive tripping or falling by giving the foot support and stability. It is necessary to keep within the school shoe policy while keeping in mind the Irish weather. School shoes are often the shoes a child wears the most, so it is important to direct consumers in the right direction.
Ingrown Toenails
As I mentioned above, ingrown toenails can often be caused by ill-fitting shoes. If a shoe is too short or narrow, it can pinch on the nail and cause excessive pressure. This excessive pressure can cause the nail to become involuted and the nail to press against the skin around the sulcus of the nail. Once this ingrown nail edge pierces the surrounding skin, we now have a problem. There is a portal or opening for infection, resulting in the classic signs and symptoms we attribute to ‘an ingrown toenail’. The toe can become red and inflamed with infection, and often yellow or green exudate can be seen. In order for immediate relief and to relieve some infection, the patient can bathe the toe in warm, salty water. However, often, even with an antibiotic prescribed by the G.P. to reduce the infection, the patient must go to a podiatrist or G.P. to remove the root cause of the problem-the offending piece of nail. To prevent such problems from occurring, patients can be encouraged to wear appropriate shoes that are wide and long enough for their feet.
Fungal skin & fungal nails
Fungal nail and skin infections can present with various symptoms. Tines pedis, commonly known as ‘athlete’s foot’, can present with red, sweaty, hot, and itchy feet. It is very common during the warmer months and can be accompanied by small red pustules on certain areas of the foot. It can be seen interdigitally and underneath the arch profile on the plantar aspect of the foot. The risk of leaving tinea pedis untreated is that small tears in the skin epidermis form, resulting in a portal for infection that can escalate to cellulitis. In warm weather, feet tend to sweat more, and such conditions as tinea pedis can be exacerbated.
Unfortunately, fungal toenails are notoriously common, and the patients coming in to see us are getting younger and younger. Again, if possible, prevention is the best solution! This can include the use of sandals during warmer weather or around the house. Giving the nails a break from nail varnish and letting air at the feet can be very effective.
The most effective treatment for presenting fungal infections are over-the-counter antifungal powders and creams such as Desenex or Daktarin. In persistent cases, an anti-fungal prescription such as Terbinafine may be required.
