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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.

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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.

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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.

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Ingrown Toenail or Onychophosis?

Ingrown toenails are probably not as common as you think. The most common cause of pain down the side of a toenail is a condition called onychophosis which many people mistake for an ingrown toenail. A true ingrown toenail is when a sharp edge or piece of the nail penetrates the skin to become “ingrown”. This typically becomes red and inflamed and runs of the risk of infection developing. Onychophosis is a callus or a corn that develops down the side of the nail from pressure between the nail and the skin. Typically the nail is curved and there is quite a lot of pressure there. Because of this pressure, the skin thickens up to protect itself, but becomes so thick it forms a painful callus or a corn. Both an ingrown nail and onychophosis cause pain down the side or edge of the nail. That pain is due to the pressure, but one is due to the nail penetrating the skin and the other is due to the pressure on the skin, so you can see why they may often be confused.

An ingrown toenail is treated by a podiatrist skillfully removing the piece of nail that has penetrated the skin. In the long term it may need a minor surgical procedure for a more permanent solution if the condition continues to occur. For an onychophosis, this is where the practical skills of a good podiatrist shine in being able to skillfully debride the callus and corn and file the nail away from the painful area. Like an ingrown nail if this becomes an ongoing problem, minor surgery can be used to remove the edge of the nail to prevent it from being a long term problem.

If you have any pain down the side of the nail, whether it be an ingrown toenail or an onychophosis, then come in an dsee us to discuss your options.

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Chilblains Season is Here

As the weather has started to cool for winter we have started to see some chilblains as it is that time of the year. That can also be a bit misleading as chilblains are not technically due to the cold weather, but are due to how the small blood vessels in the foot respond to the changes in temperature from cold to being warmed up.

Chilblains are typically red painful and itchy spots on the toes and other areas of the foot (though they can less commonly also affect the hands, ears and nose). They only appear in the colder climates and are pretty much unheard of in warmer climates. They typically occur when the foot has been cold and is warmed up too quickly for the small blood vessels to react to that change in temperature. This releases chemicals that cause the itch and creates an inflammatory reaction leading to the chilblain. They can become quite painful and break down which might lead to an infection. Repeated exposure to the cold may lead to the chilblain becoming chronic.

The best way to deal with chilblains is to prevent them from happening in the first place. This means making sure the foot does not get cold, so keep on warm socks and closed in shoes. If the foot does get cold, then make sure it is warmed up slowly. Do not put a very cold foot in front of a heat source – warm it up slowly.

If a chilblain does occur, then protect it. Keep it warm. Use some gentle rubbing of it with a cream to stimulate the circulation. Please give us a call and come and see us if you are troubled with chilblains. There is plenty we can do and plenty of advice that we can give.

You can read all the latest research on chilblains at Podiatry Arena, Craigs blog post on beetroot and chilblains as well as an episode of PodChatLive on chilblains.

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Do foot corns have roots?

This is a question we get asked a lot. They don’t. It is a myth that persists.

The reason that it persists is because corns do often keep coming back after we have removed them. They do not come back because we left the “root” there, like the plant analogy that the myth is based on. They come back because the cause of the corn is still there. They only way to stop a corn coming back is to remove that cause. Just removing a corn does not remove that cause.

A skilled podiatrist can easily remove a corn, but as that corn is caused by too much pressure on the area in which it develops, unless that pressure is removed the corn will return. You need to discus it with your podiatrist what needs to be done to either eliminate that excessive pressure or reduce it so that the corn is not so much of a problem.

The reason for that high pressure will vary from “corn to corn”, but it could be from, for example, a hammer toe pushing on tight fitting shoes; it could be between the toes and the alignment of the toes is off slightly, causing high pressure on the spot where the corn develops; or it could be from the shoe pushing on a bunion. The reason for the corn needs to be determined and that reason taken away if the corn is to be stopped from returning.

How that pressure is removed is going to be determined by the reason for the pressure. Was it the shape of the toe? Is there a bit of enlarged bone? Do the shoes not fit properly? Once that has been assessed then advice can be given on the best strategy to remove or lesson that pressure to prevent them from coming back

Bottom line is that corns do not have roots and if anyone asks you if “Do foot corns have roots?”, then tell then they don’t.

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