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Common Foot Problems

Corns And Calluses

Calluses are one of the most common problems seen by Podiatrists. They can occur on any part of the foot and vary in symptoms from a mild callus under the foot, to a more painful corn, which can be very painful.

Corns and calluses are areas of thick, dead, hard skin that result from excessive pressure and/or friction over a bony prominence. The thickening of the skin is a normal bodily response to pressure and/or friction.

The pressure experienced by the foot may be a result of poor fitting footwear, an imbalance in the structure and functioning of your foot or bony prominences. Podiatrists will remove the corns or calluses and provide a way to prevent them from regrowing or alleviate the pain caused by them.

Ingrowing/Ingrown Toenails
An ingrown nail occurs when a part of the nail grows into the skin adjacent to the nail. This can be an extremely painful problem especially if it has gone on for long periods and an infection has set in. Ingrowing nails may be minor with just the distal edge or corner piercing the skin or more severe where the entire side of the nail grows into the flesh. It is commonly caused by incorrect nail cutting, tight shoes, sweaty feet and trauma to nail.
Ingrowing nails can be easily treated by cutting away the offending nail or rounding the edge with a file. This is usually done for minor ingrown nails. A surgical procedure can also be performed under local anaesthetic in which the side of the nail is removed from the root. The root is then cauterised so that the nail does not grow on that side again. This is a permanent procedure and is only recommended for severe and recurrent ingrowing toenails.
Fungal Infections
Fungal infections are very common, especially in KwaZulu-Natal, due to the climate. These infections may affect the skin, (athlete’s foot) or the nails. Fungal infections thrive on conditions that are dark, warm and moist, such as the insides of your shoes.

Fungal infections of the skin may present as moist, itchy, white areas between the toes; dry, flaking, itchy skin on the soles of the feet; and small blisters (water pimples), which burst and become itchy when they dry. Skin infections are relatively easily treated with medication including topical creams, ointments, powders and oral medication in more severe cases. Nail fungal infections are more difficult to eradicate. Regular treatment is needed to keep the nail short and thin and oral medication is often required, which continues for at least three months.  

Foot Function
The feet endure major mechanical forces and they need to be able to process these forces with proper foot function, otherwise they will develop injuries as a result. Your feet go through two important motions: Pronation and Supination, without these motions, our feet would not function normally.

Pronation

This occurs when the foot rolls in, the arch flattens, the heel everts and the foot moves away from the midline of the body. This motion is necessary, as it allows the foot to absorb shock and adjust to various types of terrains by becoming like “a loose bag of bones”.

Supination

This is the opposite of pronation and occurs when the foot rolls out, the arch heightens, the heel inverts and the foot moves towards the midline of the body. This motion is necessary for effective forward motion/propulsion and achieves this motion by becoming a rigid lever. Problems with feet often arise when the feet do not function properly, i.e. they remain in pronation for too long and are unable to supinate enough (usually the most common) or they supinate too much and aren’t able pronate enough.    

Orthotics                                   

Orthotics are used to correct these mechanical problems with the feet. Orthotics are custom moulded insoles, which are inserted into shoes, that provide your feet with the necessary support and aid them to function properly, thereby alleviating foot pain.

Plantar Fasciitis
This is a very common foot ailment that often gets ignored until the pain becomes unbearable. Plantar fasciitis is inflammation of a thick, fibrous band underneath the foot (called the plantar fascia), which attaches at the inside of the heel bone, extends up the arch and inserts into the base of all the toes. The plantar fascia acts as an elastic band in the arch helping it to raise and flatten during different parts of the gait cycle. Pain with this condition usually occurs in the heel and occasionally more distally in the middle of the arch.

Plantar fasciitis may be caused by excessive pronation (rolling in of the foot) which places excessive strain on the plantar fascia, an increase in body weight, a sudden increase in activity or incorrect shoes. Treatment for this condition often involves changing to better-suited footwear for your feet and custom orthotics to control the excessive pronation. If this condition remains untreated for too long, it may lead to another problem called a heel spur, which is a growth of bone under the heel. This becomes more difficult to treat and may require surgical intervention.

Metatarsalgia
This is essentially pain and inflammation in the metatarsal region of your foot. The ends of your metatarsals, called the metatarsal heads should form an arch of their own (Transverse metatarsal arch). When people develop metatarsalgia, it’s usually due to that arch no longer being present, so essentially the metatarsal arch has dropped leading to excessive pressure on the metatarsal region. One may develop callus formation as a result of this, as well as, retraction or clawing of the toes. Metatarsalgia, depending on what the cause is, is most often treated with orthotics with metatarsal support, stretching and strengthening exercises.
Morton's Neuroma
This is one form of metatarsalgia and may be a painful and quite irritating condition. A neuroma in the foot is entrapment of a nerve bundle between the metatarsal heads. One usually feels pain and numbness in the toes and often shooting sensations into the toes. Treatment regimes may vary, but most often an insole or orthotic is custom made with a metatarsal support to raise the metatarsal heads and free the entrapped nerves. Cortisone injections occasionally are successful, although long-term relief is not often achieved and surgery may be indicated in more stubborn cases.

Know Your Condition