BLOG - REGULAR BLOG BY JANET McGROGGAN - PRINCIPAL PODIATRIST 

I simply cannot let another Wimbledon go by (what do you mean it’s over?) without talking about the ankle braces Andy Murray wears. 
 
And before I go on I must say that I am completely independent from the brace but have supplied it to patients with complete success. 
 
Following an injury that caused his left ankle to become unstable Andy began to wear a brace to prevent injury. Then six years ago he sustained a tendon injury to his right ankle and began to wear braces on both ankles. 
 
As a nosey podiatrist, I had to see what the braces were assuming that they would be some kind of custom made (perhaps even gold plated) device. To my surprise they are the Aircast A60 which are an off the shelf device. 
This week I want to chat a little more about what is out there for people with difficult nails. 
 
Summer is here (well it was, it’s pouring now) and many men and women are embarrassed about getting their toenails out. 
• People with fungal nails or nails destroyed from chronic fungal nail infections. 
• People with nails totally or partially removed through surgery or trauma. 
• People with thickened and distorted nails from major or minor trauma. 
 
You may feel that you are alone, but you are not and there is a very effective solution to this problem which can be used short term – over the holidays or reapplied to look great all year round. 
Finally, there seems to be a way of successfully treating fungal toenail infections!!!!  
 
Well I say finally but there was a detailed description written in 1978 and like most great ideas it took decades to be an overnight success. 
 
The fungi and flora that usually live harmoniously on our feet (yum) under the right circumstances e.g. warm, dark footwear can develop into athlete’s foot and then start to invade the nail. There are three nail layers and the infection can be limited to the lower layers causing discolouration. Over time this can progress into the whole nail causing thickening and distortion of the nail. Topical application of anti-fungal treatments struggle to penetrate the nail. 
Topical treatments from the chemist can work well especially if the infection hasn't reached the base of the nail.  
 
These are usually applied daily or weekly and the trick is PATIENCE and DO IT!!! 
 
Be prepared to treat until the affected nail grows out, a big toenail can take a year to completely replace itself. It is worth treating the skin for athlete’s foot at the same time if this is present, Canesten is great for this but athletes foot will recur while you get rid of the fungal nail. So, keep on top of it. 
 
If you are having no luck using topical treatments and you know that you have a fungal infection your GP can prescribe an oral antifungal. 
Fungal nails are very common, so don't worry you are not the only person in the entire universe with a wonky nail, or two. 
 
They don't all look the same, some are white, yellow, brown or black. Some are thick and some are crumbly. But no matter what they look like, once you know that you have a fungal nail if you decide to treat it you will be in it for the long haul, so buckle up and be diligent. 
A podiatrist is a lower limb specialist and has, you will be glad to know, a plethora or treatments in their armoury. 
 
In your first appointment, they will check if you have been wearing good footwear and had a go at stretching. 
 
They will take a history and decide if your plantar fasciitis is acute or chronic. 
 
Acute plantar fasciitis responds well to a treatment called low-dye strapping. This sports strapping supports the foot and allows you to go about your daily business and wear ordinary shoes. It lasts several days and can help reduce inflammation and get you over a ‘hump’ in your recovery. Low-dye strapping is also a good indicator of how you would respond to orthotic therapy. Sometime the strapping needs to be repeated weekly to get the best recovery. 
If footwear changes do not help your plantar fasciitis then it's time to get stretching. 
 
The plantar fascia is a ligament and ligaments are not very stretchy so we need to stretch the muscles acting on the plantar fascia and the calf muscle group are often the main culprit. 
 
Stretching the calf muscle can have a direct effect on your plantar fascia. Lunges and heel drops [standing with the balls of both feet on a step and lowering both heels down] can both help if done daily for at least a fortnight. 
 
Using a wall for support keep your front knee vertical above your ankle and stretch the back-leg’s calf muscle. Keep the heel on the floor and both feet facing forwards, the back foot usually wants to tilt outwards. There’s no need to push into the wall and don’t pulse in and out, just hold for at least 30 seconds. If you cannot feel a stretch move your back leg further away from the wall. 
 
To bring this stretch into your Soleus muscle place a rolled-up hand towel under the ball of the foot in the leg you are stretching. Again, just feel this stretch and hold for 30 seconds. 
Heel Pain… Plantar Fasci@#?* Plantar Fasciitis - Do I have it? What do I do? 
 
In this blog, I just want to give you some information about what this may feel like and the first line of treatment because I’m sure if you are reading this then you are in pain and want that to stop!!! 
 
Do I have it? 
 
Do you have heel pain like a bruised feeling or arch pain? This one is usually a sharp pain. 
 
Generally, the pain is at its worst in the morning, gets better with walking but can come back after activity. It often returns after sitting down for a while. Some mild cases may only cause problems after running. 
 
Ok, I have these symptoms, now what do I do? 
This week's blog talks about a relatively new treatment for verrucae which is great if you are busy because it's a one-off treatment with reviews roughly every two months. 
 
It's called needling and, yes, it could do with a less scary name but it is what it is!! 
 
Needling was first carried out in America in 1969 and success rates of 70 – 90% after a single treatment are common. 
 
One verrucae will be selected to treat and the surrounding area anaesthetised. 
A caustic is a substance that is destructive to living tissue. Podiatrist have access to several with different actions, my favourite is 60% Salicylic Acid.  
 
It destroys Keratin, a protein that forms part of the epidermis where the Verrucae lives. This painless treatment is usually well tolerated. 
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