BLOG - REGULAR BLOG BY JANET McGROGGAN - PRINCIPAL PODIATRIST 

A so-called soft corn is a plug of skin that occurs between the toes.  
 
The natural moisture that we get between our toes keeps the skin soft but they can be incredibly painful. 
 
This is because they are caused by pressure and movement, so two bony prominences (the equivalent of a knuckle in your hands) rub continuously and stimulate the skin to develop, flatten and become a plaque. The plaque may or may not have a hard centre. 
I know, I know... cutting your nail across is the only way to do it, right? 
 
Yeeaahish. 
 
If you are lucky enough to have none of the above and have a lovely flat nail like this one then please cut it straight across and it will stay lovely. 
 
Unfortunately, many of us do not have flat nails and have variations on the top images to a greater or lesser degree. Cutting these can be a minefield and really, it's worth seeing a podiatrist and having a lesson on nail cutting. The curly nails, called involuted nails, impact the skin and can cause hard skin and corns to develop along the nail borders. They can become painful. 
 
 
Image Alert *** 
 
I have recently seen a lot of heel pain in the clinic and at this time of the year there is one culprit which prevails in the cause of this. 
 
Picture the scene, you’ve been on your holibobs, spent a fortnight, all-inclusive sunning yourself around a clear blue pool only rising during to pad over to the pool side bar for a strawberry daiquiri. The nights are spent dancing, walking into the local town to try something new and when you look down at your feet, shock, horror you have been wearing a pair of FLIP FLOPS for two weeks!!! 
 
So what? You may say. In my opinion, you may as well stick a piece of cardboard onto your feet for a fortnight. 
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. 
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