Verrucae are caused by the human papilloma virus (HPV), which commonly infects the skin. It affects the lower layers of the skin and causes a change in the growth pattern of the skin which results in a small tumour. However, this tumour is BENIGN!
Traditionally, podiatrists were taught that verrucae affect the younger patient, but it is quite clear that they can affect any age group. I have recently treated a 70 yearold lady!
Warts occur on any part of your foot and even under the toe-nails. They also appear differently as they develop. Often starting as a small puncture mark they can develop to look like a cauliflower growing in the skin.
Plantar warts are the most common – that is on the sole of your foot – growing anywhere, including on weight-bearing areas, where they are really painful.
Diagnosis is a big problem, podiatrists believe that many hard corns are misdiagnosed as plantar warts – with resulting surgical excision – which is wrong and leaves painful scar tissue in many cases.
Plantar Wart
Recognising clinical appearance is very important and difficult. Although it starts as a small spot, later the skin striations are usually pushed aside in a wart. The growth looks like a cauliflower, with black dots in the middle. Often there is a group of them, not just a single growth. They can grow on any skin surface including the knees and hands. Pain like a pin- prick is common on pressing and also throbbing when the foot is lifted off the ground.
Treatment is variable! Some of us will freeze with Liquid Nitrogen. We also use Acids in pastes or solutions. Excision is the last resort (in my opinion), but electro-dessication under local anaesthetic does work. Although you have to get used to the smell of a bad braai whilst doing this treatment! The dead tissue always needs cutting off. This is not usually too painful.
Plantar warts are my worst nightmare and I tell my patients that I call them "reputation ruiners", because they can take weeks to clear and often new ones grow during treatment. They also spread quickly in boarding school and some families – and sometimes they don't!
That's traditional treatment. If you don't like the sound of it try some 'home remedies'. Rubbing it with liver. Kissing a toad. Rubbing with various medicinal herbs (this works). Shouting at the moon, or finally, hoping that the Golden Lions rugby side wins one game in next years Super 14 competition!
So what to do
- Image via Wikipedia
Over the past few weeks, I have seen an increasing number of patients of all ages complaining of Heel Pain – usually diagnosed as Plantar Fasciitis (PF).
The pain is usually persistent and occurs under the heel pad and around the heel. Often it only affects one foot, but after questioning and examination, they admit to "a bit of discomfort in the other foot."
This extremely painful condition also called Plantar Fasciitis (PF), but strictly speaking PF causes pain into the arches and soles too, rather than just the heel.
In 1979, one of the founders of Podiatric Sports Medicine, Dr Steve Subnotnick, devoted an entire chapter to heel injuries, in his book Cures for Common Running Injuries. He was probably the original 'running foot doctor' when the surge in road running began to take off worldwide.
Tell me where it hurts!
The pain is usually worse in the morning when taking the first few steps and then gets less with continued movement. This pattern is repeated if you sit for a while later in the day – say in a meeting, classroom, lecture or tea-break – and stand up to walk again.
Patients always point to the exact site of pain. This is right in the middle under the heel pad. On the inside (very common) or outside of the heel and at the back.
Why does Plantar Fasciitis hurt?
Overuse is the phrase we use to explain PF! It's a bit like saying stress. The basic cause is the malfunctioning of the person's foot and lower limb structure, what we call your Biomechanics. The normal -for you – rocking and rolling movements are exceeded and the tissues get strained and inflamed at the very point where the plantar fascia is attached to the heel bone.
This can be caused by too much exercise such as increasing your distance and not getting enough rest. Changing the surface you run on; for example: running on a treadmill, starting running without the correct preparation, suddenly running more quickly.
Another common cause as we get older is being overweight. Or a change of occupation where more walking or standing is required. Old worn shoes for day wear or exercise. Arthritis, a pinched nerve. All these and many more causes need to be identified.
How do you treat Plantar Fasciitis?
With difficulty to be honest! You must let your podiatrist see a good selection of your shoes. Frequently we can provide relief from the symptoms by padding, taping and some anti-inflammatories.
The basis of treatment is the biomechanical assessment to identify what goes on as you walk/run. Orthotics may be necessary, but current therapy is team-based, so I might send you to a Physiotherapist or Biokineticist for strengthening of other muscle groups in your body.
We talk of core strengthening, to improve posture and alignment above the lower limb. If the pain is at the back of the heel gentle stretching plus raising the heeel helps. Nearly always lifting and cushioning the heel gives some relief. Wearing a higher heeled shoe also helps sometimes.
Can I avoid it?
Yes, but not always. If you can diagnose the problem yourself then stop doing what caused the PF. We often get heel pain on holiday after a day of sightseeing or playing on the beach or more likely shopping!
Never let your trainers get badly worn, especially if they bulge on the inner side. Keep your weight under control. If you know you are going to have to do a lot of standing or walking, consider wearing your more comfortable shoes and change into your fashionable ones later.
At the first sign of pain seek professional help and advice – a proper biomechanical examnation will identify whether plantar fasciitis is the problem. Remember the basic First Aid of treating any inflammation of the soft tissues of your feet.
- Rest;
- Ice;
- Compression;
- Elevation.
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"Warning: toxic leather shoes sold here" This scary headline appeared on page 5 of today's The Sunday Independent, over an article about the potential danger to the environment from the toxins/chemicals used in the tanning process of many of the leathers used to make our shoes.
Chrome tanning has been the method of choice for years now and the article describes a report from the Swedish Society for Nature Conservation and its partners, expressing their concern at their findings. The major concern is the amount of chromium the could spread to the wearer and into the environment. This, coupled with the various dyes used in tanning is the source of the society's concern.
As a podiatrist, I occasionally see a patient with a skin rash that is clearly associated with the patient's footwear. Called contact dermatitis, it shows as a clearly demarcated rash at all sites where the skin has been in direct contact with the shoe. It is frequently associated with leather sandals and it shows the patient's skin is irritated by the chemicals in the leather. However, there are numerous other causes of contact dermatitis, as any Dermatologist will tell you.
For example, with the need to produce shoes at lower cost, synthetic materials are more widely used. This also brought its own problems of skin sensitivity, increased sweating and sometimes burning feet. Environmental experts frequently point out that Plastic is of course another blight on the environment.
From a foot health point of view, we recommend the use of natural materials, such as leather, because we believe it 'breathes', absorbs natural foot moisture (sweat) and is altogether more healthy. Unfortunately, all leather shoes are expensive and over time become dry and cracked due to the cycle of moisture and dryness associated with the normal foot. [which is on reason why leather is tanned in the first place].
So don't panic, rather read the article and if possible the original report, before throwing out or burning your shoes; the smoke is also toxic! We are polluting our environment with far worse things than leather shoes.
Try to alternate your shoes from day to day. Keep them clean and polished to preserve the leather [if they are leather]. wash and dry your feet carefully to prevent the build-up of bacteria which cause smelly feet. Socks of natural fibre will protect your feet from direct contact with the materials used in manufacture, if you are sensitive.
If you do develop a rash or an itchy foot, after wearing a particular pair of shoes. Stop wearing them and see your podiatrist or doctor as soon as possible, because their are tests that will be done usually by the skin specialist – Dermatologist – to identify the exact cause and what you are sensitive to.
Whilst I think this particular article is a bit sensational, it does appear to be based on research evidence. Perhaps the take home message should be a timely reminder that we should all be doing more to re-cycle paper, plastic, metal and household refuse than we are.
Foot problems can spoil our holidays, because they are so unexpected. If you click on Foot Health Articles on this site, you can get some tips on holiday care for people with diabetes, I also wrote about a patient who suffered a holiday foot injury when he fractured his metatarsal as a result of a swimming pool fall! Also, check out the post on Holidays: Sore feet and sun back on 13 December 2008.
If you have been spending lot's of time in the pool you might have felt your feet burning. Watch out for the surface of the pool - if it is a bit rough -rubbing the skin on your soles away. [This happened to a little girl I know recently]. You get red-raw skin because the protective outer layer is worn away. Just treat the area with antiseptic and a plaster, to keep the 'bugs' out and avoid an infection.
You can get a similar effect after that first, long-awaited barefoot walk along your stretch of beach! Our feet are usually protected in shoes and the skin is quite soft; our soft city-dwellers' feet need a gentle introduction to the great outdoors!
Even regular runners can get burning soles after that early morning barefoot 'quick 5 kays' along beach! So don't be afraid to wear your tekkies on the beach.
Sunburn on the foot
Sunburn is probably the most obvious holiday foot problem. Mostly to the tops of our feet and the front of the ankles. Use a high SPF cream or spray and re-apply during the day and if you go in the water.
Shoe rubbing is very common on holiday, as we spend more time in sandals. So look out for pressure or friction points that cause blisters – often made worse when there is sea sand added to the mix.
If you are somewhere exotic this New Year, try not to let sea anemone spines, puffer fish or jelly fish spoil your fun – but who really sees them coming anyway?
Then there are always the snakes! Whenever you go into potential 'snake- country', think ahead and be prepared. Make sure at least one person in your group is equipped to deal with a snake bite.
Unfortunately, this time year produces a number of common injuries like cuts from hidden glass and metal, plus aches and pains from too much walking, golf or frisbee! So don't worry too much about that new heel pain, achilles tenderness or arch pain. It should settle down – if not – see a podiatrist.
The same goes for that itchy rash – could be fungus!
However you celebrate the New Year – from where I am, I'll get a free fireworks show on Kleinleeuwkoppie at Hout Bay, courtesy of Sol Kerzner – I wish you and your families all the best for 2010.
