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 Trinidad Local - Medical Reports


Minor Foot Problems

I am a practicing doctor in Trinidad and have seen some minor problems that have intensified into serious ones from probably lack of knowledge. For instance, minor foot problems that can be treated with simple advice are sometimes left unchecked. I will try to be brief and non-medical as possible in my explanations. Below are just a few minor foot problems that can easily be remedied.

Blisters are a common problem, occurring in any location where the skin has been subjected to sustained friction. On the feet, blisters occur at points where the shoe fits poorly, allowing friction or shearing forces to occur during walking, running, or jumping. The most common points are the toes, balls of the foot, and back of the heel. The uncomplicated blister is a round or oval lesion in which the outer layers have separated and the inner area is filled with clear fluid. The raised skin is known as the roof, while the lower area is the floor of the blister. Occasionally, pharmacists will see patients who continued with their activity as the blister formed, allowing blood to enter the fluid area, creating a "blood blister." Some doctors advise leaving the blister intact, allowing the outer layers of the floor to mature and become less sensitive to infection. Others advise piercing the roof with a sterile needle and gently expressing the fluid inside. This has two benefits: it reduces the pain and it allows the roof to connect with the base, where it may readhere for a short period, thereby reducing the pain and helping prevent infection. In my opinion, the blister should be left alone where the fluid will be reabsorbed into the underlying skin. In prevention of blisters one can invest in shoe pads that may be of some benefit.

Corns - A corn is a raised hyperkeratosis (increased amount of top layer skin) with a central core. Its etiology is friction of the toe against the shoe or against another toe, which tends to occur when the patient chooses shoes that are too tight. The person with corns on the upper part of the deformed toes is known to have the condition, hammertoe. When corns are located between the toes, they are usually softer in texture. Those located on all other areas of the toes are harder to the touch when palpated. Regardless of location, as the person walks, pressure against the corn causes it to press against the skin and nerve endings, resulting in pain.

The corn serves no useful function, and can be effectively removed without problems. However, the patient should avoid drastic methods of removal such as the dangerous razor-bladed implements popularly sold as "corn planes." In addition, such devices as pumice stone and corn files should generally be avoided. The safest and most effective nonprescription intervention is the use of salicylic acid in the form of plasters, disks, or suspensions. Before use of salicylic acid, the patient should soak the corn for five minutes in simply saline water. This increases the ability of salicylic acid to macerate the skin, allowing it to slowly erode the corn. These applications should be continued as directed depending on the product but usually it takes up to about two weeks before removal. Padding and protective cushioning may also be used to relieve discomfort.

Calluses The cause of the callus is identical to that of the corn -- namely, pressure or friction against the skin. However, the callus is a diffuse thickening of the skin overlying the area where pressure has been applied. Any type of pressure can cause calluses if it is sustained for a prolonged period of time. In the foot, weight-bearing areas such as the heels and balls of the feet are most prone to developing calluses. The risk of callus formation is increased when persons wear shoes that allow the heel to move during movement, increasing the shear forces. People should be instructed to wear shoes that have a snug fit for the heel.

Removal of the callus is complicated by two factors. Firstly, unlike the corn, which serves no purpose, the callus protects the underlying skin from the continued friction that caused it. Secondly, the callus is rarely painful because it has no central core that pushes against underlying tissues with each step. For these reasons, removal is purely cosmetic in most cases and actually exposes newer, softer skin beneath. It is preferable to allow the calluses to remain in place as long as they are not bothersome. The person who ignores this advice and removes all callused skin from the soles of the feet with the products known as callus reducers or callus files may experience pain when he or she walks on the newly exposed surfaces of the feet. It will take a while for the calluses to regrow and again shield the feet.

Calluses may occasionally be so thick that they cause pain upon movement. In these cases, reduction may be necessary. Since it involves removal of tissue, a preferable method of reduction would be through a visit to a podiatrist or a doctor. Professionals are aware that judicious use of a rotary sanding tool is useful for callus removal. Removal is halted if the area begins to feel warm, or if drainage is visible from any callus fissures. The skin should feel thinner and smoother to the touch when appropriate reduction is completed. Calluses may fissure or crack open. In these cases, a doctor/podiatrist visit is advisable to ensure that the area has not become infected.

Ingrown toenails occur when the nail turns in its growth and grows into the skin. Improper cutting or shoes with inappropriately tight toe boxes can cause this painful condition. Patients should be instructed to cut their toenails straight across, without tapering the sides. No nonprescription product or device can reverse this condition safely. Some patients attempt to remove the toenail themselves with nonsterile scissors, but this may leave a section of nail imbedded in the skin, allowing it to serve as a site for infection. In all cases, patients should instead be advised to visit a podiatrist or doctor for appropriate care.

Tired Feet It is obvious that people who are required to stand long hours (such as store workers) are more prone to foot problems. Various foam/cloth insoles are available to help cushion the feet. Some are fairly shallow, while others are moderately thick. While a greater thickness can give more comfort, the patient must be sure that the product does not cause excess pressure against the top of the shoe and create a blister. Gel-filled, air-filled, and fluid-filled insoles are also available. However, "magnetized" insoles have no proven therapeutic value and are not advised. In addition to using insoles, patients may gain comfort for their tired feet with a post-workday soaking in warm Epsom salts or any of several commercially available foot soaks.

Those were just a few of the common foot problems that are encountered in everyday life. In the following weeks I will be discussing medical problems that people are faced with.

This article is referenced from Medscape.com - US Pharmacist 27(3)

 

 

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