What To Buy In The Foot Care Aisle

Choices abound in the foot care aisle.  It’s common to see a perplexed shopper scanning the displays and shelves of foot care products trying to figure out what to buy.  At McDermott Footcare, clients often ask what are the best items to purchase to care for their feet between foot care visits.

Let’s divide the items into categories.

Nail Scissors/Clippers/Files

Admittedly, it’s difficult to judge the quality of scissors/clippers since they often come in packaging.  You may have to decide by trial and error.  In general, buy the best quality stainless steel product you can afford.  It’s advisable to have 2 sizes of clippers:  a smaller one for the fingernails and a larger one for the toenails.

Nail files are available in metal, glass or cardboard.  A cardboard nail file is also known as an emery board.  It is more gentle than metal or glass and is disposable.

A metal nail file’s abrasive surface is usually made of mineral corundum.  It is the most abrasive file and is best for thicker nails.

Glass nail files are more expensive than metal or emery files.  Their abrasive surface is finer and smoother, therefore not suitable for tough jobs.

For personal nail scissors/clippers and nail files, it is advisable not to share with other people.  While it isn’t necessary to sterilize your personal nail tools, they should be regularly disinfected.  A disinfectant wipe will be suitable.

Corn and Callus Products

Many preparations and pads are available for corn and callus home treatment:  medicated pads, liquid drops, moleskin, corn and callus scrapers/shavers.

Medicated pads and drops can be harmful since the acid in the preparation can burn the skin around the corn or callus.  At a recent foot clinic, a client showed me a large, irritated area on the bottom of her foot.  She had been using an over-the-counter medicated pad for a few weeks and now the area around the callus was showing large areas of peeling and redness caused by the medication in the pad.

Non-medicated pads and moleskin are useful.  To avoid undue pressure (and pain) over the corn or callus, use pads with the hole in the middle or cut a hole yourself.  This way, the pad protects the corn or callus without discomfort.

I do not recommend corn and callus scrapers/shavers for in-home use.  These items are very abrasive and can cause bleeding, irritation, infection if used too aggressively.

Because of an increased risk of infection in diabetic feet, it is never recommended that diabetics use medicated pads or corn and callus scrapers/shavers.  Even a slight irritation or scratch can develop into a complicated infection.

Warts and Plantar Warts Medication

Like medicated corn and callus pads, wart preparations can also damage the skin around the wart.  It may take weeks to eradicate warts, especially plantar warts, despite claims on the packaging.  Before purchasing wart medications, try home remedies first.  Often, they are just as good as over-the-counter preparations (read here).

Again, diabetics should stay away from over-the-counter wart preparations.  There is a possibility of damage to surrounding skin which can cause infection.

Toe Spacers, Padding, Toe Props

These are great deals in the foot care aisle.  The purpose of these devices is to realign toes which are crowded together, clawing downwards or in need of some padding for increased comfort inside shoes.

Toe spacers are placed between toes that are crammed together.  They are generally comfortable if the right size is used.  Trial and error may be needed to find a toe spacer which fits and is comfortable.

Padding usually comes as foam tubes or adhesive moleskin.  They may be cut to size.

Foam tubes usually come in 3 different sizes and the one to use depends on the size of the toe.  The tube foam slips on over the entire toe, acting as a cushion and/or toe spacer.

Moleskin pads are adhesive and may be cut to fit the affected area.  There are different thicknesses of moleskin available.  Again trial and error is needed to find the right thickness.

Toe props are placed under the toes, to straighten and realign claw toes.

Insoles

The variety of insoles can be staggering at a well-stocked foot care aisle.  There are insoles for everything from plantar fasciaitis, diabetics, sweaty feet, runners, walkers, high heels, the list goes on.  In general, these are very good buys.  Again, trial and error is needed to find the one that suits you best.  Always get insoles that have a cloth layer on the top.  The cloth helps to absorb sweat.  Many insoles are made only of gel.  These will not absorb sweat and may increase the likelihood of developing athlete’s foot or bromhidrosis (smelly feet).

Heel Creams and Foot Soaks

Many of these preparations contain fragrance which is drying to the skin.  Instead of highly fragranced items, there are other choices that will not promote dryness.

Find a moisturizing body lotion or cream that contains urea.  Urea is a natural substance produced in the body and it serves to retain moisture.  Urea added to moisturizers does the same thing.  Choose a non-fragranced product.

Fragranced foot soaks contain epsom salts as the main ingredient.  For a cost-effective, less drying alternative to fancier products, combine regular, fragrance-free epsom salts with a shallow basin  of warm water.

White vinegar is very good for the feet.  Make a solution of 1/4 cup white vinegar and a shallow basin of warm water for a skin-smoothing, fungus-inhibiting, inexpensive foot soak.

Other Items

Pumice stones are handy and effective for gently scrubbing away dry skin on heels.  They are also good for sloughing calluses and corns.

Athlete’s foot medications come in creams, powders and sprays.  With consistent use and other measures, they can be effective for mild athlete’s foot.  Complicated athlete’s foot should be treated by your doctor.  Diabetics with athlete’s foot should always consult their doctor.

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Plantar Warts: How Did I Get Them? What Can I Do About Them?

Plantar warts are caused by a few of the 120 types of human papillomavirus, or HPV.  The virus affects the superficial areas of the skin, especially on the pressure points of the foot such as the heel and the ball of the foot.  Since it is a virus, it is contagious.  It typically enters through small cuts or irritated areas in the skin, or areas  that are constantly exposed to water.

What does a plantar wart look like?

McDermott footcare   plantar wart

A lifeguard/swim instructor developed a plantar wart on the ball of the foot as a result of long hours working in constantly wet, bare feet.

Plantar warts are small, grainy, callus-like lesions on the bottom of the foot.  There may be a single wart measuring about 2 – 3 cm; a large “mother wart” surrounded by several smaller warts; a cluster of warts grouped together, otherwise known as a mosaic wart. The centre of the wart(s) have tiny red or black dots caused by trapped capillaries.  On weight-bearing surfaces, the warts may be flattened.

How do you get plantar warts?

  • the virus enters through tiny cracks in dry skin
  • through cuts, scrapes and other skin irritations
  • through wet, softened skin from prolonged exposure to water

Who usually gets plantar warts?

  • children and teenagers since their immune system is not fully developed and since they are more likely to go barefoot
  • people with weakened immune systems

Home remedies for plantar warts

  • apply a doughnut-shaped pad (available at drugstores) around the plantar wart to reduce pressure on the area when weight-bearing
  • try an over-the-counter medicated wart remover.  Since these preparations may chemically burn the skin, protect the area around the wart with a light coating of petroleum jelly.  This remedy is not recommended for young children or diabetics.
  • gently rub the callused area with a pumice stone after soaking in a vinegar-water solution for 10-15 minutes
  • apply duct tape over the wart.  Change as needed if it becomes wet.  Re-assess the area after 3 – 4 days and leave the tape off overnight if the skin underneath appears wet.  You may apply a drop of tea tree oil before applying the tape.  It may take 6 – 7 weeks to eradicate the wart using this treatment.

When to see your doctor

  • if after 2 weeks of applying home remedies, there is no noticeable change
  • if new growths keep appearing
  • if you are unsure the growth is a wart
  • if you have a previous history of skin cancer or have a close family member with a history of skin cancer
  • if you are diabetic

How to prevent plantar warts

  • avoid walking barefoot in public shower stalls, change rooms, swimming pools, saunas
  • change your socks daily
  • check the bottom of your feet daily.  If needed, use a mirror.

    If needed, use a mirror to check the bottom of the feet.

  • keep feet clean and dry
  • do not touch warts on other people
  • if you touch a wart on yourself or on someone else, wash your hands thoroughly for at least 15 seconds using warm, soapy water
  • don’t scratch warts since this encourages their spread
  • don’t share shoes and socks
  • cover warts with waterproof tape while in swimming pools or shower stalls

Diabetes and plantar warts

If you are diabetic, always have your doctor treat plantar warts. Complications such as poor nerve functioning(neuropathy) and decreased blood circulation (micro/macroangiopathy) make home treatments dangerous for people with diabetes.

Since diabetics have concerns with decreased nerve functioning in their feet (neuropathy), it may not be possible to feel discomfort from a plantar wart.  Daily checking the entire foot to detect new growths or lesions is important.

Over – the – counter wart removers should not be used by diabetics since there is the strong possibility that harsh chemicals in the preparation may irritate healthy skin surrounding the wart.  These irritations may aggravate the area and cause skin infections.  Because of poor circulation, any skin infection in the feet of diabetics must be treated aggressively.

See also:  Lifeguards and Plantar Warts:  A Love Story

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Extreme High Heels

Extreme high heels seem to be the norm this year in women’s shoes.   Shoe store shelves are lined with them; women everywhere totter somewhat awkwardly and uncomfortably in them. 

Historically, women have had a love affair with high heels.  They will always be in fashion.  However, it seems that the heel heights of today are pushing the limits of comfort and safety.

The pictures in this blog post are the result of a visit to the local mall for an informal survey of what most shoe stores are offering for high heel aficionados.  Along with taking pictures, I tried on a variety of  shoes to find out what wearing these extreme heels feels like.

Some women argue that the platform sole in these shoes serves to soften the angle at which the shoe tilts (the pitch).  However, at heel heights of 5 and 6 inches, the pitch of the shoes is still high.

With each pair of shoes I tried, my body was thrust forward.  I could feel my toes being shoved into the front of the toe box even in shoes that were properly sized.  Balancing was precarious as I made a conscious effort to maintain proper posture.  I didn’t even attempt walking.  In the booties shown here, I overturned my ankle.

Fans of these heels often say that they are comfortable and easy to walk in when you get used to them.  Again, an informal survey watching women wearing very high heels indicates to me that they struggle to walk in them and facial expressions show some degree of discomfort.

In a previous high heel blog (here), I outlined the harmful effects of frequently wearing high heels.   These included bunion formation, hammer toes, crowding together of toes and ingrown toenails. As well, the calf muscles, knees, hips and back are strained as the body tries to maintain balance.

The McDermott Footcare client who agreed to have these pictures taken of her feet stated that she wore high, ill-fitting shoes for many years.  Now in her later years, she finds walking very difficult.

Note how the toes are permanently shortened and crowded together.  This is the result of toes being pushed forward in a narrow toe box for many years.  As well, the shape of the foot indicates that my client constantly wore shoes that were too small.

Realistically, women will continue to wear high heels.  This is understandable since a fashionable pair of shoes elevates an outfit and makes women feel attractive.

The same survey of shoes confirmed that there are many attractive, more comfortable options in high heels available at the same stores.  It’s not that women should stop wearing heels all together; it’s that we should be making more reasonable choices, keeping in mind the health of our feet, ankles, knees, hips and back.  We should also be alternating reasonably high heels with flatter shoes.

Fashion and health can co-exist quite well in the wardrobe of a stylish woman.  Many choices are available in a range of styles and prices.  There is no need to sacrifice comfort, health and safety for fashion.

.Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Skin Cancer And Your Feet

May is Skin Cancer Awareness month.   People of all skin colours and ethnicity should be aware of the signs and symptoms of skin cancer.  We often forget to give our feet the same care we give to other parts of our body.  When it comes skin cancer, this is especially problematic since skin cancer in the feet is often not detected until the later stages and the outcome is poor.

Three Types of Skin Cancer

Malignant Melanoma  is the most serious type.  A change in the appearance of a mole or pigmented area is an early sign.

Malignant melanoma. Photo courtesy of National Cancer Institute.

Look for a change in size, shape, and colour.  Watch for irregular, ragged edges, a mole that has more than one colour, is asymmetrical, oozing, bleeding or feels itchy.  While some melanomas may be tiny, most are larger than 6 millimeters.  In dark-skinned people, it usually occurs under the fingernails, the palms of the hands, under the toenails or on the soles of the foot.

In its early stage, Squamous Cell Carcinoma may appear as a small, scaly bump or plaque which may be inflamed.  It may look like a callus and have a history of repeated bleeding or cracking.

Common symptoms of basal cell and squamous cell carcinoma. Photo courtesy of National Cancer Institute.

It may resemble a plantar wart, fungal infection, eczema, or a skin ulcer that doesn’t heal.  According to the National Cancer Institute, in dark-skinned people this cancer usually occurs in areas that are not exposed to the sun, such as the feet.   In light-skinned people, it is more common on the head, face, neck and ears.

Basal Cell Skin Cancer usually occurs on areas that are exposed to the sun.  The National Cancer Institute describes it as a bump that is small, shiny, pale or waxy.

It may also be firm and red or appear as a sore or lump that bleeds or develops a crust or scab.  Alternatively, it may show up as a scaly, itchy, tender spot.

Common symptoms of basal cell and squamous cell carcinoma. Photo courtesy of National Cancer Institute.

Risk Factors

  • For all types of skin cancer, exposure to sunlight is a major risk factor.  Having even one blistering sunburn increases the risk.  Redhead or blonde, grey or blue-eyed, fair-skinned people have a higher risk of sunburn but dark-skinned and people who tan well are also at risk because of total lifetime sun exposure.
  • Having a family history of skin cancer increases the risk as does a personal history of earlier skin cancer.
  • Having a large number (over 50) of common moles is a risk factor.
  • Old scars, inflammation, burns, skin ulcers as well as exposure to arsenic increase the risk for squamous cell and basal cell carcinoma.

    Common symptoms of basal cell and squamous cell carcinoma. Photo courtesy of National Cancer Institute.

Protect Your Feet

The single, most effective way to prevent skin cancer in the feet is to avoid sun exposure, especially between 10 a.m. and 4 p.m.  For most of us, this is unrealistic as is keeping the feet covered.

A broad-spectrum sunscreen applied diligently and liberally to all areas of exposed skin is the most practical solution to sun protection.  Re-apply every two hours and don’t forget the kids who may need to re-apply more often if they have been in the water.

Check Your Feet

It is important to check your feet daily. Look carefully at all areas, including between the toes, the soles of the feet and the nail bed underneath the nails. Make note of any changes to existing moles or the appearance of new moles and other skin markings.  The same applies to skin tags.  If needed, use a mirror held under the foot to check the soles of the feet.  Similarly, ask someone to help you check areas that are difficult to see.  If you find anything suspicious or worrisome, see your doctor immediately.

The warm weather is finally here.  Enjoy it!  But remember to be kind to your feet!

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Foot Care for Bunions (Hallux Valgus)

A bunion (or hallux valgus deformity) occurs when a bony growth develops at the base of the big toe.  As the growth becomes bigger, the toe becomes misaligned and starts to lean into the other toes.   The second toe often develops into a hammer toe due to impingement from the big toe.  The joint between the base of the big toe and the ball of the foot, called the first metatarsophalangeal joint, becomes inflamed and painful.  The bursa, which is the fluid-filled sac next to the joint, can also become inflamed, leading to swelling, redness and pain.  This condition is known as bursitis. 

Although bunions most often develop at the base of the big toe, smaller bunions sometimes develop at the base of the small toe.  This is a Tailor’s bunion.

What causes bunions?

Some statistics claim that the ratio of women to men who develop bunions is 10:1.  The biggest cause is footwear.  More specifically,  the shoes in question have a narrow toe box that push the toes together and high heels that put stress on the metatarsophalangeal joints.  For more information on the effects of high heels, read here.  Heredity can be a factor.  Medical conditions that affect the joints, such as arthritis, cause it as well.

Caring for bunions:

Shoes that accommodate the bunion are a must.  The toe box should be wide enough to comfortably fit the width of the forefoot and there must be wiggle-room for the toes.

It is never a good idea to cut a hole at the side of the shoe to provide more room for the bunion.  A hole in the side of the shoe can irritate the skin around the bunion or cause herniation of the inflamed bursa – ouch!

Padding can be cut to protect the bunion and make walking more comfortable.  At McDermott Footcare, I cut special padding specific to the size and location of the bunion that cushions it inside the shoe.

Toe spacers placed between the first and second toes keep them from rubbing against each other and realign the big toe.  A bunion brace or splint may be worn at night for realignment.

A person who has bunions often benefits from custom-fitted orthotics.  A podiatrist or chiropodist provides this service.

Medical Treatment of Bunions:

The pain and discomfort from an inflamed bursa next to the metatarsophalangeal joint may be relieved by oral anti-inflammatory medication such as ibuprofen.  Before taking anti-inflammatories,  check with your doctor first if you are taking any other prescription medication.  And always take them as directed.  Ice packs provide relief as well.

For persistent bunion pain, surgery is an option to discuss with your doctor.  An osteotomy realigns the joint.  Arthrodesis surgery removes damaged parts of the joint.  The most common procedure is a bunionectomy which shaves off the bony growth.  This surgery is not always successful and the big toe may return to its deviated position post-surgery.

Preventing bunions:

The best way to care for bunions is also the best way to prevent bunions.  Proper footwear is the first line of prevention.  A wide toe box, wiggle room for the toes, a low heel; these are what to look for in an everyday shoe (read here for more on shoes and socks).   While this advice applies mostly to women, men would do well to use the same guidelines for footwear.

Copyright Terry McDermott. May not be reproduced in whole or in part without permission of author

Tennis Ball Foot Massage

We’ve all had those days…………….on our feet all day, shoes feeling two sizes too small by the afternoon, feet throbbing in pain………can’t wait to get those shoes off and give our feet a little lovin’.

There are 26 bones and 2 sesamoid bones in each foot.  Along with that, more than 100 ligaments, muscles, tendons and 33 joints are in each foot.  Add to that an abundant nerve supply. Now, take all those various parts and cram them into shoes that pinch our toes together, don’t give enough support or cushioning, don’t breathe, and abuse our feet in so many ways.  On any given day, our feet absorb about 1000 tons of force, mostly from hard surfaces.  No wonder they hurt at the end of the day!

All McDermott Footcare clients get a soothing foot massage. They love it!  In a perfect world, there would be an incredibly gifted masseuse waiting for me after a long day with the sole purpose of giving me a soothing foot massage.  Alas, I don’t live in a perfect world and I’ll bet most of you don’t either.

What do you do if there’s no one to give you a much-needed foot massage or if the person who’s rubbing your feet can’t get it right?  Enter the tennis ball.  Yup, the common, green, fuzzy staple of tennis courts and school yards everywhere is an excellent piece of foot care equipment. 

Soothe your overworked arches and caress the balls of your feet and heels by placing your foot on the ball and rolling the ball back and forth and side to side.  You can easily adjust the amount of pressure you put on your foot.  And, it’s convenient.  Give yourself a foot rub while eating, going online, watching TV, anytime you’re sitting or standing in one place.  Did I mention how inexpensive it is?

The tennis ball foot massage is great for runners, hikers, all sports enthusiasts who are hard on their feet.  Anyone whose job requires standing and/or walking for long periods will find it helpful.  People with plantar fasciaitis will find it very soothing.  All sizes of feet can use it.  It’s a must-have for anyone whose feet need a little TLC.  As the weather warms up, I’ll be spending less time on my elliptical and more time walking outside.  My trusty tennis ball, along with really good walking shoes and socks that wick away moisture, will not be far away. 

Give it a try.  I think you’ll like it. There is one caution, though:  don’t share your tennis ball if you have Athlete’s Foot (read this) or fungal toenails (here).  In fact, don’t share it at all.  Tell them to get their own tennis ball 😉

All About Toenail Fungus

Fungal toenails were the main concern of everyone seen by McDermott Footcare this week.  Everyone from the 30-year-old professional to the octogenarian needed help with toenail fungus, a.k.a. onychomycosis.  Toenail fungus doesn’t discriminate against age and there are many causes for it.

Anatomy of a nail:

To understand how a nail becomes fungal, we need to know the structure of a nail.  Anatomically, a toenail and a fingernail are the same.  The nail plate is the part that needs clipping every 6 weeks or so.  Underneath is the nail bed which is protected by the nail plate. The cuticle (eponychium) is the narrow band of skin at the base of the nail plate; it is a protective barrier, preventing  fungus and bacteria from entering the nail bed.  The  nail root (matrix), at the base of the nail bed underneath the cuticle,  is where nail cells form.  The end of the matrix is the white, half-moon shaped area (lunula) at the base of the nail.

How nails become fungal:

Onychomycosis is caused by the same dermatophyte as Athlete’s Foot.   Athlete’s Foot and Onychomycosis can be caused by the same factors (read here). 

Anyone with poor circulation to the feet, including diabetics and people with heart and vascular conditions are more susceptible.  People with weakened immune systems because of illness or medication use are at a greater risk.

Anyone who has regular pedicures may be at risk.  During a pedicure, the cuticle is pushed back.  This damages the cuticle and makes it easier for fungus and bacteria to infect the matrix where new nail cells form.  Are the pedicure and manicure instruments sterilized (read here) by autoclave?  Nail fungus is very contagious.  The Ontario Ministry of Health and Long-Term Care mandates that these instruments be autoclaved.  Ask the salon if they autoclave – buyer beware.

What does toenail fungus look like?

Onychomycosis starts off as a small area of whitish or yellowish discolouration in one corner of the toenail. This picture shows mild toenail fungus.  As it spreads, the area of discolouration becomes larger and the nail becomes rough and thickened.  You may notice a darker colour under the nail because of debris that has collected.  The nail plate may separate from the nail bed. If bacteria are involved in the infection, there will be a slight odour. 

Treatment:

 Over-the-counter topical medications may or may not work.  Your doctor may prescribe a stronger topical medication but even that will take months of regular use.  Oral medications may be prescribed for diabetics or those with other medical conditions.

The vinegar – water soak I talked about in (this) previous blog  is a home remedy that has been shown to work if used constantly over many months.  Eating a healthy diet will boost immunity and help to fight the infection.  Probiotics which are added to certain foods such as yogurt may help.

Tea tree oil applied to a piece of cotton and used to clean under the nail plate may show results over time.

As a certified foot care nurse, I treat fungal nails by clipping away as much of the infected nail as possible.  For thickened nails, I use a special file that thins out and removes pieces of the damaged nails.  Regular nursing foot care halts the spread of infection.  A McDermott Footcare client is looking forward to being able to wear sandals this summer for the first time in years since I have treated her fungal toenails for the past 6 months and we are now seeing favourable results.

Preventing fungal toenails:

  • The measures used to prevent Athlete’s Foot (here) will also prevent fungal toenails. 
  • Try to avoid wearing shoes that are tight in the toe box. Squashing the toes together damages the matrix and increases the likelihood of infection.
  • If you get regular pedicures, do not let the esthetician push back the nail cuticle.  Find a salon that will honour your request to leave your cuticles alone.  It may be tempting to cover fungal nails with nail polish but this will trap moisture and worsen an existing infection.
  •  A fungal toenail infection is contagious.  Again, use the same prevention measures as with Athlete’s Foot.

Toenail fungus, or onychomycosis, may be frustrating and embarrassing.  Diligence and patience are needed to end the problem and prevent it from recurring.