Common Foot Treatments
ELDERLY AND SENIOR FOOT CARE
Often, as we age it becomes more and more difficult to care for our feet. There can be several contributing factors such as arthritis, patient immobility, diabetes, thick/damaged toenails, etc. When these medical conditions are combined with other systemic illnesses, elderly nail care is a great concern. Often we see delayed healing, loss of blood circulation, and many dermatological (skin and nail) problems.
​
TREATMENT
At Tri-City Foot Clinic the Chiropodist/Foot Specialist is able to accurately diagnose and treat all conditions of the feet. Once an issue is determined, the Chiropodist has all of the required instrumentation to begin treatment. In dealing with a medical service, all patients will be treated in a sterile environment to assures any condition/issue will resolve.
WITHOUT TREATMENT
Without treatment the feet become neglected due to the inability to care for the foot. Neglected feet are problematic. Increase in nail conditions/length may lead to ingrown toenails, pain, infection of the nail plate, skin infection or even ulceration. Delay in hyperkeratosis (callus) debridement can result in pain, ulceration, and lack of patient mobility. Delay in treatment of inflammation can lead to arthritis and further foot deformity.
PAEDIATRIC / CHILD FOOT CARE
In early development, our are rapidly growing. In fact, not all bones are formed at birth. Skeletal (bone) maturity does not occur until approximately 13-15 years. Gait (walking) is constantly developing, and we do not reach a heel-to-toe gait until approximately the age of 3. (A heel-to-toe gait is considered the normal pattern of gait). Many paediatric conditions differ from elderly conditions. Younger population's are more prone to plantars warts, ingrown toenails, foot trauma and biomechanical faults.
​
TREATMENT
We can provide the corrective measures as soon as the problems arise. This will be done after a thorough gait and biomechanical analysis. If deemed necessary, a treatment plan will be put into place. REMEMBER – our children’s feet are still developing therefore, the foot may not need treatment at all. We suggest seeing a Chiropodist yearly to ensure proper foot progression through these critical early years.
WITHOUT TREATMENT
Without treatment our children’s feet can become problematic. For kids, feet are considered fat, flat and floppy until the age of 3. However, overly flat feet or feet that severely in-toe/out-toe may need corrective measures. Without the proper correction, there may be permanent gait disturbances for the remainder of the individual's life. A wart that is left untreated may develop further. An ingrown toenail can become infected, and it may reoccur. It is easier to perform required surgery on a patient that is young, healthy, and will recover easily than a patient that is old and frail.
​
THICK TOENAILS (ONYCHAUXIC)
Thick toenails occur for several reasons. For instance; permanent damage due to nail plate trauma, a previous infection, a fungal infection, or a systemic condition. Most commonly a nail plate will thicken due to trauma.
​
TREATMENT
If the thick toenail is permanently damaged we can treat your nail by filing it with specialized instruments. This helps decrease the pressure and it appears to look like a normal nail. In severe cases, surgery may be required – this would be a permanent removal of the nail plate. If an infection is present, the proper prescription medication will be supplied to rid you of the infection.
WITHOUT TREATMENT
A neglected thick toenail can cause extreme discomfort/pain as the nail rubs on the top or end of the shoe. This can cause additional pain to the nail bed (underneath the nail plate). Often if the thick toenail is not filed the nail bed may open and an ulcer can form. A thick toenail also increases your risk of infection and further damage to the nail/toe.
​
FUNGAL NAILS
Fungal toenails (onychomycosis) can present differently for each individual. It can include the presence or absence of smell, discoloration, and altered appearance of the nail. The infection affects the nail bed (skin underneath the nail) or nail plate (the surface nail), often causing it to become thickened and raised. Commonly, patients see their nails become crumbly. Fungal nails often affect more than one nail, and happen more prevalently in individuals with persistent moisture in/near their feet. Fungus tend to like warm, dark, wet places.
​
TREATMENT
Treatment of the fungal nail usually requires regular reduction of the nail with an ongoing prescription of an anti fungal.
Laser treatment is another alternative we offer at the Waterloo Foot Clinic. Fungi colonize the nail plate, bed, and matrix, leading to discolouration of the nail, thickening of the subungual region. The energy delivered by the Genesis laser penetrates the nail plate to selectively target the internalized fungus without causing damage to the rest of the nail, nor the surrounding tissue. The treatment is quick, efficient and can be done during regular appointment times including during an initial consultation. Fungus can usually be cleared up in 2-4 treatments with continual use of a topical anti fungal.
After the fungus is cleared up the nail will grow back healthy and sightly within a year with results appearing after about 3 months.
Treatment for fungal nails can be difficult because the nail plate can protect the fungus from being exposed to medication – this is why regular reduction is required. Oral medication is not usually considered a viable option due to the toxicity effects on the liver. In some cases, the infection may be so severe that surgery is required to remove the nail. Early prevention is key in the quick recovery of a fungal nail. Do not hesitate to see a Chiropodist / Foot Specialist.
WITHOUT TREATMENT
Without treatment the nail will become very thick, discoloured and unsightly – it may appear as though the infection is moving up the nail closer to the base of the toe. In some cases, the nail may be painful and further infection may result. Fungus may also spread to surrounding skin and other parts of the body.
​
HEEL PAIN / PLANTAR FASCIITIS
Plantar Fasciitis is an overuse syndrome causing inflammation of the plantar fascia. The most tender spot tends to be the origin of the Plantar Fascia on the bottom of the heel (medial tubercle of the Calcaneus). Often a patient will complain of severe heel pain that is worse during the first few steps in the morning or after long periods of walking. The pain often decreases with rest.
DIAGNOSIS
The Chiropodist will examine your foot for swelling, redness, and tenderness of the area. A full biomechanical and gait analysis will be performed.
TREATMENT
Treatment may include a number of the following; stretching exercises, tapping and strapping, rest, ice, proper or custom footwear, custom orthotics, prescription anti-inflammatory medication (NSAIDs). More invasive treatment can include corticosteroid injection or a surgical procedure such as needling or plantar fascia release.
Depending on the severity of the plantar fasciitis, and other health factors, treatment can span from a matter of weeks to several months and may involve a combination of management approaches. Patient's should be made aware that “Guaranteed” or “fast fixes” by unregulated persons or non-foot specialist often will not suffice.
WITHOUT TREATMENT
Plantar Fasciitis will most often not improve unless the root biomechanical and gait problems are addressed. The predisposing factors must be taken into consideration to rid the pain and inflammation of the tissue. The pain can become so debilitating the individual may stop exercising, may take time off work, or completely refrain from participating in activities they love. Eventually permanent damage to the plantar fascia and surrounding tissue can occur.
SHOCK WAVE THERAPY
(for plantar fasciitis)
Shockwave therapy is a non-invasive treatment involving a series of low energy acoustic wave pulsations that are directly applied to an injury through a person’s skin with the use of a water-based Gel medium. The pulsations promote the regeneration and reparative processes of the bones, tendons and other soft tissues. The application of shockwave causes dissolution of calcium deposits leading to an increase of blood flow to the afflicted area. The result, immediate alleviation of pain with relief after a few short treatments.
With guided stretching, icing, and resting, shockwave therapy can relive pain associated with plantar fasciitis or tight calves. Treatments last around 10 minutes and are done without the use of local anesthetic. Shockwave therapy is non-invasive, has a short recuperation period, and reports only minor side effects. The treatment is mostly painless with slight to mild discomfort occurring throughout the treatment. Shockwaves are one of the most effective means of treating pain associated with musuloskeletal systems including plantar fasciitis. Ask your Chiropodist or schedule an appointment to determine if you are a candidate for shockwave therapy.
​
INGROWN TOENAILS | ONYCHOCRYPTOSIS
An ingrown toenail (Onychocryptosis) is when a piece of the nail has started to grow into the skin surrounding the nail plate. This piece of nail is often referred to as a nail spicule. An ingrown toenail can be the result of improper nail trimming, narrow-fitting footwear, trauma, foot shape, and nail shape (hereditary). REMEMBER: to avoid ingrown toenails cut your nails straight across, try not to cut or angle downward as you move into the corners.
​
TREATMENT
Treatment will depend on the severity of the ingrown toenail. (Remember preventative medicine is the best medicine). The main treatment goal will be to remove the nail spicule. At Tri-City Foot Clinic, we try to make this as comfortable as possible for the patient. This may mean applying a freezing (local anesthetic). Once the ingrown toenail is removed the next step will be to rid the area of any infection. Prescription antibiotics may be issued. Finally, prevention will be vital to deter a repeat instance. All patients will be educated on knowledge and prevention techniques for ingrown toenails. If the ingrown toenail does continue to reoccur, surgical permanent removal may be required. This procedure is called a Partial Nail Avulsion with Matrixectomy.
WITHOUT TREATMENT
The nail spicule will grow with the nail plate. In the primary stage the spicule may push on the surrounding tissue – this may be the start of the pain sensation. If left untreated, the spicule may puncture the skin and cause a portal of entry for pathogens (germs). This stage is more of a concern as pathogens can easily enter and cause infection. If an infection is present, the body will initiate an immune response, often presenting as a pus pocket with surrounding inflammation. The toe will now look red, feet hot, appear swollen and be quite painful to touch.
​
WARTS / VERRUCAA PEDIS
Warts (Verruca Pedis) can appear in different sizes, shapes, and locations. Warts are an infection of the skin caused by the Human papillomavirus (HPV). There are many different strands of the HPV virus. We do not like to use the term Plantars Warts because warts do not have to appear on the bottom of the foot. (Although this is the most common location, it is not the only location). For any infection, there need to be three components: Infectious agent (Virus), susceptible host (patient), and portal of entry (eg: open sore). Often we pick up the HPV virus from communal bathing places – eg: public pools, showers, or places where we go barefoot. Warts can have a cauliflower-like appearance, can have black dots located in the center, and may be tender to walk on or pinch. Not everyone who comes in contact with the virus will present with a wart. However, those with decreased immunity are more susceptible to warts.
​
LASER WART TREATMENT
Warts on the foot can be extremely difficult to treat (especially if they have been there fore a while), this is believed to be due to the fact that we have an extra layer of skin on the soles of our feet (Stratum Lucidium). Often overlying Callus (hyperkeratosis) also forms. This overlying callus causes more pain and may make the host more susceptible to the virus. Treatment may take weeks or months to complete.
We now offer laser wart treatment, available after a quick assessment/consultation!
Laser Wart treatment includes the non-selective destruction of the epidermis, cauterizing tiny blood cells resulting in the absence of blood flow to the affected tissue. Eventually the affected tissue without blood will fall off. This can usually be achieved in a single to very few treatments making it one of the quickest and most efficient treatments against plantar warts.
It is especially effective against those difficult warts that seem to never go away. Laser wart treatment can be done with or without the use of local anesthetic for patient comfort. Please contact us if you require any further information including costs.
​
TREATMENT
At Tri-City Foot Clinic we may accompany treatment with an application of prescription medication, salicylic acid, injection with medication, needling, freezing, surgical excision or laser treatment. Each treatment plan will be tailored specifically to each patient.
WITHOUT TREATMENT
Without treatment, you may be surprised to learn that some warts can simply go away. However, it is more common to see the wart become increasingly painful, spread to surrounding tissue or appear to grow. When warts are left untreated, it can hinder our ability to walk or run due to the influx of pain during weight bearing (standing).
​
DIABETIC FOOT CARE
(including ulcers)
All Diabetics should be seeing a Chiropodist/Podiatrist/Foot Specialist at regular intervals. Diabetics have an increased risk of problems leading to foot and/or lower limb issues which can range in severity including amputation. Common conditions associated with diabetes are neuropathy (loss of sensation), peripheral arterial disorders (loss of blood flow), and a decreased immune response. All of these make diabetic patients especially exposed to risk and increase the need for them to get their feet checked regularly.
​
TREATMENT
Your Chiropodist/Podiatrist/Foot Specialist will monitor your condition through thorough vascular (blood), neurological (nerve), dermatological (skin and nails), biomechanical and gait exams.
WITHOUT TREATMENT
Problems from diabetes are the leading cause of non-injury related amputations. Wounds or serious infection can manifest quickly.
Diabetic Peripheral Neuropathy:
Often, a patients first complaint of peripheral neuropathy will be altered sensation. This can feel like tingling, burning, numbness or pin-and-needles. As the neuropathy progresses the patient eventually loses all sensation. Protective sensation may become completely lost. Therefore, the patient may not feel if they are suffering from an open sore, cut, or blister. Often patients are unable to feel the temperature of the bath water and burn themselves. Foot shape may change in a diabetic due to the loss of sensation and vascular compromise. This may manifest as a “Charcot Foot” or an “Intrinsic Minus Foot” – both leading to decreased Quality of Life and increased risk of complications.
Vascular Compromise:
Diabetics are more prone to blood circulation problems. These can be of Arterial (blood flow away from the heart) or venous (blood flow back to the heart) origin. Most commonly the blood flow to the foot is compromised due to the high levels of glucose circulating in the blood (may present as bounding or absent pulses in the foot). Blood flow back to heart becomes compromised and most often presents as swelling in the legs.
Immunological Compromise:
Diabetics have a decreased chance in healing from infection due to the the high levels of glucose and the compromised blood supply. The glucose causes the immune system to become "sluggish" and a diabetic ulcer may take months to years to heal.
​
DIABETIC FOOT CARE (including ulcers)
Corns (Helomas) and Callus (Hyperkeratosis/ Tyloma) develop due to pressure. They can be physiological (normal) or pathological (abnormal). If an individual work with their hands all day (eg: shoveling) the natural physiological response of the body will be to build up the skin in pressure areas. This presents as a callus – if the pressure is more localized a corn may develop. These areas become pathological if left untreated or if the increased pressure is chronic. Corns and Callus are very common in the foot due to the pressure placed on the foot with every step we take. A more rigid foot tends to present with more callus or corns. Often a patient may complain of pain – feeling as though they are walking on something hard such as the sensation of walking on a rock.
​
TREATMENT
Treatment of corns and callus involves removing the pressure – This is best done with prescription custom foot orthotics. The overlying callus and corn should always be removed. This can be done by regular debridement and filing. It is also suggested to apply emollient (skin moisturizer) to help your body slop off the dead skin cells. It is hard to completely remove a pressure area in the foot. The most effective way to offload a pressure area is through the use of custom foot orthotics. Surgery or wound care may be indicated if the callus becomes severe.
WITHOUT TREATMENT
If corns and callus are left untreated it will become very painful for the patient. Often blood may form below the callus. This is known as a hematoma. If the pressure continues the skin underneath the callus may open and ulcerate. This may cause scar tissue in the area, which is more prone to callus formation – thus causing further damage. All callus should be treated and monitored frequently.
​
BUNIONS
Bunions (HAV – Hallux Abducto Valgus) often present as a bone prominence on the inside of one or both feet, near the bottom or base of the big toe. The first ray (metatarsal) has deviated to the midline of the body (medial deviation). The big toe (Hallux) then rotates (valgus rotation) and deviates towards the outside of the foot (abduction). Bunions do not have one direct cause, but instead are due to a multitude of factors including hereditary, improper footwear, faulty biomechanics, gait pattern, and trauma.
​
TREATMENT
We will develop a treatment plan dependent on the stage of bunion you are experiencing.
If in the earlier stage, a patient would benefit from orthotics to prevent the progression of the bunion. It is also essential that the patient get into new proper footwear. All patients will be educated on the proper foot wear based on their feet.
If a patient is in the later stage, our clinics will try their best to reduce the pain. This may be done by therapeutic injection, surgery, orthotics, footwear, etc. Bone surgery is considered last resort due to the high chance of recurrence and long length needed for recovery time.
WITHOUT TREATMENT
Without treatment, the bunion will keep progressing towards the later stage. The late stage is when the big toe (hallux) has completely dislocated/deviated and is now over or under-riding the lesser digits. It is common for the lesser toes to claw – due to the faulty biomechanics. The digital deformities will cause increased likelihood of callus and corn formation – which may eventually lead to ulceration. The patient may also find the bunion extremely painful as arthritis will start to set in.
​
GANGLION CYST | DIGITAL MUCOID CYST
A ganglion cyst presents as a lump or bump under the skin occurring at any joint in the foot. Ganglion cysts are also very common in the wrist and hands. At Waterloo Foot Clinic, we often see a ganglion cyst on the lesser digits (smaller toes). These cysts are known as digital mucoid cysts. The cyst forms when the joint capsule is damaged and there is a leakage of joint (synovial) fluid into the surrounding tissue. Often patients will complain of unsightly appearance. The cyst may rupture and a clear sticky fluid may drain (this is synovial fluid). The cyst can also become very painful if located in a spot of frequent friction or irritation.
​
TREATMENT
Conservative treatment is available for a ganglion cyst. The main goal is to prevent the irritation/causing factor in the area, for example; pressure redistribution. This can be effective, however, often ganglion cyst treatment requires surgery. Surgery can range from simple aspiration (removal of the fluid), and introduction of corticosteroid to a more invasive procedure in which surgical excision is required. At our clinics we tailor a treatment plan to each patient based on best practice. If surgery is required, it can be performed on site at the clinic by the Chiropodist.
WITHOUT TREATMENT
Ganglion cyst may rupture from a heavy, external force. At one time, people used heavy books to strike the cyst (hoping for it to rupture) and allow the fluid to drain into surrounding tissue. Often a Bible was used (due to weight), hence why ganglion cyst may also be referred to as a Bible Cyst. This is not recommended for obvious reasons. A cyst should always be diagnosed before it is treated – make sure there is no possibility the bump is cancerous (neoplastic). Additionally, we do not want to cause further damage to an already susceptible joint capsule, or surrounding tissue. Finally, it is simply not effective.
If a ganglion cyst is left untreated overlying Callus (hyperkeratosis) may form. This area can become extremely painful. The callus causes increased pressure – potentially causing the cyst to become bigger. The callus may also cause the cyst to open and rupture. Once opened, there is now a portal of entry for pathogens (virus, bacteria, fungus, etc) to enter; potentially causing infection. It is also highly likely that the cyst will return. Therefore, you should always see a Chiropodist/Podiatrist/Foot Specialist for a comprehensive treatment plan.
​
GENERAL FOOT AND NAIL CARE
A Chiropodist/Podiatrist/Foot Specialist is a regulated health professional with the ability to treat all conditions of the foot and ankle. Preventative medicine is the best medicine; therefore a Chiropodist will be able to address any concerns. These concerns may be what the patient states to the practitioner, but the practitioner also does a full biomechanical, vascular, neurological, dermatological, and footwear assessment. Therefore, the practitioner may find concerns that go unnoticed by the patient.
We recommend you see a Chiropodist once a year for a complete foot assessment.
​
WOUND CARE
Wounds in the foot can form for several reasons. Complications in healing may occur depending on a patient’s health and co-existing systemic illnesses. At our clinics, we commonly see Diabetic Foot Ulcers. It should be noted – although these are the most common, they are not the only ulcers we see. Ulcers can be due to trauma, venous insufficiency, arterial insufficiency, neuropathy (nerve insufficiency), or a combination of the aforementioned. An open ulcer is always a concern as any open skin can lead to impending infection. The increased risk of infection in combination with systemic problems (eg. decreased blood flow) leaves the patient at increased risk. Wounds in an immune-compromised patient can take months if not years to heal. In some cases, wounds may not heal, and foot wounds can lead to amputation or in extreme cases loss of life.
​
TREATMENT
The Chiropodist at Tri-City Foot Clinic will be able to determine the cause of the ulcer. The Chiropodist will provide the necessary dressing changes and debridement of necrotic/unviable tissue. They will also properly redistribute pressure. Often a multidisciplinary approach is used the healing of wounds including involvement from: The Chiropodist, Family Doctor, Nurse and Personal Support Workers. The Chiropodist will work alongside any other persons involved in a patient’s treatment plan of a wound – to make sure you are receiving the best treatment.
WITHOUT TREATMENT
The patients general health will determine how easily a wound on the foot will heal. A young healthy child with a wound will heal quite fast – (its recommended you see Chiropodist/ Foot Specialist if you have any concerns or see any delays in healing). Any individual who is immuno-compromised or suffers from decreased health will see a delay in healing. If left untreated these wounds may not heal and will progressively worsen. The normal stages of healing are inflammatory, proliferative and maturation/remodelling a wound that isn’t healing may become stuck in any of these stages. As stated earlier an open wound is also a portal of entry for pathogens. Once infected the wound becomes that much more difficult to heal. The infection needs to be cleared, and then the wound healed. Every patient should be checking their feet daily, any noticed wound should be addressed immediately to prevent further damage or progression.
​
SPORTS INJURY AND REHABILITATION
A Chiropodist is a specialist in the foot and ankle. Any pain is abnormal and should be addressed. The presence of pain may take an athlete away at performing at their peak performance. Common addressed concerns at our clinics include ankle sprains, turf toe, plantar fasciitis, Achilles tendon pain, Haglund's deformity, ankle instability, runners toe, etc.
​
TREATMENT
Each patient will be given a unique treatment planned tailored to the patients severity of injury, timeline, sport engaged in and treatment goals. All treatment plans will provide the patient with an abundance of education, for preventative and rehabilitative measures. Therapeutic modalities may be used depending on the injury. Taping techniques may be applied and taught to the patient. If the injury is severe, invasive procedures may be indicated such as surgery or injections. A patient may also be prescribed medication – often anti-inflammatories (NSAIDs) are used in sports injuries.
WITHOUT TREATMENT
Without proper treatment, recurring injuries may develop or a patient may suffer from other injuries. Other injuries may occur as an athlete compensates for a current injury. The athlete will also suffer from loss of playing time and return to the game.
​
-
Do you do pedicures?We provide medical foot-care appointments done by our team of medical professionals, a foot-care appointment includes full assessments, ongoing monitoring of one's foot health, and much more.
-
Do you offer seniors discounts?Our pricing is based on the most recent recommendations from the Ontario Society of Chiropodists, we strive to keep pricing as low as possible while maintaining our level of standard and care. Therefore, discounts of any kind are not offered on services.
-
What does a foot-care appointment include?We begin most treatments with a foot soak, to help soften the skin and nails ahead of a treatment. Soaks are available only during the first 5 minutes of an appointment, patients presenting late to the clinic may have this skipped. Our practitioners clip, trim, and file nails, callus, corns, warts, and any other hard skin, before applying our specially formulated foot cream HEAL. During these appointments, one's foot health is monitored for any changes/abnormalities, especially important for Diabetic patients.
-
Do you offer freezing/local anesthetic?Most of our common foot treatments are completely painless, other mild discomfort. Though local anesthetic is available, it is often reserved only for invasive procedures.
