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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




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



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



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



 

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.




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



Get Arches in Your Feet

The Medial Longitudinal Arch (MLA) extends from the inside of your heel along the bottom of your foot and connects to the big toe. It is a critical structure to allow for good shock absorption of the forces transmitted through the body from the feet during gait.
When the MLA is lower to the ground or €˜flat€™ it can cause an uncontrolled over pronation of the ankle joint.
Overpronation is where the ankle joint €˜rolls in.€™ Common injuries that occur from a flat MLA and over pronation include: Achilles tendonitis, heel pain, bunions, stress fractures, arch pain, shin splints and over use tendon injuries.
Custom made Orthoses Devices can be implemented to strengthen the MLA and maintain a neutral ankle joint alignment to control over pronation and relieve pain.
A custom made Orthoses is made by taking a mould of your feet to get the exact shape of each foot. It is then uniquely modified to create the individual€™s perfect Medial Longitudinal Arch and neutral ankle joint to allow the ideal heel to toe gait.



Flatten your Curved Nails
Curved nails are where one or both of the linear aspects of a nail starts to form down into the skin to form a curved shape.
Having curved nails is a common problem and can cause great distress to the surrounding skin which can lead to pain, inflammation and even infections.
To correct the curvature and pain it is important to address how the curves developed. Nails can curve due from certain medications, ageing, tight footwear, hereditary, improper cutting, fungal infections and skin problems such as Psoriasis or Ecemza.
Treatment involves assessing the steepness of the curve and choosing the best treatment plan for each patient.
Options include
Corrective Nail Trimming
Nail Braces: where a small plastic device is medically applied to the top of the curved nail. The brace works with a spring-like action to pull up the corners of the curve to straighten out the nail. Leaving a pain free, perfect toe nail. Treatment period = 6-8wks.
Partial Nail Avulsion (PNA): If the curve or nail rydge is steep then a PNA may be recommended. A simple procedure where local anasethetic is administered to the side of the nail to achieve anasethsia. The small section of aggravating nail is then carefully removed right from the nail root. This procedure takes approximately one hour and usually ready to exercise and swim within 10days.



Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)
‘Onychocryptosis’ is a medical term for 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 sometimes even bacterial infection in the soft tissue around the toenail.
Why do I get ingrown toenails (and they keep coming back)?
The many causes of developing painful ingrowing toenails including:
Incorrect cutting of the nail €“ (too short / leaving sharp edges / cutting down the sides of the toenail)
An underlying biomechanical issue of the foot such as ‘Pronation’ of the hallux – where the toe rotates – and Hallux Valgus (bunions)€“ causing skin to €˜bulge€™ on one side of the nail leading to an increase in pressure between of the toenail on the surrounding toe
Involuted nails €“- where the nail is growing extremely curved at one or both edges rather than lying straight across the nail bed
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, such as kicking something or dropping an object on your toe
Swollen toes €“- chubby digits or due to swelling during pregnancy can increase the skin bulging around the nail leading to an ingrown nail
Fungal nail infections €“- deformed, brittle or thickened nails increase the chances of developing an ingrown nail.
How can a Podiatrist help?
At Dubai Podiatry Centre, we work differently to Chiropodists and even other Podiatrists. We recommend treating any underlying root cause of all problems, so that the problem doesn’t come back. Rather than constantly seeing a podiatrist to correctively trim back your nail (which tends to keep coming back as the underlying problem hasn’t been fixed), we advise finding out and fixing any root cause. For example, if the ingrowing nail is due to an internally rotated toe and over-pronation at the ankle, simply correctively cutting the nail will not fix the issue for more than a few weeks. We may advise corrective orthotics to re-align your foot and ankle correctly to stop the resulting pressure on the toe and nail. Otherwise, you may find yourself constantly treating the painful ingrowing nail, which may simply be a symptom of an underlying biomechanical issue.
Other issues such as an underlying chronic fungal nail infection should also be treated and addressed, as otherwise your nail will continue to grow in thickened / ingrown.
Therefore, we look at every single factor from your footwear, to hormones, underlying bacterial and/or fungal infections, growth pattern of the nail, biomechanics of your foot, ankle and leg and general medical history to get to the cause of why your nail is ingrowing. Then, you can be sure that you are receiving the correct specialist nail advice and precise course of treatment appropriate to the cause of your ingrowing nail. At Dubai Podiatry Centre, it is an important part of our ethos that patients are fully informed and can make treatment decisions based on a full assessment and best course of action for both the short and long term.
Diabetes and Ingrowing Nails
If you are Diabetic, it is also very important that you see a Podiatrist at least annually for your regular foot check up. If you experience any foot issue, including early signs of an ingrowing nail, seek prompt and early treatment from your Podiatrist to prevent more serious complications.
What should I do if I have an ingrowing nail?
We treat every nail as if it were our own, and know how painful ingrowing nails are. For permanent help and treatment of your painful ingrowing nail, come and see the nail experts at Dubai Podiatry Centre. Chief Podiatrist Michelle Champlin advises early intervention and rather than just constantly trimming the nail and putting up with pain every month, identify and fix any underlying cause.
Do not ever cut down the sides of your nail, or let anyone except a qualified medical professional such as a Podiatrist, do this. Do not let a pedicurist cut down the sides of your nail. Before seeing your Podiatrist, you can soak the feet for 10-15 minutes in a warm saline solution. Do not oversoak and keep the toe clean and dry otherwise. Avoid tight fitting hosiery, socks and shoes. You can also pack a little piece of gauze or cotton under the side of the nail to lift the nail up from pressing into your skin, if you can. Make an appointment with your Podiatrist to stop the ingrowing nail from causing infection to the surrounding tissue and to stop the nail from ingrowing again. If you already see redness and pus, you should see your GP in the meantime for a course of antibiotics.
For caring and professional treatment for any toenail, foot or leg issue, contact Dubai Podiatry Centre on 04 3435390.



Plantar Fasciitis

Introduction
Plantar Fasciitis is a common cause of heel pain. The plantar Fascia Sheath is made up of connective tissue it becomes painful, inflamed and degenerative at its attachment to the calcaneus bone or along one of its three bands that span the longitudinal arch of the foot. Chronic forms can develop a heel spur €“ 70% of plantar fasciitis sufferers have been noted to have this

Etiology
The Plantar Fascia acts as a shock absorbing bowstring which supports the longitudinal arch of your foot. It transfers the weight from your rear foot to your fore foot during gait. It is consistently getting stretched when your foot is weight bearing and relaxed when your foot is Non Weight Bearing. If this stretch increases or becomes too much it can create micro tears in the fascia. With repetition this can create pain and inflammation. Over a long period of time a degenerative process is witnessed.
Overpronation or Pes planus foot type €“ causing the Fascia to stretch more when placed in a NWB position
High Arch feet that drop due to ageing process, medication or trauma €“ causing increased stretch to the fascia
Obesity €“ can put extra stress through the Fascia
Middle Age Woman>Men are more prevalent
Occupations where standing/walking long periods especially on hard surfaces €“ waitresses, construction workers, hairdressers, factory workers
Improper footwear €“ Shoes that are hard or thin soled, unsupportive or loose. Continual wear of high heeled shoes can cause the Achilles Tendon to tighten which increases the strain to your heel and Plantar Fascia
Symptoms
Pain develops gradually €“ getting worse over weeks/months
One or both feet can be affected
Pain at medial aspect of heel, along the longitudinal arch and occasionally at the fascia€™s attachment to the metatarsal heads
Pain worse on first steps or after periods of rest, pain will decreases as foot/fascia warms up
Pain then increases as day goes on or if exercise is increased
Pain on palpation of the medial aspect of the calcaneus or along the fascial tendons

How a Podiatrist can help?
Diagnosing and treating any occurring foot deformities with orthoses devices €“ Thus reducing the stretch/strain on the longitudinal arch and fascial tendon
Stretching Regime of Achilles and Plantar Fascial Tendons
Footwear advice
Advising activity modification and ice management
In severe cases a Night Splint can keep the heel stretched during the night €“ so it does not become contracted
Non Steroidal Anti-inflammatory drugs can help minimise pain and inflammation


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