What are Chillblains?

It’s been a bit chilly of late and we have already seen a number of clients present to the clinic in the last few weeks concerned about their toes which are a red/blue/ purplish colour, swollen, itchy and also painful and their question is what is wrong with my toes and our answer is… You have chilblains!!!

So the question of the day is what are chilblains, also known as Erythemia Pernio, which I must say is a bit of a mouth full.

Chillblains are painful regions of discoloured skin (usually red purple and or blue) which are more likely to develop on our extremities during the colder months. Most commonly they occur on your toes fingers nose, and even earlobes. They can cause a nasty itching or burning sensation and at times the skin which is affected can ulcerate. Ouch

Chillblains tend to develop on our toes after they are exposed to prolonged cold and damp weather. This exposure causes the peripheral blood vessels to constrict in response to the cold. When the toes are warmed up they are often warmed too quickly, the blood flow returns rapidly and there is leakage of fluid from the blood vessels into the surrounding tissue and this can cause area of inflammation and swelling leading to chilblains.

 Chillblains can occur at any age but are more common in children and older people and also occur more in females than males. People who have reduced circulation to their extremities are also more likely to be affected, for instance people who are smokers and/or have been diagnosed with diabetes, Raynaud’s Pheneomenon, and also Lupus.

So the big question is how, if I’m in a high risk group, how do I prevent getting these dreaded chillblains. Well the answer is prevention; as the old adage goes “Prevention is better than cure”.

It is essential to keep your feet warm and dry as is possible. Try and keep your feet at a consistent temperature. Wearing multiple layers of clothing will help for instance wearing long johns, stockings or leggings will help in keeping your legs warm.  Woollen or nature blended socks are also preferable and you can also purchase sock liners which are worn under your normal socks.  It is also important to make sure your shoes fit well.  Fur lined boots are also fabulous to wear and for some short period of time ye olde Ugg boot is appropriate. It is also essential to keep active which ensures you keep warm and also encourages blood flow to your extremities.

If your feet do get cold make sure you warm them up gradually as you don’t want to go from one extreme of temperature to the other. Avoid going from cold tiles in the bathroom to a hot shower, and avoid coming in from the cold and putting your feet in contact with direct heat, g hot water bottle, heater, electric blanket, and heat pack. All these types of heat will cause the feet to warm too quickly. Instead massaging your feet with a suitable cream would be ideal.

At Launceston Podiatry Clinic we also have the fabulous Perfectsense Paraffin wax therapy treatment which helps in the prevention and management of chillblains.  Not only does it help in promoting blood flow to your feet it also is a wonderful 30 minutes of relaxation.

How can we help, you ask, if you already have developed a chilblain? Well as podiatrists we can have a chat and see if there is something that can be done better in your prevention plan. We can also advise a variety of treatment protocols which will help in reducing the inflammatory process and ultimately get your feet back to optimal health.

Our aim at Launceston Podiatry Clinic is to ensure you a have the healthiest feet possible as we definitely know healthy feet provide the foundation for a happy and active body.

Lets talk about Corns

Corns are something that we see and treat on a daily basis at our clinic. They can be quite unpleasant and feel quite painful for patients who present with it. We usually use fancy terms for them such as heloma durum (hard corns), heloma milliare (seed corns) or heloma molle (soft corns) which are different types of corns that are either hard or soft, but in essence they are all corns! We know they can be extremely painful and if you have ever had one you know how it can affect your daily life, activity and mobility. But what are they? Well essentially corns develop from callus (excess build of dead skin) and often develop over bony areas and areas with a lot of friction in combination with excessive pressure. Occasionally the fatty padding or cushioning under our feet become thinner and this also leads to excessive forces that lead to the formation of callus. This together with poorly fitted shoes, your biomechanics (the way you walk) and bony prominences (like bunions or hammertoes), can lead to hard skin build up and with all these callused areas of pressure and friction, keratin cells (protein found in our hair, nails and skin) are tightly packed even further to form a core. This hardened core is what is known as corn which applies pressure to the tissue below the skin hence causing that uncomfortable, painful feeling. Common sites for corns to develop may be under the ball of your feet, under the big toe joint, the tips or tops of the toe, and between the toes.

There are a few different types of corns that was mentioned previously such as hard corns (heloma durum) which are usually larger and covered with hard skin that will appear over areas of pressure like bony areas and joints. Soft corns (heloma molle) are mostly associated with soft, macerated (moist) skin due to excessive moisture which commonly develop in between the toes. Seed corns (heloma milliare) are a lot smaller in size and appear in clusters that commonly occur in areas of friction such as the balls of the feet. So who develops corns? Well they really don’t discriminate, but they are very common in athletes and in individuals who are exposed to uneven friction from footwear, including elderly people, diabetic patients and amputees as well as abnormal foot mechanics, foot deformities and high activity levels. Individuals who work in jobs that require them to spend a lot of time on their feet are also prone to developing corns.

So how do we treat them? We can treat them successfully by removing the hard, painful centre of the corn with a sterile scalpel. This is usually a completely pain free process that can provide instant relief! Depending on where the corns are, we can provide a variety of treatments to reduce the load to a specific area to delay the recurrence of corns, or even prevent corns from reoccurring altogether. For instance if there is a corn between your toes, we often make custom moulded silicon devices to reduce friction and pressure or provide you with a foam or silicon toe sleeve. For corns on the sole of the foot, we may provide offloading devices such as padding in your shoes or even orthotics to reduce pressure. We can also assess your footwear as more often than not it is ill fitting shoes that can cause corns to occur.

Please never attempt to remove a corn yourself as hacking away at the centre of the corn can damage healthy tissue, nerves and blood vessels which may result in infections, scarring or in severe cases ulceration (a hole through the skin). Another thing to avoid is using corn pads purchased from the chemist. If applied improperly these pads can move and shift to the healthy skin tissue, creating chemical skin burns in the healthy tissue around the corn which can cause skin breakdown leading to infections and ulcers especially with individuals with diabetes, poor circulation or numbness in their feet.

If you are suffering from pesky corns, then why put up with the pain and book in an appointment with one of our podiatrists so we can help you get back to moving well and feeling great. 

Written By Sonia Konstantinovic.

Ingrown Toenails - What they are and how we can help

One of the most common complaints and painful problems we have come into the clinic are ingrown toenails, known as onychocryptosis. A true ingrown toenail is when a spike, shoulder or edge of nail pierces the skin at the nail edge, known as the sulcus.

There are many ways you can develop an ingrown toenail. The most common cause is a result of incorrectly cutting your toenail and leaving a spike of nail in the sulcus. It can also be a result of a curved nail, known as an involuted nail, with external pressure. There are many other causes such as trauma, medical conditions and vascular complications, ill fitting shoes and deformities, to name a few. We highly recommend you come and see one of our experienced team for assessment to understand the underlying cause of your ingrown toenail to allow for the best treatment plan to help keep your toes happy and pain free!

Early symptoms include localised redness, shiny and tight skin with mild swelling. Pain is acute, tender, may throb and very painful on direct pressure. The lightest touch can be painful depending how bad it is. This is the sage we encourage you to come and see us so we can quickly fix the problem before it gets worse. We can also assess your feet, try and determine the cause and give advice to try and prevent it from happening again. Treatment may include removing the offending piece of nail, cotton wool packing, which involves gently packing a small amount of cotton wool with anti-septic to elevate the nail off the skin and allow the area to fully heal, self-management at home and education on nail cutting. Sometimes the use of toe spacers is advised to keep pressure off the nail.

If symptoms are not addressed and the offending part of the nail is not removed from the skin it will continue to grow further into the skin, which prevents normal healing. At this stage symptoms can include the same as above but pain is more sever along with localised hyperhidrosis (excess sweat production), Puss and/or a bad odour and hypergranulation tissue, which is red swollen skin folds, which overlap the nail plate, is extremely painful and easily bleeds. At this stage sometimes conservative treatment will still work, however more commonly nail surgery is required.

Nail surgery, where you remove part or all of the nail, has gotten a bad rap over the years as it used to be a very painful procedure and lots of people tell horror stories of their nail surgery and how painful it was. Here at Launceston Podiatry Clinic we ensure to make this procedure as easy and pain free as possible. We know something like this can be very daunting and we endeavor to keep you calm and at ease. You can feel free to bring in your own music, console, book, whatever keeps you relaxed and distracted, if needed. We want to make your experience as comfortable and pleasant as possible. Under local anesthetic we gently elevate and remove the offending portion of nail, then apply Phenol, which is used to try and kill the nail bed to prevent nail regrowth. Once the local anesthetic wears off there can be minimal localised dull throbbing for a few hours. However because the offending portion of nail has been removed there is no further pain. We then monitor the wound for the following 2-4 weeks until it heals and give advice on how to bandage it and take care of the toe at home. I cannot tell you how many people have been too scared to get it done and once they have the procedure say “I wish I had done this years ago!” Instead of putting up with ongoing pain and infections for years.

If this sounds familiar don’t put it off any longer! Please call our clinic and speak to one of our friendly receptionists to book an assessment today. I promise you won’t regret it and your feet will thank you for it!

Written by Sinead tracey.

Tinea - What is it?

Tinea pedis, also commonly known as “Athlete’s Foot”, is a common fungal infection of the skin on the feet. It is often associated with high rates of treatment failure or recurrence.  Caused by dermatophyte fungus, it often manifests in between the toes.  It is estimated that approximately 70% of the population will be affected with tinea pedis at some point in their life. [1]

The 3 most common dermatophyte fungi causing Tinea pedis are: Trichophyton (T.) rubrum, T. interdigitale and Epidermophyton floccosum.

The dermatophytes that cause tinea pedis grow best in a moist, damp environment.  The fungal spores can survive for extended periods (months or even years) in bathrooms, changing rooms and around swimming pools.[2]  Coming into direct contact with the causative fungal organisms, can result in the development of tinea pedis.  In most cases it is picked up innocuously without you necessarily knowing until symptoms develop.

Other risk factors may include, but are not limited to: excessive sweating (hyperhidrosis); occlusive footwear; poor peripheral circulation or lymphedema; underlying immunodeficiency or Diabetes Mellitus; or medication such as systemic corticosteroids and immunosuppressants.  

Symptoms of tinea pedis can include itchiness, redness and small blisters, however each presentation depends on the type of fungal involvement.

Commonly, there are 3 typical presentations:

1.      Itchy, scaly skin, often in between the toes, especially between the 4th & 5th toes.

2.      Flaky, scaly skin more often on the bottom and sides of the feet

3.      Small to medium-sized blisters affecting the inner aspect of the feet.

At worst, and less common, oozing, pustules and ulceration may occur between the toes.  Should any of these look or feel familiar, please see your Podiatrist who is trained in recognising and diagnosing tinea pedis.  The diagnosis of tinea pedis is usually based on the patient’s symptoms and clinical appearance.

Tinea pedis develops due to direct contact with the causative fungal organisms.  Direct contact may be something as simple as trying on footwear in a shoe shop; walking barefoot in a public place, sharing a towel.   Other risk factors may include, but are not limited to: excessive sweating (hyperhidrosis); occlusive footwear; poor peripheral circulation or lymphedema; underlying immunodeficiency or Diabetes Mellitus; or medication such as systemic corticosteroids and immunosuppressants.

In most cases, tinea pedis can be managed with topical antifungal treatment, however oral antifungal treatment is sometimes required when severe infections, fungal toenail infection and those with repeated topical treatment failures occur.   Ensure that you see your Podiatrist who will provide you with the correct treatment advice.

Some practical advise that podiatrists can give is the help reduce both the risk of contracting tinea pedis and re-infection includes:

- Wearing less occlusive footwear and regularly changing shoes & socks when they become wet, this may even be half-way through the day

- Thoroughly drying feet after showering or swimming

- Wearing thongs or flip-flops in communal showers and changing rooms

- Ensuring reinfection isn’t due to an untreated family member

- Treating socks and footwear to prevent reinfection

Ensure that you see your Podiatrist who will provide you with correct diagnosis, treatment and advice for the prevention and recurrence of tinea pedis.

[1] Iikit M, Durdu M. Tinea pedis: The etiology and global epidemiology of a common fungal infection. Crit Rev Microbiol 2014

[2] DermNet NZ. Tinea pedis. DermNet NZ, 2013.

Written By Fiona Allen.