Psoriasis under the toenails

Psoriasis under the toenails can result in severe thickening, discoloration and pitting of the toenails. Learn how to make your toenails better!

Psoriasis under the toenails and fingernails

Causes of psoriasis under the toenails

The cause of toenail psoriasis is unknown. What we do know is that a good percentage of people suffering from psoriasis also develop nail problems as well. The reports vary with some saying only about 10-15% suffer from them, but other studies claim much higher numbers. The average seems to be around the 25% range.
You are more likely to have psoriasis under your toenails if:

• You have had psoriasis longer.
• You are older in age.
• Your psoriasis is more severe.

Symptoms of psoriasis under the toenails:

Toenail psoriasis displays the following symptoms:

• A discoloration beneath the nail. It is described as an “oil spot”.
• The nail is much more thick.
• The nail is extremely rough.
• The nail displays characteristic pitting.
• The distal part of the nail appears abnormal.
• Beau’s lines – these are horizontal ridges.
• Callus formation under the nail.
• Loosening of the nail.

Diagnosis of psoriasis under the toenails:

The toenails are graded by a system known as the Nail Psoriasis Severity Index (NAPSI). It is a numerical and reproducible system for monitoring the toenail psoriasis. The system is based on assigning numerical values for some of the symptoms listed above.

Home treatment for psoriasis under the toenails:

Some Quick Tips for Home Care:

• Keep your nails short and smooth. They are susceptible to bacterial and fungal infections which could make them look much worse.
• Wear gloves to protect your nails while you are performing activities to keep your nails protected.
• Wear properly fitted shoes to avoid excess pressure on your nails. Even light irritation and inflammation can make things worse.
• Make sure to dry your nails properly after bathing.
• Nail psoriasis is hard to treat, as nails grow very slowly. Be careful with them! They only grow 1mm per month.
• You can try topical steroid cream temporarily to improve nail appearance.
• Taking Vitamin D Vitamins may help.
• Moisturizing ointments at night before bed work well.
• Soak nails in vegetable oil while watching TV. You can then use an emery board or nail file to take the nails down a little bit.
• Synthetic nail hardeners can make the nails look much better. These are glossy covers, no one will know the difference!
• Acrylic nails are dangerous because you are more susceptible for nail fungus already with your psoriasis- I don’t recommend these.
• Salicylic ointment can work great for your psoriatic nails. Follow directions of your prescriptions.
• A mutlivitamin- while not completely proven through medical trials, has been recommended by many specialists.

Podiatrist treatment

There are many advances that are occuring in this field, so get excited! The outlook for psoriasis, while still dim is looking better and better every year.
Treatments focus on managing symptoms with a rheumatologist. Individualized plans can included topical and intralesional creams and injections. You can combine these with systemic and combination oral medication therapies.

Check this link for more information about psoriasis under the toenails.

Do you suffer from plantar fibroma?

Plantar Fibroma: It presents as a hard lump or nodule under the skin in the arch of your foot. Learn how to handle it easily and permanently!

Photo Credit: Shenandoah Podiatry

What is a plantar fibroma?

A plantar fibroma is a relatively non-dangerous condition; but it can become extremely painful. A plantar fibroma is the development of what feels like a “pebble” of connective tissue. It could even feel like a much larger thickening of the cords at the bottom of your foot.
These nodules are extremely slow growing. It could take months to years before they even begin to irritate you. They eventually lead to more and more irritation. Eventually causing your toes to bend and stiffen because you adapt your biomechanics and walk improperly.

Plantar fibroma symptoms:

• Usually on the inside bottom of the foot, near the highest point of the arch.
• The lump itself is usually pretty painless.
• Only the pressure of the floor creates pain.
• Only 1/4 people show it in both feet.

Plantar fibroma risk factors:

• Family history.
• Associated lumps in hands as well.
• Associated with Ledderhose disease: Nodules in the hand.
• Associated with Peyronie’s disease:  Nodules on penis shaft.
• Diabetes Mellitus.

Plantar fibroma treatment:

Treatment of the plantar fibroma depends on whether your goal is to make the pain go away, or to focus on making it disappear. The unfortunate news is that usually invasive means are the only way to make it go away permanently.

1) If the nodule is small:

Treat this like plantar fasciitis to see if the symptoms get better, we have developed a 4 stage guide that will take you through the complete treatment of bottom of the foot pain. Use this only if the nodule is small!
Non-invasive options:

• Anti-inflammatory medication.
• Accommodative orthoses.
• Offloading padding.
• Physical therapy.
• Massage techniques.
• Corticosteroid shots can relieve the pain

Plantar fibroma four stage treatment guide.

2) If the nodule is large:

These techniques should be reserved for the end stage of this disease. The consequences of surgery must be balanced; while the fibroma is gone, worse problems may develop.

• Corticosteroid shots can relieve the pain.
• Surgical resection of the plantar fibroma. This is a very rough option, as a part of your plantar fascia would need to be removed to permanently get rid of it. This may eventually impact your biomechanices and lead to flat foot.

For more information about plantar fibroma and its treatments visit this link.

Do you have foot wart (verruca) pain?

A foot wart, verruca or plantar wart is no different than a wart on any other part of the body. These warts eventually go away by themselves, but they are potentially contagious and could stay around for a couple years; treatment is usually recommended to decrease the length of pain, the duration of pain and to decrease the chance of transferring it to other parts of the body.

 

Cause of a foot wart or verruca

• HPV (Human Papilloma Virus) is the cause of warts.
• The virus can stay alive for many weeks without a host ,especially in the shower!
• The wart enters through microscopic cracks in the skin of the foot or the fingers.
• If a cluster of warts forms, it is called a Mosaic wart which can create extremely large surface areas.
• It is completely normal to get a wart – most warts occur in 12-16 year old children, but are very rare in older age.

Symptoms of a foot wart or verruca

• Not usually painful although may be tender when pressed, especially from the sides.
• The verruca may feel like a small stone under the foot.
• It looks different from a callus because of little red pin like dots- a callus looks like normal but thicker skin.
• There is usually a callus that forms around the wart.

Diagnosis of a foot wart or verruca

• Verrucas vary in size from a 1mm to over 1 cm and may vary in shape too.
• The surface of the verruca is usually covered with small black dots (blood vessels).
• They are usually surrounded by hard skin.
• There is usually nothing ever really tricky about diagnosing a wart.
• If the wart is really large then it is a more resistant mosaic wart that needs more attention.

Prevention of a foot wart or verruca

• Warts and verrucas are very common and nothing to get worked up about (especially ages 12-16 years old), although they should be treated as they are mildly contagious.
• They are only passed on via direct skin to skin contact and can be passed to other people or to other areas of your body (although this is more common when warts appear on the fingers).
• There is a higher risk of passing a verruca  if the skin is damaged or wet.
• Swimming pools are common infection area for verrucas.
• To avoid passing on a verruca, make sure it is covered when you go swimming (either buy a waterproof plaster, duct tape or special verruca sock), wear flip flops when walking barefoot and in the shower and don’t share towels.

Home treatment of a foot wart or verruca

There are many available treatment methods without a clear winner, because even doing nothing after a little while will make the wart go away! Studies show that you can make them go away a little bit faster and some of the best treatments achieve 70-90% cure rates within a couple weeks. If you have a mosaic wart then the chemical treatment approaches are recommended.

1st line therapy of a foot wart or verruca

- Duct tape is my favorite method to try first!

A) Duct tape treatment

This is a controversial treatment method, some scientific literature states that it works great and it can resolve the majority of warts over a couple weeks, but then other papers say it does not work at all. I say whats the harm in trying it! This method has always worked for me, and if it didn’t work in the future- you can always move on to the other treatments!

B) Apple cider vinegar treatment

- Theoretically this should work, there will be some pain! Compare this to the duct tape method which is slower, safer and has no pain.

C) Salicylic acid

- This medication is known as a keratolytic agent which works by “loosening” the surface of the wart. Use this medication as directed by your pharmacist or your podiatrist.

2nd line therapy

- All of these have shown to be effective, but it is unclear which is the best (which means none of them are clearly better than any other). Canthardin and Cryosurgery are the most commonly used in podiatrist offices.
- Canthardin- This is a more painful but more effective agent than salicylic avid. It causes a blister to form within a day or so of application to your blister.
- Cryosurgery- The wart is touched by a liquid nitrogen swab. This freezes the cells of the wart destroying the tissue and stimulating new tissue to come up behind it. This sounds a lot more intense then it really is!
- Immunotherapy- This is a fairly new treatment that involves injecting something (any dead foreign particles that are not dangerous) that irritate your immune system to attack this area. As a “coincidence” the immune system cells wipe out the HPV virus that is causing the wart.

3rd line therapy

- The most common method is to cut the wart out and then use electricity to singe the underlying tissue under anesthesia.
- If the wart is extremely resistant consult a podiatrist about invasive treatment. These treatments are usually reserved for warts that have survived the first and second lines of treatment.
- Surgery- This can be done inside the office if the foot is not massive, but if it is a large mosaic wart- then the OR is usually necessary. The foot is numbed with anesthetic, then then the wart is simply cut out down to bleeding. The tissue is then heated to close it up; don’t worry, you won’t see whats happening! The wart can be considered as good as gone at this point and while there will be a scar, it should not be something that ever bothers you.
- Electrocautery- this is combined with surgery to burn the area where the wart used to be.
- Laser Surgery- It is a choice, but from what I have heard and seen it is more expensive than practical.

For more information about foot wart or verruca visit this link.

Do you suffer from painful and sore blisters on foot and toe?

Painful and Sore Blisters on the Foot and Toe should be offloaded to reduce damage and pain.  Focus on relieving shear pressure and decreasing friction!
Painful blisters on the foot and toe  are a common problem caused by friction from shoes or clothing which rubs repeatedly on the skin. Blisters usually do resolve by themselves if they are small and you stop putting stress on them, but if a blister is larger and has some obvious fluid buildup as seen above- then it might just be best to drain it so that more pressure doesn’t spread the blister. The following is a complete guide for treatment of itchy foot blisters, prevention and foot accessory advice.

Preventing sore foot blisters

• Ensure that shoes fit correctly.
• Protect the potential ‘hot spots’ by applying a second skin and / or taping. Click here for details of how to tape the foot.
• If you wear boots such as those required for mountain walking ensure all seams are flat inside the boot.
•  Take care of the boots, do not leave them on radiators or near heaters. This may cause the leather to shrink and seams protrude.
• Keep feet as dry as possible. Wet shoes, boots and socks will cause blisters far quicker than dry ones.
• Wherever possible change socks regularly and use foot powder to help keep them dry.

Taping for foot blisters

Painful and sore blisters on the foot and toe

Running and painful foot blisters

Blisters are common among long distance runners. All of the above can be used to help prevent developing blisters, but there are a couple of extra points which may help:

• Introduce new running shoes gradually.
• Wear socks with a double layer. The second layer stops the first one from rubbing against the skin.
• Try using petroleum jelly on areas prone to blisters. This helps the material glide over the skin, reducing friction.
• Try using zinc oxide tape on blister prone areas to prevent friction on the skin.

What are blood blisters?

• Blood blisters are those which appear red in color due to damage also occurring to a blood vessel, causing a bleed into the skin tissues.
• They tend to occur more from a sudden impact or pinching of the skin, rather than a repetitive friction.
• This type of blister should be treated in the same way as a normal blister, although be aware that due to the deeper damage, the skin underneath would be raw and usually very sore and more prone to infection.

Treatment of painful and sore blisters on the foot and toe

• Most small blisters should be left alone and they will usually heal fine on their own.

At the first sign of painful and sore blisters on the foot and toe

• The first sign of blisters will be redness over the skin, possibly at the back of the heel, the instep or toes.
• Apply a second skin dressing or blister plaster and tape the affected area.
• Ensure the feet are dry and change socks (unless you are in the middle of a race).
• A highly effective but short term measure is cover the foot and affected area in petroleum jelly. This should provide instant relief from pain but as the heat from the foot melts the petroleum jelly it will run away and be ineffective.
• When should you pop blisters?

For larger blisters or those which are causing problems, it may be necessary to pop them. Popping blisters should be done with caution, following these guidelines.

• Make a small hole at the edge with a sterilized pin or needle, particularly if the blister is on a weight bearing surface. A pin can be sterilized by passing it through a flame.
• Do not drain a blood filled blister.
• Drain the fluid but leave as much of the skin as possible covering the wound. This is an important protective layer for the underlying skin and will help to prevent infected blisters.
• Clean the blister with a sterilizing wipe.
• Cover the wound with a second skin or blister plaster – take the time to apply it correctly.
• For additional security apply tape over top.

How to get rid of painful and sore blisters on the foot and toe?

• Blisters will usually just drain and heal on their own. Even if you have had to pop a blister, you should then simply clean the area, cover it to protect it and leave it to heal naturally.
• If no pain, leave them alone!

To learn more about blisters visit this link. Good luck with your painful and sore blisters on the foot and toe!

Do you have heloma molle?

Heloma Molle – Another name for this is the foot corn, and it is experienced as a hard painful skin bump! Learn what it is and how to treat it!
AKA Foot Corn or Heloma Durum.

What is a heloma molle?

A heloma molle is a uniquely shaped callus that resembles a corn kernel. Because of it’s shape, the corn concentrates the pressure into a pinpoint area. This causes deep tissue pain and possible ulceration.

Heloma durum vs. heloma molle:

A heloma durum is a hard corn, while a heloma molle is a soft corn. This is usually just semantics as both are usually treated very similarly; except the durum may need to be softened slightly more ahead of time.

Diagnosis of a heloma molle:

• Thick and hard skin.
• Deep tissue pain.
• Shaped like a corn kernel.
• Pinpoint pressure rather than diffuse pressure.
• Hurts when you push on it.
• It does not have red dots like a wart.
• Usually in the ball of the foot, base of the big toe or 5th toe.

Foot Corn (aka Heloma) vs Callus

• Callus formation can be large and spread out. A corn is more pinpoint, small and hard.
• Corns usually occur on the ball of the foot, under the first toe, the fifth toe and on top of the toes (especially if you have hammertoes). A callus usually occurs in the forefoot, but is usually very spread out.
• Both can occur together- it is necessary to take the callus down then pop out the corn.

Corn vs. wart

Warts have little red dot’s due blood vessels, corns and calluses do not.

• Skin lines go through a callus, whereas if you have a wart, the skin lines go around the wart.
• A wart can display little red “dots” that are blood vessel growth into the wart. The callus should not have any red “dots”.

What causes a heloma molle?

• Wearing loose, old or poorly stitched shoes.
• If you ever have to really tighten your laces to get a snug fit.
• High heels that can cause pressure or friction.
• High arched feet form calluses under the first toe, fifth toe and under the heel.
• Flat foot is the primary cause of increased pressure in areas of the foot, especially everywhere in the forefoot and inside part of the big toe and heel heel.
• Rubbing in of the tops of the toes against a tight shoe is also a leading cause of corn formation in the toes.
• The main cause: all types of biomechanical or foot deformities.

Home treatment guide

There are two + one steps to keep foot corn pain away. You have to get rid of them and then take measures to keep them away!

1) Stop them from appearing. 

2) Removing the actual corn.

3) Foot corn removal surgery

Please visit this link to learn more about heloma molle and its treatment.