Skin Problems
Allergies
Two kinds of skin allergies, or dermatitis, are caused by substances coming in contact with the skin: primary irritant dermatitis and allergic contact dermatitis. Primary irritant dermatitis is a non-allergic reaction of the skin resulting from exposure to an irritating substance. Allergic contact dermatitis is an allergic sensitization to various substances.
People who work in areas where their feet are exposed to repeated or prolonged contact to hot water, chemicals, oils, or wet cement can develop primary irritant dermatitis. Some solutions are safe if used properly. However, improper use can lead to a serious contact dermatitis. This is particularly dangerous for diabetics. For primary irritant dermatitis, soaking feet in solutions, such as bleach, vinegar, salt water, or Betadine, can be beneficial as long as excessive amounts are not used.
Allergic contact dermatitis is the result of exposure to substances that sensitize the skin. Each time the foot is exposed to the substance, an inflammatory reaction occurs. Some people are allergic to the substances in sock dyes or certain shoe materials. Adhesive tapes can cause an allergic reaction with blisters or a rash developing beneath the tape. Because of the heat and the accumulation of moisture beneath the tape, an acute Athlete's Foot infection can also be caused by an allergic reaction to the adhesive. Treatments include the use of cool compresses, topical steroid compounds (like hydrocortisone creams), and antifungal creams.
Athlete's Foot (Tinea Pedis)
Athlete's Foot, also known as tinea pedis, is a skin disease caused by a fungus that usually occurs between the toes. The fungus attacks the feet because shoes create a warm, dark, and humid environment that encourages fungus growth. Warm, damp areas around swimming pools, showers, and locker rooms are also breeding grounds for fungi.
Symptoms of Athlete's Foot include drying skin, itching, scaling, inflammation, and blisters on and between the toes. Athlete's Foot can spread to the soles of the feet and to the toenails as well as other parts of the body, which is why timely treatment is so important.
You can prevent Athlete's Foot by:
Not walking barefoot, particularly in public pools and locker rooms.
Reducing foot perspiration by using talcum powder.
Wearing light and airy shoes.
Wearing socks that keep your feet dry, and changing them frequently if you perspire heavily.
While fungicidal and fungistatic chemicals are usually used to treat Athlete's Foot problems, they often fail to contact the fungi in the lower layers of the skin. For persistent Athlete's Foot, a prescription topical or oral anti-fungal drug may be needed. Note: Please consult your physician before taking any medications.
Blisters
Most blisters on the feet are caused by friction and do not require medical attention. New skin will form underneath the affected area and the fluid built up in the blister is simply absorbed back into the tissue. You can soothe ordinary blisters with vitamin E ointment or an aloe-based cream.
Do not puncture a blister unless it is large, painful, or likely to be further irritated. If you have to pop a blister, use a sterilized needle or razor blade. Wash the area thoroughly, then make a small hole and gently squeeze out the clear fluid. Apply a dab of hydrogen peroxide to help protect against infection. Do not remove the skin over a broken blister. The new skin underneath needs this protective cover. Cover the area with a bandage and mild compression.
If the fluid is white or yellow, the blister is infected and needs medical attention.
Preventing Blisters
You can prevent blisters by breaking in new shoes gradually, and putting petroleum jelly or an adhesive bandage on areas that take the rub—before the blister happens. Wear socks that have heels instead of tube socks (they bunch up and cause blisters). Acrylic and other synthetic-fiber socks are good choices. Be sure to wash and dry your feet daily to prevent bacterial infections, such as Athlete's Foot.
Burning Feet
Burning feet refers to a foot sensation that is most frequently experienced by adults over age 50 and those who are diabetic. Thyroid dysfunction, gastric restriction in morbidly obese people, and heavy use of alcohol also have been linked with burning feet. Nerve problems, such as neuromas and tarsal tunnel syndrome, may also be associated with the sensation of burning feet.
It is not unusual for feet to ache or burn at the end of a long day. However, on an ongoing basis, burning feet can be a symptom of a more serious health problem. Please consult our office and schedule an appointment if you experience persistent burning feet.
There are some simple ways to mitigate burning feet:
Make sure you wear shoes that fit properly and provide support for your unique foot structure.
Take foot baths daily to treat hot and sweaty feet.
Wear socks of cotton, versus synthetic, fibers as they are lighter and cooler.
Avoid long periods of standing.
Try cushioned or shock-absorbing insoles in your shoes to make standing more comfortable.
In some cases, orthotics may be helpful to correct any underlying mechanical imbalances which may be responsible for your burning feet.
Cysts
Cysts are fluid-filled masses under the skin. Common cysts of the feet include synovial cysts, ganglia, and cutaneous mucoid cysts.
Most foot cysts are located under the skin, although occasionally they appear in tendon or bone. Synovial or ganglionic cysts are connected to a nearby joint or tendon, which makes them harder to treat. Mucoid cysts are not connected to a joint. Most cysts lead to mild pain as a result of the pressure created by wearing shoes. When any of these cysts enclose or press on a nerve, they can cause a sharp pain. X-rays, ultrasound, MRI, or CT scans are common methods for diagnosing cysts in the feet.
The best way to prevent cysts from forming is to wear well-fitted, comfortable shoes and avoid repeated foot injuries. Persistent ganglion cysts can be treated by numbing the area and extracting the fluid inside. A steroid or hardening agent may then be injected into the cyst to try to prevent it from filling again.
Frostbite
Extreme exposure of your feet to cold for a prolonged period can lead to a serious condition called frostbite. Frostbite starts by producing pain and a burning sensation in the exposed areas. This is followed by numbness in toes or feet and changes in skin colour, from pale or red to bluish-grey or black. People with a history of frostbite often get it again in the same place.
Superficial frostbite injuries refer to those that involve the skin and subcutaneous tissue. When the damage goes more deeply, beyond the subcutaneous tissue and into muscles, nerves, tendons, or bones, they are classified as deep frostbite injuries. The extent of the injury impacts the prognosis for healing and long-term complications.
Children, the elderly, and diabetics are more prone to frostbite because of the size of their extremities or poor circulation. People who live or work outdoors also have a higher likelihood of contracting frostbite because of their increased exposure to the cold.
If you suspect that you have frostbite, seek emergency medical care as soon as possible. Get out of the cold and into a warm environment as quickly as possible. Keep the feet dry and warm. Do not expose the flesh to extremely warm or hot temperatures (such as a fire or portable heater). A gradual and steady warming procedure should be followed.
Gangrene
Gangrene is caused by lost blood supply to the foot or bacterial infections that result from open sores or ulcers. Diabetics are most prone to foot gangrene because they typically have poor circulation or nerve damage, which can lead to loss of blood supply.
Any sudden onset of foot or leg pain accompanied by lower skin temperature and skin color changes may indicate a sudden blockage of blood flow to the legs.
Gangrene is a serious condition, particularly when it is caused by an infection, which can spread throughout the body. Gangrenous tissue must be surgically removed, followed by oxygen treatment and intravenous antibiotics to kill any infection. If you suspect gangrene, please contact our office or seek other immediate medical attention.
Lesions
Skin lesions refer to any variation in skin colour or texture anywhere on the body. Some skin lesions are present at birth, such as moles, freckles, or birthmarks. Others are acquired over time, such as acne, warts, allergies, sunburn, or abrasions. Most skin lesions are harmless. However, it is important to keep an eye on them because they can change over time, which may be indicative of a serious problem. For example, one pigmented lesion that can occur on the foot and lower extremity is malignant melanoma.
A condition called actinic keratosis is another cancer-causing lesion that can occur on the feet. It is most commonly found in sun-exposed areas, such as the top of the foot. Treatment consists of freezing the lesions with liquid nitrogen or sharp excision.
Kaposi's Sarcoma is another cancerous lesion that may appear on the soles of the feet of people with HIV infection or AIDS. Kaposi's Sarcoma lesions are irregular in shape and have a purplish, reddish, or bluish-black appearance. They tend to spread and form large plaques or become nodular. The nodular lesions have a firm, rubbery appearance.
Swelling
Swelling of the feet, ankles and legs, also known as edema, is often caused by an abnormal build-up of fluids in ankle and leg tissues. Painless swelling of the feet and ankles is a common problem, particularly in older people. It may affect both legs, including the calves and/or thighs. Because of gravity, swelling is particularly noticeable in the lower legs. Swelling in the legs and feet may also be a symptom of other, more serious health issues, such as heart failure, renal failure, or liver failure.
Common causes of foot, ankle, and leg edema include:
Blood pressure-lowering drugs
Body fluid overload
Burns
Certain antidepressants
Congestive heart failure
Diagnostic tests
Environment
Estrogens and progestin oral contraceptives
Extremity surgery
Generalized allergy
Glomerulonephritis or other kinds of kidney disorders
Infiltration of an intravenous site
Injury or trauma to the ankle or foot
Insect bite or sting
Long airplane flights or automobile rides
Long-term corticosteroid therapy
You can mitigate swelling by elevating your legs above the heart while lying down. Avoid sitting or standing without moving for prolonged periods of time. Avoid putting anything directly under the knees when lying down, and don't wear constricting clothing or garters on the upper legs.
Exercising the legs causes the fluid to work back into the veins and lymphatic channels so that the swelling goes down. Mild pressure applied by elastic bandages or support stockings.
-
Medical treatments
-
Medications
-
Menstrual periods (for some women)
-
Pregnancy (mild to severe swelling)
-
Prolonged standing
-
Starvation or malnutrition
-
Sunburn
-
Testosterone
-
Venogram
-
Venous insufficiency (varicose veins)
Ulcers
Ulcers are skin wounds that are slow to heal. In the foot, as prominent metatarsal heads on the plantar (bottom of the foot)are subjected to increased pressure, the skin begins to become callused. When subjected to shearing forces, there is a separation between the layers on this callused skin, which fills with fluid and becomes contaminated and infected. The result is a foot ulcer.
Ulcers are classified in four stages, according to how deeply they penetrate the layers of skin they have broken through.
The four stages of ulcers are:
Stage 1—Characterized by reddening wounds over bony areas. The redness on the skin does not go away when pressure is relieved.
Stage 2—Characterized by blisters, peeling, or cracked skin. There is a partial thickness skin loss involving the top two layers of the skin.
Stage 3—Characterized by broken skin and sometimes bloody drainage. There is a full thickness skin loss involving subcutaneous tissue (the tissue between the skin and the muscle.)
Stage 4—Characterized by breaks in the skin involving skin, muscle, tendon, and bone and are often associated with a bone infection (osteomyelitis).
The are also four major cause of foot ulcers:
Neuropathic—Related to the nerves and characterized by a loss of sensation in the feet.
Arterial—Related to poor blood circulation to the lower extremity. This type of ulcer can be very painful and is usually found on the tips of toes, lower legs, ankle, heel, and top of the foot. It can very easily become infected.
Venous—Related to compromised veins. These ulcers are often seen around the inside of the ankle and are slow to heal.
Decubitus—Derived from excessive and prolonged pressure on one area of the foot. The most common type of decubitus ulcer of the feet is bed sores on the backs of the heels of people confined to bed for long periods of time.
Foot ulcers are a common problem for diabetics. Contact casts are sometimes applied to the diabetic foot to relieve the bony prominent areas of pressure, allowing ulcers to heal.