Chiropody is a branch of medical science that involves the assessment, management and prevention of diseases and disorders of the foot and lower limb. Foot injuries and deformities can limit mobility, and affect your health and quality of life.
Chiropodists are essential members of the interprofessional healthcare team. The role of chiropodists is to maintain and improve patient mobility, alleviate foot pain, and provide health education. Chiropodists are skilled in assessing their patient’s needs, and managing both acute and chronic conditions.
Chiropodists provide care to a wide range of patients, which include but is not limited to:
- Routine and diabetic nail care
- Fungal nails
- Ingrown nails
- Corn and callus management
- Plantar warts
- Nail and soft tissue surgeries
- Wound care
- Foot pain
- Custom made orthotics
- Compression socks
Fungal Nails (Onychomycosis)
Onychomycosis is an extremely common infection caused by microscopic fungi that enter through a trauma in the nail. It is more commonly seen in toenails rather than fingernails due to the moist environment of the feet. Typically, onychomycosis presents as a thickened and discoloured nail, which can vary from yellow or brown or white. The nail is usually crumbly, brittle and accompanied by a foul odour.
Risk factors for picking up fungus include exposure to damp environments such as public swimming pools and gyms, excessive sweating, non-breathable socks and shoes, and a weakened immune system. Onychomycosis is easily preventable with the following tips: towel dry your feet after showering, do not share nail clippers, air out your feet and shoes, wear breathable socks and shoes, change your socks and shoes if you are prone to excessive sweating, and wear sandals in public areas.
There is usually no pain associated with onychomycosis, however permanent deformity of the nail may arise from long-standing cases. In addition, the fungus can spread to the surrounding skin and other nails, therefore it is important to visit the chiropodist for treatment options. Treatments include: thinning the nail for easier penetration of medication, topical and oral antifungals, laser ablation, and surgical or chemical temporary nail removal.
Ingrown nails are a common and painful problem that usually affects the big toenails. They can be caused by improper nail cutting, trauma, extremely curved nails, and tight footwear. Symptoms typically include pain, redness and swelling, and sensitivity to pressure of any kind. It is important to visit a chiropodist as soon as these symptoms begin, as it can progress further and become infected.
In cases where ingrown nails are severe, or a recurring problem, the chiropodist may recommend an in-office procedure called a partial nail avulsion. The ingrown part of the nail will be permanently removed to provide relief.
Calluses vs. Corns
Callus is an accumulation of hard, thickened skin which forms to protect the feet from increased pressure and friction. However, once a callus becomes too thick, it can become painful with touch or pressure.
Corns are similar to calluses, however they contain a cone-shaped core which impinges on nerves and causes pain. They typically form on the tips and between the toes, and are irritated with constant friction and pressure from footwear.
Calluses and corns arise due to a combination of factors, including increased pressure on certain areas of the foot while walking, poor foot mechanics and inappropriate footwear. They can be maintained between visits to the chiropodist with regular filing using a pumice stone, moisturizers and toe props/separators.
Plantar Warts (Verrucae)
Plantar warts are benign growths on the skin as a result of the human papilloma virus (HPV). Warts can appear anywhere on the foot, but they typically are seen on the bottom of the foot. They can occur in people of all ages, however they are more commonly seen in children and those with compromised immune systems.
HPV thrives in warm and moist environments, so it is commonly transmitted in places like public swimming pools and showers. The virus also needs a point of entry into the skin, through cracks, cuts, scrapes, or wet and softened skin.
Plantar warts can resemble a callus as it will consist of thickened skin overtop, and they may be painful when squeezed. Warts typically resolve on their own, however many patients seek treatment for reasons including irritation, pain, cosmetic embarrassment and risk of transmission. Many patients use over-the-counter medications, which are ineffective and can make the wart more difficult to treat. Therefore, it is best to have a chiropodist assess and treat warts. There is no treatment that is 100% effective, and they all vary in their success rates. Treatments include silver nitrate, salicylic acid, imiquimod, Canthacur, surgical excision and needling.
Medical compression socks are specialized hosiery that are designed to prevent and treat a var
iety of venous disorders. They are tightest around the ankles and are gradually less compressive towards the knees and thighs. The socks come in a variety of colours, patterns, lengths (knee-high, thigh-high and pantyhose), and compression levels (from 8-15 mmHg to 50-60 mmHg). The length and compression level of the socks depends on the severity of the person’s condition, and is determined by your family physician or chiropodist.
Compression socks are recommended for various conditions, including tired, aching legs, swelling (edema), spider veins, varicose veins, and chronic venous insufficiency. During ambulation, the calf muscles work to help the veins pump blood back up towards the heart. Those with venous disorders likely have compromised valves in their veins, allowing the flow of blood backwards into the leg and are unable to return the blood to the heart. Compression socks help in blood flow by promoting the contraction of the calf muscles to close the valves and prevent the backflow of blood to the legs.
The compression socks should be put on at the beginning of the day and removed before bedtime. They should be washed in a delicate cycle in cold wash and hung to dry. It is best to wear compression socks daily for maximum benefit, as they are essential for the prevention and treatment of venous disorders.