Some possible conditions • Skin Conditions – Toes – Plantar
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 to pain 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 jeopardised 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 or BioPed clinician immediately. PAD prognosis can improve with exercise 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 process 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.
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 vessel, 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. When oxygenated blood is blocked, it 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 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. BioPed Chiropodists and Pedorthists are well-trained in treating wounds and offering pressure relief to allow for healing.
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 in the toes 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 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 or death 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 worse, 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 as they all share similar symptoms. Discolouration on toes due 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 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. The bottoms of the toes endure friction when walking which could cause worsening of eczema symptoms. Eczema is a long-term skin condition more commonly seen in young adults and 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, the fluid inside them reabsorbs into the body. The skin will then become red and may start to peel. This process can leave the toes tender 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 using a mild and fragrance-free soap keeps the skin clean and drying well afterwards is crucial to ensure the moisture balance of skin is maintained. If eczema is bothersome, it is best to seek the advice of a primary care professional or a medical footcare clinician. A topical corticosteroid may be required to reduce inflammation and increase comfort. If there are cracks in the skin, there is a risk for a fungal or bacterial infection. Infections may need to be treated with topical or even oral antimicrobials to prevent spread and further complications.
Psoriasis is a skin condition that causes an itchy, scaly rash and can occur on any part of the body including the feet. Psoriasis on the bottom of the foot is known as palmoplantar psoriasis. This type of psoriasis affects the palms of the hands, the soles of the feet and the bottom of the toes, areas on the body that naturally have thicker skin for protection. Psoriasis is categorised as an immune-mediated disease that causes skin cells to grow and multiply abnormally resulting in inflammation in the body. Psoriasis is a chronic disease with no known cure, and may lead to other health issues such as psoriatic arthritis.
Psoriasis on the feet is sometimes confused with a fungal infection as both cause a similar rash that is often itchy. Psoriasis on the bottoms of the toes will present as slightly raised, red and inflamed patches with silvery scales or plaques on top. The plaques can be thick and dry and may cause the skin to crack and bleed. When cracks in the skin occur, pain and discomfort will likely be experienced when walking. There will also be an increased risk for skin infection.
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 achieved by stopping skin cells from growing so quickly and removing scales caused by 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 as will natural or artificial light therapy. Oral or injected medications may be required if other treatments are not effective. Stress management can help reduce the frequency of psoriasis flares. Seeing a medical footcare clinician on a regular basis will keep thickened skin on the bottom of the toes under control.
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, 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. 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. A Rash can develop within hours or days of contact with the irritating substance. Burning, itchiness and tenderness may be experienced and the severity of discomfort will determine how intense the symptoms feel and look.
Contact dermatitis on the bottom of the feet is often caused by overexposure to excess moisture due to sweating and contact with wet socks and shoes. Similar to other areas on the foot, contact dermatitis on the bottoms may also be caused by frequent exposure to a weak irritant or brief and sudden exposure to a stronger irritant. Weak irritants may include soaps and detergents and stronger irritants may include industrial cleaning solvents or plants, such as poison ivy.
It is important to determine what is causing the contact dermatitis and avoid exposure immediately. If sweaty feet are the suspected cause, it is a good idea to change socks often during the day and allow your shoes to dry completely before wearing them again. Infection can be prevented by using a mild, fragrance-free soap to wash and skin can be soothed with a cool compress or by applying over-the-counter anti-itch treatment. Benadryl can also help control the body’s reaction. It is recommended to seek medical attention if the rash becomes 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.
A wound is an injury to living tissue in the body. A skin wound occurs when it opens, cracks, tears or ruptures. The skin is the largest organ in the body and its main purpose is to protect internal organs and tissues. The skin is subjected to the elements and to friction and pressure during gait. When an opening in the skin occurs, infection can easily result. The type of wound depends on the cause and early treatment is crucial to prevent worsening and serious complications.
A wound on the bottom of the toes typically involves callus due to pressure and friction. A wound may ooze fluid such as blood, clear fluid or pus. A wound can be quite painful, but if sensation and feeling in the toes is reduced or absent, a person may not even know they have a wound in the first place. Redness, swelling, increased temperature of the surrounding skin and the presence of a foul smell are signs of infection. If infection is left untreated, fever and flu-like symptoms may be experienced.
Wounds require prompt assessment and treatment from a medical footcare clinician or a primary care professional. Wounds must be treated to promote healing and monitored closely to prevent worsening and complications that can be serious and even limb and life threatening. Treatment of wounds typically involves debridement or removing dead tissue and callus that impedes proper healing. Medicated topicals and dressings applied directly to the wound treat and prevent infection and encourage healthy tissue growth. Wound healing must occur from the inside out. Well-fitting and appropriate footwear is imperative to support the feet and toes. A Certified Pedorthist can work with you to take the pressure off the wound to allow it to heal.
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.
Callus is an area of thickened skin, also known as hyperkeratosis. Callus forms in the outer layers of the skin known as the stratum corneum, which as a protective layer, is susceptible to pressure and friction when walking and moving around day-to-day. The stratum corneum contains a protein called keratin that helps keep skin healthy and strong. The body will attempt to protect itself by thickening the skin when it is subjected to repetitive pressure and friction.
Keratin in the skin contains melanin, which is the part of the skin that gives it colour. When callus forms, the area of thickened skin will appear darker or more pronounced in colour. Depending on skin tone, callus can look yellow or brown. It can feel rough, lumpy or smooth and may have patches of white, dry skin overtop. Callus on the bottoms or underside of the toes typically covers the area that endures friction from the ground. If pressure is significant, bleeding can occur, visible within the callus on the toe. Callus that is thick and untreated will likely cause pain and discomfort as it places pressure on the structures underneath the skin.
Callus forms when the foot and the ground move in opposite directions, creating a shearing force. In addition, high heels, shoes that are the wrong size or too narrow and shallow and not wearing socks, can all cause undue friction to occur. Callus can also be caused by a repetitive movement experienced at work or in life. If toes are bent or curved, such as hammertoes, the underside of the toes will be more susceptible to pressure and friction when walking.
If callus is not bothersome, treatment is not necessarily required. The thickness of callus can be reduced using a foot file on a regular basis. Moisturising the skin with a rich emollient will keep callus soft and prevent cracks in the skin from forming. If at-home treatment is not effective, BioPed’s medical footcare clinicians can safely remove callus using a scalpel blade or electric file. Silicone toe sleeves can be worn to act as a buffer between the skin and ground/shoe. Wearing custom foot orthotics or off-the-shelf insoles are useful in offloading high pressure areas of the foot and reducing the amount of callus that forms in the first place. Well-fitting footwear is imperative to support and cushion the toes and feet. BioPed Canadian Certified Pedorthists and Registered Chiropodists are well-trained to assess areas of high pressure.
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 bottom or pulp of a toe are called plantar warts. A wart on the pulp of a toe can be painful as this is the area of the toe that bears weight when walking.
The medical term for a plantar wart is verruca pedis. They are located on areas of the foot that typically bear the weight of the body. Plantar warts are the pulp of the toe, are flat, and either brown, grey or similar in colour to a person’s skin. They tend to be small in size and feel rough to the touch and firm in texture. There are usually black dots within the wart which indicates bleeding from the tiniest blood vessels in the body and is a common feature of warts. Warts need a supply of blood to feed the virus and keep it alive.
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 linked to warts on feet. 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.
With warts, 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. After application, Duct tape is applied to cover the wart and increase the effectiveness of the medication. Other treatments provided by foot care clinicians at BioPed include liquid nitrogen, Cantharidin and silver nitrate among others. Professional debridement or trimming is a key component of treatment. The type of treatment depends on the age, a person’s overall health and the type of wart and where it is located.
Corns can occur on various areas of the foot, and are quite common on the bottom of the toes because of pressure and friction from the ground reaction forces or contact with the ground when walking. A corn is a circular area of thickened skin known as hyperkeratosis which has a core or “nucleus.” A corn on the bottom of the toe is known as a hard corn or heloma durum. This type of corn is often mistaken for a wart and needs to be properly assessed and diagnosed to ensure effective treatment is achieved.
Pain and discomfort are often felt with a hard corn on the bottom of the toe which can make walking and activities of daily living challenging at times. A hard corn may be round or irregular in shape and can vary in size. The area of thickened skin typically appears yellowish or brownish depending on a person’s skin tone. A hard corn will feel hard or firm in texture and may have flecks of red or brown which indicates bleeding in the tissue because of excessive pressure and friction. If left untreated, corns can begin to break down causing an opening in the skin. This can lead to infection and 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, treatment by a medical footcare clinician is recommended. They will assess the area and provide treatment, which includes reducing the thickness of the corn. If there is a nucleus or core in the lesion, it may need to be removed. Wearing a silicone toe prop can be beneficial as it helps to straighten the toe when walking and prop it up off the ground. This can be an effective way of reducing the pressure causing the corn in the first place. This toe prop should be removed for personal hygiene routines and for sleeping. Also, consider a more permanent offloading solution, which is orthotics. Orthotics and footwear can be discussed with a BioPed Pedorthist.
An infection on the underside of toes typically is caused by a fungus or bacteria. Both types of infections usually start in between the toes where the skin is moist from sweat and less air flow. When an infection is left untreated, it can spread to the underside or bottom of toes as this part can also be sweaty and moist. A fungal infection on the bottom of toes is also known as Athlete’s foot and usually itches or burns. A bacterial infection on the bottom of toes may present as a sore and warm abscess with pus or a red rash.
Fungal and bacterial infections can look and feel different, but they also have similarities. Both can cause the skin to peel, crack, discolour, itch, burn and throb. There could also be a foul odour. Increased moisture and sweating is an ideal breeding ground for microorganisms. Infections can start small and be superficial in the top layer of the skin, but could spread to a larger area if left untreated. If infections spread or enter the bloodstream, a person may feel feverish or experience flu-like symptoms.
A fungal infection on the toes is also known as tinea pedis and is most commonly caused by fungi known as dermatophytes. Bacterial infections on the underside of the toes could be caused by a bacteria known as Corynebacterium minutissimum. Increased moisture, excess sweating and poor personal hygiene increase the risk for both types of infections and must not be ignored when initiating treatment. Systemic health conditions such as diabetes can compromise the immune system making a person more susceptible to infections as well.
If the infection is mild, at-home treatment may suffice. It is important to wash feet and change socks daily. Allowing shoes to air out and dry from sweat and moisture will also help. Using rubbing alcohol in between and on the underside of toes will help to evaporate and dry up excess moisture. If symptoms of infection persist, it is recommended to seek the advice of a primary care professional or BioPed Chiropodist to know what type of infection needs to be treated. Fungal skin infections respond well to antifungal treatments in the form of cream or solution. Use an antibacterial soap, cream and solutions for bacterial infections. Apply consistently, once or twice a day and choose an alcohol-based topical if moisture level is high.
