Skin Conditions
As a pedorthist I am primarily focused on the mechanics of the foot: how the joints operate, how the structures react to weightbearing, dynamic gait analysis. Essentially how a person stands, how they walk, and how that can influence any pain or fatigue that they are feeling.
Related to all of this is our skin and how it is interacting with our environment. Our skin protects the other systems of our body from harm. It acts as both a barrier to harmful stimulus, such as changes in temperature or excessive pressure, and as a sensor to inform us of the changes in our environment that could damage our body.
Skin is a dynamic part of our body. It reacts to our environment and can change, especially in response to excessive pressure, rubbing, or biological agents like fungus or viruses.
Some commonly seen skin conditions are:
Calluses – A callus is a thickening of the skin to protect it from excess pressure or friction. The skin feels harder or firmer to the touch, often also looking somewhat pale or even yellowish. The thicker skin is more durable and protected against these stimuli, it is an effective protective measure. However, this extra material takes up extra space, making the area the callus covers even more prominent. This means that the area is even more likely to experience greater pressures or rubbing, especially on the inside of the shoe. A pedorthist can use custom orthotics with padding, low friction materials, or that shaped in such a way to offload the affected areas to help reduce callusing. Footwear can also be stretched or modified to reduce high pressure areas.
Corns – A corn is effectively a bigger, deeper callus, caused by the same things that cause calluses. Corns especially like to pop up over bony prominences like the joints of hammer toes or bunions. They often appear raised, bulbous, yellowed. Shoe stretching can often help prevent corns from subbing against the inside of shoes. An allied healthcare professional like a foot care nurse can debride or take down corns, reducing their prominence and the amount they rub on footwear.
Dry skin – Various conditions can result in dry skin that appears scaly, powdery, or flaky. In extreme cases the skin may even crack, especially over callused areas such as the back of the heal. A pedorthist may recommend the use of a urea based moisturizing cream in cases like this.
Plantar Warts – Are small, often painful bumps that primarily show up on the heel, ball of the foot or in between the toes. Unlike calluses and corns plantar warts are caused by the presence of the human papillomavirus (HPV) rather than a mechanical source. Plantar warts may be distinguished from corns by the presence of a dark kernel or spot within the bump. Orthotics using padding and offloading may help reduce the discomfort caused by the warts but to deal with the root of the condition a client would be referred to a physician or foot care nurse who would use various methods (such as freezing, lasers, or direct removal) to deal with the virus itself.
Ingrown Toenails – An ingrown toenail occurs when the hard nail grows into the surrounding soft tissue. They can be extremely painful and difficult to trim without help. A pedorthist may be able to stretch footwear to accommodate the painful area and refer you to a physician to deal with any underlying causes or resulting infections and a foot care nurse to help with physically cutting the nails themselves.
Peripheral neuropathy – Essentially if your feet are often tingly, numb, or feel like they are filled with pins and needles then something about the nervous system isn’t working correctly. This could be due to physical impingement of the nerves or as an effect of an ongoing condition such as diabetes or Charcot-Marie-Tooth disease. This limited sensation can make it difficult avoid placing too much weight on one part of your foot for too long or to maintain balance. A pedorthist can create a set of custom foot orthotics that provide padding and contact as much of the foot as possible in order to spread the weight out and put more overall area of skin in direct contact with the ground to improve the total amount of feedback you can get from your surroundings.
Ulcer - An ulcer is a break in the skin that refuses to heal. Foot ulcers are commonly associated with diabetes and peripheral neuropathy because without the ability to feel the wound it is very easy to accidently to pressure on it or reinjure it. Custom made orthotics with padding and an especially soft area directly under the ulcer can aid in the healing process.
