Chiropody and Podiatry

with Sophie Combarel

What Is Chiropody and Podiatry?

Chiropodists specialise in assessing, diagnosing and treating disorders, abnormalities and diseases of the upper and lower limbs. They undergo intensive training in order to prevent, treat and correct these disorders and provide professional advice on proper foot care to patients of all ages and abilities. Below are just some of the conditions Sophie can treat.


What Is Achilles Tendonitis?

The Achilles tendon is the large tendon at the back of the ankle. It connects the large calf muscles (Gastrocnemius and Soleus) to the heel bone (Calcaneus) and provides the power in the 'push off' phase of the gait cycle. The Achilles tendon can become inflamed through overuse as well as a number of contributory factors. The Achilles tendon has a poor blood supply which is why it is slow to heal. Achilles tendonitis can be acute or chronic. Acute Achilles tendonitis may happen as a result of overuse or training too much, too soon - especially on hard surfaces or up hills. It is estimated that Achilles tendonitis accounts for around 11% of all running injuries, but it is not an injury that affects only the sporting community, it can affect any one at any time.

What Causes This?

Overuse and over stretching the tendon more than its normal boundaries. Too much too soon is the basic cause of overuse injuries when it comes to the sporting world. However, other factors can make an overuse injury more likely. Over pronation or feet which roll in, can place an increased strain on the Achilles tendon. As the foot rolls in (flattens) the lower leg rotates inwards, which twists the Achilles tendon, causing further stress. The wearing of high heels on a regular basis causes the tendon to shorten , and then when flat shoes are worn, it puts abnormal strain on the Achilles tendon causing it to stretch further than it is comfortable.

What Are The Symptoms?

Achilles tendonitis can be either Acute or Chronic.

Symptoms for acute inflammation of the Achilles tendon are:

  • Pain on the tendon during exercise/motion. Achilles pain will gradually come on with prolonged exercise but will go away with rest.
  • Swelling over the Achilles tendon.
  • Redness over the skin
You can sometimes feel a creaking when you press your fingers into the tendon and move the foot

Chronic Achilles tendonitis may often follow on from acute Achilles tendonitis if the acute injury is not treated properly or allowed to heal. Chronic Achilles tendonitis can be a difficult conditions to treat. Symptoms for chronic Achilles tendonitis are similar to those for acute tendonitis, but also include:
  • Pain and stiffness in the Achilles tendon, especially in the morning. This pain may be described as diffuse along the tendon rather than specific
  • There may be nodules or lumps in the Achilles tendon, particularly 2cm above the heel
  • Pain in the tendon when walking - especially up hills or stairs
Chronic tendonitis differs from acute tendonitis in that it is more of a long term, persistent problem.
What is Athletes Foot?

Athletes Foot is a name given to a fungal infection of the skin on the feet. It occurs primarily between the toes, but can be anywhere on the foot, and can affect anyone, NOT just athletes. If left untreated it can spread to other parts of the foot, and hands, sometimes even the face.

Athletes Foot can be extremely uncomfortable, causing the skin surrounding the area to become inflamed and swollen, sometimes containing a sticky fluid. People suffering from this condition may also experience a scaly rash on the underside of their foot , causing cracks in the skin.

What Are The Symptoms?

  • Dry, itchy lesions
  • Burning or stinging sensation in the feet
  • Sticky fluid between the toes
  • Rash, or cracks on the underside of the foot
  • Often people with athletes foot can also develop fungal nail infections
  • If left untreated, this condition can become very painful

What Are The Causes Of Athletes Foot?

Anyone can develop this condition, though it is more common in people with sweaty feet, as the fungi thrive on a warm, moist environment. Many people can have the fungus present on their feet but are not affected by it - things like cracks in the feet or bruising, allow the entry for the fungus into the skin, meaning symptoms will develop.

Athletes foot can be spread around your body - ie. if you itch your feet then it can spread to your hands. It can also spread between individuals, so places such as swimming baths, bathrooms, showers etc, can be a common place to pick up the infection.
People who do not change their socks regularly are more prone to this condition.
Arch Pain

Arch pain is often felt as a burning sensation under the arch of the foot, which can be caused by many factors. This is often the only symptom, but it can be extremely painful.

What Are The Causes Of Arch Pain?

Structural Imbalances of the foot, such as a pronated foot (rolls inwards at the ankles), especially with the addition of factors such as running or walking on hard surfaces, inadequate footwear and being on your feet all day
Plantar Fasciitis is one of the most common causes. This is a strain of the plantar fascia, a ligament which supports the arch of the foot.

Tarsal Tunnel Syndrome, which is a pinched nerve at the ankle that refers to pain in the arch.

Foot strain from a pronated foot, or a flat foot Osteoarthritis of the joints.
Bunion Care

Bunions are one of the most common foot deformities. They are caused by a displacement of the bone under the first toe causing it to move towards the smaller ones. This shifting of the bone causes a bony prominence on the side of the foot, and in time the big toe may come to rest under the second toe.

Bunions are more common in women than men, as they tend to wear tighter fitting shoes.

Bunions can lead to a variety of other soft tissue and bone complaints, such as:

  • Arthritis
  • Bursitis
  • Corns
  • Hard Skin
  • Ingrowing toenails
What Are The Causes of Bunions?

Poor fitting footwear, genetic factors, abnormal foot function, such as excessive pronation (excessive rolling in of the foot at the ankle joint while you are walking).
What Is A Corn Or Callus?

A corn or callus are areas of thickened skin that occur in areas of pressure. They are actually a normal and natural way for the body to protect itself. For example, callus develops on the hand when chopping a lot of wood - the skin does this to protect itself . In the foot, the skin will thinken up to protect itself. In the foot, the skin will thicken up to protect itself when there are high areas of pressure. The problem occurs when the pressure contiues, so the skin gets thicker and thicker. It eventually becomes painful and is treated as something foreign by the body. Corns appear as a horny thickening of the skin on the toes. This thickening appears as a cone shaped mass pointing down into the skin. Hard corns are usually located on the outer surface of the little toe or on the upeer surface of the other toes, but can occur between the toes. A soft corn occurs between the toes and are kept soft by the moisture in this area. A callus is a more diffuse area of thickening and does not have the focal point of the corn.

What Causes Them?

Corns and callus are caused by one thing - TOO MUCH PRESSURE, usually in combination with some friction. There is no other way to get them - the pressure stimulates the skin to thicken to protect itself, but as the stimulation of the pressure continues, it becomes painful.

Too much pressure can be from causes such as:

  • Footwear that is too tight
  • Toe deformities, such as hammer toes - the top of the hammer toe is an area for increased pressure on the top of the toe
  • Bony prominence
  • Biomechanical or gait abnormalities that cause pressure under different areas of the bottom (plantar) surface of the foot (this is a common cause of callus)
As there are a whole range of problems that can result in a corn or callus, it is often good to consider that they are not really a condition at all, but are a symptom of an underlying condition.

How Do I Prevent Them?

Corns and callus are easy to prevent, just take away the cause - EXCESSIVE PRESSURE. No Chemical applied to the corn or callus will take away the pressure. Correct fitting footwear around the toes, the use of pads to relieve pressure, surgical management of bony prominence and/or regular podiatric care are the best options for prevention of corns and callus.

People who suffer from diabetes are at a higher risk of developing foot ulcers, but with proper care of your feet, and the correct control of the diabetes, there is absolutely no reason why you cannot be ulcer free. If you have regular checks with your doctor or chiropodist, they can ensure that any problems are caught as early as possible, and treated accordingly.

If you suffer from diabetes it is important to regularly check your feet, and a good foot care routine would involve the following:

Look carefully at your feet each day, including between the toes - if you cannot do this yourself, then you should ask someone else to do it for you. It is particularly important if you have reduced sensation in your feet, as you may not feel anything is wrong at first.

If you notice anything different, such as redness, swelling, bleeding, any blisters, cuts or bruises, that you cannot deal with yourself, you should see your doctor or podiatrist.

If you have any corns, calluses, verrucas or other problems you should not try to treat them yourself, but visit a registered health professional such as a chiropodist or podiatrist, as they will have specialist equipment to deal with the problem, Do not use chemicals, or special 'acid' plasters to remove corns etc.

You can use a moisturising cream on the feet to help prevent dry skin and cracking, but you should not use it between the toes, as the moisture provides an ideal environment for bacteria to grow.

Keep an eye out for any signs of athletes foot - this is a skin infection which will cause flaky skin, and cracks between the toes, which can become sore and infected. If you do get athletes foot, it should be treated with an antifungal cream.

If you are able to see well enough to do it, then keep your nails cut by following the curvature of the nail - if you cannot see clearly enough, then get someone else to do it for you.

Make sure you wash your feet regularly and dry them thoroughly - especially between the toes. Do not walk barefoot, even at home, make sure you always wear socks and suitable footwear (ensure the socks are not too tight around the ankle as this may affect the circulation). Make sure you wear correctly fitting shoes, with broad fronts, low heels and good laces or buckles. Avoid slip on shoes, shoes with pointed toes, sandals and flip flops. Always break new shoes in gradually.

To avoid foot burns, always check the temperature of the bath before you step in, do not use hot water bottles, electric blankets or foot spas.

If you do experience any problems then consult your doctor or chiropodist straight away
Dry, Cracked Heels

Cracked heels are a common foot problem, and usually caused by dry skin. This is made worse if the skin around the rim of the heel becomes thickened (callus). Cracked heels can be unsightly and become a cosmetic problem, but if left to become deep fissures, then this condition can become very painful. If the cracks are deep they can bleed, and become difficult to stand on and sometimes even get infected.

What Are The Symptoms of Cracked Heels?

The skin will normally be dry and hard, sometimes appearing yellow or dark brown. Cracks in the skin will appear and if deep enough become very painful to stand/walk on.
The skin around the edge of the heel will often become thickened, and discoloured.

What Causes Cracked Heels?

Some people have naturally dry skin that will easily crack. If the skin around the heel becomes callus, then mechanical factors in the way we walk can contribute to the problem - ie. if there is increased pressure on these areas

  • Prolongeed standing, expecially on hard floors
  • Skin conditions, eg eczema or psoriasis
  • Open backed shoes
  • Being overweight
  • Some medical conditions such as diabetes, underactive thyroid, or anything that reduces sweating
Some medical conditions such as diabetes, underactive thyroid, or anything that reduces sweating
Fungal Nails

Who Gets Fungal Nail Infections?

Fungal nail infections are extremely common, with about 3 in 100 people suffering at some stage in their lives. These infections can occur in people of any age, though they are more commonly found in people over 55 or those who share communal shower areas, or swimming baths, such as swimmers and athletes.

How Do You Get A Fungal Nail Infection?

Fungal nail infections are often spread from a fungal infection of the skin. One of the most common causes of fungal infections in toenails is when people suffer from Athletes Foot (a fungal infection of the toes), and the infection spreads to the toenails. This can then be spread to the finger nails if you scratch your toes after the infection in the toenail has become established.

If the nail has been damaged, you are more likely to develop an infection there, as there is an opening for the bacteria to grow. It is also more common in people living in hot and humid climates.

There are many factors that can increase your likelihood of developing a fungal nail infection, such as diabetes, psoriasis, smoking, poor circulation and poor immunity, but in a lot of cases, there is no obvious cause. Fungus germs are common and an infection can occur without any warning.

What are the symptoms?

Quite often the infection is just in one nail, though several may be affected. At first it will usually be painless and the only symptoms will be a thickening and discolouring of the nail (normally a yellowy colour), which looks unsightly.
If the infection becomes worse, it can cause the nail to come away from the nail bed, either in patches, or the whole nail. The nail may become soft and crumble, and bits may fall off. The skin around the nail can become inflamed and scal, and if left untreated then it can become very painful, as well as destroying the nail and the nail bed.

What Is The Treatment?

Nail infections can be easily and effectively treated, normally in 1 to 3 sessions with a registered chiropodist.
What Are Flat Feet?

The raised space that most people have between the ball of their foot and the heel of their foot, is known as the 'arch' of the foot. Occasionally this arch is very low, or even missing, and the foot is flat to the floor from toe to heel. This condition is known as 'Flat Foot'.

Many babies are born with what appears to be 'fallen arches' in their feet, which can lead to a diagnosis of 'flat feet'. However, it cannot be properly diagnosed until all the bones, muscles, ligaments and tendons have properly grown and developed. Children who suffer with flat feet tend to walk on the outer edges of their feet or lean in to the inner aspect of the foot, in order to balance better and stop themselves from falling.

It is not a particularly serious condition, and my only affect a child if they are running, which may cause pain. Over time flat feet can encourage poor posture to develop, which can lead to back pain and heel spurs among other problems.

Age, weight and hormonal changes may all increase the chances of developing flat feet, and once it has occurred, it may not return to its former state regardless of interventions.

What Causes Flat Feet?

There can be a hereditary link to flat feet, meaning it is passed through the generations.

Conditions such as spina bifida, cerebral palsy or conditions of the muscular system can also lead to flat feet Injury to the tendons in that region of the foot.

Hormonal changes during pregnancy may cause the tendons and ligaments to slacken resulting in a flat foot.
Heel Spurs

A heel spur is a small bony hook, or projection that is formed on the heel bone (calcaneus). It is caused by putting too much pressure on the sinews in the soles of the feet, usually over a long period of time. When we take a step, the heel has to support the weight of our body, and this load is softened by a pillow of fat under the heel and a large sinew under the soles of the feet.

The muscles of the calf and the Achilles tendon attach to the heel bone, so if you do not warm up properly before exercise, you risk overloading these structures and causing an extra strain on the sinew and muscles in the sole of the foot. This can lead to inflammation, pain and sometimes even small cracks in the sinew.

When rested, the muscles in the sole of the foot will contract in an attempt to protect the damaged sinew, so the pain will cease, but upon use it will return and cause even more damage on movement.

To repair this, the body will 'wrap' the broken, or cracked sinew, in bone, which is what causes the bony projection - known as a calcaneal spur. It is not the spur itself that causes the pain, rather the prolonged overload of the sinew in the sole of the foot.

What Are The Symptoms?

You will feel a sharp, stabbing pain in the inside or underside of the heel

The pain will disappear when you are resting the foot, but as soon as you start using it again it will come back

Normally the pain is at its worst in the morning when the foot has been rested, and then you start to use it again

Walking on a hard surface or carrying a heavy load will make the pain worse

What Are The Causes?

Heel spurs can occur in any person, of any age, but there are certain factors that make you more at risk, such as:
  • Being over weight, particularly if you are middle-aged, as the shock absorbing pillow of fat under the feet shrinks with age and become less effective
  • People suffering from over-pronation
  • People who have quite sedentary jobs during the week and then do sports/athletics at weekends
Can It Be Prevented?

There are certainly things that you can do to try and minimise the risk of developing heel spurs:

Wear sensible and suitable footwear for the purpose

If necessary cushion the heel with a support, or use arch supports to help support the arch of the foot

Make sure you warm up and stretch before doing and sports or athletics, and make sure you cool down afterwards

It is better to run a short distance several times a week than a long distance just once

Do not overestimate your abilities, and gradually build up your workload to represent your abilities

If you experience pain in the heel, you may be overloading the tendons, so try to ease off the exercise and stress on the feet

If you are overweight then losing weight can help the problem

If you are experiencing pain and problems, rest the foot and do not run until it is completely healed. Ica can be applied to the area, wrapped in a towel or cloth and an support bandage can be used to compress the area. Elevating the foot to rest it is also beneficial.
What Are Hammer Toes?

A hammer toe is a term that is commonly used to describe a bending of one or both joints of the second, third, fourth or fifth toes. It is a common ailment that may or may not cause you a problem. In a hammertoe, the deformity usually exists in one toe (at the proximal inter phalanggeal joint) - the base of the toe points upward and the end of the toe points down.

What Are The Symptoms?

The symptoms of a hammer toe are usually first noticed when a corn develops on the top of the toe and becomes painful, usually when wearing tight shoes.

There may be a bursa under the corn, or instead of a corn, depending on the pressure. Most of the symptoms are due to pressure from footwear on the toe.

There may be a callus under the metatarsal head at the base of the toe. Initially a hammer toe is usually flexible, but when longstanding it becomes more rigid.

This problem can be quite painful

What Causes Hammer Toes?

Hammer toes can be due to a number of things. Several factors are known to increase the risk of developing hammer toes.:
  • Some people are just structurally prone to develop hammer toes (hereditary)
  • Tight footwear is an important factor in the cause of hammer toes as well as providing the pressure that causes the symptoms
  • Weaker small muscles in the foot may also play a role

How Can I Prevent Getting This?

Prevention of a hammer toe can be difficult as symptoms do not usually start until the problem is well established. Wearing shoes that have extra room in the toes may help the problem or slow down its development.
Hard Skin

Hard skin or callus, occurs when the skin becomes thickened due to pressure. Callus can occur over a bony prominence, on the ball of the foot, or on the heel, often as a reult of prolonged periods of standing. Callus appears a yellow or dark brown discoloured skin, and can become very painful.

What Are The Symptoms?

Weight bearing can cause the foot to become very painful, but this will be relieved by rest.

There will be a hard growth of skin, which will usually occur on the ball of the foot.

Discomfort will be increased by wearing thin soled, or high heeled shoes

What Are The Causes?

  • Prolonged standing
  • Being overweight
  • Wearing thin soled or high heeled shoes
  • Bunions
  • Surgery to the lower extremities can lead to hard skin
  • Flat feet and high arched feet
  • Abnormalities of gait (walking)
  • Mis-alignment of the metatarsal bones (the bone structure of the sole of the foot)
Ingrowing Toenails

Ingrowing toenails are one of the most common complaints seen by chiropodists. They can be very painful, and need specialist treatment, as they cannot resolve themselves. Ingrowing toenails are caused by a splinter of nail or the whole nail causing pressure into the skin. They can be acute, and occur due to an injury to the toe, or they can be chronic, which means the patient has had the problem for a long period of time. It is usually the large toe which is affected, however, it can also affect the smaller toes.

In an acute ingrowing toenail the toe will appear very red and inflamed, and it will be very painful to touch. There may be a watery discharge with a hint of blood. In a chronic ingrowing toenail, the corner of the nail will be slightly inflamed.

What Are The Symptoms?

Ingrowing toenails can be very painful and this can be aggravated by wearing tight shoes or shoes with inadequate depth.

They can be very painful to touch and there may be an infection present- this is particularly the case in acute cases.

In chronic conditions the toe will be painful when the patient is walking with shoes on

The toe may appear, red, swollen and can sometimes have a discharge

What Are The Causes?

  • Improper cutting of the nails can lead to ingrowing toenails
  • Tight or ill-fitting shoes or footwear
  • Trauma to the nail
  • Abnormal shape of the nail plate
  • Abnormal thickness of the nail
Can It Be Prevented?

There are certain things you can do to decrease the chances of developing an ingrowing toenail, such as making sure you cut toenails straight across and let them grow slightly longer and avoid wearing tight shoes.

If you start to experience discomfort, try soaking the feet in warm salt water for 10 minutes each day

Metatarsalgia is the name given to pain in the front of your foot under the heads of your metatarsal bones (the ball of the foot). It can be caused by a number of different conditions, but is more a symptom of other problems, rather than a specific disease in itself.

What Causes Metatarsalgia?

There are a number of different conditions which can lead to metatarsalgis. Common causes include:

  • Wearing high heeled shoes - this can put extra pressure and stress on the metatarsal heads
  • Being overweight - which puts extra stress on your feet
  • Overuse - more commonly seen in runners and athletes
  • Bunions - a deformity of the joint of your big toe - extra stress is then put on the ball of your foot
  • Hammer toe - an abnormal positioning of one or more joints in the smaller toes - this causes extra pressure on the ball of the foot
  • Arthritis or gout - this causes inflammation of the joints in the ball of the foot
  • Diabetes - this can cause damage to the nerves in your feet and can lead to metatarsalgia
  • Stress fracture of a metatarsal - a stress fracture is a type of incomplete fracture in a bone. They tend to occur as a result of overuse. These can lead to metatarsalgia
  • Previous surgery to your foot - for example, surgery on bunions

What Are The Symptoms?

Metatarsalgia causes pain in the ball of the foot, that is often made worse by walking or running. This pain can occur in one or both feet, and is normally felt as either a generally aching, or like 'walking on pebbles'.

Can Metatarsalgia Be Prevented?

Some causes of metatarsalgia are unpreventable, but there are some things you can do to help prevent other causes:
  • Ensure you wear correctly fitting shoes, with low heels and a wide toe area
  • When doing sports make sure you wear the correct footwear
  • If you are overweight, losing weight is beneficial in preventing this cause of metatarsalgia
  • If you are diabetic then ensure you control your condition correctly

Neuroma refers to the swelling of a nerve. Most commonly with foot neuroma (also known as Morton's Neuroma), it is the small nerve that connects the 3rd and 4th toe that is affected.

The term neuroma refers to a swelling of a nerve. The nerve commonly affected is a small nerve that connects the 3rd and 4th toes, counting from the big toe. The patient will complain of pain in the sole of the foot.

What Are The Symptoms?

Initially the patient will feel a numbness or tenderness in the foot just behind the 3rd and 4th toes, which can lead to on to pain, numbness, burning and tingling sensations all around the foot. These symptoms can come and go, but often pain will be worse when weight bearing.

Spontaneous shooting pains may also be felt during sleep, which are often referred to as 'electric shocks'.

What Are The Causes of Neuroma Pain?

  • High heels can damage the nerve
  • The pulling of ligaments underneath the foot can irritate the nerve
  • A tight shoe around the toes can squeeze the toes and put pressure on the nerve
  • Over pronation and other mechanical problems with the feet causes the structures of the feet to be put under excess stress and can increase the likelihood of a neuroma occurring
Over Pronation

Over pronation, or 'excessive pronation', is one of the most common causes of foot and leg discomfort. Normal pronation allows the foot to roll inwards, particularly at the heel and arch, but when this occurs excessively it causes the arch to flatten and collapse and the soft tissues to stretch. This then affects the position of the joint structures causing them to become loose and flexible. Eventually strain on the muscles, tendons and ligaments of the foot and lower leg can cause permanent problems and deformities.

What Does Over Pronation Look Like?

When you are standing, your heels will lean inwards, and one or both of your kneecaps may turn inwards. This can lead to knee pain when you are active or involved in sportsor athletics. The pain in the knee will gradually decrease when you rest.

People with this condition often wear out the soles and heels of shoes very quickly.

What Are The Causes of Over Pronation?

Over pronation occurs due to a biomechanical dysfunction (walking abnormality). If left untreated, they can lead to many other problems, some of which are listed below.

Symptoms Of Over Pronation

There are many conditions that are associated with over pronations, such as:
  • Bunions
  • Arch pain
  • Metatarsalgia
  • Ankle sprains
  • Achilles tendonitis
  • Knee pain
  • Corns and calluses
  • Osteochondrosis
  • Shin splints
  • Flat feet
  • Hammer toes

Plantar Fasciitis

What Is Plantar Fasciitis?

Plantar fasciitis means inflammation of the plantar fascia - a strong band of tissue (like a ligament) that stretches from the heel to the middle foot bones. The plantar fascia supports the arch of the foot and acts like a shock-absorber. The main cause of plantar fisciitis is thought to be repetitive small injuries to the fascia, occurring near where the plantar fascia attaches to the heel. It is possible to have plantar fasciitis in both feet at the same time.

What Are The Symptoms?

Plantar fasciitis can be very painful, and this isoften the main symptom. The pain can be anywhere on the underside of the heel, and commonly will be mainly in one spot, which can be very tender to touch.

The pain will usually be helped by resting the foot, but will then be at its worst when the foot is used to bear weight again. Often the symptoms will be at their worst following sleep or prolonged rest of the foot. Gentle exercise may ease the pain a little bit, but using the foot too much often makes the pain worse.

Actions which involve stretching the sole of the foot - for example, walking on tip toes, or up stairs, can often make the pain worse.

Who Gets Plantar Fasciitis?

Plantar fasciitis is quite common, and can affect any one at any time. However, it is more commonly found in people over 40, and more so in women than men. It is also common in athletes and sportsmen. Certain things make plantar fasciitis more common:
  • People who do a lot of walking, running, standing, etc, especially if you are not used to it
  • If you have recently started exercising on a different surface. For example, running on the road instead of a track
  • Wearing shoes with poor cushioning or poor arch support
  • Sudden gains in weight or being overweight will put extra strain on the heel
  • Overuse or sudden stretching of the sole. For example: athletes who increase their running intensity or distance; poor technique starting 'off the blocks', etc.
  • Tightness of the Achilles tendon (at the bottom of the calf muscles above the heel) causing reduced ability to flex the ankle
Often there is no obvious cause for plantar fasciitis - especially in older people.

Can Plantar Fasciitis Be Prevented?

There are certain things that you can do to try to prevent plantar fasciitis, especially if you have had it before. These include:

  • Losing weight if you are overweight
  • Wearing shoes with good arch support and cushioning in the heels
  • Regularly changing/updating trainers used for running or walking
  • Avoiding exercise on hard surfaces
  • Regularly changing trainers used for running or walking
  • Wearing shoes with good cushioning in the heels and good arch support
  • Losing weight if you are overweight
  •  Regularly stretching the plantar fascia and Achilles tendon (see exercises above), especially before exercise
  • Avoid exercising on hard surfaces
What is a verruca?

A verruca is simply a wart that is usually found on the soles of your feet, though they can also appear around the toes. In the early stages, a verruca looks like a small, dark, puncture mark but later turns grey or brown. It may become rough and bumpy with a cauliflower-like appearance and may develop a black spot in the middle, which is caused by bleeding. A verruca can grow to half an inch in diameter and may spread into a cluster of small warts.

What causes them?

Verrucae are caused by the human papiloma virus (HPV). This virus is very contagious, but can only be caught by direct contact. It thrives in warm, moist environments such as swimming pools, changing room floors and bathrooms. So if an infected bare foot walks across the poolside, it may release virus-infected cells onto the floor. If you then walk on the same floor, you can pick the virus up, especially if you have any small or invisible cuts and abrasions that make it even easier for the virus to penetrate. You could also catch the virus from an infected towel.

Is it serious?

Though Big Brother’s Jade kicked up a fuss when she got a verruca, there is no need to be alarmed! They are harmless. However, they can cause a sharp, burning pain if you get one on a weight-bearing area such as the ball or the heel of the foot. Because you are constantly pressing on the area when walking, they can protrude into the skin and become more painful.

When you have verrucae on a non-weight-bearing surface (such as on the top of the foot or on the toes), they protrude above skin level, tend to be fleshier and cause less pain.

Who gets them?

Then tend to be common in children, especially teenagers. However, for unknown reasons, some people seem to be more susceptible to the virus, whereas others are immune.

What’s the difference between a corn and a verruca? A verruca is a viral infection, whereas a corn or callus are simply layers of dead skin. Verrucae tend to be painful to pinch, but if you’re unsure, your podiatrist will know.

What can I do?

Minimise your chances of catching a verruca by keeping your feet clean and dry, and covering up any cuts or scratches. Avoid walking barefoot in communal showers or changing rooms (wear flip-flops) and don’t share towels. Though you should wear verruca socks when swimming to avoid passing on the virus, they can also be worn as a preventive measure.

If a verruca does appear, avoid touching or scratching it as it may spread into a cluster of several warts. Instead, cover it up with plaster. In some cases, this may cure it.

Do not self-treat if you have diabetes or circulation problems. However, if you are fit and healthy, it’s fine to treat yourself with over-the-counter gels and ointments. Ask your pharmacist for advice or look for products containing salicyclic acid, such as Verrugon. Ensure, however, that you follow the instructions carefully. If, at any stage, your verruca becomes painful or the surrounding skin goes red, stop treatment immediately and see a podiatrist. If you damage the healthy tissue that surrounds the wart tissue you could hamper further treatment.

What can a podiatrist do?

Because verrucae usually often disappear in time (fought off by your immune system), the general policy in the UK is to only treat them when they are causing pain. Verrucae generally resolve spontaneously within six months in children. But in adults, they can persist for years.

If yours is causing pain, there are a number of treatment options available – though no one particular treatment can guarantee a cure. A recent review of treatments in the British Medical Journal (August 2002) concluded that the safest and most effective treatments were those containing salicylic acid. This acid is applied to the wart to disintegrate the viral cells and has a cure rate of 75%. It may need to be applied at weekly intervals over a set period of time.

Other treatments include:

Cryotherapy This involves freezing warts off with liquid nitrogen or nitrous oxide gas. This needs to be done every 2 or 3 weeks for a few months before the verruca is fully removed. However, it can lead to soreness and blistering in some people. You can still swim after this treatment, but it’s not advised for sensitive or anxious children.

Electrosurgery After a local anaesthetic, the verruca is pared down. An electric needle is then placed in the middle of the wart for a few seconds until the wart boils – the verruca is then scooped out.

Excisional surgery Similar to above, but using a scalpel.

Laser surgery Lasers are sometimes used to kill the virus. This is useful for treating portions of large verrucae at a time.

In short, you can treat your verruca with an over-the-counter medicine unless you have diabetes or circulation problems. If you do however, or find that the verruca appears to be getting bigger, consult a podiatrist.