Dermatology #2

WHAT ARE BLISTERS?

Definition

Blisters are painful, fluid-filled lesions, often caused by friction and pressure.

Causes

  • Ill fitting or stiff shoes.
  • Wrinkled socks against the skin.
  • Foot deformities.

What Can You Do?

Keep your feet dry. Always wear socks as a cushion between your feet and shoes. Wear properly-fitting shoes. If a blister does occur, don’t pop it. Cut a hole in a in a 0.065cm  piece of foam, place it over the area then cover with a soft gel-type ointment and protective so# gel dressing to prevent infection and speed up the healing process.

What Might A Podiatrist Do?

  • Remove the blister surface if needed. Prescribe appropriate medications, topical or oral.
  • Recommend padding, dressings and friction reducing measures.
WHAT ARE CORNS OR CALLUSES?

Definition

A corn or callus is a build-up of skin that forms at points of pressure or over bony prominences. Calluses form on the bottom side of the foot. Corns form on the top of the foot and between the toes.

Statistics

  • 65 out of 1000 people are afflicted with corns or calluses.
  • 37 out of 1000 males are afflicted.
  • 91 out of 1000 females are afflicted.

Causes

  • Repeated friction and pressure from skin rubbing against bony areas or against an irregularity in a shoe.
  • Heredity disorders.

What Can You Do?

  • Wear supportive shoes with a wide toe box and a low heel.
  • Use over-the-counter creams, avoiding any acid preparations.
  • Use a pumice stone or file to treat, if not a diabetic.

What Might A Podiatrist Do?

  • Perform a physical examination.
  • Perform x-ray evaluation if needed.
  • Perform trimming or padding of the lesions.
  • Perform surgery as indicated.
Cracked heels

What can you do about cracked heels?

Avoid footwear in which your foot will slip around, so as to avoid the friction that stimulates callus formation.  Buy shoes and sandals with shock-absorption in the soles.  Heels can dehydrate to greater or lesser degrees in open-backed footwear it is important to maintain adequate hydration by means of heel cream preparations. Avoid the use of excessively hot water in bathing or showering – it may cause your feet to perspire while doing so, resulting in loss of valuable moisture from underlying skin layers. Keep skin supple.  Hard skin can be removed by means of daily light abrasion (using a pumice stone or fine grit foot file) together with regular daily use of a heel cream containing urea.  Always moisturize at the end of the day:  applying heel cream in the morning could cause your feet to perspire excessively inside your shoes.  Consult a podiatrist if deeper cracks are present.

Never pick or peel skin on thickened heel callus. This will tear across layers, leaving uneven patches that act as a haven for bacteria, and may cause further cracking.  Never attempt bathroom surgery on cracked heels or heel callus. If cracks bleed, you may use adhesive dressings or gauze to relieve pressure on the heels until such time as you can consult a podiatrist.

Never use any form of chemical pads or metal objects (including skin “graters” or scissors) or blades to remove callus.  Your best efforts will result in an uneven surface – that alone will stimulate more callus formation by creating micro-overload areas. You may risk self-injury and infection.  All cracked heels are best treated by a podiatrist.

When should you consult a podiatrist about cracked heels?

When dry heels and/or callused cracked heels fail to respond to light abrasion, combined with daily use of a heel balm containing urea, that’s the time to see your podiatrist. A podiatrist will painlessly and smoothly remove the cracks.  He or she may apply various temporary pads to relieve the pressure.  Permanent solutions may include special heel pads or heel cups to stop sideways heel expansion, recommendation of appropriate shoes, or special accommodative innersoles to relieve pressure, or orthotics to correct or accommodate functional problems of your foot structure or gait.

If callus only seems to appear on one side of your heels, or more so on one side of your heels than another, you may have an anatomical or gait imbalance.  These are common problems in biomechanics, which podiatrists are trained to treat.  Your podiatrist is qualified in dermatology of the foot, so consult a podiatrist should you have psoriasis or eczema.

Ask your podiatrist to simply assess your shoes and your heels if you’re uncertain.

Untreated cracked heels can result in complications.  The most common is development of other callused areas under the foot as you change your posture and/or gait to avoid further pressure on your cracked heels.  You may even develop knee, hip or back pain.  Cracks may deepen to the dermal layer, resulting in bleeding.  Open cracks can become infected with viral, fungal and/or bacterial infection.  In diabetics and persons suffering from poor circulation, healing is slower so cracked heels should be avoided.  Always seek professional help.

What should you know about footwear to prevent cracked heels?

Look for a good fit at the heel area. Remember that pressure or friction is the cause of callus in the heels.  In the case of open-backed styles, poor fit may result in part of your heel constantly stepping on the edge of the shoe or sandal.

Styles that improve fit are those that grip around the heel (either closed heel or strap) plus a fastening or closure across the instep of the foot.

Shoes that are too wide will cause shearing stress under the foot as it slides around in the shoe, causing callus to build up under the foot.  Look for a style with suitable fastening across the instep of a shoe to prevent the slide.

Shoes that are too narrow in the heel will pinch the edges of the heel, causing hard ridges of callus.

Shoes made from leather and breathable materials are best since they neither contribute to dehydration nor excessive sweatiness of the feet.

Thin soled shoes or shoes without innersole cushioning will transfer all the ground reaction forces of hard impact with man-made surfaces directly into the bones of your feet, causing the stimulus for callus formation.

What Are Chilblains?

Chilblains show up as red, inflamed, painful patches of skin–particularly on the toes, fingers, ears, or nose.

What Causes Chilblains?

Failing to protect or properly cover extremities with a hat, gloves, and footwear in cold and humid weather is one of the quickest risk factors in developing the condition–especially if the cold, exposed skin is suddenly exposed to much warmer air afterward.

Some experts believe that when the blood vessels in extremities are rewarmed suddenly, the small blood vessels expand more quickly than the large blood vessels, ultimately causing a bottleneck that results in blood leakage into the surrounding tissue.

Risk factors

  • tight clothing, or clothing that exposes skin to the elements during cold weather
  • Men are more likely than women
  • people who are underweight
  • people who live in areas that are not just cold but humid
  • Raynaud’s
  • Diabetes
  • circulatory disorders
  • Smokers

Symptoms of Chilblains

If you have the following symptoms, you may be experiencing chilblains:

  • Red patches of skin, particularly in the toes, fingers, nose, ears, or chin
  • Swelling that is accompanied by pain, itching, or a burning sensation
  • Blisters sometimes, but not always, accompany chilblains
  • Erythema (this means that when you press a finger down on a reddened area of skin, then let go, the area stays white for several seconds)
  • Skin discoloration (skin may turn blue or purple in severe cases)

Chilblains may appear and reappear several times throughout the course of a winter, and may even resurface over the course of several years in response to exposure and cold.

 Complications of chilblains

If you have severe or recurring chilblains, there’s a small risk of further problems developing, such as:

  • infection from blistered or scratched skin
  • ulcers forming on the skin
  • permanent discolouration of the skin
  • scarring of the skin

Preventing chilblains

If you’re susceptible to chilblains, you can reduce your risk of developing them by:

  • limiting your exposure to the cold
  • looking after your feet
  • taking steps to improve your circulation

If your skin gets cold, it’s important to warm it up gradually. Heating the skin too quickly – for example, by placing your feet in hot water or near a heater – is one of the main causes of chilblains.

The following advice should help:

  • stop smoking– nicotine causes the blood vessels to constrict, which can make chilblains worse
  • keep active– this helps improve your circulation
  • wear warm clothes and insulate your hands, feet and legs– wearing long johns, long boots, tights, leg warmers or long socks will help, and it’s a good idea to wear a clean pair of socks if you get cold feet in bed
  • avoid tight shoes and boots– these can restrict the circulation to your toes and feet
  • moisturise your feet regularly – this stops them drying out and the skin cracking
  • eat at least one hot meal during the day– this will help warm your whole body, particularly in cold weather
  • warm your shoes on the radiator before you put them on– make sure damp shoes are dry before you wear them; if your feet are already cold, make sure your shoes aren’t too hot to avoid causing chilblains
  • warm your hands before going outdoors– soak them in warm water for several minutes and dry thoroughly, and wear cotton-lined waterproof gloves if necessary; if your hands are already cold, make sure not to warm them up too quickly to avoid causing chilblains
  • keep your house well heated – try to keep one room in the house warm and avoid drafts
  • if you’re diabetic, regularly check your feet(or ask someone else to do this) – people with diabetes may not be able to feel their feet and could have infected chilblains without realising it

 Medical Intervention

While most cases of chilblains will heal without medical help, keep a close eye on any blistering. If you think your chilblains might be infected, or if you are experiencing high levels of pain, seek medical attention. You also may want to involve the podiatrist if you have complications like diabetes. Your podiatrist  may prescribe a topical corticosteroid to the affected skin, or blood pressure medicine to help open up affected blood vessels.

Sources : www.scpod.org/foot-health/common-foot-problems/chilblains/ & https://www.nhs.uk/conditions/chilblains/