What hurts?
Some possible conditions • Skin Conditions – Foot – Plantar
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Dry Skin -
Wound -
Callus -
Corns -
Wart -
Eczema -
Foreign Body -
Fungal Infection
Some possible conditions • Skin Conditions – Foot – Plantar
Dry skin is also known as xerosis and occurs when the skin is lacking sufficient moisture. Dry skin is common and often occurs with aging. Dry skin is not usually serious but it is more susceptible to cracks and splits, which pose a risk for infection. The skin on the bottom of the foot is thicker for protection when walking and moving around. Dry skin on the bottom of the feet 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 feet is important for proper treatment. Keep feet clean using a mild soap and after doing so, apply a rich cream containing a skin softening agent, such as urea. This will help replenish needed moisture. If skin on the bottom of feet 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.
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 foot will be superficial at first, but can quickly worsen becoming a deep opening or hole. Callus around the wound is typical on this area of the foot, from pressure and friction. A wound may ooze fluid such as blood, clear fluid or pus. A wound is sometimes painful, but if sensation and feeling on the bottom of feet 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 and if protective sensation is less than optimal, wounds can develop quickly. One of the complications of diabetes is peripheral neuropathy. This can significantly reduce a person’s ability to sense injury and pain. If an area on the bottom of the foot has an excessive amount of pressure, skin is at great risk of cracks, tears and ruptures.
Wounds require prompt assessment and treatment from a BioPed clinician and 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. Offloading high pressure areas with orthotics and footwear is imperative.
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 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 joints and bone, 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 joints are misaligned or more prominent than they should be, they will be more susceptible to pressure and friction when walking.
If a callus is not bothersome and you are healthy, treatment is not necessarily required. However, if you have diabetes or cold feet or arterial disease or take a blood thinner, it is a good idea to seek treatment. 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. If at-home treatment is not effective, BioPed’s medical footcare clinicians can safely remove callus using a scalpel blade or electric file. Wearing custom foot orthotics or off-the-shelf insoles are useful in offloading high pressure areas on the foot to lessen the amount of callus that forms in the first place. Orthotics are created by Canadian Certified Pedorthists and can be modified with padding or material can be removed in certain spots to further offload pressure. Well-fitting footwear is also imperative to support and cushion bottoms of the feet.
Corns can occur on various areas of the foot and are quite common on the bottom of the foot because of pressure and friction from 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 foot 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 performed.
Pain and discomfort are often felt when a hard corn develops on the bottom of the foot, making walking and activities of daily living challenging. 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 due to excessive pressure. If left untreated, corns can begin to break down causing a skin wound. This can lead to infection and significant pain.
Ill-fitting or inappropriate footwear that does not support the foot well can contribute to the development of corns. Hammertoes and bunions change the position of toes and can create pressure points on the bottom of the foot. Flat feet with fallen arches can cause instability and hypermobility when walking which places more pressure and friction on the certain areas of the foot. High arches can also cause pressure points on the bottom of the foot leading to painful corns.
When a corn is painful, treatment by a Chiropodist or Footcare Nurse 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 enucleated or removed. The lower limb clinicians at BioPed Footcare work together to remove the corn but also treat the cause. Custom foot orthotics can correct the mechanics in the lower body and improve the position and movement of the foot. They can also be modified to effectively offload high pressure areas. Supportive footwear is key and acts as an excellent “house” for orthotics.
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 foot are called plantar warts. The word “plantar” is derived from Latin and means “of the sole.” A wart on the bottom of the foot can be quite painful especially if it is in an area that bears weight when walking.
The medical term for a plantar wart is verruca pedis. These warts are usually flat with callus surrounding and have a cauliflower-like texture on the surface. They can be either brown, grey or similar in colour to a person’s skin and can vary significantly in size. Plantar warts can be singular or clustered in a group. 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, 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. Other treatments provided by foot care clinicians at BioPed may include liquid nitrogen, Cantharidin or others. Professional debridement of the wart is also a key component. The type of treatment depends on the age, a person’s overall health and the type of wart and where it is located.
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 feet endure significant pressure and friction when walking which can worsen symptoms of eczema. 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 soles of the feet tender and may even lead to painful cracks or fissures in the skin. Cracks in the skin increase 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 afterwards when the skin is still moist, will 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.
The bottom of the foot is at risk for injury when walking, especially when barefoot. Even though the skin on the bottom of the feet is thick, it is still susceptible to being pierced with a foreign object. In medical terms, a foreign object is something in the body that should not be there. The skin naturally sheds its layers and therefore a foreign body may come out on its own, but it can also become embedded deeper into the bottom of the foot due to pressure and weight-bearing.
Foreign objects in the foot are not normal and therefore often lead to infection, inflammation and pain. Redness around the suspected area and pain when walking is a sign of a foreign body. There may also be a presence of pus, blood or clear fluid draining from the site of injury and may or may not cause a visible bump to form on the surface of the skin.
Footwear protects the bottom of the foot from an injury to the skin when walking inside and outside. Inside homes, shards of broken glass, hair, kitty litter and slivers can occur. Outside, feet can become pierced with slivers, rocks, pebbles and glass. The smaller the foreign body, the more difficult it can be to remove. Skin that is dry or too moist is weak and will be more susceptible to injury from a foreign body.
The goal of treatment of a foreign body on the bottom of the foot is thorough removal of the offending object. It is strongly recommended to see a primary care professional or a medical footcare clinician for safe and complete removal of a foreign body. This will lessen the risk for infection and will improve the treatment outcome. The surface of the skin should be cleansed with an antiseptic before removal. After removal, immediate relief is usually felt and healing can finally occur. The area should be cleansed and covered to prevent infection.
A fungal infection on the bottom of the foot is known as moccasin tinea pedis as it typically covers the sole and sides of the foot like a moccasin or slipper. Fungus likes to live where it is warm, dark and moist, socks and shoes can be an ideal breeding ground for this type of microorganism. People with sweaty feet are more susceptible to developing a fungal infection. It can be uncomfortable and smelly and can lead to other types of infections which can complicate treatment and recovery. Fungal infections are contagious and can be spread from person-to-person.
The skin on the sole and sides of the foot is typically itchy and may appear dry and scaly with peeling skin. Moccasin tinea pedis is often mistaken for dry skin. This type of fungal infection tends to be long-lasting and difficult to eradicate, making proper diagnosis key. In more severe cases, small blisters or openings in the skin can develop as part of the rash.
Moccasin tinea pedis is caused by a fungus known as dermatophytes. Fungus thrives in warm, dark and moist places. Our shoes and socks are the ideal setting for fungi to set up residence. When skin is overly moist, it becomes weakened and is more susceptible to becoming infected. Sweaty feet increases a person’s risk for developing a fungal skin infection. If a person’s immune system is compromised they will be more susceptible to skin infections such as tinea pedis.
It is important to seek treatment from a primary care professional or a BioPed medical footcare clinician if any skin issue becomes persistent or causes discomfort. At home, washing and drying feet thoroughly and on a daily basis is imperative and if moisture still persists, applying an over-the-counter anti-perspirant could help. Allow shoes to air out between wears and change socks frequently if feet are on the sweaty side. Over-the-counter and prescription anti-fungal creams and solutions are effective when applied as directed. If moccasin tinea pedis does not resolve with topical treatments, an oral medication may be required to cure the infection. Contact your local BioPed to find out where to go or what would work best.
