Corns & calluses
Corns and calluses develop when skin is irritated by friction and rubbing. These lesions usually develop under the foot, on top of the toe joints, at the ends of or between the toes. Corns and calluses can cause excruciating pain and effect a patient’s ability to walk comfortably.
Corns and calluses are treated by removal of the lesions. The use of moisturising creams and various forms of padding, orthotics and shoe modifications may be required to improve comfort and reduce the likelihood of the corn or callus happening again.
When the skin around the heel develops callus it can often split or crack and become painful. The cracks may also act as a portal for infection which can be very serious in patients with uncontrolled diabetes or poor circulation.
Regular debridement of the heel callus along with podiatric advice is usually all that is required to manage this condition.
Onychomycosis is the name for nails that have been infected by a fungus. This causes discolouration of the nail so it has blotches of yellow to creamy white and often some darkening of the surrounding nail plate. The skin under the nail and the nail itself usually thickens and develops a white powdery appearance. Fungal nails can involve just a small portion of a single nail or the nails of all 10 toes.
Early in the development of a fungal nail only a small portion becomes discoloured. If treated at this early stage the nail usually only requires some reduction and the daily use of a topical anti-fungal medication. When the fungal infection involves a larger portion of a nail or there are multiple toenails involved laser therapy using a 1064 diode laser may be more appropriate
When using laser therapy to treat fungal nails our podiatrists will first make an assessment to determine if the discolouration is due to a fungal infection. To make this assessment a nail scrapping is often taken, sent to a pathology laboratory and the results obtained 4 weeks later. If there is a positive result from the nail scrapping laser therapy is commenced. The nails are first reduced and then a laser is applied. A second laser application is performed 2 weeks later. In addition to using the laser the podiatrist will advise the patient on the use of appropriate footwear, foot soaks and the application of a topical anti-fungal medication to each nail. The patient is usually reviewed every 2 months to assess the progress of clearing the infection and advise on the need for ongoing treatment. Most fungal nail infections take 12 months to clear completely because it takes that long for a nail to grow from the base to the front edge. Laser therapy is successful in treating fungal nails in up to 80% of cases.
A neuroma develops when the protective coating that surrounds a nerve becomes thickened and scared. This is called a Morton’s neuroma when it occurs in the nerve that runs to the 3rd and 4th toes. However, neuromas can occur in the nerves that supply any of the toes or elsewhere in the foot and ankle. Neuromas cause burning, cramping, shooting and sharp pain in the ball of the foot which often extends into the toes.
Treatment of neuroma usually requires the use of appropriate footwear and orthotic therapy with specially placed deflective padding. When symptoms persist cortisone injections may be indicated and will be administered by our podiatric surgeon Read more. Surgery to remove the neuroma is usually indicated in the small number of cases where symptoms are unresponsive to 3 months of conservative treatment. Read more
Foot and ankle pain and instability
Poor foot and ankle posture or alignment can cause pain and instability. These symptoms tend to increase with longer periods of weight bearing. When this condition develops activities such as standing, walking or running can be difficult or too painful to undertake.
Treatment of poor foot and ankle posture requires orthotic therapy and shoe advice. If there is inflammation of tendons, ligaments and joints then extra corporal shock wave therapy is indicated. Read more In other cases a series of cortisone injections will be administered by our podiatric surgeon Read more.
When a bone is broken it is called a fracture. In the foot and ankle fractures may be quite obvious due to pain, swelling and an inability to bear weight. Other times fractures can be quite subtle and easily missed. Your podiatrist is able to diagnose if you have a fracture and where required order the appropriate imaging to confirm the diagnosis. Most fractures will heal by using an immobilising postoperative shoe or a “moon boot” for a period of a few weeks. Sometimes surgery is required to ensure that a fracture heals. Read more
Patients with flat feet have little or no arch when they stand. Some patients are born with flat feet and others will develop flat feet as they get older. Not all flat feet are symptomatic and require treatment. However, when flat feet become progressively worse over time or there is pain and instability, treatment is indicated. Patients with symptomatic flat feet tend to complain of generalised foot and ankle fatigue at the end of the day. There can be knee, hip and lower back pain associated with flat feet. When left untreated problems like bunions, hammer toes and arthritic foot and ankle joints can more readily develop in flat feet. In most cases the use of appropriate footwear and prescription orthosis is all that is needed to successfully treat flat feet and make a patient comfortable. In other cases, muscle stretching and strengthening is needed to treat flat feet. There is a small proportion of patients with flat feet who require surgical management in order to eliminate pain and instability. Read more
Ankle ligament sprains and tears are one of the most common injuries suffered everyday by patients. These injuries cause pain and instability and often recur. If left untreated patients are more likely to develop arthritis of the ankle.
Ankle conditions are usually managed well with the use of orthotic therapy, “moon boot” and braces. Sometimes extra corporal shock wave therapy is used to treat ankle pain or ligament strains Read more. Often our podiatric surgeon will prescribe non-steroidal anti-inflammatory drugs(NSAIDs) or administer cortisone injections to treat ankle pain or ligament strain Read more. Where a patient’s ankle joint has become chronically unstable due to a torn ligament or there is ongoing ankle pain surgery may be required. Read more
Warts, plantar warts or verruca are a benign thickening of skin caused by human papillomavirus infection. They are often painful and most common in children and teenagers but can occur in all ages.
The weekly application of a painless cream containing a strong acid with debridement of the wart is often all that is required to eliminate warts. In persistent cases it is sometimes necessary to perform a simple procedure to excise the wart under local anaesthetic. Read more
An ingrown toenail occurs when the edge of a nail becomes embedded into the surrounding skin. This can cause excruciating pain and often becomes infected. This condition is very common in teenagers but occurs across all ages. Ingrown toenails always require treatment in order for a patient to be comfortable. However, in patients with diabetes or poor circulation significant risk of toe, forefoot or below knee amputation can occur if ingrown toenails are ignored.
In many cases the podiatrist will treat the nail edge to make the patient comfortable and to prevent recurrence. Where appropriate our podiatric surgeon will prescribe antibiotics to manage infection Read more. In cases where recurrent pain or infection occurs a simple procedure can be performed under local anaesthetic to permanently remove a small portion of the nail. Most patients are back to normal activities in 1 to 2 weeks. Read more
Hammer toes develop when 1 or more of the 3 joints that comprise a toe become contracted and poorly positioned. The toe will often rub against the inside of shoes or the ground and develop inflammation, calluses, corns and pain.
Treatment is focused on reducing the rubbing on the hammer toe using suitable footwear, padding and splints. When the condition is persistent and non-responsive to conservative treatment surgery may be indicated. Read more
This condition occurs when the big toe bone deviates towards the little toe and the metatarsal bone behind the big toe moves away from the rest of the foot. The big toe joint then becomes prominent which can make it impossible to walk or wear shoes with comfort. The medical term for this condition is hallux abducto valgus.
Treatment of bunions requires the use of orthotic therapy and footwear advice. In some cases, our podiatric surgeon may prescribe non-steroidal anti-inflammatory drugs(NSAIDs) or administer cortisone injections Read more. In other cases, where bunions remain painful or become larger and more symptomatic, surgical correction can be indicated. Read more
Heel spurs & plantar fasciitis
The plantar fascia is a ligament that runs from the bottom of the heel to the ball of the foot. When the plantar fascia becomes inflamed and painful it is called plantar fasciitis. This condition may have a painful bony spur at the bottom of the heel associated with it. Most patients complain of pain when first weight bearing in the morning after getting out of bed. Long term heel spur and plantar fasciitis can cause pain at night and sleep disturbance.
Most patients respond very well to the use of appropriate footwear, orthotic therapy and a program of soft tissue stretching. In cases where symptoms are ongoing extra corporal shock wave therapy is indicated. Read more In other cases a series of cortisone injections will be administered by our podiatric surgeon Read more. In a small fraction of patients surgery may be required. Read more
Diabetes and poor circulation (vascular disease)
Diabetes is a condition which can affect the lower limb including the foot and ankle. This is more likely to occur when blood sugar levels fluctuate greatly and cause damage to the blood vessels and nerves of the foot and ankle. When such damage occurs the foot and ankle is less able to heal from injury to the skin, soft tissue, bones or joints. Patients with poor blood supply or inefficient veins (vascular disease) can also develop problems with healing after injury.
Patients with diabetes or vascular disease need to be assessed by their podiatrist at least every 12 months. Such assessments by the podiatrist are important to prevent foot and ankle complications such as ulceration, arthritis and amputation.
Tendonitis involves inflammation and pain of the sheath surrounding a tendon. When force is particularly large or is repetitive over a long time a tendon can strain or even tear. Tendonitis can develop in any of the tendons of the foot and ankle. The more common sites that tendonitis will develop include the tendon that; attaches to the back of the heel bone (Achilles tendon), supports the inside of the arch (Posterior tibial tendon) and supports the top of the arch (Tibialis anterior tendon). If not treated tendonitis can weaken the tendon leading to rupture.
Tendonitis can usually be successfully treated with orthotic therapy and muscle strengthening and stretching exercises. When required Extra corporal shock wave therapy is used to treat tendonitis Read more. Often our podiatric surgeon will prescribe non-steroidal anti-inflammatory drugs (NSAIDs) or administer cortisone injections to treat tendonitis Read more. Such treatment is often combined with the use of a postoperative shoe, “moon boot” or brace. In some cases, surgery is required in order to achieve healing. Read more
High arched feet
Patients with high arched or cavus feet tend to lack the ability to absorb shock when standing and walking. Cavus feet often develop hammer toes, neuromas and callus under the ball of the foot. Unstable ankles are a common symptom associated with cavus feet.
Most patients with symptomatic cavus feet respond well to orthotic therapy but some may need additional treatment methods. Our podiatrist and podiatric surgeon can provide all required treatments for the management of symptomatic cavus feet.