Routine Nail Care
Professional nail cutting service is available to patients who have mobility issues, where they face difficulties in bending and reaching their feet. This service is also rendered to those who are unable to cut their nails due to poor vision and those facing difficulty in cutting nails because of thickening due to trauma, age or fungal infections.
The service is extended to those who suffer from diabetes or who are on blood thinners or those that just require a professional nail cutting service.
Nail care is also available for those who have traumatised their nail leading to partial avulsion (tearing off) and for sub-ungula haematomas (blood blisters under the nails).
Ingrown Toenails (Onychocryptosis)
An ingrowing toenail is where a splinter of nail grows into the flesh. These are extremely painful and are usually but not always found on the big toe. They are often caused by poor nail cutting – usually by cutting too short down the sides of the nail leaving a spike of nail which as it grows forward pierces the flesh. This leads to a break in the skin and the person often develops an infection as the bacteria enter through the break. It may also be caused by trauma and is more common is people who have weak nails that break more easily. The person can often not touch the toe or wear closed toed shoes and even the sheets or bedclothes resting on the toe can cause pain. Active sporty people are prone to them as are young people who pick their toenails.
Treatment by a podiatrist sooner rather than later is better. The longer the nail is left to grow in the more swollen the toe becomes and there is increased likelihood to catch an infection. Home ‘surgery’ is not recommended as people tend to cut the nail further back leaving a deeper spike that is then more difficult to remove. If treated early by a podiatrist the offending portion of nail can be removed simply without anesthetic. The forward growth can then be monitored on a regular basis until the nail has fully grown out again.
If the ingrown toenail is very advanced as in the picture a minor operation may be necessary which involves a local anaesthetic, removal of a small portion of the nail and a chemical to kill to root to stop the nail re-growing. Healing takes place in 3-4 weeks and usually leaves a normal looking nail.
Ingrown toenails are often confused by the public with involuted nails. This is where the nail is excessively curved instead of being flat. Pain is caused along the sulcus (side edge of the nail) as pressure from the nail and often from the shoe cause a build up of hard skin in the area. This needs to be removed by a podiatrist. It is usually a chronic condition
Corns & Callus
Corns and callus can occur on any part of the foot and can range from a mild callus under the foot, to a corn that can develop into an infected ulcer in the case of a person who has reduced blood flow to the feet. Callus is a thickening of the skin in response to high pressure or increased friction. It is actually a normal response to the external forces and is the body protecting itself. The callus eventually becomes painful if it becomes too thick or if a corn develops.
Callus tends to form over larger areas on the soles of the feet. Some of the causes of callus are an underlying problem like a bone deformity, a particular style of walking, loss of fat pad from under the feet or poorly fitting footwear. Some people have a natural tendency to form callus due to their skin type. A podiatrist can painlessly remove corns and callus and give advice on how to help prevent it from happening again. The removal of callus has been shown to reduce high foot pressures by up to 26% (Young et al, 1992).
There are several types of corns. The most common type of corn is the hard corn, which is a small conical shaped area of hard skin that usually forms on the tops of the toes, on the outside of the little toe, or on the sole of the foot. They penetrate deeper into the skin and are the most painful type. Soft corns are usually found between the toes where the skin is moist and are rubbery in texture.. Seed corns are tiny corns that are usually painless and are often found with people who have dry skin. Vascular and fibrous corns are uncommon and are usually found when people have had corns over long periods of time and have left them untreated.
It is not advisable for people to cut their own corns and corn plasters and paints should not be used by those with diabetes or circulatory problems. Self treatment can cause injury in the form of cuts and wounds, and this can be highly dangerous for people in these groups.
A podiatrist can remove the corns and give advice on how to help prevent them from reoccurring. Pressure redistribution and compensation for underlying biomechanical problems with custom made orthotics will slow down the return and sometimes stop the growth of corns and callus
Heel Callus and Fissures
Hard skin and cracking around the heels is a common and unsightly problem that both men and women suffer from. It is particularly prevalent in Singapore due to the environment we live in.
Walking barefoot on hard floors increases the rate at which hard skin grows, air-conditioning dries the skin and there is an inclination to wear more open back shoes such as flip-flops, sandals and mules due to the hot climate. Other factors that must not be overlooked which can contribute to callous formation include naturally dry skin, being overweight and prolonged standing especially on hard floors. It is also important to be aware that underlying medical conditions such as diabetes and skin conditions such as psoriasis and eczema may also contribute to the problem.
In some cases if the skin is left to grow too thick deep crack appears within the callous this is known as a fissure (see photo). If particularly severe and deep this may bleed and be prone to infection. In this case it is advisable to seek the help of a qualified podiatrist for treatment. This will involve addressing the underlying cause of the hard skin, careful debridement of all callous and advice on dressings, strapping, footwear and prevention of re-occurrence.
Plantar Warts (Verrucae)
Verrucae are caused by an infection by the human papiloma virus (HPV). They are spread through direct contact. They are more easily picked up by those with very moist or very dry skin which tends to lead to small invisible breaks or openings in the skin which makes it easier for the virus to penetrate.
Initially they may appear as a small dot but later may get small black dots in them (bleeding into the skin) or turn brown in colour. They can grow up to one centimetre in diameter and sometimes form in clusters known as mosaic verrucae. If on non-weightbearing areas of the feet they can protrude above skin level and may have a ‘cauliflower’ appearance.
Verrucae are common in children and those who have poor immunity. They are usually painless unless they are over a high-pressure area such as the ball of the foot. They can be left untreated and may disappear on their own in time, however in Singapore’s moist humid environment they tend to spread more easily so it is wise to keep a close eye on them.
The podiatrist will discuss the different treatment options for you and this may involve cryotherapy (freezing), home treatment, and strong acid treatments or in more resistant cases referral for laser treatment. Advice on how to reduce the spread of the verrucae will also be given.
Fungal Infections (Athlete's Foot)
Fungal infections are common in Singapore due to the humid environment. They can start off as dry flaky skin or small blisters and can lead to intense itching, cracking, blistering, redness, and in between the toes, soggy white skin. They are commonly picked up in showers and changing rooms. People with very dry or very moist skin are more prone to infections. The fungus can also spread to the toenails causing discolouration and thickening and can be transferred to other areas of skin such as the groin and hands. The podiatrist will advise you on treatments to get rid of the infection and steps to help prevent re-occurrence.
In the case of nail infections they may also cut back the infected area and drill the nail to make topical treatments more effective.