Some possible conditions • Skin Conditions – Toes – Dorsal & Distal tip
A wound is an injury to living tissue in the body. There are several types of wounds depending on what caused it in the first place. The skin is the largest organ in the body and its purpose is protection of internal organs and tissues. The skin is subjected to the elements and to friction and pressure day-to-day. A wound occurs when the skin opens, cracks, tears or ruptures. An opening in the skin will increase a person’s risk of infection. Early treatment is crucial to prevent worsening and serious complications.
A skin wound is open tissue that may ooze blood, clear fluid or pus. Sometimes referred to as a “cut” or “break” in the skin. A wound will be tender or painful if sensation is normal or if the oxygenated blood in the arteries is reduced. If sensation is not normal or absent, a complication of diabetes, a person may not even know they have a wound. The skin around the wound may appear red, swollen, odorous or puffy and feel warm to the touch if an infection is present. If infection is left untreated, fever and flu-like symptoms may be experienced.
The most common skin wound is a skin ulcer. A skin ulcer is an open sore associated with poor blood flow, injury and pressure. The tops and tips of the toes are susceptible to injury as they endure body weight, pressure and friction when walking. Ill-fitting or tight footwear, thickened toenails and toe deformities can all cause increased pressure on the tops and tips of toes. Injury due to pressure may lead to the development of a wound. A lack of oxygenated blood to the toes may cause an ischemic wound and can lead to tissue death.
Wounds require assessment and treatment from a medical footcare clinician or a primary care professional. Wounds must be treated to encourage healing but also monitored to prevent worsening. Depending on the cause of a wound, complications can be serious and even limb and life threatening. Treatment of wounds may involve removal of dead tissue and application of medicated topicals and dressings to stave off infection and encourage healthy tissue growth. Offloading high pressure areas and wearing well-fitting footwear is imperative. Registered Chiropodists and Canadian Certified Pedorthists both offer footwear and offloading expertise.
Peripheral arterial disease (PAD) is the narrowing or blockage of the arteries in the lower extremity. The inner walls of arteries are normally smooth which facilitates the flow of blood. PAD results when the diameter of arteries are narrowed from plaque formation on the walls. This narrowing reduces the amount of oxygen rich blood actually reaching the legs, feet and toes. PAD will progressively worsen over time if it is not addressed and treated effectively.
Mild PAD may be asymptomatic but will progress from pain/cramping in the legs with exertion or exercise, to pain in the legs when resting and eventually to tissue death involving skin wounds and gangrene. Pain is most commonly felt in the very tips of our lower extremity, our toes and will move closer to the body’s core as it becomes more involved. The toes will be cold and may burn or ache. The colour of the skin will change, appearing mottled, reddish or purplish. If skin becomes broken or scratched, healing is jeopardized and wounds may never heal.
When the toes show signs and symptoms of reduced blood flow and nourishment from oxygen, the cause stems from PAD itself. The walls of the arteries are narrowed or blocked, decreasing or preventing the oxygenated blood from reaching legs, feet and toes. The risk factors for PAD, also known as atherosclerosis, include smoking, diabetes, are over the age of 50, family history of heart or blood vessel disease, high blood pressure and high cholesterol.
If pain and changes in the skin is noticed in the toes and feet, it is important to seek the advice of a primary care professional immediately. PAD prognosis can improve with exercise, medication and getting blood pressure and cholesterol under control. Early diagnosis and positive lifestyle changes can prevent PAD from getting worse. Certain medications may be required to control the disease and increase comfort and function. Surgery is always a last resort, but it may be needed to prevent tissue death, amputation and to keep a person alive. Additionally, having Pad puts you at risk for foot complications and regular nail and skin care with a Chiropodist or Footcare Nurse is essential.
Shower emboli is also known as blue toe syndrome or cholesterol embolization syndrome. Elevated cholesterol levels in the blood may lead to a build-up of plaque in the body’s larger arteries. This build-up narrows the diameter of the vessels, decreasing blood flow. If small pieces of these plaques break away from the arterial wall, a “shower” of embolic cholesterol crystals become free to circulate in the blood. Small emboli work their way down to the feet, blocking blood flow to the toes. This can cause pain and blue discolouration of the toe.
Sudden onset of a painful blue toe is a good indication of shower emboli. Shower emboli can cause small nail bed infarcts which appear as reddish streaks under the nail. When oxygenated blood is blocked or reduced, this causes pain. Shower emboli occur in the presence of arterial disease and therefore a blue toe may develop after undergoing a vascular procedure elsewhere in the body. If left untreated, a blue toe can worsen causing wounds, tissue death and gangrene.
Blue Toe Syndrome is caused by blockage or narrowing of arteries in a toe by small clots or pieces of cholesterol circulating in the blood. It can also be caused by vasoconstriction of these tiny arteries because of a blood vessel condition, medication or even some infections. Hypertension, smoking and elevated cholesterol in the blood cause arterial disease and subsequent occurrence of shower emboli in the toes. Mild blue toe syndrome is not serious, but can be the first sign of more serious and life-threatening issues in the body.
The cause of shower emboli must be addressed. Prompt assessment by a primary care professional or Chiropodist is crucial and can reduce the chances of complications. Medication to thin the blood may be required to increase viscosity and make it easier to flow through the vessels in the body. At home, it is important to keep feet and toes warm with appropriate clothing and warm ambient temperature. If wounds develop, proper treatment is imperative, as is rest and staying hydrated.
Raynaud’s disease affects the toes causing them to feel numb and discoloured. Cold temperatures cause the blood flow in the toe’s smallest arteries to become constricted or more narrow. This limits the blood flow to toes leading to temporary loss of feeling and discolouration of the skin. Raynaud’s disease is considered a primary condition because it is not connected with another disease or condition. Raynaud’s phenomenon is different from Raynaud’s disease as it is a sign of an underlying systemic disease, in particular one that affects the immune system.
Toes will feel cold and at first appear pale or white. The colour of toes will progress from pale to blue to red as it cycles through the stages of reduced blood flow, to an improved blood flow and warming of the tissues. With this cycle, toes will go from feeling cold and numb to tingling, burning or throbbing as the skin warms. Symptoms will resolve once the toes are warmed and they are no longer exposed to cold temperatures. If Raynaud’s is severe and blood flow is prolonged, tissue damage can happen.
The cause of Raynaud’s disease is not fully understood but an attack is caused by narrowing of the tiny blood vessels responsible for supplying oxygen and nutrients to the skin. Toes are at the tip or end of our lower extremities and are therefore more susceptible to compromised blood flow. Raynaud’s disease is more common in women and is almost always caused by exposure to cold temperatures. There are risk factors for developing Raynaud’s including genetics, climate, medication and underlying medical issues.
There is no cure for Raynaud’s disease therefore prevention of an attack is the key. Dressing appropriately in cold weather to lessen exposure to the cold is imperative. Try to warm up the car, house or work space before settling in and be aware of air conditioning in the warmer weather months as this cold air can also cause an attack. If Raynaud’s attacks are not easily prevented or if symptoms worsen, seek the advice of a primary care professional as medication may be required to improve blood flow to the lower extremity and toes.
The Coronavirus has been linked to an uncommon rash on the toes known as COVID toes. They are thought to be a result of a strong immune response to the Coronavirus in an effort to fight off the virus. COVID toes may or may not be accompanied by more typical symptoms of the Coronavirus and they may affect one or more toes, presenting as pink, red or purplish swelling. They have been reported in the early stages of the Coronavirus, but have also been seen following the acute phase of the illness.
A pink, red or purplish, rash on one or more toes that may have pus or liquid under the skin. Raised bumps and blisters on the skin have also been reported. COVID toes will usually accompany other symptoms of the Coronavirus. The affected toes often feel sore, itchy or burn. COVID toes may be confused with a skin disorder known as Chilblains or even frostbite, or associated with lupus, as they all share similar symptoms. Discolouration on toes related to covid typically lasts 1-2 weeks.
The exact cause of COVID toes is unknown but could be due to the immune system going into overdrive to fight off the Coronavirus. Reaction to illness varies from person to person and is not predictable. Skin rashes are not an uncommon symptom of illness and viruses. People of any age may experience COVID toes but it seems to be more common in children, teenagers and young adults who are otherwise healthy.
COVID toes will resolve on their own but if they become bothersome, there are ways to relieve symptoms at home. It is important to keep the skin clean by using a mild soap, and drying well afterwards. If the rash feels itchy or burns, a cortisone cream can help reduce inflammation and irritation. If skin becomes broken, preventing infection is key. Washing feet regularly and applying an antibiotic ointment as needed will lessen the risk for infection. If COVID toes are suspected, it is a good idea to seek the advice of a primary care professional.
Eczema on the feet is known as dyshidrotic eczema, a type of eczema that causes small blisters on the palms of hands, soles of the feet and edges of the fingers and toes. It is also referred to as atopic dermatitis because it can be a sign of allergy. Eczema is often confused with psoriasis as both cause a dry and bumpy skin rash but it typically causes more intense itching than psoriasis. Eczema is a long-term skin condition more commonly seen in young adults. It can occur as a single flare-up in a person’s life or come and go for years.
Dyshidrotic eczema is a common form of eczema and is also referred to as pompholyx, a Greek derived word meaning “bubble.” This type of eczema only occurs on the hands and feet and usually begins with a painful rash of blisters or vesicles. As the blisters heal, they dry up and the skin often becomes red and peels. This process can leave the toes tender and quite dry and sometimes results in painful cracks or fissures. Cracks in the skin may become infected.
The cause of dyshidrotic eczema is unknown, but it is more likely to occur in multiple family members, suggesting a genetic link. Eczema is a form of atopic dermatitis because it is frequently triggered by the presence of an allergy. It can also be triggered by stress, heat and humidity, sensitivity to soaps and detergents and various metals, such as nickel. Sweaty feet may aggravate eczema, especially if the feet are in contact with sweat-moistened socks and shoes for prolonged periods of time.
It is important to know what triggers or exacerbates eczema. This will help avoid a flare-up. Washing feet daily with a mild and fragrance-free soap and then applying a rich emollient with active ingredients like urea and ceramides while the skin is still moist, will keep skin in good condition. If eczema is inflamed and bothersome, it is best to seek the advice of a primary care professional or a Chiropodist or Footcare Nurse. A topical corticosteroid may be required to reduce inflammation and increase comfort. Eczema that has caused the skin to break or crack can also lead to fungal and bacterial infections, which should be treated with topical antifungals and antibacterials to prevent further complications. Oral medication may be required if eczema is severe and affects activities of daily living.
Psoriasis is a skin condition that causes an itchy, scaly rash. It most commonly affects the knees, elbows, and scalp, but can occur on any part of the body including the toes. Psoriasis is categorised as an immune-mediated disease that causes skin cells to grow and multiply abnormally resulting in inflammation in the body. It does not weaken the immune system but it is a sign that a person’s immune system is not working as it should. Psoriasis is a chronic disease with no known cure and may lead to other health issues, such as psoriatic arthritis. Depending on how much of the body it affects, it ranges from mild to severe.
Psoriasis on the feet is sometimes confused with a fungal infection as both cause a similar rash that is often itchy. Psoriasis on the toes will present as slightly raised, red and inflamed patches with silvery scales or plaques on top. Psoriasis typically causes significant dryness which may result in bleeding and cracked skin on the toes. Pain and discomfort will be experienced if cracks in the skin occur. Plaques on the toes are usually located around the toenails and tips of the toes.
The cause of psoriasis is not clear but the immune system and genetics both play a role in its development. Trigger events such as stress, injury to the skin, weather, illness, allergies, food, alcohol or the environment may alter the immune system leading to symptoms of psoriasis. Stress is one of the most common triggers of psoriasis and psoriasis may also lead to increased stress. Scratches and bug bites injure the skin and could lead to a flare-up in psoriasis as can the colder weather months which have less sunlight and humidity.
There is no known cure for psoriasis therefore the goal of treatment is symptom management. Stopping skin cells from growing so quickly and removing scales will ease symptoms of psoriasis. It is best to use a mild and fragrance-free soap when washing feet and apply moisturiser daily to maintain the health of the skin. Topical creams and ointments containing corticosteroids, retinoids or coal tar will help with inflammation and scaling. Natural or artificial light therapy is useful in moderate to severe psoriasis. Oral or injected medications may be required if other treatments are not effective. Relaxation techniques, stress management and increased awareness of triggers can also help to reduce the frequency of psoriasis flares.
Contact dermatitis by definition is an inflammation or irritation of the skin in reaction to contact with a substance. Fragrances in creams, soaps and detergent, certain jewellery such as toe rings and some types of fabric fibres may cause irritant contact dermatitis. A person may even develop a rash after ingesting a disagreeable food which results in an allergic contact dermatitis. Contact dermatitis typically causes an itchy rash, which is not contagious or spread from one person to another, but will likely be uncomfortable until it resolves.
A rash from contact dermatitis can vary in how it manifests. If a reaction occurs, the rash may be itchy, reddish or brownish, become cracked or scaly, appear dry or feel like the skin is thicker than usual. Bumps, blisters or hives are also common. Rashes can develop within hours or days of contact with the irritating substance. Burning, itchiness and tenderness may be experienced and the severity of the reaction will determine how intense the symptoms feel and look.
Exposed and susceptible skin may eventually react to frequent exposure to a weak irritant or brief and sudden exposure to a stronger irritant. Irritant contact dermatitis results from contact with a substance and allergic contact dermatitis results from an allergy or sensitivity to an ingested food or medication. Weak irritants may include soaps and detergents and stronger irritants may include industrial cleaning solvents used to clean floors or plants, such as poison ivy.
It is important to determine what is causing the contact dermatitis and avoid exposure immediately. Prevent infection by using a mild, fragrance-free soap to wash. Skin can be soothed with a cool compress or by applying an anti-itch treatment such as calamine lotion, zinc or hydrocortisone cream. Colloidal oatmeal is a specially prepared form of oatmeal that can also help provide relief. Benadryl may be considered to combat the body’s response. It is recommended to seek medical attention if the rash is widespread, affects your sleep or does not completely resolve within a week or two. Immediate medical intervention is needed if you experience difficulty breathing or develop a fever or if pus is oozing from the skin.
Ingrown toenails are painful nails that dig into the skin at the sides of the nail. Skin is the largest organ in the body and is an excellent defense against the elements and microorganisms. When an ingrown toenail pierces or breaks the skin, it can easily become infected with bacteria and extend to the skin around the nail. This is known as a paronychia which can be acute or chronic, depending on how quickly it developed and how long it lasts. In addition to a bacterial infection, a chronic paronychia may also involve a yeast infection as well.
If the toenail punctures the skin, it can quickly lead to infection, inflammation, and pain. If infection occurs, the skin around the nail may appear red, puffy or swollen, have blood or pus seeping out, and feel warm to the touch. The infection will start where the nail actually punctured the skin, but can quickly become worse and spread around the entire nail. Pain and discomfort can worsen to the point when wearing shoes is intolerable or bed linens touching the toe causes a restless sleep.
Toenails that are overly curved or hooked at the sides are more likely to dig into the skin, causing pain. Sweaty feet are more susceptible to ingrown toenails because overly moist skin is weak and punctures more easily and creates movement in the shoes displacing soft tissues around the nail. Cutting toenails too short or ripping them off can leave a spike of nail in the corner that will pierce the skin as it grows. Ill-fitting footwear that is too tight, narrow or shallow can press on toes and cause an ingrown toenail. Injury to the toe caused by stubbing or kicking a ball repetitively, can inadvertently drive a sharp corner of the nail into the skin. Bacteria is always around and is not necessarily bad, but a break in the protective skin layer can lead to unexpected infection.
Removing the offending nail is key and is best done by a medical footcare clinician. To help ease inflammation and pain, an at-home Epsom salt water soak for 5-10 minutes is helpful as it will draw out pus and infection. An antibacterial cream or ointment applied to the infected site will help control infection causing bacteria and may even resolve it all together. Always make sure shoes fit well and allow toes to move freely and if cutting your nails at home, cut them straight across and not too short.
Microorganisms, such as bacteria and fungi, like to live where it is warm, dark and moist. Feet are an ideal breeding ground for infection if the proper steps are not taken to prevent and protect. Skin is a protective layer from the environment and from bacteria and fungi. The tips and tops of our toes are susceptible to irritation and possible breaks in the skin which can result in subsequent infection.
Depending on the type of infection, it will present differently. Cellulitis is a bacterial infection of the skin and will appear red, warm and swollen. A fungal skin infection is known as tinea pedis or athlete’s foot and causes a reddish or white rash that may be itchy or burn. Skin infections can also erupt in the form of vesicles or pustules, which are small bumps filled with clear fluid or pus, respectively. Bacterial and fungal skin infections on the tips and tops of the toes are typically warm to the touch, appear red or discoloured and will feel irritated which causes pain and discomfort.
When there is a break in the protective skin layer, infection is more likely to occur. Breaks in the skin create a portal of entry for bacteria and fungi. The most common bacteria to cause a skin infection is Staphylococcus aureus. This bacteria exists almost everywhere, including on normal skin and in the environment. The most common fungus found in this area of the foot is a dermatophyte. Dermatophytes have the ability to break down the keratin in our skin leading to subsequent rash and irritation. Bacteria and fungi are transmitted person-to-person and are therefore contagious. Sharing shoes, showers, and pedicure sinks and tools are common culprits.
Skin infections can be managed at home if they are mild. Washing feet daily with a mild or antibacterial soap and drying well afterwards will help keep the surface of the skin clean. There are over-the-counter antibacterial and antifungal treatments in the form of topical creams and solutions. After bathing feet, apply the topical cream or solution to the affected area twice a day. If you suspect an infection is present, it is best to seek the advice of a medical footcare clinician. A prescription topical treatment may be needed to prevent worsening and complications.
A wart is a benign or non-cancerous skin lesion that is caused by the human papillomavirus. Warts, also known as verrucae, are contagious in nature and can be spread from one person to another. They are classified depending on where on the body they occur and how they look. Warts on the top or end of the toes are usually referred to as Common Warts. Even though they may not be particularly painful, they can feel itchy and may cause a person to feel self-conscious.
The medical term for common warts is verrucae vulgaris. They are located on areas of the foot that do not typically bear the weight of the body. Common warts are similar in colour to a person’s skin, are small in size and appear as a visible bump on the surface of the skin. Common warts feel rough to the touch and are firm in texture. There may be black dots within the wart, which indicates bleeding from the tiniest blood vessels in the body and is a common feature of warts.
Warts are caused by the human papillomavirus (HPV). HPV is a viral infection that causes skin and mucous membrane growths, such as warts. There are over a hundred different strains of this virus, but only a few are usually the culprits of foot warts. Not everyone who is exposed to HPV will develop a wart. A weak immune system or a break in the exposed skin can increase a person’s risk for developing a wart. Warts are common in children and teenagers because their immune systems are still developing.
Warts don’t always require treatment, but since they are contagious, it is recommended. Certainly if they are bothersome, it is a good idea to seek advice from a primary care professional or medical footcare clinician. At home treatment includes a medication called salicylic acid, that is applied to the wart as a solution or cream or patch. After application, apply duct tape to cover the wart. This can increase the effectiveness of the medication and creates occlusion of the virus. Other treatments provided by foot care clinicians at BioPed may include liquid nitrogen, Cantharidin or silver nitrate, combined with professional debridement. The type of treatment depends on the age, overall health and type of wart.
Corns can occur on various areas of the foot, but commonly affect the toes if they endure pressure from footwear. Toes that are bent or curved, can result in more pressure from shoes and walking around. A corn is a circular area of thickened skin known as hyperkeratosis. They can occur on the tips and tops of the toes. A corn on the tips or top of the toes is known as a hard corn or heloma durum, and they are often mistaken for warts, but certain features differentiate the two lesions.
A corn can be quite painful when pressure is directly applied. This can make walking and activities of daily living challenging at times. A corn is round and varies in size. The area of thickened skin appears yellow or darkened and can be smooth or slightly rough in texture. If left untreated, the corn can begin to break down causing an opening in the skin. This can lead to a wound, infection and/or significant pain.
Ill-fitting footwear that presses on toes or does not provide proper support may cause corns to occur. Shoes with narrow, shallow or pointed-toes will restrict natural movement of toes. Hammer toes and bunions may increase a person’s risk for developing these lesions as they tend to place more pressure and friction on particular areas. Wearing shoes without socks may result in more friction on toes. Some people have more of a genetic predisposition for these thickened areas of skin.
When a corn is painful or if the sight of it is undesirable, treatment is advised. A medical footcare clinician can assess the lesion and provide treatment by reducing the thickness. If there is a nucleus or core, it may need to be enucleated or removed. Treatment at home may include soaking, using a file or pumice stone, applying cream and making sure to wear socks inside footwear that fits properly. At BioPed, all staff are footwear fit certified and can help you find the right shoe fit!
