Routine Footcare Our routine nail care services include nail care, nail cutting, the removal of corns and calluses and the treatment of bunions…
Many people find it difficult to cut their toenails or prefer a professional to give them a good cut and file from time to time. Nails vary a lot in the speed in which they grow and many people’s toenails are slightly thickened from a lifetime of wear and tear. Randell’s Footcare are able to offer a nail cutting service with our Podiatry Assistants who have been trained and examined within our practice under the supervision of the Society of Chiropodists and Podiatrists. This service is accessible through one of the Podiatrists who will have assessed your foot care needs and can refer you to the Podiatry Assistant for nail and basic foot care, followed by a relaxing foot massage. For many people this service will be all that is required on a regular basis.
Corns and Callus
There are five different types of corns, the two most common are hard corns, which appear as small, concentrated areas of hard skin up to the size of a small pea usually within a wider area of thickened skin or callous and soft corns which are whitish and rubbery in texture and appear between toes, where the skin is moist from sweat, or from inadequate drying. A callus, or callosity, is an extended area of thickened skin often found on the soles of the feet and occurs on areas of pressure. It is the body’s reaction to pressure or friction . A callus on the sole of the foot is often likened to ‘walking on a stone’ and can be very painful. Both corns and callosities can be removed by the Podiatrist who will be able to advise you why this has occurred and, where possible, how to prevent it happening again.
We offer specialised footcare for several medical conditions…
Diabetes can reduce the circulation and the sensation in the feet. One of the early changes can be loss of sensation in the feet, often starting at the toes. This is known as peripheral neuropathy. As a result, foot problems can occur without the sufferer being aware. Diabetes can also affect the blood supply to and within the feet and this can delay healing and increase the risks of infection. Blood supply can be checked by looking at the colour of the skin, checking the pulses in the feet and by asking questions about certain kinds of pains in the feet and legs. People with diabetes are recommended to have a professional cut and file their nails in case of minor abrasions to the skin surrounding the nail edges which then acts as a portal of entry for bacteria to enter and cause infection. During regular check- ups we can check the flow of blood to the feet with an ultrasound device called a Doplar and sensation loss can be assessed and monitored with a monofilament which is a plastic probe that is designed to buckle at a given pressure and with a tuning fork to check vibration sensation. Footwear advice is very important and is given generally and where there are signs of pressure build-up affecting the feet in the shoes, sometimes orthotics or padding is recommended. Podiatrists can also refer people to a specialised clinic at the hospital for any serious deterioration or worrying diabetic foot issues.
Arthritis is a disease of the joints which causes them to become inflamed and stiffen. There are three main types of arthritis; Rheumatoid Arthritis, Osteoarthritis and Gout.
You can download our PDF Arthritis fact sheet using the link below:
Rheumatoid Arthritis can be particularly damaging to the foot producing joint deformities that make shoe fitting difficult and build-up of callosities that can result in ulceration. Foot care may provide protective shields for toes or padding to relieve pressure and reduce friction and hard skin formation. Any secondary problems such as ulcers or corns that have been caused by foot deformities can also be treated. Sometimes Orthotics are issued which are a special type of insole that can be fitted into shoes. These will help walking in such a way to reduce the pressure on affected joints. Professional advice on fitting and styles of shoe available may help many of these problems to be minimised.
Osteoarthritis is sometimes referred to as the ‘wear and tear’ type of arthritis. It commonly affects the joint at the base of the big toe which is more likely to suffer from wear and tear due to pressures from walking. Sometimes the surface of the joint, the cartilage, becomes eroded and the two bones may join together with the big toe becoming rigid, known as Hallux Rigidis. Another effect of osteoarthritis in the big toe joint can cause it to change its joint position and lie closer to the lesser toes, known as Hallux Valgus or more commonly as a bunion. We can help in providing shoe advice, not just styles but what type of sole to wear and what heel height is best, sometimes with the application of special insoles that help re-distribute the pressure as you walk and also with silicone devices that help prevent the big toe pushing against the lesser toes.
Gout is the result of an imbalance of uric acid in the body; it affects more men than women and is an extremely painful inflammation in most often the big toe joint although it can affect other joints. The affected joint becomes very red and swollen, often overnight and is too painful to put any pressure on such as walking, this lasts 3-4 hours and then often subsides although not always. Podiatrists may suggest a visit to the GP as a prescription may be necessary to control the gout, again footwear advice and padding’s are often helpful.
Ingrowing toenails mainly affect the greater toe and can be caused by footwear, trauma, sporting activities and can even be hereditary. These often can be treated during a routine appointment however, if the nail bed is damaged this results in the nail growing abnormally up the side of the toe, the skin may become broken by the nail which could result with an infection, the toe can swell and antibiotics may be required.
Ingrowing Toenails or Onychocryptosis
Some patients have this condition for years as the nail bed will never right itself, here treatment on a regular basis is required by cutting the nail back along the side, however this is not a permanent solution. Severe pain, infection or repeated occurrence may require a minor surgical procedure which is performed under strict sterile conditions and with the aid of local anaesthetic. This procedure will cure the problem with patients comfortably walking out of the clinic.
Surgical Procedure Available
There are 3 main stages to remove in-growing toenails surgically:
- Firstly a small anaesthetic injection is given either side of the toe which is necessary to numb the area and is performed with a small dental needle. Sensation is checked to ensure complete loss of feeling temporarily. A small ring like tourniquet is then placed over the toe so that bleeding is minimal.
- Secondly, the offending side/sides of the nail are removed (or where necessary the whole nail), and a chemical called Liquefied Phenol is placed directly onto the nail bed and onto the cells that produce the offending piece of nail, this destroys these cells but only in this part of the nail bed so preventing this part of the nail from growing back.
- Thirdly, the tourniquet is removed and a dressing is put in place and the toe is bandaged.
Patients are asked to bring an open-ended toe shoe to accommodate the initial dressings which is left until 2-3 days later when it is removed by the Podiatrist at the first dressing appointment. The whole procedure takes about 20 minutes and the patient can walk out. A day of rest after is recommended. A few weeks will pass where dressing appointments are given until the toe is completely healed. It is important to note that most of the nail plate will remain with only the in-growing segment permanently removed, however the nail plate will be narrower.
Ingrowing Toenail Operation
Ingrowing Toenail Side Removal
Ingrowing Toenail Full Removal
Verrucae can be described as warts on the feet caused by a viral infection, they commonly affect children, but can affect any age group.
Here at Randell’s Footcare, we specialise in the treatment of Verrucae. There are many different treatments available; ours range from acid preparations to cryo-surgery. Cryosurgery is a course of therapy which involves freezing the Verrucae.
We are fortunate to be one of the first practitioners in the country to be able to offer Swift Microwave Therapy. Swift is a new technology, developed in the Uk. Swift uses microwave energy which is delivered through a special probe applied to the skin to treat the affected tissue. The number of treatment sessions required is determined by the type and number of verrucae present.
Swift Therapy information
Microwaves have been in clinical use for over 30 years, and are used globally in the effective treatment of cancer. Now in 2016 for the first time, this technology has been applied for use on skin lesions such as verrucae. Infected tissue can exist several millimetres below the surface. Swift delivers a precise, highly controlled energy dose. As microwaves travel into the tissue, water molecules begin colliding and creating localised heat energy – quickly destroying all infected tissue within a predetermined depth. In just seconds the treatment is complete and the healing cascade begins immediately. Treated tissue is quickly replaced, repaired and regenerated.
What is a Morton's Neuroma?
A neuroma is the swelling of a nerve due to a trauma or compression. That swelling within the nerve may lead to a permanent nerve damage. The most prevalent site for a neuroma is on the ball of the foot. The most common cause of neuroma in ball of the foot is the stress and abnormal movement of the long bones behind the toes called metatarsal bones. A puncture wound or laceration that injures one of the nerves can cause a neuroma..A small nerve passes between the spaces of the metatarsals. At the base of the toes, the nerves split forming a "Y" and enter the toes. It is in this area the nerve gets pinched and swells, forming the neuroma. Burning , sharpening , dull or throbbing pain are common symptoms. Taking off the shoe and rubbing the ball of the foot helps to relieve the pain. As the nerve swells, it can be felt as a popping sensation when walking. Pain is intermittent and is aggravated by anything that results in further pinching of the nerve. When the neuroma is present in the space between the third and fourth toes, it is called a Morton's Neuroma. This is the most common area for a neuroma to form. Another, but unfrequent neuromas can be Joplin´s neuromas, which are rare neuromas, involving the proper digital nerve of the big toe .
Physical examination, key for proper diagnosis
Your podiatrist will diagnose the neuroma and will carry out a physical examination or biomechanical assesment. Conditions that mimic the pain associated with Neuromas are shorter first metatarsal bone, stress fracture of the metatarsals, inflammation of the tendons in the bottom of the toes, joint artrhitis , or nerve compression or nerve damage further up in the foot, ankle, knee, hip, or back. X-rays are generally taken to rule out a possible stress fracture or arthritis. The x-ray will not show the neuroma. A skilled podiatrist o physician will be able to actually feel the neuroma while examing your feet. Special studies such as ultrasoundgraphy, MRI or nerve conduction studies have little value in the diagnosis of a neuroma. Additionally, these studies can be pricey and generally the results do not alter our treatment plan.
Conservative treatment as first step
Conservative treatment must be taken into account as first step . If it fails, then surgical procedures should be considered
The primary aim of the treatment is to relief the mechanical stress from the metatarsal heads where the neuroma develops, which are subjected to a high pressure.Treatment for the neuroma consists on cortisone or colagen(is getting popular in some countries , with good results) injections or chemical destruction of the nerve. Cortisone injections could be used as an initial form of treatment. Cortisone may be useful when injected around the nerve, because is can shrink the swelling of the nerve. This relieves the pressure on the nerve. Cortisone may provide relief for many months, but is often not a cure for the condition. The abnormal movements of the metatarsal bones continue to aggravate the condition over a period of time, so we need to ask patients to get some cushion-sole shoes with a wide toe box is often adequate treatment to mitigate the symptoms.Moreover, the use of foot orthosis should be considered the vast majority of times. However, for severe conditions and when the conservative treatment fails, surgery should be considered to remove the tumor.
Special padding at the ball of the foot may change the abnormal feet mechanics and relieve the symptoms caused by the neuroma.
What can you do for relief?
· Wear shoes with plenty of room for the toes to move, low heels, and laces or buckles that allow for width adjustment.
· Wear shoes with thick, shock-absorbent soles, as well as proper foot orthosis that are designed to relief the pressure off of the foot.
· High-heeled shoes over two inches tall should be avoided
· Resting the foot and massaging the affected area
· Use over-the-counter shoe pads. Padding can relieve pressure around the affected area.
· Make sure your trainers or sport shoes have enough room in the front part of the shoe and that your toes are not excessively compressed.
· Wear shoes with adequate cushioning sole in the ball of the foot.
· Avoid prolonged time in shoes with a narrow toe box or excessive heel height (greater than two inches).
We recommend that people experiencing this condition, should have a biomechanical examination at least once a year. At Randell’s Footcare we have a fantastic biomechanics podiatry team who strongly believe in prevention as the best way to keep our bodies and feet in great condition.
You should visit a podiatrist at the first sign of pain or discomfort. If left untreated, neuromas tend to get worse.
biomechanics, feet, pain, shoes
Iván Maestre, HCPC registered podiatrist at Randell’s Footcare
Information For Patients
Frequently asked questions by patients considering treatment using Swift microwave therapy.
What Is Swift?
Swift is a new technology, developed in the UK, which has been licenced for the general treatment of skin lesions in Podiatry and Dermatology. Here at Randell’s Footcare, we use Swift as a highly effective treatment for Verrucae. Swift uses microwave energy which is delivered through a special probe applied to the skin to treat the affected tissue.
What Can I Do After Treatment?
In some cases, the treated area may feel sore but will not prevent you undertaking normal daily activities.
How Many Treatments Will I Need?
This is dependent on how you respond to treatment. In some cases, you may need more than one treatment (these can be from 14 days to over a month apart depending on the response). Your Podiatrist or Dermatologist will be able to discuss this with you.
Does It Hurt?
Like many treatments for skin lesions, some minor discomfort may be experienced. Before treatment, your podiatrist or dermatologist may decide to reduce the lesion with a blade. Pain levels vary from person to person but most people undergoing Swift liken it to a pain similar to an injection or a scratch, lasting 2 – 3 seconds then quickly subsiding.
Can Anyone Receive This Treatment?
With a few exceptions, most people with skin lesions would be able to have this treatment. One of our Podiatrists will carry out an assessment prior to treatment and be able to advise you on this.
For more information on Swift Therapy please visit their website at www.treatverruca.com.
Fungal infections of the foot are very common…
Fungal Nail Infections
This is very common and can affect individual or several toenails. Nails can become thickened and/or discoloured. Often the nail becomes difficult and tender to trim,initially it may only affect one nail and maybe secondary to a trauma or damage to that nail. Usually it is slow to develop and often people assume that it is part of the ageing process or wear and tear, eventually all nails may become infected and it can also affect nails on the other foot. During treatment we can reduce the nails to near normal thickness and provide medication in the form of drops/oil that need to be applied regularly. Further appointments are spread over a certain period in order for the nails to be reduced during the treatment phase to enable the medication to work. Treatment is usually successful with the return of healthy new nail plates which are then easy to manage once again. However, occasionally too many nails are infected or the infection does not respond to conservative methods and in this case the Podiatrist will refer the patient for some oral tablets that are available on prescription. The treatment must still be monitored closely so that medication can be stopped as soon as the infection has cleared.
Fungal Skin Infections:
Tinea Pedis/ Athletes Foot
This is another very common infection, often secondary to a fungal nail infection. The skin on the soles of the feet can be very dry and flaky especially around the borders of the heels. This does not improve with moisturising creams and often gets worse. Sometimes little brown blisters are present, especially under the arch of the foot. Between the toes becomes itchy and moist and often very odorous. There is often redness associated with fungal infection both between the toes and on the soles of the foot and around the borders of the heels. Advice can be given as to which cream or spray will be the most effective in treating the infection which usually clears up within a few days.
This is when the skin around the borders of the heels becomes dry, scaly and cracked, often breaking apart causing deeper fissures which can then be very sore and can sometimes bleed.
The skin around the heel borders tends to be thicker anyway and if the skin becomes too dry and lacking in moisture then the top layers become weaker and lose their elasticity causing the skin to split and crack. This can be caused by a number of possible factors such as:
- Wearing shoes with open backs that expose the heels allowing the skin to dry out
- Shoes that put pressure on and rub the edges of the heels
- Skin conditions such as psoriasis and eczema
- Being overweight
- Diabetes which can cause dry skin
- Increasing age – skin naturally loses moisture as we get older
- Fungal skin infections, which causes drying of the skin and can affect the heels
This may include careful removal of any excessive build-up of skin especially around the edges of any fissures which will help the skin close together and heal up quickly, the Podiatrist will advise on the application of any special creams or balms that contain moisturisers for heels and how regularly to use them, your feet will also be checked for any sign of fungal infections and the Podiatrists will also give advice regarding your footwear needs.
This is a term used for inserts that fit into shoes in order to correct an abnormal or irregular walking pattern by slightly changing the angles at which the foot strikes the ground.
They are prescribed to help control abnormal foot function and / or to accommodate painful areas of the foot. There are many different types of inserts or inner-soles available, however, Podiatrists can prescribe specific insoles that help to correct specific problems and so are not to be confused with many ‘over the counter type arch supports’ that can make the problem worse because they do not fit properly or are intended for a completely different problem. Each of our feet are often slightly different let alone from patient to patient, so prescription orthotics would be the correct treatment. Orthotics help to control the position and motion of the foot during the walking cycle and although they will not change the structure of the adult foot, they may help to relieve pain and prevent the development of additional deformity giving rise to further pain and discomfort.
The plantar fascia is a strong, thick, band of connective tissue that begins at your heel (the calcaneus bone) and runs all the way to your toes (it connects at the metatarsal bones).
The tension in the plantar fascia is increased in individuals with increased body weight or who have feet with lower than normal arch height.
Plantar fasciitis may also be caused by any shortening or tightness in the calf and hamstrings muscles since increased tension in the Achilles tendon stress the fascia tissues.
Note that the term “fasciosis” or plantar heel pain is more appropriate than “fasciitis”
Plantar fasciitis is temporary swelling of the plantar fascia, while plantar fasciosis is degeneration of the plantar fascia. ... as it has been proved by researchers that there are non-inflammatory changes within the fascia, with evidence of fibre fragmentation in association with myxoid degeneration of the fascia due to mechanical problems.
The aim of the plantar heel pain treatment is to reduce the stress on the collagen tissues of the plantar fascia which includes a combination of ice therapy, collagen injections (much better than corticosteroid injection as it has been reported as a possible complication (rupture of plantar fascia) following cortico- steroid injection, so we should avoid corticosteroids). Ice twice or three times a day, 15 minutes per session, placing the heel directly onto either a plastic zip bag filled with ice, reusable cold pack or a bag of frozen peas.
To reduce the mechanical tension in the plantar fascia, we advised the patient to stretch the calf and hamstrings muscles, starting on a twice or three times daily. Another useful way to have the plantar fascia pain relieved is by using a small bottle of frozen water for 10 minutes a day.
At Randell´s footcare we also use over-the counter orthotics, such as SIDAS, Langer orthotics and we design and adapt casting foot orthosis. Casting-made foot orthosis are suggested for people who are unsuccessful or only partially successful at having their plantar heel discomfort relieved. It is a well-known fact that casting-made foot orthosis are a more permanent and successful way of treatment than OTC standard orthotics.
Most of patients can be made asymptomatic with appropriate treatments.
- Podiatrist £35
- Podiatry Assistant £25
- Home visits £48
- Ingrowing Toenail Surgery £320 one toenail
- £400 for both big toenails
- Swift microwave therapy for Verrucae £280 for 3 month course
- Additional treatments £60
- Orthotics/ Insoles from £40