What hurts?
Some possible conditions • Skin Conditions – Foot – Heel
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Eczema -
Psoriasis -
Wart -
Wound -
Piezogenic Papules -
Fissures -
Dry Skin -
Callus
Some possible conditions • Skin Conditions – Foot – Heel
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 heels of the feet endure the weight of the and pressure during gait which can make eczema worse. Eczema is a long-term skin condition more common 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 heels feeling tender and may even lead to painful cracks or fissures in the skin. A break in skin such as a crack increases risk for infection.
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. The combination of washing feet daily using a mild and fragrance-free soap and applying a rich moisturiser containing urea when the skin is still moist, will maintain the moisture balance of skin. 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 heels of the feet is known as palmoplantar psoriasis. This type of psoriasis affects the palms of the hands and the soles of the feet, two 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 heels is sometimes confused with a fungal infection as both cause a similar rash that is often itchy. Psoriasis on the heels of the feet will present as slightly raised, red and inflamed patches with silvery scales or plaques on top. The plaques can be quite thick and dry and may cause the skin to crack and bleed. The skin on the heels endures a considerable amount of body weight and impact during gait. Cracks in the skin will cause pain and discomfort and will increase the risk for infection and subsequent complications.
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 heels under control.
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 of the heel are called plantar warts. The word “plantar” is derived from Latin and means “of the sole.” A wart on the heel can be quite painful as this part of our foot endures a large amount of pressure and bodyweight when it strikes the ground during gait.
The medical term for a plantar wart is verruca pedis. Plantar warts on the heel tend to be flat as pressure from the ground pushes the wart deeper into the tissue. These warts will have a cauliflower-like texture on the surface and may have callus around it as well. Plantar warts will appear either brown, grey or similar in colour to a person’s skin and can vary significantly in size. There may be a singular wart or a cluster. Black dots within the wart tissue indicate 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 or patch. After application, Duct tape is applied to cover the wart and increase the effectiveness of the medication and occlude the virus. Other treatments provided by medical footcare clinicians at BioPed include liquid nitrogen, Cantharidin and others. Professional debridement is key. The type of treatment depends on the age, a person’s overall health and the type of wart and where it is located. BioPed Chiropodists and Footcare Nurses are qualified to assess and treat plantar warts.
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. It is subjected to pressure and friction and pressure when walking, putting it at risk for injury. When an opening in the skin occurs, a person is at risk for infection. The type of wound depends on the cause and early treatment is crucial to prevent worsening and serious complications.
A wound on the heel may occur on the bottom or on the back. It is usually superficial at first, but can quickly become a deep opening or hole. A wound on the bottom of the heel may be surrounded by callus. Wounds typically ooze fluid such as blood, clear fluid or pus. A wound is sometimes painful, but if sensation and feeling 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.
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 bottom of the foot endures body weight, pressure and friction when walking. Peripheral neuropathy is a complication of diabetes and can significantly reduce a person’s ability to sense injury and pain. Wounds can develop quickly if protective sensation is less than optimal. If a person is bedridden and unable to shift body weight sufficiently, a wound on the back of the heel may develop. This type of wound is referred to as a bedsore, decubitus ulcer or pressure sore.
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 removal of dead tissue and callus and application of medicated topicals and dressings applied directly to treat and prevent infection and encourage healthy tissue growth. Wound healing must occur from the inside out. Offloading high pressure areas with orthotics from a Canadian Certified Pedorthist and being properly fitted for footwear is imperative.
Piezogenic papules are benign protrusions in the skin on the heels and are caused by normal fat tissue being pushed through the dermis or the inner layer of the skin. Piezogenic papules typically develop on the bottom of the heel and are usually seen on the inside part of the heel. The heel endures an enormous amount of pressure and body weight during gait. The word piezogenic means “resulting from pressure.”
Piezogenic papules are usually asymptomatic. Pain can indicate fat necrosis due to lack of blood circulation. These papules will be firm but compressible, yellowish to skin-coloured bumps that protrude from the edges of the heel. They become more prominent when standing in a full weight-bearing position and will be less noticeable when non-weight bearing.
The specific cause of piezogenic papules is not known but it is known they do not typically run in families and are not usually serious or painful. If piezogenic papules are seen in a toddler, it could be a red flag for a connective tissue disorder known as Ehlers-Danlos Syndrome. A heavy heel strike when walking and standing for long periods of time can both cause piezogenic papules to form in the heel.
The most effective way of getting rid of piezogenic papules is reducing weight-bearing exercise(e.g. trade in the treadmill for a bike), losing excess weight if needed and wearing compression socks. A biomechanical assessment by a lower limb clinician is important as the cause can be determined. Custom foot orthotics can help to reduce the pressure and strain on the heel when walking. Footwear with added cushioning will provide shock absorption and can help to protect the heel from injury. Both BioPed Chiropodists and Pedorthists can help you with orthotics and footwear needs.
Fissures are cracks in the skin commonly associated with dry skin and callus. The skin around the heels is particularly at risk for cracks because they endure a considerable amount of stress and pressure from the weight of the body during gait. Fissures can vary in depth from superficial to deep. Deep fissures are typically open and may lead to more serious complications such as infection as breaks in the skin are a portal of entry for bacteria, fungus and viruses.
Heel fissures can be quite sore and may bleed if they are in fact open. If bleeding occurs, a scab may develop. Callus is frequently built up around the heels where fissures have formed. The skin is often dry and may appear slightly white, peeling or scaly. Fissures can be small or large and there may be one or several on the heel. Pus from the fissure, redness and increased temperature of the surrounding skin can all be indications of infection.
The heels endure a considerable amount of stress and pressure from the weight of the body during gait, as they are the first part of the foot to strike the ground. Other causes of heel fissures are obesity, diabetes, thyroid issues, various vitamin or nutrient deficiencies, genetics and skin disorders. Skin disorders that cause excessive dryness of skin are particularly problematic as dry skin is weakened and not as resilient to stress, pressure and injury.
It is always best to seek the advice of a medical footcare clinician if a heel fissure develops. Infection is a common complication and can be avoided with the proper attention, treatment and advice. Callus will need to be reduced using a scalpel blade or file. At home, open cracks can be kept clean with salt water or by using a mild soap and water. Application of an antibacterial cream or ointment will protect against and treat infection. It is best to cover the open area with a bandage or dressing. If heel fissures are compounded by a health issue, advice from a primary care professional will provide insight on what is going on and what should be done next.
Dry skin is also known as xerosis and occurs when the skin is lacking sufficient moisture. Dry skin is common and often occurs with ageing. Dry skin is not usually serious but it is more susceptible to cracks and splits which poses a risk for infection. The skin on the heels is naturally thicker for extra protection when walking and moving around. Dry skin on the heels can also resemble other skin conditions such as a fungal infection, eczema or psoriasis.
Dry skin can feel rough, scaly, flaky, tight, itchy or can lead to cracking. Cracks are more common on the bottoms of the feet as they endure body weight and friction when walking. Redness and inflammation can arise if dry skin is severe.
Dry skin can run in families but can also be caused by overbathing, cold and dry weather, sun damage and harsh soaps. Harsh soaps may contain perfumes or fragrances and those that are considered antibacterial can cause or exacerbate dry skin. After washing feet, it is important to thoroughly rinse soap from skin as leaving a residue can cause dryness. Certain medical conditions such as hypothyroidism and diabetes can lead to dry skin, as can vitamin and mineral deficiencies.
Knowing the cause of dry heels is important for proper treatment. Keep feet clean using a mild soap and apply a rich cream containing a skin softening agent such as urea afterwards. This will help replenish needed moisture. If skin on the heels is rough or scaly, an exfoliant wash or coarse foot file can help slough off dead skin build-up. Using a humidifier at home will increase the moisture in the air during winter weather months. If dry skin becomes widespread or is bothersome, a cortisone cream can provide relief. If cracks or breaks in the skin occur as a result of dry skin, it is best to seek the advice of a medical footcare or primary care professional.
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 on the heels, 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 bottom of the feet can be diffuse or cover a large area or can be more pinpointed and localised. 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 such as tissue and bone underneath the skin.
Callus forms when the foot and the ground move in opposite directions, creating a shearing force. The heel is usually the first part of the foot to make contact with the ground when walking. It encounters a considerable amount of pressure and stress. Shoes that are the wrong size and not wearing socks, can cause unnecessary friction to occur. Callus can also be caused by a repetitive movement experienced at work or in life. If joints are misaligned or more prominent than they should be, they will be more susceptible to pressure and friction when walking.
If you are healthy and the callus is not bothersome, treatment is not necessarily required. Using a foot file and a rich emollient on a regular basis, will keep callus soft and can prevent cracks in the skin from forming. Thick callus on the heels is at risk of cracking which can lead to infection. BioPed’s medical footcare clinicians can safely remove callus during a foot care appointment. Wearing custom foot orthotics from a Canadian Certified Pedorthist or off-the-shelf insoles are useful in offloading high pressure areas on the foot and correcting gait to reduce the amount of callus that forms in the first place. Well-fitting footwear is imperative to support and cushion bottoms of the feet.
