No mean feet

Our feet are at the end of our bodies in more senses than one - literally of course, and also at the receiving end of the extremely hard work we expect them to do for us and the tough, sometimes rough, treatment that we dish out to them.

Even without any strenuous activity we walk on average about four miles every day, or about four times around the planet in a lifetime, and each day we subject our feet to a cumulative force equivalent to several hundred tons. On top of that we do not always treat our feet with the consideration they deserve, squeezing them into fashionable but ill-fitting and uncomfortable shoes and generally overlooking their welfare.

So it is no wonder that we sometimes have problems with them. However, these can mostly be avoided with a few sensible and simple measures (see Panel 1) and, when something does go wrong and a minor foot problem develops, they can usually be effectively dealt with by products that you can buy in a pharmacy. This article will look at common foot ailments and their treatment, give some tips on how to keep feet healthy, and suggest when you might need to get help from a chiropodist or a doctor for a foot problem.

Athletes foot
Cause: This common nuisance is caused by a fungus infection, and around one in two of us can expect to get it at some time in our lives. The infection gets its name from the fact that it is easily picked up in places with shared facilities and moist floors, such as changing rooms in gyms, sports clubs and swimming pools. It can also be caught from sharing someone else's shoes or personal care items such as towels or wash cloths. People with moist, i.e. sweaty, feet are more likely to be sufferers.

How to recognise: The infection is usually first noticed as itching between the toes, starting at the small toe; the skin becomes soggy and whitened, then red and inflamed and blisters may form. The infection can spread over the sole and top surface of the foot and affect the toenails, but a chiropodist or doctor should be consulted if things progress this far.

Treatment: (To reduce the chances of getting athlete's foot, see Panel 2.) Effective over-the-counter treatments are available in the form of creams, sprays and dusting powders. They contain anti-fungal agents, the most effective of which are probably those belonging to a group called azoles, and terbinafine. Older products containing tolnaftate and undecenoic acid are also effective, and slightly cheaper, although they may have to be used for longer. Some creams also contain hydrocortisone to directly reduce itching.

Anti-fungal products are applied to freshly washed and dried skin twice a day, and with most products treatment should be continued for two weeks after the symptoms have cleared to make sure that all the fungus has been killed off. One of the azole creams, containing bifonazole, requires only one application a day, and terbinafine cream and spray need only to be used for one week. Anti-fungal dusting powders are useful to dust inside socks to prevent re-infection, particularly for people who have sweaty feet, and who tend to get recurrent attacks.

Verrucas
Cause: Verrucas are warts that grow on the sole of the foot and under the toes. The pressure put on them by standing and walking squashes them down into the skin, pressing on nerves and making them painful. Like athletes foot, verrucas can be picked up off of the floors in swimming pools, showers and changing rooms. Children and adolescents are most prone to infection, as resistance to the virus builds slowly with age.

How to recognise: A verruca looks like an area of hardened skin, often with a dark spot in the centre. It is painful when pressure is put on it. It can be distinguished from dry skin by rubbing the surface gently with an emery board or file, when dark pin-point spots, which are the ends of small blood vessels, appear.

Treatment: Verrucas will usually clear up on their own in time, but it can take up to two years and most people do not want to wait that long, especially if there is pain. The process can be speeded up using verruca treatments available in a pharmacy, but patience and persistence are needed. These preparations contain mildly corrosive substances such as salicylic acid and lactic acid that work by slowly destroying the skin containing the virus. Most preparations come as paints that dry to form a plastic skin when applied, this seals the active ingredient in place over the affected area and stops it spreading to unaffected skin where it might cause damage. Gels and ointments are also available.

The preparations must be used regularly, usually every day, until the verruca is completely gone (for details, see Panel 3); if any infected skin is left the virus will grow back. Deep-seated verrucas may have to be removed by a podiatrist by freezing or laser treatment.

Corns and calluses
Cause: Corns and calluses are areas of thickened skin caused by friction, often from badly fitting shoes.
How to recognise: 'Hard' corns form on the tops of the toes and the outside of the small toe. They are small, shiny, well-defined areas of hard skin, and cause sharp pain when pressure is put on them.

• 'Soft' corns occur between the toes and are caused by toes being squashed and rubbed together. They are white and rubbery, due to the presence of moisture from sweat, and they cause soreness.
• Calluses form on the ball of the foot. They cover larger, less well-defined areas than corns and cause a burning sensation when pressure is put on them.

Treatment: There are three ways to get rid of corns and calluses:

1. With gentle friction. Soften the area first by soaking in soapy water, then rub soap onto a foot file, pumice stone or chiropody sponge, and gently rub the corn or callus with it for five minutes. Repeat every night for a week.
2. With hydrocolloid plasters. These contain a gel-like substance that absorbs moisture from the skin and forms a soft cushion, and they put water back into the hardened skin to soften it up. The plaster is left on for a week, and when it is removed the corn or callus should come away with it.
3. With corn plasters or paints. These usually contain salicylic acid, which softens and gradually destroys the hardened skin. They are usually applied daily for about a week, after which the hard core of the corn or callus should come out easily.

Bunions
Cause: Bunions are caused either by a weakness in the big toe joint, or by pressure on the joint from badly fitting shoes.

How to recognise: The big toe is gradually pushed out of line and up against the other toes. The area around the joint at the base of the toe becomes inflamed and painful, and a fluid-filled sac may develop as a cushion to protect the joint.

Treatment: Professional advice is usually needed, but comfortable, broad shoes with low heels and protective padding will help to relieve pain and discomfort.

Ingrowing Toenails
Cause: Ingrowing toenails are most commonly due to cutting nails too short and rounding the corners.

How to recognise: A spur on the edge of the nail starts to grow into the flesh of the toe causing inflammation and pain, and often infection.
Treatment: Attention by a chiropodist is essential, but cutting toenails straight across and not rounding the edges will help to avoid the problem happening in the first place.

Sweaty and smelly feet
Cause: Our feet contain about 250000 sweat glands, so some perspiration is to be expected. However, some people's feet sweat excessively and bacteria then act on it to produce a smelly breakdown product

How to recognise: People with a problem will notice that their feet sweat for no reason and the skin is white and clammy. Their feet may become stained from the dye in their footwear, and their shoes, socks, etc. may get damaged by sweat. Their feet and shoes will give off an unpleasant smell, and the moistness can encourage athletes foot.

Treatment: The worst effects of sweaty feet can be reduced by frequent washing and changing socks and tights, etc. Antiseptic and anti-fungal dusting powders can be used inside shoes and hosiery. Sufferers should wear shoes and hosiery made from natural materials, as these allow air to reach the feet better than synthetics, and they should change them frequently. Moisture absorbing and deodorising insoles are also available. Formalin and potassium permanganate foot soaks can be used in more serious cases, but it is best to use these under the supervision of a chiropodist.

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