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27/Jun/2017

A corn on the foot can be painful. With time it comes back faster after every removal. Having a corn removed every 6 months, will soon become 4 months then 1 month and then just a few days of relief. To discover the reason for this we must look at why the corn is coming in the first place. A corn on the side of the 5th toe is purely from a shoe being to narrow. It will be worse on one foot compared to the other due to one foot being slightly wider and longer than the other. The pressure from a shoe, even a soft shoe presses the skin against the bone. This makes the skin toughen. If the pressure continues the concentration of the hard protein called keratin becomes so pure that it is harder than toenail. It creates a hard centre which can be very painful. If the shoe is not changed to a better fitting one for reasons of uniform or fashion, then the corn is expected to return. In warmer months when the foot may be more puffy, the corn will return faster. When the weather is cooler the return will be longer. If you have walked more or become more active, the pressure and friction increases and the corn will return faster. Smoking and weight gain will also increase the rate of return.

A corn under the foot is purely due to a bone being too close to the skin. They are usually found under one or more of the 1,2,3,4,5 metatarsal heads. These are in the forefoot. A patient will often complain that the “corn is now coming back faster” or ” you didn’t remove it all because it’s only been 2 months this time, or two weeks etc”. The patient must understand when the Podiatrist explains the reasons for the corn. A dropped forefoot arch causing the metatarsals to collapse and press through the skin. An insole / orthtoic will help prevent them. If the patient is not willing to change the position of the bones by wearing an insole then they must expect the corn to return at some point. Weight gain will also cause callouses and corns to become bigger, more painful and return faster. The patient may be advised to lose weight but if they do not and the weight stays the same or increases, then understandably the corn will return faster.
Smoking causes small friction areas on the foot to became much more thickened and painful . Corns also are exaggerated and much more painful. They return much faster. Smoking decreases the amount of oxygen that can be carried in the red blood cells. The feet are the most oxygen starved area of the body. If you smoke this makes any repair of the skin much slower. In the case of the feet the body defends itself by growing thicker skin. A smoker that quits smoking will notice in 6 months the skin is much healthier to the feet. Weight loss also reduces hard skin build up and corns. Make an appointment to see a nutritionist for expert advice and to make a plan and approach it as a scientist would a research project and keep a log by charting your progress.

A Podiatrist always explains to a patient with a corn why they have it, it is up to the patient to also help with the plan. If there is no orthotic / insole worn, shoes changed, weight loss achieved, quit smoking then the corn is guaranteed to return. And it will come back more frequently until there is no relief from any removal due to the living tissue becoming damaged.


27/Jun/2017

Does it feel like your feet are burning or tingling like pins and needles?
You’ve been suffering foot pain for years but don’t know what to do about it?
Neuromas – The Symptoms
This may be something called Morton’s Neuroma or Intermetatarsal Neuroma. Patients also often speak about an intense pain either in the ball of the foot or into the toes or in both areas. Patients also can complain in some instances of a numbness or a “fuzzy” sensation in the toes. Along with these descriptions patients also mention a sense of ‘fullness’ or cramping in the toes especially with activity. Some relate that the pain moves from the sole of the ball of the foot into the toes or even radiating into the arch or up the leg. Dress shoes or running in athletic shoes tends to increase the severity of these symptoms. In most instances, patients do report that removal of the shoes and massaging the ball of the foot and the toes gives immediate relief of symptoms. However, in some instances, walking barefoot on hard surfaces can also cause extreme discomfort and duplicate the symptoms.
What is a Neuroma?
Morton’s Neuroma or Intermetatarsal Neuroma is caused by an entrapment or pinching of the nerves, or repeated micro-traumas which result in a degeneration of the nerve branches. The condition is most commonly found between the 3rd & 4th toes and is much more common in women than in men, possibly due to women’s footwear being more pointed / higher heeled causing the forefoot to be a bit ‘squashed’. These neuromas can most often be found in flattened foot arch types, but also in the normal as well as the high arched foot.
What Should You Do?
At Dubai Podiatry Centre, we can correct the flattened forefoot arch by using a custom orthotic to lift the transverse arch. This enables the metatarsals to align normally and prevent further trauma to the nerves. The transvere arch runs across the forefoot and is different to the most commonly known arch along the instep of the foot. Call Dubai Podiatry Centre on +971 4 3435390 for an appointment with the Podiatrist – we’re here to help!


27/Jun/2017

Children with strong, healthy feet often avoid many kinds of lower extremity problems later in life. Contact our office to have your children’s feet and lower extremities examined.

Infants

The size and shape of your baby’s feet change quickly during their first year. Because a baby’s feet are flexible, too much pressure or strain can affect their feet’s shape. It’s important to allow your baby to kick and stretch his or her feet. Also, make sure shoes and socks do not squeeze the toes.

Toddlers

Try not to force your toddler to walk before she is ready. Carefully watch her gait once she begins to walk. If your toddler’s toe touches down instead of the heel, or she always sits while others play, contact our office. Many toddlers have a pigeon-toe gait, and this is normal. Most children outgrow the problem.

When foot care is needed

To help with flatfeet, special shoes or custom-made shoe inserts may be prescribed. To correct mild intoeing, your toddler may need to sit in a different position while playing or watching TV. If you child’s feet turn in or out a lot, corrective shoes, splints, or night braces may be prescribed.

The foot’s bone structure is well-formed by the time your child reaches age 7 or 8, but if a growth plate (the area where bone growth begins) is injured, the damaged plate may cause the bone to grow oddly. With a doctor’s care, however, the risk of future bone problems is reduced.

Remember to check your child’s shoe size often. Make sure there is space between the toes and the end of the shoe, Make sure their shoes are roomy enough to allow the toes to move freely. Don’t let your child wear hand-me-downs.


27/Jun/2017

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)
Neuromas can be one source of pain to the ball of your foot (as well as sesamoiditis and bunions, for example). Neuromas are enlarged benign growths of nerves, most commonly between the third and fourth toes. They are caused by tissue rubbing against and irritating the nerves. Pressure from tightly-fitting shoes, high heels or abnormal bone structure can create the condition as well. Treatments include custom orthotics, padding within your forefoot to lift your transverse arches and/or cortisone injections, but surgical removal of the growth is sometimes necessary.
If you are worried about possibly having a Morton’S Neuroma, make the foot experts at Dubai Podiatry Centre your first stop. Arrange a convenient appointment on +971 4 3435390


27/Jun/2017

Introduction
Onychocryptosis is otherwise known as an ingrown toenail. It occurs when part of the nail penetrates or increases pressure on the skin which causes pain, inflammation, hyper granulated tissue and commonly infections.

Etiology
The many causes of developing onychocryptosis including:
€¢ Improper cutting of the nail €“ too short, leaving sharp edges, cutting down the sides
€¢ Pronation of the hallux and Hallux Valgus Deformity €“ causing skin to €˜bulge€™ on one side of the nail leading to an increase in pressure
€¢ Involuted nails €“ where the nail is curved at each edge rather than lying straight across the nail bed
€¢ Ill fitting footwear €“ tight shoes causing increased pressure on the nail and skin
€¢ Trauma – deforming the nail growth will increase the chances of developing into an ingrown nail
€¢ Swollen toes €“ chubby digits or during pregnancy can increase the skin bulging around the nail leading to an ingrown nail
€¢ Fungal nail infections €“ deformed, brittle or thick nails increase the chances of developing an ingrown nail

How a Podiatrist can help?
Pending on any nail deformity, severity or presence of infection to the ingrown nail we can help by:
€¢ Referring to a Doctor for treatment if an infection is present – antibiotics
€¢ Corrective trimming of the nail €“ cutting straight across
€¢ Packing the nail sulci with gauze and antiseptic solution – will allow the nail & skin to be separated so inflammation can reduce
€¢ Removing the nail spike €“ if it is too painful we can administer a local anesthetic. If this nail spike is not removed, the infection will likely continue with the irritant still in place
€¢ Nail Braces €“ clear small strips are applied across the nail which then acts as a €˜spring back€™ to lift up the sides of the nail creating a nail that lies straight across the nail bed. This is a painless procedure but can only be applied to certain nails once infection has been removed. The nail brace is worn for a few weeks to insure the nail sides do not fall back down
€¢ Persistent occurrences of ingrown nails €“ A Partial Nail Avulsion will be needed. Where the digit is under local anesthetic and only a part of the nail, the irritating side is removed from the nail root. No skin is cut, so no stitches are required. We can administer Phenol Acid to the nail bed to ensure re-growth does not occur if the problem lies at the nail bed. Patients can continue with their normal lives that same day but rest and foot elevation is advised. We ask that constrictive footwear or sporting activities are not carried out for at least 10 days while the toe is healing.
€¢ Patient information €“ corrective self trimming, not wearing tight footwear or socks, check digits daily, keep feet clean, treat fungi infections.
€¢ It is advised if patients have poor circulation or Diabetes that they get their nails trimmed by a Podiatrist to ensure corrective trimming and lessens the chances of cutting the skin, ingrown nails and infections.
€¢ Assess foot alignment for deformities such as Hallux Valgus – correct this with Orthoses Devices which will offload the pressure being exerted from the nail into the skin


27/Jun/2017

Introduction
An Intermetatarsal (Mortons) Neuroma is a thickening of nerve sheath/tissue located between the metatarsal bones of the foot. Most commonly located between the 3rd and 4th interspace as this is where the Medial and Lateral Plantar Nerves combine making it an already larger nerve. This location is known as Mortons Neuroma.
Etiology
Causes of developing an Intermetatarsal Neuroma include:
€¢ Compression and irritation of the nerve
€¢ Ill fitting footwear €“ Shoes that are too small, have a tight/narrow toe box or high heel shoes that increase pressure onto the metatarsal heads
€¢ Foot deformities €“ Bunions, flat feet, over pronation, hammer digits, collapsed transverse arches will all increase the susceptibility of compression to the nerve sheath and thus may develop a neuroma.
€¢ Sporting Activities €“ Sports such as; running, tennis, ballet and Irish dancing require extra load/time on the ball€™s of the feet
Symptoms
€¢ Localized pain intermetatarsally that can be sharp or dull
€¢ Tingling, burning or numbness may be present
€¢ Symptoms can radiate along the foot distally or/and proximally
€¢ The associated digits may be numb
€¢ Pain usually increases with wearing footwear
€¢ Pain can increase with palpation of the metatarsal interspace
€¢ Pain can increase with testing €œMulders Sign€ and a €˜click€™ may be heard

How a Podiatrist can help?
€¢ Diagnosing and treating any occurring foot deformities with orthoses devices
€¢ Pain can increase with testing €œMulders Sign€ and a €˜click€™ may be heard
€¢ Applying a metatarsal arch pad to footwear to reduce the compression forces on the nerve
€¢ Advising activity modification €“ Rest and icing the area
€¢ Non Steroidal Anti-inflammatory drugs can help minimise pain and inflammation
€¢ Footwear advise €“ wear shoes with wide toe boxes and avoid high heel or narrow shoes
€¢ An X-ray may need to be taken to rule out differential diagnosis such as stress fractures
€¢ Doctor or Orthopaedic referral for corticosteroid injection or reconstructing bone alignment through surgery

Sesamoiditis & Dubai Podiatry Centre
Details
Written by Maureen Duffy B.A.Hons.,A.C.I.M.,U.K.
What is sesamoiditis?
Sesamoiditis is an inflammatory condition affecting the periosteum of the seasmoid bones.
The tibular and fibular sesamoid bones are two well defined bones located on the plantar surface of the first metatarsal head and lie within the flexor hallucis brevis and longus tendons which are responsible for moving the big toe (hallux).
Sesamoids are present in approximately 85% of the population. They appear in the third fetal month of development and remain as cartilage until about 8-10 years of age when they ossify (become bones).

The purpose of the sesamoids are to:
55 Act as a fulcrum for the FHB tendon by increasing the mechanical force of the tendons
56 Serve to protect the FHL tendon
57 Reduce friction
58 Absorb shock at the forefoot during loading by redistributing ground reaction forces thus protecting the metatarsal head.€
Just over 1% of all running injuries involve the sesamoids with 40% of these being stress fractures and 30% diagnosed as sesamoiditis. There are different types of injury to the sesamoids – find out more here.
The main causes of sesamoiditis include:
26 Increase in activity
27 Sports involving weight onto the forefoot e.g. Jumping, Ballet, Irish Dancing
28 High heel shoes
29 Shoes with little cushioning
30 Foot posture: Pes Cavus, plantar flexed first rays, hyperextended hallux and pes planus or flat feet.
31 Relative lengths of the 1st and 2nd metatarsals.
Examination & Diagnosis
There may be a history of gradual onset of pain (chronic) localized to the plantar surface of the first metatarsal head, or an initial trauma (acute) can offset symptoms. Pain on palpation on either of the sesamoid bones which can be distinguished by dorsiflexing and plantarflexing the hallux. Movement of the joint can increase pain. While swelling and erythema are often present thus limiting the first metatarsal/phalange joint range of motion. The favouring of one foot with a limp can be present.
How a Podiatrist can help?
Initial modification of your exercise regime may be advised, to allow the sesamoids to recover. Conservative treatment includes: rest, ice, anti-inflammatory medication and flexibility exercises.

We will assess the your foot alignment, identify any foot anomalies and perform a gait analysis. Custom orthotics may be advised to accommodate any foot issues causing too much load through the forefoot, offloading the sesamoids, redistributing the forces across the foot and preventing future injury. This also gives the area time to heal. We may also modifying your footwear to provide extra support and cushioning and where possible, advise limiting or avoiding high heels.
If you have any concerns about your feet or are experiencing pain, contact the foot experts at Dubai Podiatry Centre for friendly and detailed professional advice, treatment and care. +971 4 3435390


27/Jun/2017

Introduction
An Intermetatarsal (Mortons) Neuroma is a thickening of nerve sheath/tissue located between the metatarsal bones of the foot. Most commonly located between the 3rd and 4th interspace as this is where the Medial and Lateral Plantar Nerves combine making it an already larger nerve. This location is known as Mortons Neuroma.
Etiology
Causes of developing an Intermetatarsal Neuroma include:
€¢ Compression and irritation of the nerve
€¢ Ill fitting footwear €“ Shoes that are too small, have a tight/narrow toe box or high heel shoes that increase pressure onto the metatarsal heads
€¢ Foot deformities €“ Bunions, flat feet, over pronation, hammer digits, collapsed transverse arches will all increase the susceptibility of compression to the nerve sheath and thus may develop a neuroma.
€¢ Sporting Activities €“ Sports such as; running, tennis, ballet and Irish dancing require extra load/time on the ball€™s of the feet
Symptoms
€¢ Localized pain intermetatarsally that can be sharp or dull
€¢ Tingling, burning or numbness may be present
€¢ Symptoms can radiate along the foot distally or/and proximally
€¢ The associated digits may be numb
€¢ Pain usually increases with wearing footwear
€¢ Pain can increase with palpation of the metatarsal interspace
€¢ Pain can increase with testing €œMulders Sign€ and a €˜click€™ may be heard

How a Podiatrist can help?
€¢ Diagnosing and treating any occurring foot deformities with orthoses devices
€¢ Pain can increase with testing €œMulders Sign€ and a €˜click€™ may be heard
€¢ Applying a metatarsal arch pad to footwear to reduce the compression forces on the nerve
€¢ Advising activity modification €“ Rest and icing the area
€¢ Non Steroidal Anti-inflammatory drugs can help minimise pain and inflammation
€¢ Footwear advise €“ wear shoes with wide toe boxes and avoid high heel or narrow shoes
€¢ An X-ray may need to be taken to rule out differential diagnosis such as stress fractures
€¢ Doctor or Orthopaedic referral for corticosteroid injection or reconstructing bone alignment through surgery


27/Jun/2017

Diabetes and good footwear
Diabetes can lead to poor blood circulation. This decreases the circulation getting to the legs and feet which can cause injuries in the feet to heal poorly and can create ulcers, changes in shape of the feet, and loss of feeling.
Be careful when buying new shoes.
This can lead to rubbing of the skin and development of a foot ulcer.
Buy new shoes in the afternoon/evening when your feet are at their largest size.
Have your feet accurately measured by the store staff. Be aware that your foot size and shape will change with age!
Most commonly due to decreased sensation €“ Neuropathic Diabetics buy shoes that are too small as they are unable to feel the sides
Going bare foot increases your chances of damaging your skin
Wearing cushioned, supportive footwear with good quality socks is essential for all Diabetics


27/Jun/2017

 

Poorly controlled Diabetes can lead to poor circulation, dry skin, decreased sensation and calluses. These can increase the chances of developing a fungal infection.
Fungus can cause itchiness, redness and cracking of the skin.
If the skin breaks down the fungus can cause infection under the skin.
If the blood glucose levels are high the extra Glucose feeds the germs making infection worse.
Fungal infections can be present on toenails as well €“ discolouration and thickening usually occurs.
Diabetes leaves a €˜sweet sweat€™ on your skin which is excellent for fungus to thrive. Just as you have to wash your hands before your blood glucose monitoring (otherwise the reading is very high due to the €˜sweet sweat€™ being present on your hands), care must be taken to wash, dry and moisturise the body and feet thoroughly.
Check your skin after you wash!
To treat fungus you need to see your General Practitioner or Podiatrist.


27/Jun/2017

Diabetes
People with Diabetes should pay extra special care to their feet.
Those who lead a healthy lifestyle with well controlled Diabetes and get annual feet checks should continue to have fantastic trouble free feet.
Those who have untreated diabetes or live a poor lifestyle are more likely to develop complications which include blindness, kidney and heart disease, stroke and loss of limbs.
Diabetes often leads to poor blood circulation. This decreases the circulation getting to the legs and feet which can cause injuries in the feet to heal poorly and can create ulcers, changes in shape of the feet, and loss of feeling.
Diabetes and the UAE Facts:
Prevalance of Diabetes among citizens of the UAE is second highest in the world
20% of UAE Residents have Diabetes
25% of Emirati Nationals have Diabetes
Up to 90% of people with Type 2 Diabetes were shown to be triggered by lifestyle factors, like poor diet and limited exercise

Diabetes = poor blood circulation Decreased circulation getting to the legs & feet

Reduces the amount of Oxygen Injuries to heal poorly/slowly
and Nutrition getting to the skin Ulcers & Infections
& tissues
Swelling & Dryness of the feet

Treatment and Prevention
Have an annual Pain Free Diabetic Assessment of your feet with your Podiatrist. Here we check the circulation and sensation of your feet.
Wear cushioned, supportive footwear
Check your feet Daily for cuts, sores and hard skin €“ Use a mirror if needed
Wear shoes and socks at all times to limit chances of €˜friction sores€™
Dry between your toes
Do NOT use corn pads or attempt self removal of hard skin €“ see a Podiatrist
Control your Diabetes
Make healthy lifestyle choices with Diet and Exercise
Keep your blood sugar levels normal
Stop Smoking
Work with your GP to create a plan that fits you


Copyright Dubai Podiatry 2017. All rights reserved.