Nail & Skin problems

Ingrown toenails are caused by a number of things, like poor cutting technique, low-quality footwear or abnormal nail shape. Your nail starts embedding itself into the skin, and this causes a painful irritation.

At The Foot & Posture Clinic, our first focus is assessing the level of irritation or inflammation, and we have a number of treatments available, to get rid of your skin and nail problems.

Non surgical nail avulsion and surgical nail avulsion.

The procedure is generally performed under local anaesthetic via injection into the toe to numb the area. The anaesthetic will most often wear off in about two hours.

Once numb, a tight elastic ring called tourniquet is applied to the toe to control bleeding and the area is prepped to minimise the risk of infection.

The portion of nail to be removed nail is then gently lifted and resected, generally without the toe being cut or stitched. Both sides or the entire nail may be removed this way. A chemical is used to assist in preventing nail regrowth.

Once the procedure is completed, the tourniquet is removed, and a sterile surgical dressing is applied. The patient is able to walk immediately afterwards, however, assistance getting home is strongly recommended.

A person can help speed their recovery after ingrown toenail surgery by:

• soaking the foot in warm water or Epsom salts every day
• taking a nonsteroidal anti-inflammatory drug (NSAID) to help with pain and swelling
• applying an antibiotic ointment twice daily or as often we will recommend, if there is an infection
• keeping the wound bandaged until it heals, which usually takes few weeks
• keeping the wound clean and dry, except when showering or cleaning the area
• avoiding strenuous activity that puts pressure on the nail
• wearing properly fitted shoes that are not too tight
• avoiding picking at the wound

For most people, the wound will heal within few weeks. The pain will steadily lessen in the days following surgery and should have gone by the time the wound heals.

All surgical procedures have some risk of complication; however, this procedure is associated with a low rate of complications.

• Toenail deformity. Toenails may grow back misshapen or deformed. In some cases, they might not regrow, or they may not reach their previous length.
• Subsequent ingrown toenails. Removing one ingrown toenail does not necessarily prevent a person from developing future ingrown toenails. In some cases, a person might need another surgery or even multiple surgeries.
• Infection. A person may develop an infection following surgery. Surgery creates an open wound that makes it easier for bacteria and other pathogens to enter the body. It is important to report to your doctor or podiatrist for any signs of infection following surgery because untreated infections can seriously damage the toe or lead to amputations.
• Anaesthesia complications.  Have an adverse reaction — such as an allergic reaction — to local anaesthesia.

To help stop ingrown toenails:

• Do not cut your toenails too short
• Cut straight across the nail, not the edges
• Do not wear shoes that are too tight or do not fit properly
• Keep your feet clean and dry them thoroughly

Verrucae pedis is the most common viral infection of the skin and is caused by the Papilloma group of viruses. The virus tends to thrive in damp conditions and is mainly transmitted in communal areas such as swimming pools and gym floors through direct contact with the skin.

The virus is contagious and gains entry to the body through micro-injuries to the skin. This can easily take place through barefoot activities, especially when the skin has been wet for some time as in swimming or due to sweating after intense exercise followed by showering.

To help prevent verrucae, always take sensible precautions in communal changing areas, such as not walking barefoot i.e. wearing flip-flops or verrucae socks to avoid infection. As a rule, if a verruca appears cover it with a plaster.

If you are sure you have a verruca you may decide to try an over the counter verruca treatment for 4
to 5 weeks. If is not solving the problem or If you have multiple verrucae, or the verrucae is
spreading or growing rapidly please sick help from your Podiatrist. If you are not sure what the
lesion is, we recommend that you see a Podiatrist to make a firm diagnosis prior to commencing any
self-treatment.
Treatment options vary from chemical therapy to dry needling.

Needling is a procedure where the verrucae/wart is punctured with a small needle to cause bleeding and stimulate the body’s immune system to resolve the problem. Needling is proving to be the most reliable treatment for the removal of warts and is very practical for the busy person who cannot come in for regular sessions.

Acids and Cryotherapy involve multiple appointments which can add up a lot of time out of work and expense and rely on the
patient being fit and healthy.

The procedure is performed under local anaesthetic to ensure the foot is completely numb before proceeding.
Having established that the area to be treated has been completely anaesthetised a hypodermic needle is used to repeatedly puncture the verruca. This pushes verrucae tissue from the epidermis through into the dermis and underlying adipose tissue layer.
Once this process has been completed a simple dry dressing is applied. This must be kept dry for at least 24 hours.
The anaesthetic will start to wear off in 2 to 3 hours but do not be concerned if it takes a little longer as the effects vary from person to person.

After 48 hours showering is permitted, and life can continue as normal.

Is It Painful?

This procedure is performed under local anaesthetic and therefore does not hurt. There may be some slight discomfort for the first couple of days and pain relief may be taken to ease.

Using our advanced new Dermatophyte Test Strip, we can rapidly and accurately diagnose
nail infection in the clinic in just five minutes.
A breakthrough in indicating the presence or absence of the common fungi which cause 90-
95% of all toenail infections, the Dermatophyte Test Strip is a simple, reliable test we can
complete on the spot.
The test takes no more than five minutes and involves no pain or discomfort. All that’s
required is a small nail clipping for the scientific process to produce an immediate result – a
the result proved to be over 97% accurate.

It’s already transforming the way we diagnose nail infections. And because it means we
could save you waiting for treatment, it will speed up your transformation from unhealthy
and unattractive, to feel-good, trouble-free toenails.
If your results come back negative, your toenail condition may be caused by a trauma to the
nail or nail bed. In this situation, we would use standard chiropody treatment, trimming and
remodelling the nail to improve its appearance.
However, if fungal nail infection is confirmed, we’ll advise the best course of treatment for
you.
If you have a mild infection, you can use topical treatments such as oils, sprays or creams.
Most topical treatments require application over several months. A chiropodist can advise
which treatment to purchase, and, in some cases, it may be best to use topical agents
alongside regular chiropody treatments, where we can file and remodel your nail. This helps
to clear away some of the infected nails, which helps the nail absorb the medication,
speeding up the healing time.
If your infection is moderate to severe, you may need a course of oral medication, which
can only be prescribed by your GP. Anti-fungal tablets enter directly into your bloodstream,
attacking and killing the fungus from within.
The initial course of medication lasts 12 weeks. However, you’re unlikely to see much
improvement during this period because the infected nail plate needs to grow out. For this
reason, the course of medication is often extended. After the 12-week period has passed,
you should be able to see the healthy nail appearing at the nail base.
Oral medications are the most effective course of treatment for severe infections although
they can have side effects, which we will discuss with you. You can’t take them if you’re
pregnant, breastfeeding, or suffer from liver or kidney conditions. For some infections, we
recommend a combination of oral and topical treatment.

Some nail clinics offer laser treatment. However, this is expensive and, yet results have not
proven to be any more effective than other treatments. So, for now, we have chosen not to
offer this.

Risk level What this means
Low-risk diabetic
foot

This indicates you are at low risk of developing non-healing
ulceration and amputations

Moderate risk
diabetic foot

This indicates you are at moderate risk of developing non-healing
ulceration and amputations

High-risk diabetic
foot

This indicates that you are at high risk of developing non-healing
ulcerations and amputations