Canandaigua Medical Group Are These Symptoms Serious? Common Foot Problems
Minor troubling foot problems are common complaints seen in our office. There are a variety of over the counter treatment agents for some of the common foot problems such as athlete’s foot, onychomycosis (toe nail fungus), foot pain, corns, warts and bunions. Several of these products are cost effective alternatives to office based prescription treatments. Patients with diabetes or vascular disease should consult their physicians prior to undergoing any type of aggressive over the counter foot treatment plan.
Properly fitted shoes
Ill fitting shoes contribute to abnormal foot mechanics and excessive pressure and wear on patient’s feet. Properly fitted shoes do not need to be broken in but instead should be comfortable to wear right out of the box. Shoes should be fitted on both feet during weight bearing, preferably at the end of the day when the feet are most swollen. You are to allow a space of 1/2" between the end of the shoe and the longest toe, however in athletic shoes you may allow up to 1". Checking the width is important as adequate room should be allowed across the ball of the foot. The heel should fit snugly. The fit over the instep should be checked. A shoe that laces allows for adjustment in this area. Orthotics and inserts will change the fit of the shoe, therefore someone buying new shoes should bring their orthotics with them so that they will be fitted while wearing the orthotic.
Anti-fungal Agents
Tinea pedis (athlete’s foot) is a fungal infection of the skin of the feet. Heat and dampness are predisposing factors. Diffuse involvement of the sole of the foot and dorsal surface of the foot is called a mocassin type tinea pedis and often requires systemic anti-fungal therapy which will require prescription and physician consultation. However, athlete’s foot in between the toes presents as cracking and pain. It may be treated with over the counter medications. These include Clotrimazole (Lotrimin) , Miconazole (Monistat-Derm), Terbinafine (Lamisil AT ), Tolnaftate (Tinactin) and Undecylenic Acid (Desenex). Results of control studies have demonstrated that all of these agents have high rates of mycologic cure in symptom relief. All are used once or twice daily for 4 weeks except Terbinafine (Lamisil AT) which is effective with one week of therapy in 88-99% of cases. This product is much more expensive but considerably more effective than the other agents mentioned and usually a single tube is sufficient. Foot hygiene is important as well. All studies show cure rates of 30-40% in patients even taking placebo which suggests that even hygiene measures will result in cure in many patients. T Tree Oil ( an essential oil derived from the Australian Melaleuca Alternifolia) is marketed for the treatment of athlete’s foot. The results of studies have found the tree oil was comparable to the Tolnaftate treatment in reducing symptoms. However, there is no effective mycological cure in this.
QUALITY CARE FOR ALL AGES
Copyright Canandaigua Medical Group, 2004 335 Parrish Street · Canandaigua, NY 14424 (585) 393-2888 www.canandaiguamedical.com
Canandaigua Medical Group
Onychomycosis
There are no over the counter treatments for onychomycosis (toe nail fungus) that have been shown to be effective. Treatment of this requires prescription strength systemic medications, although there is a new agent which is a painted on antifungal treatment and which requires a prescription.
Wart Treatment
Several brands of 17% Salicylic acid are available over the counter such as Duofilm, Compound W, Wart Off. Results of one study showed no significant difference in cure rates of hand warts between the 17% Salicylic Acid and Cryo-therapy with liquid nitrogen alone or combined. In the treatment of simple plantar’s warts 17% Salicylic Acid paint cured approximately 84% of patients. This form of treatment requires daily applications of the acid paint for 2-3 months for complete eradication of warts. Mosaic plantar warts are clusters of small plantar warts that are resistant to treatment. This condition many times requires referral to a specialist for treatment.
Corn Plasters, Corn Cushions and Metatarsal Pads
A corn is a thickened area of skin forming a nodule that is caused by excessive pressure on the foot. Soft corns are nodules usually between the toes, often the 4th and 5th toe that often become cracked and split by perspiration and extremely tender. Soft corns can be difficult to distinguish between inter-digital tinea pedis (athlete’s foot). Corns are frequently tender and have a clear hard keratin center when shaved. Treatment of corns involves the removal of excessive keratin as well as relieving the pressure. Sometimes the physician or podiatrist may have to remove hard corns by paring with a sterile blade followed by a curettage of bleeding areas. Corn plasters are felt pads that contain 40% Salicylic acid. No significant studies have been shown to prove that corn plasters with 40% Salicylic Acid are effective.
Insoles and Arch Supports
Ready made insoles are marketed for relief of heel pain, foot pain and back pain. Pain in the heel is often caused by strain on the tissue that supports the arch where it attaches to the front of the heel bone. This condition called plantar fasciitis may be relieved by anti-inflammatory medications, steroid injections and stretching exercises as well as heel cup inserts. In older people the normal fat pad becomes thinner and this may also be a source and cause of heel pain for which heel cups often relieve the symptom. Although stretching of the plantar fascia and Achilles’ tendon is the mainstay of treatment in plantar fasciitis, inserting cushioning insoles are helpful as an adjunct. Because the flattening of walking triggers the pain by over stretching the plantar fascia, orthoses designed to maintain the medial longitudinal arch are preferred. Orthoses made of cork, visco elastic polymer or closed cell foam provide cushioning by reducing the shock of walking by as much as 40%. Results of a survey of runners using orthotics for plantar fasciitis showed that 74% reported significant improvement of symptoms with the use of orthotics and 90% continued using orthotics even after resolution of symptoms.
QUALITY CARE FOR ALL AGES
Copyright Canandaigua Medical Group, 2004 335 Parrish Street · Canandaigua, NY 14424 (585) 393-2888 www.canandaiguamedical.com
Canandaigua Medical Group
These over the counter foam insoles and arch supports generally cost between $8 and $20 per pain while custom molded orthotics cost between $100 to $300 . A trial of the inexpensive alternative seems justified prior to spending the extra money for the custom molded orthotics.
Your doctor knows you and your family best. Nothing takes the place of talking directly with your doctor about your health and questions that you have. The information provided here is not medical care or treatment and is not specific to your situation. You need to contact your own doctor for your medical care.
QUALITY CARE FOR ALL AGES
Copyright Canandaigua Medical Group, 2004 335 Parrish Street · Canandaigua, NY 14424 (585) 393-2888 www.canandaiguamedical.com
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