Calluses

Ingrown Nails Got You Hanging?

If you have an ingrown toenail, you can relate when I say the pain and discomfort is beyond aggravating. Trying to find comfortable shoes is sometimes impossible. But what do you do about an ingrown toenail? Do you try to cut it out with a toenail clipper? Will it be there forever? Some people are scared to seek medical attention because they think they will have to get their nail removed. Though sometimes this is necessary, it is rare that one will have to lose their entire nail.

An ingrown toenail is a nail that digs into the skin and causes pain, swelling, redness, and sometimes infection. It can be caused by genetics, trauma, or improper trimming. Stubbing your toe or dropping an object on your toe may result in an ingrown toenail. Many people cut their nails too short. This encourages the skin to surround the nail and the nail can then pinch the close confiding skin.

A podiatric physician can do a simple in office procedure to remove the offending nail border. The nail will continue to ingrow unless the matrix or the root of the nail is destroyed. When only the outside border is causing problems, the doctor can remove that portion of the nail and only kill the root of that area of the nail. Thus you will still have a nail but a small portion will be removed and will not grow back. Those concerned with cosmetics will be happy to know that the removal of the border of a nail often goes unnoticed by others when the condition is minor. If there is a serious infection present, the root of the nail will not be killed due to the reaction of the chemicals used with the infectious tissue. The nail border is removed and the injury is allowed to heal until the tissue is healthy to undergo chemical cauterization.

Though some need to undergo more invasive surgeries to remove the matrix, most have their problems solved by a simple 15 minute visit to the doctor. The most important thing to do is to keep your hands off your toenails. Do not try to pick at it or cut it because a small problem can become a big problem if you do not remove it correctly.

Heel Pain

The most common cause of heel pain is a condition called plantar fasciitis. The plantar fascia is a ligament on the bottom of the foot that goes from the heel to the ball of the foot. The definition of-ITIS is disease or inflammation. So plantar fasciitis is inflammation or disease of the plantar fascia.

The plantar fascia ligament consists of 3 bands-the medial band in the arch of the foot, the middle band and the outside band. If you suffer from plantar fasciitis, you have inflammation and tightness usually of the inside or medial band in the arch of the foot.

If you have plantar fasciitis, you have a very tight ligament that acts like a rubberband. When you sit or sleep, the ligament tightens up and gets stiff. As soon as you get up and stand from sleeping or prolonged sitting, the arch in your foot drops, your foot lengthens and ultimately pulls that tight plantar fascia. This causes severe pain especially with the first steps in the morning after getting out of bed. That initial first step pain may ease up a little as you walk it out as the ligament stretches or loosens with less pain. The more pulling you get, the more inflammation develops and inflammation causes the pain.

There are numerous reasons why you can develop plantar fasciitis but a common source is due to overuse. The most common causes of heel pain from plantar fasciitis are unfavorable work conditions, exercise-induced or improper use of shoe gear. You are at-risk for heel pain, if you have an occupation involving a lot of walking and/or prolonged standing on hard floors. Nurses, dancers, athletes, runners, teachers, farm workers, construction works, just to name a few are prone to heel pain. Also if you are involved in a traumatic injury such as a car accident or fall at work, you are susceptible to having heel pain. If you recently started a new exercise or workout routine or change in your activity level, you may develop this heel pain condition. Even if you are a world-class athlete, you can 'overdo it' and develop plantar fasciitis. Finally, if you suffer from chronic low back pain, you can be prone to heel pain. Your back condition should be treated and monitored by a back specialist at the same time as seeing a podiatrist for the heel pain.

The symtoms of plantar fasciitis include pain in your arch, your heel or the entire bottom of your foot. If left untreated, your acute heel pain can develop into painful, long-term chronic heel pain.

If you have experienced these symtoms, it is crucial to see a foot and ankle specialist as soon as possible to prevent further pain and suffering. Diagnosis by a podiatric foot and ankle specialist will involve clinical evaluation and x-rays to further evaluate the heel bone and foot structure contributing to the pain. MRI is sometimes needed if a rupture of the ligament or other condition is suspected.

Good News! If you suffer from plantar fasciitis, it can be successfully treated without having surgery most of the time! Initially, the inflammation needs to be addressed and reduced first before the other treatments can work. Stretching and orthotics are very important but they can make your heel pain worse if there is a lot of inflammation and pain.

There are many ways to reduce the pain and inflammation such as Resting by reducing physical activities and 'babying' your foot, Icing your foot 20 minutes 2-3 times a day, Compression with a snug wrap or brace and Elevation of your foot. This can be summarized by the R.I.C.E. mnemonic. Also there are oral steroid and non-steroidal anti-inflammatory medications that can be prescribed by your podiatrist for pain relief. The most effective way to reduce the inflammation and pain by far is a cortisone steroid injection performed in the office of a podiatrist.

Comfortable, supportive shoe gear is important for heel pain relief in addition to wearing high-quality prefabricated or custom orthotics, which can be obtained by your podiatrist. A strapping or taping of the foot can also be performed by your podiatrist or therapist to support your arch. You should not walk barefoot not even around the house (not just socks) to aid in increased shock absorption and heel pain relief. Flip-flops and non-supportive shoes can make your heel pain worse.

Stretching the tight plantar fascia is imperative in the reduction of heel pain from plantar fasciitis. Stretching can be accomplished by using a combination of three different modalities: 1) home stretching exercises, 2) devices to stretch the ligaments and tendons called a night splint and day splint and 3) a formal program of physical therapy done 2-3 times a week by a trained professional.

If all else fails, there are a variety of other types of treatment for chronic, long-standing cases of plantar fasciitis.There is a new, non-invasive treatment of heel pain called the MLS laser. This laser therapy works by interacting with the tissues on a cellular level, speeding up metabolic activity to improve the nutrients crossing cell walls, promoting quick and healthy healing. This is done in the Willow Street Office of Henderson Podiatry with a series of 6 pain-free, quick 8-minute visits.

The last resort for heel pain relief is surgery to release the ligament. This minimally invasive procedure performed in a sterile operating room is called an Endoscopic Plantar Fasciotomy (EPF). It releases the tight medial band only of the plantar fascia.

Once the pain goes away, it can always return no matter what treatment you have had-even surgery. Maintenance to prevent the pain from coming back involves wearing a good, supportive pair of custom orthotics in your shoes, not walking barefoot and stretching the ligaments twice a day.

A callus, also known as hyperkeratosis, is an 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. Although many consider them a skin problem, they are indicative of a problem with the bone.

Calluses form from repeated friction and pressure, as the shoe (or ground) rubs against a bony prominence (bone spur) 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. A great deal of friction or pressure over shorter periods of time can cause blisters or open sores. Calluses typically develop under a metatarsal head (the long bone that forms the ball of the foot). 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 can be treated with over-the-counter callus removers, which use strong acids to peel this excess skin away after repeated application. Be careful using these products as they can cause chemical burns when misapplied or used in excess. Alternatively, treat calluses as follows: Begin by soaking the foot or feet in warm soapy water and gently rubbing away any dead skin that loosens. Next, use a pumice stone or emery board to file away the thickened skin. Apply a good moisturizer to the hardened areas to keep them softer and relieve pain. Nonmedicated corn pads or moleskin (a thin fuzzy sheet of fabric with an adhesive back) are available in stores and can relieve pain caused by calluses. However, use caution removing pads or moleskins to avoid tearing the skin.

If you need assistance relieving calluses, please contact our office. We can trim and apply comfortable padding to the painful areas. In more severe cases, we may prescribe medication to relieve inflammation, or inject cortisone into the underlying bursal sac to rapidly reduce pain and swelling.

A plantar callus forms on the bottom of the heel over time where one metatarsal bone is longer or lower than the others. This structure causes the one metatarsal to hit the ground first and with more force than it is equipped to handle. As a result, the skin under this bone thickens. In most cases, plantar calluses can be treated without surgery. In some recurring cases, however, a surgical procedure, called an osteotomy, is performed to relieve the pressure on the bone.

A condition called Intractable Plantar Keratosis (IPK) is a deep callus directly under the ball of the foot. IPK is caused by a "dropped metatarsal," which happens when the metatarsal head drops to a lower level than the surrounding metatarsals and protrudes from the bottom of the foot. This results in more pressure being applied in this area and causes a thick callus to form. A dropped metatarsal can either be a congenital abnormality, a result of a metatarsal fracture, or a structural change that may have occurred over time.

You can prevent calluses by:

  • Switching to better-fitting shoes or using an orthotic device to correct an underlying cause.
  • Buying socks with double-thick toes and heels or nylon hose with woven cotton soles on the bottom of the foot.