Footcare

What are the causes of athletes foot?

Sweaty skin encourages infection but passed by direct contact/clothing contact and floors, likely at changing rooms or swimming pools. Fungal infection

What are the symptoms of athletes foot?

• Itching between the toes and sometimes on the soles or sides of the feet

• Soggy white skin between the toes

• Dry, flaking, peeling or cracked skin

• Red and inflamed skin

• Small blisters between the toes

• Thickened, yellow toenails, if the infection has spread to the nails.

What are the warning signs for patients with athletes foot?

• All patients with diabetes – remember, never treat a patient with diabetes with a foot condition

• Where the base of the nails have become discoloured, thickened and brittle. This indicates a severe nail infection and may require treatment with a prescription only medicine

• If a large part of a nail or more than two toenails appear to be infected

• Where there is weeping, pus or yellow crusts. This indicates a secondary bacterial infection has developed

• If medication has already been tried without any improvement

• Anyone taking prescribed medication

• Women who are pregnant or breastfeeding.

What are the treatment options for athletes foot?

• Dealing with the fungus causing the infection by applying an antifungal preparation to the affected area

• Preventing re-infection by treating the socks and shoes

• Keeping the infected area clean and dry.

What are the different preparation types for dealing with athletes foot?

• Cream - used for treating the infection and are applied directly to the skin normally at night and in the morning

• Powder - These are dusted in the socks and shoes to prevent re-infection. A powder alone used on infected skin would be ineffective to treat the condition

• Spray - for larger or more hairy areas or as an alternative for other products

What are imidazoles? (Miconazole, ketoconazole, clotrimazole, binfonazole)

Antifungals that inhibit fungal growth

How do imidazoles work for treating athletes foot?

Should be applied 2-3 times a day (apart from binfonazole which is treatment once a day) and treatment should continue for 2 weeks and for a while after symptoms have disappeared to prevent reinfection - for all ages.

What is the benefit of having hydrocortisone with some imidazoles?

Help if the skin is inflamed - only licensed for 7 days so patient will need a different product as well and are only for over 10

How does terbinafine work?

Kills the fungus causing the infection - applied once or twice a day for 1 week and residual levels remain in the skin for a week after treatment. For over 16s

How does terbinafine work as a one off treatment (Lamsil once)?

A solution that dries into a clear film and releases the active ingredient over 3 days - can fight athletes foot for up to 13 days. For patients over 18

How does tolnaftate work for treating athletes foot?

Twice a day and treatment should continue for a week after the infection has used - for all ages

How does undecenoates work for treating athletes foot?

Prevent the fungi from multiplying any further and can be effective in treating athletes foot - applied twice a day and continued for a week after the infection has cleared, is for all ages

How does benzoic acid work for treating athletes foot?

It is a greasy preparation and it may sting slightly on application. Newer products have largely replaced its use.

How does amorolfine work for treating athletes foot?

If it has spread to the toenails this can be considered - can treat mild fungal nail infections. Nail lacquer applied once a week but can take 9-12 months to fully clear up. NOT for under 18s or pregnant and breastfeeding women

What additional advice can you give patients with athletes foot?

• Correct use of both antifungal cream and powder is vital to completely clear the infection and to prevent it coming back

• Complete the course of treatment as indicated on the product, stopping early is likely to lead to re-infection. Most products require treatment for at least a week after symptoms have disappeared

• Dust socks and shoes with antifungal powder, to help prevent further infections

• The feet should be washed and dried particularly between the toes before the antifungal cream is applied

• Keep a personal towel and do not share it to prevent the infection from spreading from person to person.

What prevention tips can you give patients with athletes foot?

• Some products (e.g. Daktarin Aktiv spray powder) are licensed for use in preventing athlete’s foot

• Trainers and shoes made of synthetic materials should be avoided as much as possible as these do not allow moisture to evaporate and create an environment for the fungus to grow

• Wear leather shoes where possible or open toe shoes in the summer to allow the skin to breathe

• Socks should be made from natural fibres such as cotton to allow the feet to breathe and they should be changed daily

• Good foot hygiene is important. Feet should be washed daily with soap and dried thoroughly

• Athlete’s foot is easily transmitted and changing room floors in gyms, sports clubs, and schools are a likely place to pick up the infection. Wear some form of footwear at all times to minimise the risk of infection.

What is a verruca?

Wart on the sole - can occur in adults and children but most common 12-16

Where are verruca’s found and what do they look like?

can be singles or in clusters and can last a while if not treated - found usually on the ball of the feet, underneath the big toe or the heel

What are the causes of a verruca?

Caused by the human papilloma virus - passed through skin to skin contact or contaminated items such as towels. if the skin is wet, soft or has cuts or scratches caused by a virus that gets into the skin through a small cut, particularly if the skin is warm and moist.

What are the symptoms of a verruca?

• Flattened white area on the sole of the foot

• Tiny black spots in the verruca often visible, which are blood vessels or capillaries in the verruca

• Usually on the ball of the foot, underneath the big toe or on the heel

• Sometimes painful when walking as the verruca can grow back into the skin due to the weight of the body on the feet.

What are the warning signs for a verruca?

• All patients with diabetes – remember, never treat patients with diabetes and a foot condition

• Any patient who complains of any symptom not listed above

• If medication has already been tried without any improvement

• Anyone taking prescribed medication.

What treatment options are available for verrucas?

Can go away on there own but can take years - treatment usually lasts 12 weeks and should be applied daily to be effective. Most of the treatment contains caustic ingredients which destroy the infected skin

How does salicylic acid work for treating verruca’s?

softening and destroying the skin. The preparations are available as ointments, gels, or medicated plasters.

How do you apply salicylic acid products?

• Peel off any product applied the previous day

• Soak the affected area in warm water and towel dry

• Once every week, rub the surface of the verruca with a pumice stone or emery board to remove any hard skin

• Carefully apply the salicylic acid preparation to the verruca, making sure it does not cover any healthy skin around the verruca. Covering the surrounding skin with petroleum jelly will protect it

• Repeat the procedure daily, remember it can take up to twelve weeks.

How do freeze treatments work?

Same as a doctors - 1 treatment needed and can be for anyone over 4 but not pregnant/breastfeeding women

How does glutaraldehyde work for verrucas?

Same as salicylic acid but twice a day application, can stain the skin brown and can cause irritation

How does formaldehyde work for treating a verruca?

Same as salicylic acid but twice a day - effects are unpredictable so shouldn’t be first line of treatment

What additional advice can you give for verruca’s?

• Correct use of the medicine is vital to remove the verruca and prevent damage to healthy skin

• Put petroleum jelly or a dressing around the verruca before application of acid treatments to protect the healthy skin

• For acid treatments, file the surface of the verruca with an emery board or pumice stone once a week to remove any hard skin and rinse thoroughly before application of the medication

• The treatment with salicylic acid will take up to twelve weeks and should be used every day to be effective.

What tips can you give as prevention for verruca’s?

As verrucas are often picked up at the swimming pool, wearing thin plastic socks (verruca socks) helps to prevent the spread of infection.

How is a corn formed?

From pressure and friction on the bony outer part of the foot, making the outside layers become thicker due to repeated friction. Produces a cone shaped nucleus, pressing down the nerve can cause pain

What is a hard corn?

commonly appear on the top of the toes or on the outside of the little toe.

What is a soft corn?

develop between the toes due to friction between the knuckles of the toes. They appear white and rubbery in texture as they are kept soft by the moist environment between the toes.

What is a callus?

Area of hard dead skin caused by constant rubbing or pressure. It usually occurs on the sole of the foot beneath a prominent bone. Has no nucleus so won’t cause pain. usually found around the balls of the feet, around the big toe and the heel. Can cause a burning sensation

Who is more at risk of developing corns and calluses?

Older patients and women

What are the causes of corns and calluses?

Tight or ill-fitting shoes - leads to a buildup of dead tissue

What are the symptoms of corns?

• Central core of hard grey skin surrounded by a ring of painful yellow inflamed skin (hard corns) or white, rubbery areas in between toes (soft corns)

• Located over a prominent bone (hard corns) or in between toes (soft corns).

What are the symptoms of calluses?

• These can range in size from a few millimetres to much larger areas. They have no centre and have a much less defined shape

• The skin tends to be hard and rough, yellowish in colour and can be painful.

What are the warning signs for corns and calluses?

• All patients with diabetes – remember, you should never treat a patient with diabetes and a foot condition

• Any patient who complains of any symptom not listed above

• If medication has already been tried without any improvement

• Anyone taking prescribed medication.

What are the treatment options for corns and calluses?

Medication can be used to remove the hardened skin and cushioning products will help to relieve the pressure. Files and pumice stones can also be used to reduce the amount of dead skin.

How does salicylic acid work for corns and calluses?

Same as verruca - gently softens and erodes the skin

How do medicated plasters work to remove corns and calluses?

Remove corns - provide cushioning to relieve discomfort and contain salicylic acid in the centre

How do cushioning pads work for corns and calluses?

Allows pressure to be taken off and relieves burning sensation

How does mechanical removal work for corns and calluses?

Abrasive synthetic sponges, emery boards or a pumice stone can be used to rub the dead skin off. Special blades to remove corns and calluses are normally available in the footcare section of your pharmacy. used after it is softened with salicylic acid

What is the advice for corns and calluses?

• Protect the surrounding skin with petroleum jelly or a dressing before application of a salicylic acid preparation

• To speed up the treatment, file the dead skin on the surface with an emery board or pumice stone to remove the hard skin

• Soaking the foot with mild soap and water for 10 minutes prior to rubbing with a pumice stone (or similar) for about 5 minutes will help soften the dead skin.

What are some tips to prevent corns and calluses?

• Women often suffer with calluses on the balls of the feet caused by wearing high heels. Inserting a cushioned pad into the shoes can reduce this problem. You may find these cushion pads dual sited within your store, so find out where they are kept

• Wearing properly fitted footwear will help prevent corns and calluses

• Regular trips to a podiatrist will help keep the feet healthy.

What are the causes of an ingrown toenail?

toenails are not cut correctly, when the skin softens and splits due to sweating or when the toenails become harder and thicker or due to pressure from tight fitting shoes.

What are the symptoms of an ingrown toenail?

• Pain at the corners of the nail, or if pressure is placed on the affected toe

• There may be inflammation and redness, sometimes bleeding if the skin is broken

• A build-up of fluid in the area surrounding the toe

• An overgrowth of skin around the affected toe

• An infection may develop where the nail penetrates the skin, leading to white or yellow pus coming from the affected area.

What are the warning signs for patients with an ingrown toenail?

• All patients with diabetes – remember, never treat patients with diabetes with a foot condition

• Where the area appears to be infected.

What is the treatment for an ingrown toenail?

cleaned with soap and water at least twice a day to help prevent an infection developing. Minor surgery may be required if the toenail does not improve. No products available to buy

What is the advice for an ingrown toenail?

• Wear comfortable shoes that fit properly to remove pressure from the nail

• Gently push the skin away from the nail using a cotton bud (this may be easier after using a small amount of olive oil to soften the skin)

• Cut toenails straight across to stop them digging into the surrounding skin

• Change your socks regularly.

What are some tips to prevent an ingrown toenail?

In-growing toenails can be prevented by cutting the toenails straight across and by wearing suitable footwear. Regular trips to the podiatrist can also help.

What are the causes of a fungal nail infection?

When another fungal infection spreads to the toes

What are the symptoms for a fungal nail infection?

• Toenails become thick and coloured and perhaps separate from the nailbed

• Sometimes the toenail can crumble

• Sometimes the skin around the nail will become red and inflamed.

What are the warning signs for a fungal nail infection?

• All patients with diabetes – remember, you should never treat a patient with diabetes and a foot condition

• Where two or more nails are affected.

What is amolorfine?

A fungicide used to treat fungal nail infections - nail lacquer applied once a week and can take 9-12 months to fully clear up

How should patients apply amorolfine?

Before the first application, file down the infected areas of nail, including the nail surface, as much as possible using the nail file provided. Do not use nail files used for infected nails on healthy nails, otherwise you may spread the infection. Clean the area and apply the nail lacquer evenly over the entire surface of the nail. Let the treated nail(s) dry. Wait at least 10 minutes before applying cosmetic nail varnish.

What are other treatments for fungal nail infections?

Fungal sprays, brushes and pens

How does urea work for fungal nail infections?

Softens the infected part of the nail which can then be gently removed - repeat the process daily until the infected nail is removed. Canespro is the brand and takes 2-3 weeks to clear up

What is some additional advice for fungal nail infections?

• Do not use the same nail accessories or tools across normal and infected nails – buy two sets to prevent contamination

• Wash and dry your hands thoroughly after contact with any fungal infection or treatment.

What are some tips for prevention for fungal nail infections?

• If you spot symptoms of athlete’s foot, treat it straight away to try to avoid the infection spreading to the toenails

• Avoid walking barefoot in public spaces – wear flip-flops in public changing rooms, showers or around a swimming pool.

Why do bunions occur?

result of displacing the joint of a toe, usually the big toe. It does not occur suddenly but is caused by pressure on the foot, which slowly forces the toe into the wrong position over a matter of months or even years. The big toe is pushed over towards the other toes, causing a deformity of the point between the big toe and the foot. Causes the joint to be enlarged and produces a protective sack

What are the causes of bunions?

Unknown cause but some people are more likely than others to develop them - could be wearing ill fitted shoes

What are the treatment options for bunions?

Painkillers and correctly fitting shoes minimise the pain - can have special bunion pads

What additional advice can you give for bunions?

• Make sure your shoes are the correct size and have enough room for your toes

• Avoid shoes with high heels or pointy toes

• Try to lose weight if you are overweight.

What are chillblains?

small, itchy swellings on the skin that occur as a reaction to cold temperatures - affect toes, heels, fingers, ears and nose and are more common in children and old people

What are the causes of chillblains?

Poor health and can run in families

What are the symptoms of chillblains?

• Burning or itching on hands and feet

• Can swell and turn red/dark blue

• Broken skin

What are the treatment options for chillblains?

Heal by themselves in a few weeks

What prevention tips can you give for chillblains?

A good diet, warm clothing, a warm environment and regular exercise to stimulate the circulation will all help prevent chilblains.