High risk or elderly general care - Karin Bruckner
Karin specialises in nail surgery and does procedures to prevent ingrown toenails from reoccurring. Onychomycosis (nail fungus) is also a special interest of hers. Patients seen by Karin are athletes, retirees, diabetics, children and anyone needing foot care. Her practice is nestled at the foot of Table Mountain in Vredehoek, also known as Devil’s Peak, which is close to the centre of Cape Town with easy access and parking. The surgery is equipped with the latest technology including computerised gait analysis (RSSCAN) equipment, laser, and a nail debriding machine. The laser which is available at the practice allows for treatment of nail fungus infections without the side effects which can result from drug therapy. It’s non-toxic and can treat all ten toes in 15-20 minutes with no downtime.
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Arthritis in the Foot

Arthritis can affect any of the movable joints in the feet which can result in foot deformities such as enlarged swollen joints or toes becoming crooked and causing problems when walking in shoes.

CAUSES

In Rheumatoid Arthritis, the toes and the forefoot joints are the most commonly affected. These joints can become displaced and deformed and often the muscles and tendons shorten causing the toes to become hammer-shaped or clawed.

Pain associated with osteoarthritic changes in the feet will vary with the type and duration of the condition. The pain may be acute as in the initial stages of gout, with the affected joints inflamed and swollen. The pain may present with morning stiffness and limited joint movement, which increases on weight-bearing in rheumatoid arthritis. Joint movements may be lost altogether due to bony deformity of the joints with osteoarthritis, resulting in limited movement and pain experienced with normal day to day activities.

It is important to recognise that arthritis can affect other areas of the body, which results in poor posture and restricted movements. It is sometimes difficult for the feet to operate correctly as weight-bearing structures that support and propel the body forwards when some of the key joints such as the hips or shoulders are affected.

CARE OF YOUR FEET

Correct washing and drying of your feet is vital in maintaining foot health. It is most important to clean well between toes, lifting each toe and thoroughly clearing out any debris.

 

Foot exercises are essential to help keep the joints moving and reduce joint stiffness that can make a person unsteady and liable to fall more easily.

 

Nails should be cut regularly following the natural separation line of the nail plate and not cutting down at the corners. Corns and callouses if painful can be treated professionally by a podiatrist, and pressure and friction over these areas can be relieved by protective devices such as tubular foam and other padding. Cushioning soles can be used in all footwear to provide some shock absorption against all hard walking surfaces.

FOOTWEAR

It is important to buy footwear that provides the best comfort with protection and support for you. It is often a good idea to get yourself professionally measured and fitted with suitable footwear at least once a year, especially as changes can occur in a short time with all forms of arthritis. Shoes should be lightweight, flexible and allow the air to circulate around the foot.

The ideal materials are leather and canvas, however, most modern materials are well designed to accommodate feet. A good example of a lightweight shoe that can accommodate foot deformity is the common jogger or running shoe that is easy to put on and secure with laces or velcro straps to suit arthritic fingers.

Shoes must have a broad deep toe box that will provide additional comfort and reduce frictional points that can cause corns and callouses. Heel height ideally should not exceed half an inch or two centimeters. Soles should have a non-slip grip pattern.

 

Always choose the right shoe for the job (such as for walking or gardening) to protect the arthritic foot and support them during the activity.

 

To download this information, click here Arthritis

Ageing feet

We all grow older and as we do, our feet naturally change, after all, they have carried us around for many years! There are a number of issues that affect our feet as we get older, including:

 

  • Thick toenails
  • Ingrown toenails
  • Corns and callus
  • Orthotics

 

To download this information, click here Ageing

Thick Toenails

Toenails can grow thicker as we age, leading to abnormal thickening of the toenail. It is common to experience this as you get older.

 

CAUSES
Thickened toenails usually occur as a result of an injury to the toenail bed, such as dropping a heavy object on your toe. They can also result from fungal infections. They may just occur naturally as the toes age with our bodies.

 

TREATMENT

They are easily treated and can be painlessly thinned down by a podiatrist, however, it often requires ongoing care.

Ingrown Toenails

Ingrown toenails are one of the most common complaints that podiatrists are asked to treat at all ages. It can be very painful condition and because of fear of surgery, many people put off seeking treatment until the nail has deteriorated to a chronic state. Many ingrown toenails can be treated without the need for surgery, although conservative measures may mean that you have to visit a podiatrist at regular intervals. If surgery is required, it is very likely that it can be done without the need for admission to hospital. Many ingrown nails can be treated surgically in a podiatrist’s rooms with the procedure taking an hour or less.

 

CAUSES

 

Ingrown toenails are caused when the nail is cut too close to the nail bed along the side of the nail or where the toe box of the shoes pushes the toenails inwards. This causes the toenail to grow into the toe itself, causing redness, swelling, and pain. Poor toenail cutting techniques (where the toenail is cut down the side) can cause a nail spike to grow sideways into the toe, causing an ingrown toenail.

 

TREATMENT

 

The procedure carried out by podiatrists is to remove the ingrown part of the nail under a local anaesthetic. To stop the offending part from re-growing, a chemical is applied to the tissue from which the nail grows. This method leaves no scar on the skin and leaves most of the nail in place resulting in a good cosmetic appearance. Healing is slightly slower by this method, but there is usually less post-operative pain than with other procedures.

 

If you have pain in your toenails see your podiatrist, the treatment may not be as bad as you might imagine.

Corns and Callus

The skin is able to protect itself from pressure and friction by growing more quickly, forming a thick outer layer, over a bony area, this is a callous.

 

Sometimes the pressure is too high and the outer layer of skin becomes so thick and forms a compacted circular structure that it acts like a foreign body on the skin.

 

A focus of pressure within the callus can occur causing a hard plug of skin to form and this is a corn.

 

CAUSES

Corns and calluses are the body’s protective mechanism. Because corns and callus form on the dead outer layer of the skin there is no “root”. The symptoms of pain simply are reminding us that there is a problem with our footwear and we need to address it.

 

TREATMENT

A podiatrist will treat corns and calluses by debriding or paring the callus and removing the centre of the corn. Pads are often used to reduce the friction and pressure of the corn. The podiatrist will also discuss the type of footwear most likely to cause corns or calluses and in some extreme cases prescribe orthotics to reduce excessive weight-bearing forces on the foot. The podiatrist will finally devise a treatment plan that will include the following:

 

  • Recommend regular treatment
  • Suggest a softening cream
  • Advise on self-care
  • Give footwear advice or prescribe special footwear
  • Provide padding devices to take the pressure off the painful area
  • Analyse the pattern of walking and prescribe functional orthoses to help correct it.
  • Refer for a surgical remedy

Orthoses (Orthotic devices)

Orthotic devices can be used to maintain proper foot support. They are made of plastic or rubber and must be regularly checked (at least once every three years) to ensure they are still doing the job they were designed and fitted to do. Orthoses help to realign the foot and distribute body weight evenly. They can be used for all for a variety of problems including pain, poor stability, and gross motor problems. These devices are not simple ‘arch supports’ and need to be custom-made for each individual, as they change the relationship with the foot and the ground.

 

The Podiatrist, after assessing your foot function may recommend orthoses or insoles to help relieve foot pain and discomfort.