An ingrown toenail (also known as onychocryptosis) occurs when the nail grows sideways into the toe, and not outward. The result is pain in the side of the toe. The big toe is most commonly affected. It can be caused by any situation that interferes with the proper outward growth of the nail, such as improper trimming of the nail or incorrect footwear.

Diagnosis

The diagnosis of an ingrown toenail can be made on the basis of the appearance of the toe. A history is also obtained to determine the cause of the ingrown toenail, and to address any predisposing conditions.

Treatment

In some cases, the edge of the nail can be separated from the side of the toe. Padding is the placed between the nail and the toe to encourage growth in the correct direction. Many cases require surgical removal of the toenail. A new, normal nail then grows in over the next several months.

Without Treatment

The nail may continue to grow into the side of the toe. This can lead to progressive pain or recurring infection. It is most serious in people with underlying medical problems such as diabetes or peripheral vascular disease.

Fungal infection of the toenails (also called onychomycosis) occurs when a fungus infects the tissue underneath the toenail. The result is discolouration of the nail. Often the nail becomes thickened and raised. It commonly involves several nails simultaneously. It often occurs in people with persistent moisture in their feet, such as with footwear that does not allow air circulation or in those who perspire excessively in their feet. 

Diagnosis

The diagnosis of fungal infection of a toenail can be made based on the appearance of the toe. In some cases a sample may be obtained, to look for fungus under a microscope or to grow and identify the fungus in a laboratory.

Treatment 

The treatment for fungal nail infections usually involves an anti-fungal antibiotic medication. Topical or Oral antibiotics are generally required to treat the fungus while new nail grows in. The medication needs to be used or taken for several weeks to months while a new, healthy nail grows in. Anti-fungal medications applied to the surface of the nail are not usually effective in extreme infections. In some cases, the infected nail is removed.

Without Treatment

The nails can become very thickened, discoloured and unsightly. In some cases, pain or infection can result from very thickened nails.

More than half the population will at one time or another develop athlete’s foot, a fungal infection on the skin of the feet. It causes itching, burning or scaling of the skin, especially between the toes or on the soles. Also known as tinea pedis, it affects men more than women, and it becomes more common with older age. Excessive moisture and lack of airflow around the feet predispose people to infection with the fungus. To decrease your chances of contracting athlete’s foot, avoid walking barefoot in public locker rooms and showers, and keep feet clean, dry and in shoes that allow the feet to get air.

Diagnosis

Your podiatrist will diagnosis athlete’s foot after conducting a physical examination of your feet. In some cases a skin scraping is obtained to look for fungus under a microscope, or a culture is taken to grow and identify it.

Treatment 

Usually an anti-fungal cream or ointment applied to the affected area for 2 to 4 weeks will resolve the problem. Depending on the severity of the case, the medication will be available by prescription or over-the-counter. In certain cases, oral medications will be prescribed.

Without Treatment

Although uncommon, athlete’s foot can lead to cellulitis, a more serious bacterial skin infection of the foot that can spread up the leg.

With expertise in Bio-mechanics, the podiatrist can take a mould or scan of your feet and have custom inserts made, by prescription, to treat your feet. We can make orthotics for kids, athletes and for everyday use.

About Orthotics

With years of medical training in foot care, Stephen is an expert in treating foot problems with orthotics. Just as contact lenses improve vision, orthotics improve foot function.

Custom orthotics are made from “casts” /moulds or scans of your individual feet. Each orthotic exactly matches the contour of each foot. In addition, “angled posts” or wedges are added that match the angular relationship between your leg, rear foot and forefoot.

Unlike an arch support, a custom orthotic moves with your foot. It controls certain parts of your foot at certain times during your gait, or walking cycle. Although orthotic devices may look like simple pieces of plastic or rubber, they profoundly affect your entire musculoskeletal system.

Orthotics may protect the tender areas of your foot from the wear and tear of constant use. Even if your foot problem is best treated by surgery, orthotics may delay the need for surgery and help maintain your surgical correction afterwards.

An Orthotic for Everyday Needs

Orthotics come in a variety of materials, ranging from rigid plastics to soft foam. All of these materials can be shaped to fit your individual foot. The rigid orthotics offer the most control of movement, while the softer ones provide better cushioning and protection. When prescribing your orthotics, Stephen will make the best match between your needs and the qualities of the materials.

When sweat gets trapped inside shoes, the result can be foot odour, an embarrassing and uncomfortable condition. The foot has more sweat glands than any other part of the body, and that sweat isn’t easily absorbed due to the wearing of socks and shoes. Bacteria can grow which causes an odour. The medical term for sweaty feet is hyperhidrosis, while the term for smelly feet is bromhidrosis.

Diagnosis

The patient will usually recognise the problem at home and come into the office to seek treatment.

Treatment

A topical ointment, cream, powder or spray can be applied daily to reduce to the growth of the odour-causing bacteria. Other procedures using an electric current or botulinum injection may be indicated to decrease the amount of sweating.

Without Treatment

Sweaty, smelly feet may continue to make people feel uncomfortable. In certain situations these conditions may be a sign of a more complicated medical problem.Prevention

Bathing daily and drying feet completely will help to decrease foot odour. Applying a thin layer of baby powder and changing socks every day will also keep sweating down. Don’t wear the same shoes two days in a row. Wear cotton socks and shoes that are breathable.

Warts that occur on the bottom of your feet are called plantar warts. Often they occur on the areas of the foot that experience the most pressure, such as the ball of your foot or the heel. Because of the increased pressure to those areas from walking and physical activity, plantar warts in these areas often penetrate deep into the tissue and can be very painful. Warts are caused by a virus known as human papilloma virus, or HPV. They can be spread in moist environments such as public showers, locker rooms and swimming areas, but not everyone who comes in contact with a plantar wart will develop one.

Diagnosis

Your podiatrist will diagnosis a plantar wart based on physical exam and description of symptoms.

Treatment

If your doctor determines that your wart needs to be treated, the usual choice of therapy is salicylic acid, which when applied daily eventually softens the skin layers of the wart so that it can be peeled off. This process may take several weeks or months. Other treatment options for plantar warts include Needling, Microwave Therapy (Swift), freezing them with liquid nitrogen, and removing them with surgery. Caustic Therapy can also be performed using approved substances which are applied topically to reacted with the infected tissues, it generally is less painful than some other forms of treatment.

Without Treatment

Sometimes plantar warts go away on their own if left untreated. However, many warts can become increasingly larger and more painful and can begin to multiply into clusters of warts called mosaic warts. Walking and running will become difficult in these situations. Over time, some plantar warts can lead to other complications and unwanted tissue changes.

A bunion occurs when the joint at the base of your big toe becomes enlarged, sore and swollen. Your big toe may start to angle toward your second toe, or move underneath it. Women are most affected by bunions, which are often caused by wearing narrow, tight shoes, or high heels. A bunionette occurs on the other side of the foot, near your small toe, and is much smaller than a bunion.

Diagnosis

A podiatrist can usually diagnose a bunion during a physical exam. An X-ray may provide further information about the joint, the angle of the toe, and if arthritis or gout are concerns to further investigate.

Treatment 

Wearing comfortable shoes with a wide toe-box at the first signs of a bunion appearing can decrease its growth and reduce any further complications. Resting the foot, using anti-inflammatory medications and icing the area may help. In some cases a cortisone shot at the base of the big toe may help. In cases when the bunion is causing severe pain, surgery may be performed to remove the bony bump and to realign the toe.

Without Treatment

Ignoring a bunion will lead to increased pain and the chance of contracting bursitis, when the small fluid-filled sac next to the joint becomes inflamed. Depending on how severe your bunion is, your foot can become deformed and continue to cause chronic pain.

A callus, or tyloma, on the foot is caused from repeated pressure and friction, leading to the build up of thickened skin. The callus, which be may hard, dry or cracked, acts to protect the area underneath it. A corn is similar to a callus but is smaller and appears on toes rather than on the sole of the foot.

Diagnosis

A callus or corn is typically diagnosed upon examination.

Treatment

Your podiatrist can recommend simple over-the-counter treatments such as pads or pumice to decrease the calluses or corn. In severe cases calluses may require regular shaving to keep them from becoming too large.

Without Treatment

While treatment for calluses and corns is not always necessary, it may provide you with more comfort. Larger calluses can cause significant pain. In some patients, especially when they become cracked, calluses can lead to wounds that can lead to serious problems, especially in people with diabetes.

Gout is painful inflammation of a joint as a result of build up of crystals within the joint. The crystals are made of uric acid, a substance that is found in many foods and usually excreted by the kidneys. People who produce too much uric acid, or whose kidneys do not excrete it enough, are predisposed to the development of gout. When the levels of uric acid in the blood are high enough, it begins to collect as crystals in joints which leads to pain and swelling. Gout most often affects the base of the big toe, but can affect any joint. It tends to recur in repeated attacks of acute inflammation.

Diagnosis

The diagnosis of gout is often suggested on the basis of the history and physical exam. A sample of joint fluid can be obtained with a needle and examined under a microscope. The urate crystals can then be seen. This is also the best way to make sure the joint is not infected, or inflamed due to another condition.

Treatment

Acute attacks of gout are treated with anti-inflammatory medications. Sometimes a steroid injection is given directly into the joint to relieve pain and swelling, or steroids are taken orally. Colchicine is a medication that can help an attack of gout resolve faster. Some patients then take a daily medication to decrease the level of uric acid in their blood to prevent attacks of gout.

Without Treatment

Repeated attacks of gout tend to last longer, and the pain may not go away entirely. Eventually the bones of the joint can be damaged, and large collections of urate crystals can accumulate under the skin and cause nodules.

A hammer toe is a toe that is deformed, with the end of the toe bending downwards. It usually affects the second, third or fourth toe, and appears to look like a claw. A corn may form on the top of the toe, and a callus may form underneath it. It may be caused by a muscle imbalance or by poorly fitting shoes, when toes are unable to be fully extended. A flexible hammer toe can be manually straightened out while a rigid hammer toe cannot be pulled straight.

Diagnosis

A physical exam will confirm the presence of a hammer toe. An X-ray can show more about the patient’s specific condition.

Treatment 

Treating a hammer toe before it becomes “fixed” in position is essential. Orthotics, splints, or wearing shoes with roomy toe-boxes may help non-severe cases of hammer toe. In severe cases, surgery may be performed.

Without Treatment

Pain and walking difficulty may increase, and a permanent deformity may occur. Repeated friction to the tip or the top of the toe can lead to wounds and infection.

A neuroma is thickening of the tissue surrounding a nerve that travels between the base of two toes. It is caused by repeated mild injury to the space between two toes, which can occur when footwear does not fit properly or in people that run frequently. The thickened tissue then causes pain in this area, especially felt when walking.

Diagnosis

A neuroma is first diagnosed based on the history of the type of pain someone is having. There are also ways to examine the foot that can diagnose this condition. In some cases an MRI is done to obtain pictures of the tissue in the foot.

Treatment

The simplest form of treatment involves wearing shoes that allow the feet plenty of room on the sides. In some cases an injection can be given into the neuroma. In difficult cases surgery can be curative.

Without Treatment

The pain caused by a neuroma can progress and become severe.

The sesamoid is a small bone under the ball of the foot. It can become strained in repetitive activities that place pressure on the ball of the foot or involve repeated upward flexion of the big toe. Sesamoiditis is inflammation and pain as a result of this.

Diagnosis

The diagnosis of sesamoiditis is made based on the location of the pain and on the type of activities that make it worse. There is also pain when pressure is applied to the sesamoid, especially on the inside part of the ball of the foot.

Treatment

Treatment involves primarily rest. Special footwear with a rigid sole that minimizes movement of the joint at the base of the big toe may also be prescribed. In some cases a steroid injection along the sesamoid is given.

Without Treatment

Pain may increase. In some cases the sesamoid can become fractured. In severe problems that involve the seasamoid the bone itself can be surgically removed.

The sesamoid is a small bone under the ball of the foot. It can become strained in repetitive activities that place pressure on the ball of the foot or involve repeated upward flexion of the big toe. Sesamoiditis is inflammation and pain as a result of this.

Diagnosis

The diagnosis of sesamoiditis is made based on the location of the pain and on the type of activities that make it worse. There is also pain when pressure is applied to the sesamoid, especially on the inside part of the ball of the foot.

Treatment

Treatment involves primarily rest. Special footwear with a rigid sole that minimizes movement of the joint at the base of the big toe may also be prescribed. In some cases a steroid injection along the sesamoid is given.

Without Treatment

Pain may increase. In some cases the sesamoid can become fractured. In severe problems that involve the seasamoid the bone itself can be surgically removed.

A callus, or tyloma, on the foot is caused from repeated pressure and friction, leading to the build up of thickened skin. The callus, which be may hard, dry or cracked, acts to protect the area underneath it. A corn is similar to a callus but is smaller and appears on toes rather than on the sole of the foot. 

Diagnosis

A callus or corn is typically diagnosed upon examination.

Treatment

Your podiatrist can recommend simple over-the-counter treatments such as pads or pumice to decrease the calluses or corn. In severe cases calluses may require regular shaving to keep them from becoming too large.

Without Treatment

While treatment for calluses and corns is not always necessary, it may provide you with more comfort. Larger calluses can cause significant pain. In some patients, especially when they become cracked, calluses can lead to wounds that can lead to serious problems, especially in people with diabetes.

Charcot foot is a chronic foot condition that is found in conditions that cause loss of sensation in the foot, most commonly diabetes. As a result of the loss of sensation, the foot is unable to maintain its normal structure, and the bones of the foot and ankle collapse. The result is pain and inflammation. Over time, the bones and joints of the ankle can become damaged, and lead to chronic pain and ulcers on the feet.

Diagnosis

The diagnosis of Charcot foot can be made on the basis of loss of normal shape and structure of the foot and ankle. This can bee seen on physical exam, and demonstrated by X-ray or MRI.

Treatment 

Ideally, the treatment of Charcot foot includes treatment of the underlying condition causing the loss of sensation. During acute pain, the foot can be immobilized and anti-inflammatory medication can be taken. Measures are taken to maintain the proper shape and weight bearing of the foot and ankle.

Without Treatment

As Charcot foot progresses, chronic ulcers can develop. These are painful and can lead to infection.