What to do about toe jam?

‘Toe Jam‘ is not a medical term and is a lay term for that yucky ‘stuff’ that accumulates between the toes. It is really a collection of things such as sock lint, dead skin cells and sweat that have nowhere to go in the tight cramped spaces between the toes. At the best of times this can be unpleasant, even have a cheese-like consistency to it and can emit a foul odour. It is likely to be worse if you wear closed in shoes, your feet sweat a lot and your foot hygiene is not as good as it should be.

The best way to deal with toe jam is to practice good foot hygiene. You need to carefully clean and then dry between the toes.

Toe jam can only become serious if a fissure or split develops between the toe and an infection can get in; or if a secondary bacterial or fungal infection develops in the unhygienic environment created by the accumulation of the toe jam.

Toe jam is unpleasant and yucky and can be the butt of jokes, but please take it seriously and practice good foot hygiene habits to get rid of it. If any of the complications of it develop then come in and see us.

Why we don’t like the corn removal pads

Corns are a thickening of the skin in response to do much pressure on the area. Corns are relatively easy to remove by careful debridement, they are not so easy to stop coming back. Corns do not have roots that they grow back from; they come back after being removed because the cause of them is still there. That cause is that too much pressure on the area. There are a number of options to help reduce that pressure and we are happy to discuss those options with you for your corn.

Corn removal pads are not the answer to stop a corn coming back. These corn pads contain a low dose of an acid with the aim being that the acid will eat away and remove the corn. The typical acid used is salicylic acid. There are a number of problems with these corn removal pads. Firstly, the acid has no idea what is corn and what is normal – is will eat away at whatever you put it on, so the potential for a disaster from that is high, especially if you have diabetes. All the podiatry and diabetes professional associations advise against using them if you have diabetes. Secondly, they do not deal with the cause of the corn. So even if the corn pad can remove enough of the corn to help the symptoms, it is only a matter of time before it comes back again.

The best advice is, do not use corn removal pads as the risk of something going wrong is high. Have a discussion with your podiatrist what the best long term solution for your corns are and what is the best way to get rid of them permanently.

Foot care for those with dementia

All types of dementia, of which Alzheimer’s disease is the most common and the most well known is a devastating condition. We certainly see it in many patients that we see drift away slowly and the impact that this has on their loved ones.

We sometimes get asked if is foot pain associated with dementia and Alzheimer’s disease? Generally, the answer to that is no. There is nothing that is inherent in the physiological processes that go on in those with Alzheimer’s disease that can cause foot pain. However, as those who tend to get Alzheimer’s are older and foot problems are more common in those are older, it stands to reason that they will get the usual and typical types of foot problems that those in that age group get. There are also issues with the ability of those with the Alzheimer’s to care for their own feet and the necessity for caregivers to check the feet on a regular basis for any problems. Also the general frailty associated with the condition does make the foot more vulnerable to damage.

Getting foot care for those with all forms of dementia is just as important as any other health service provided. The development of foot problems is going to affect the mobility and quality of life. Providing foot care can be a challenge at times, mostly due to them failing to understand and appreciate what is going on around them, perhaps even lashing out physically and verbally. Foot problems do develop in Alzheimer’s disease, so please check your loved one and bring them in if there are any problems.

How to protect a bunion in tight fitting footwear?

Sometimes you just have to do what you have to do. When you have a bunion the advice that podiatrists are going to give you are going to be to make sure that your footwear is of an adequate width in the forefoot so as not to push on the bunion or push the big toe over further. You will probably get some advice on some exercises that you could do to help keep the toe mobile and flexible. You will be given some education about the cause of the bunion being a combination of hereditary factors and poor fitting footwear and the importance of getting the right footwear for a better long term outcome. You may even get admonished at a follow-up visit if you are not following the advice. There may also be a discussion of different types of pads that can be used to relieve pressure over the bunion and different ones that you can wear in your shoes to make them more comfortable if they are painful. You will probably have a discussion about the surgical options for bunions and how different surgical techniques can be done and just what is the recovery time following bunion surgery.

But sometimes (or maybe often) you find yourself in a position where you have to wear or use the shoes that you have just been told are not good for your bunions, or even worse, you have to wear tight fitting footwear for some sort of special occasion. The world is not going to end if you do that occasionally, but it is going to be a problem for your bunion if you do it a lot. What can you do if you find yourself in that position and need something to get you through to help protect the foot and maybe even prevent future problems? There are some options that maybe you might want to try to help you get through the very short term use of the wrong footwear. One of these products that we often advise patients to use is the Bunion Assassin or similar products. These are a sleeve that goes around the forefoot and between the first and second toe. In between the toes it has a silicone pad that puts a gentle separation between the toes to put it in a more correct position. It also has some silicone gel that goes over the bunion to protect it from shoe pressure to make it more comfortable. The Bunion Assassin is not going to fix your bunion, it is however, going to make it more comfortable and perhaps make those shoes that you really should not be wearing more tolerable. Additionally, if you do end up wearing those wrong shoes very occasionally, you could consider the bunion corrector night splint that will go a little way to undoing some of the damage that the shoe might have done. Also after a night out in those wrong shoes you know you should not be using, do some exercises to mobilise the joint.

Do you have an ongoing problem with an ingrown toenail?

An ingrown toenail is due to a combination of a curved shape to the nail, poor cutting technique and pressure on the toe from the shoe. Many cases can be managed with conservative care periodically and that combined with good self-care can often take care of it. For some, that is not enough and something more drastic and radical seeds to be done to prevent it from becoming such a regular problem.

If you are in that latter category where the problem is ongoing, then please come in and discuss it with us. A minor surgical procedure under a local anaesthetic can remove the side of the of the toenail that is causing the pain and an acid is used on the growing area of the nail to prevent that side or edge of the nail from growing back. Healing afterwards is usually uneventful, but we do like you to wear an open shoe or sandal for up to a week and keep it dry for at least a few days so that it heals up properly. The worst that can usually happen is that a phenol burn may take a little longer to heal (phenol is the chemical that we use to destroy the growing area of the nail so it does not grow back). Please come in and discuss your options if you have this problem.

What is the difference between a hallux valgus and a bunion?

Sometimes the terms that get used medically, hallux valgus (or hallux abducto valgus) and bunions are used to describe the same thing when they aren’t.

A bunion is the enlargement that occurs on the big toe (hallux) joint, or technically the first metatarsophalangeal joint. Hallux valgus is when the big toe angles in a valgus direction, which is towards the outside. There is debate about if this is valgus or abductus (hence the term hallux abducto valgus and which one occurs in which direction, but that can wait for another day).

Basically, a bunion is the lump and the hallux valgus is the deformity.

So, yes they are not the same thing, but a bunion almost always occurs with a hallux valgus and they are both parts of the same problem.

The Effectiveness of the urea based creams

We use a lot of the urea-based creams, specifically the Walker’s brand. We have found it very effective for the dryer skins and the Walker’s comes in two concentrations (15 and 25), so we can choose which is more effective.

Urea based creams have been widely used for since the 1940’s to treat dry skin and conditions like psoriasis and dermatitis. It has next to no side affects, though an allergic reaction is a rare one. Below a concentration of about 20 (ie the Walker’s 15) the action of the urea is to act as a humectant, which means it helps the skin retain moisture. Above a concentration of about 20 (ie the Walker’s 25) it causes a breakdown of proteins in the skin and the dry skin can flake of and soften the skin. We will often choose to use one or the other depending on the clinical needs. Varying the use of the two can prove to be quite effective.

Foot Pain and Menopause

Pain in the foot does have a higher incidence after menopause. This study in a group of women in Spain looked at the foot-related quality of life issues surrounding menopause and found that, yes, there is a poorer quality of life-related to foot pain after menopause. There are a number of physiological changes during the ‘change of life’ that affect foot pain in menopause. These changes include:

  • Changes occur to the properties of the soft tissues. For example tendons become stiffer and this increases the risk for injury to those types of structures.
  • Osteoporosis is much more common after menopause to the changes in the different hormones. This makes the bones ‘softer’ and more likely to have a bone stress injury, a stress fracture or a fracture.
  • there are changes to the hormone control of the small blood vessels and this can predispose to issues with the circulation as the circualtion reacts sluggishly and differently.
  • After menopause, there is almost always in increase in weight. This increase puts more load on the foot and increases the risk for developing a wide range of foot problems.

Menopause on its own does not cause foot pain. It is the physiological changes that happen during menopause that increase the risk for a lot of different types of foot problems. We can help with those foot problems.

Runners Should Rotate Their Running Shoes

The type of running shoe is a key decision that any runner needs to make. The good (or bad) news is that runners should have at least two pairs of running shoes and rotate them on different days. This study shows that runners who use more than one pair of running shoes are less likely to get an overuse injury.

Probably the most likely reason for this is that different running shoes will stress a different set of tissues differently. For example, running shoes can come with different ‘drops’. This is the height difference of the midsole between the heel and forefoot. Some running shoes are 10-12mm, some are 8mm and a few are down to zero. It is not hard to see that running in a 10mm drop running shoe one day and a 0mm drop running shoe the next day how the load or forces on the calf muscle are going to be different.

Moving the loads around like this can be important in preventing injuries by stressing tissues differently from day to day. The best way to do this with running shoes would be to make sure that the design features in the 2 or 3 or more shoes that you run in a very different from each other. Also, it is important that you spend time to adapt to any new running shoe so the body gets used to them, especially if they have design features that you are not used to running in.

Archies Footwear for Children

Archies Footwear are a thong or flip flop that have an arch support built into them. We are one of the largest Archies stockists in Melbourne and have the full range of sizes and colours. It is exciting that the Archies are now available in children’s sizes. Besides being functional and helpful, they are also really cute.

Pretty much anyone who tries the Archies on in the clinic, buys them. They really are that good and comfortable. They are also functional and have a useful arch support for those that need them. This can make them particularly useful for kids. Please come in and give them a try.

archies thongs smelbourne