Athlete’s foot is a fungal infection on the feet usually seen between the toes but may also spread to the sides of the foot. The fungus that causes Athlete’s foot thrives in moist conditions and spreads easily but can be prevented by simple precautions like keeping feet and shoes clean and dry; wearing sandals or flip-flops at pools and public showers.

Causes:

• Bare feet in public showers and around swimming pools

• Feet in closed shoes that do not get adequate ventilation

• Damp socks and shoes

• Excessively sweaty feet

Symptoms:

• Itching, scaly skin between the toes

• Peeling and flaking skin on the sides of the foot

• Inflammation

• Blisters

Treatment:

• Topical antifungals

• Adequate cleaning and drying of feet

• Products that control excessive sweating

• Use of clean and dry acrylic or wool socks

• Footwear that allows ventilation

Fungal nail infections can occur underneath the surface of the nail. The fungus attacks the nail, makes it discolored, thickened and brittle. Nail infections can occur as a single condition or in conjunction with other conditions like Athlete’s foot or other bacterial and yeast infections. Fungal infections can spread to the other toe nails, skin and fingernails.

Causes:

• Wet damp conditions for feet e.g. around swimming pools and public showers

• Excessive perspiration

• Poorly ventilated shoes

• Damp shoes or socks

• Sharing nail clippers, socks and shoes

• Injury to the nail

• Conditions like diabetes, circulatory problems, immune-deficiency disorders

• People with a tendency for Athlete’s foot are more prone to fungal nail infections.

Symptoms:

• Walking is painful when wearing shoes

• Nails appear discolored and thickened

• Nails become brittle and difficult to trim.

Treatments:

• Over-the-counter ointments, cream and medicated liquid treatments that can be applied on to the affected nail

• Oral medication

• Use of foot powders to keep feet dry

• Change into clean, dry moisture wicking socks often

• Ensure shoes are dry and ventilated

• Wash, clean and dry feet

• In extreme cases, partial or complete removal of the nail may be recommended.

Ingrown toe nails are those that press into the skin of the nail grooves causing swelling, callus build up and pain. Although any toe nail can be affected, the big toes are most vulnerable to this condition.

Causes:

• Heredity

• Very tight shoes that press the nails

• Improperly trimmed nails

• Pulling or tearing at the corner of the nails while trimming may cause infection

• Injury (e.g. Stubbing the toe)

• Nail infection

• Deformities in the foot or toes

• Conditions like arthritis and diabetes may aggravate ingrown nails due to poor circulation, nerve damage and mobility issues.

Symptoms:

• Painful toes where the nail digs into the flesh

• Nails appear sore and red

• Very hard swollen toes

• Infected nail

• Skin begins to grow over the nail and/or peels away from the border

Treatments:

• Soaking the foot in a warm salt bath

• Antibiotics may be used topically or orally to treat the infection

• Partial or complete removal of the infected nail

• Partial or complete removal of the ingrown nail

Hyperhidrosis, or excessive sweating, can be localized to one area or it may be generalized. In the localized type, the most common sites are the palms and soles of the feet. The cause of this excessive sweating is not well understood. There is an emotional component to it in some, but not all, cases. The excessive moisture contributes to athlete’s foot and plantar wart infections. When bacteria becomes involved, a strong odor develops.

There are no good oral medications for the control of hyperhidrosis. Topical antiperspirants are available. A prescription topical medication called “Drysol” works for some people. This medication works best if applied to the feet before going bed, then wrapping the feet in plastic wrap and wearing socks. This should be done three to four nights in a row. Although this is not a cure for the problem, it does provide temporary relief and is useful as part of the treatment plan for athlete’s foot.

A wart is a viral infection that affects the soft tissue through abrasions or small cuts in the skin. Warts can cause pain and discomfort. Warts on the soles of the feet are called plantar warts. They usually appear as ‘cauliflower-like’ lesions with pinpoints of black and have a tendency to disappear and/or recur. If left untreated, warts may grow in size or create a cluster.

Causes:

• Walking barefoot on dirty surfaces

• Going barefoot around public swimming pools and showers

• Plantar warts are contagious and are easily spread by contact, skin shed from a wart or a bleeding wart. Family members should also check their feet.

Symptoms:

• Burning or stinging sensation on roughened, raised skin

• Dull raised circular patches of skin that are painful

• Discomfort while walking when pressure is applied on the wart.

Treatment:

• Regular examination of your feet as warts do tend to reappear in similar locations

• Medication: Use of topical treatments with caution as they contain chemicals that may burn the wart along with healthy tissue around it.

• Freezing the warts

• Surgery

• Laser therapy

Hyperpigmented lesions should always be inspected and observed. Most pigmented areas are nothing but freckles and moles. However, a potentially deadly pigmented lesion that can occur on the foot and lower extremity is Malignant Melanoma. A physician should evaluate any pigmented lesion that suddenly appears or a pigmented lesion that starts to change its appearance. A biopsy may be performed in the office under local anesthesia. Although any part of the body may be affected, the most frequent site is the foot. Overall, the incidence of malignant melanoma is quite low.

Another cancer-causing lesion that can occur on the feet are called Actinic Keratosis. Although most commonly found in sun-exposed areas of the body such as the face, ears, and back of the hands, these lesions can also occur on the foot. They are characterized as either flat or elevated with a scaly surface. They can either be reddish or skin-colored. On the foot, they are frequently mistaken for plantar warts. These lesions are the precursor of squamous cell carcinoma. Most skin cancers of the feet are painless, and often there is a history of recurrent cracking, bleeding, or ulceration.

Venous Stasis results in increased pigmentation/dark patches of skin about the ankles and lower legs. Venous stasis is caused by an accumulation of fluid in the lower extremities due to poor venous return of blood to the heart. As the fluid accumulates, veins break or leak fluid into the tissues. As blood cells break up in the tissue, they deposit the iron that is part of hemoglobin in the blood cell, which stains the skin causing a light to dark brownish appearance. With time, the skin becomes thinned and weeping venous stasis ulcerations can occur. This condition requires professional attention by a physician.

Another cause of generalized increased skin pigmentation is diabetes. The condition termed Diabetic Dermopathy occurs most frequently on the shins and lower legs. They may have the appearance of small scars. Their appearance may precede the diagnosis of diabetes by several years. The actual cause of diabetic dermopathy is not well understood, but it does not cause any particular problem or pose any particular health threat.

Psoriasis is a chronic autoimmune condition that causes faster-than-normal turnover of skin cells. In people who have psoriasis, the new cells move to the surface so rapidly that the dead cells build up on the surface in dry, whitish-silver patches. Psoriasis may also affect the toenails causing thickness and pitting which may be mistaken for fungus. Symptoms include raised, inflamed, dry patches of skin which may crack and bleed, itching and burning. These symptoms are triggered by stress, alcohol, injury, infections and certain medications. Symptoms usually go into cycles of remission.

If the symptoms are unclear or if we want to confirm a suspected diagnosis, our doctors may take a small sample of skin. This is known as a biopsy, which is done in the office under local anesthesia.

Creams and ointments applied directly to the skin can be helpful for reducing mild to moderate psoriasis.

Corns and calluses are areas of thickened skin that develop when rubbing or excess pressure is placed against part of the foot. When these areas develop on the bottom of the foot they are called calluses. When they occur on the top of the toes they are called corns. They can also occur between the toes. People who have diabetes are at risk of these areas breaking down producing sores or ulcerations that can become infected. People with diabetes should not try home remedies and should see a doctor for the treatment.

There are numerous over the counter treatments for corns and calluses. These remedies are only temporary because the source of the pressure has not been alleviated. Professional treatment consists of removing the thickened skin, padding, and/or using a special shoe insert called an orthotic that corrects foot function. In certain instances, surgery may be recommended to correct the alignment of the protruding bone.