Plantar Warts

Plantar Warts (Verrucae Plantaris)

Nobody likes a wart and plantar warts can be a real problem, especially if they become painful and make normal activities, like walking, uncomfortable.

What is a Wart?

A wart is a small, contagious growth on the skin that develops when the skin is infected by the Human Papilloma virus (HPV). The infection occurs as a result of the skin coming in direct contact with the virus.  The virus causes an excess amount of keratin, a hard protein, to develop in the top layer of skin (epidermis). This extra keratin produces the rough, hard texture of a wart.

What is a Plantar Wart?

Plantar Warts are warts that develop on the bottom surface, the plantar surface, of the foot and are most commonly seen in young children, adolescents and the elderly.

There are three types of warts that commonly affect the foot:

–          A solitary wart is a single wart. It often increases in size and may eventually multiply, forming additional ‘satellite’ warts.

–          A periungual wart is one that develops under and around the toenails. These warts can affect the shape of the toenail

–          Mosaic warts are a cluster of several small warts growing closely together in one area. These warts are often more difficult to treat than solitary warts.

How does the virus spread?

HPV is passed on through close skin-to-skin contact but can also be transmitted indirectly from contaminated objects or surfaces, such as areas surrounding a swimming pool, towels, shoes or floors of communal changing areas. You are more likely to get infected if your skin is wet, soft or has been in contact with a rough surface. Warts are thought to be contagious for as long as they are present on your body.

How do I know if I have a Plantar Wart?

Plantar warts normally have an array of signs and symptoms, which include:

Thickened skin:
Often a plantar wart resembles a callus or corn because of its tough, thick tissue.
A plantar wart will often be noticed when walking or standing, if it is in a particular prominent area, but are also known to be painful when squeezed.
Tiny black dots:
These often appear on the surface of a wart. The dots are actually dried blood contained in the capillaries that grow into and support the wart.
Skin striations:
Feet are covered, which are akin to fingerprints on the feet. Skin striae will go around a plantar wart; if the lesion is not a plantar wart, the striation continues across the top layer of skin.

What do I do if I have a Plantar Wart?

Most research states that a plantar wart can clear up without treatment, however it can take more than two years for the virus to disappear. There are numerous treatments available for warts, however, no single treatment is 100% effective. Here at Mullins Podiatry, we use a combination of sharp debridement of the viral tissue with potent Salicylic Acid and Cryotherapy. This will commence the process of reducing the viability of the surrounding tissue to become infected by the virus and introducing the virus to the body’s immune system.

If you think you have a plantar wart or have attempted Over-The-Counter products without any success, feel free to give the team at Mullins Podiatry a call today at one of our many locations.

Heel Pain

Heel pain is one of those conditions that all Podiatrists see regularly in their clinics. Anyone can suffer from heel pain, but certain groups seem to be at increased risk, including:

–          Middle-aged men and women

–          Physically active people

–          People who are overweight or obese

–          People who are on their feet for long periods of time

–          Children aged between eight & 13 years (particularly boys)

–          Women who are pregnant

For some patients, their pain resolves relatively quickly whilst others can experience the debilitating effects of heel pain longer.

What is the cause of heel pain?

Heel pain can be a result of numerous causes with patients usually reporting pain either underneath or just behind their heel. Of the 26 bones in our feet, our heel is the largest and designed to provide a rigid support for the weight of our bodies; absorbing up to 1.25 times our body weight when walking, even more with higher-impact activities like jumping and running. Consequently, it is vulnerable to damage and ultimately pain.

Below are just a few of the conditions that many of our patients present with to our clinics:

Plantar Fasciitis

The plantar fascia is a band of connective tissue that travels along the sole from the heel to the ball of the foot. Plantar Fasciitis is a musculoskeletal condition causing pain under the heel or into the inner arch of the foot as a result of inflammation at the insertion point of the plantar fascia on the heel. The condition is due to mechanical over-stretching of the fibrous tissue in the arch. Most patients report pain with the initial few steps out of bed or after rest and returning towards the end of the day.

In many cases, plantar fasciitis is associated with a heel spur. During gait, abnormal mechanics can causes the insertion point of the plantar fascia to tear and bleed and, over time, these injuries calcify and form a bony growth.

Heel Spur

It’s estimated that 1 in 10 people have a heel spur and may not present with any symptoms. During gait, excessive or abnormal mechanics can place extra strain on the plantar fascia. Chronic inflammation may develop and, over time, lead to a bony growth or spur. A spur can only be seen on x-ray, but its presence is often flagged by a tender patch at the heel on the sole of the foot. Displacement and loss of the fatty tissue under the heel can lead to the spur being more prominent. The spur itself does not cause the pain, but the pain may be associated with inflammation in the area.

Stress Fracture

A stress fracture of the calcaneus is a hairline fracture of the big heel bone and is usually caused by overuse from abnormal mechanics. Common in long distance runners, ballet dancers and sports involving jumping, a stress fracture of the calcaneus is the second most common stress fracture location in your foot. Symptoms of a calcaneal stress fracture may be similar to that of a bruised heel and pain will come on gradually over time and be made worse with weight bearing activity like running and jumping.

Achilles Tendinopathy

Achilles tendinopathy is a condition characterised by tissue damage and pain in the Achilles region and it is most commonly brought about through physical activity or a sudden change in the level of activity. Repetitive activity, trauma or high loads cause excessive tension to occur in the tissues damaging the tendon and causing subsequent inflammation and degeneration. As a result of the degeneration, the tissues within the tendon function abnormally and lose strength, contributing to further localised inflammation to occur, and can increase the risk of rupture with continued activity. Patients usually report pain and tenderness in their heel along with heel stiffness after rest and swelling.

Regardless of whether your heel pain is something new or something you have learnt to cope with, seeing our Podiatrists can help you identify the cause and establish a treatment plan to enable you to return to the activities you love – heel pain free!!!

What can I do about a painful ingrown nail?

At Mullins Podiatry we have a range of options to treat and manage your ingrown nail. We first take a history and detailed examination to ascertain why the nail is ingrown.

It may be that

  • The nail has been cut incorrectly
  • The nail has been damaged
  • The nail shape causes it to break the skin
  • Genetic disposition
  • Footwear and lifestyle may be contributing to the way your nail may be growing

Our conservative approach is to cut and re-shape the nail to provide immediate relief and reduce chance of infection. We then educate you on the best way to avoid the recurrence of the nail growing into the skin.

If this conservative approach does not achieve long term relief or the recurrence is causing repeated discomfort or infection, a surgical procedure may be advised.

What is nail surgery?

Nail surgery refers to the technique of removing the nail and phenolising the matrix so the nail does not grow back.

This procedure is done under local anaesthesia in the clinic after a sterile field is constructed. After the ingrown nail is removed, the growth plate (matrix) is neutralised using the repeated application of phenol, a strong alkaline designed to stop the nail growing back.

Does it hurt?

The injection of LA will feel similar to any other injection. After the anaesthesia is applied, it is a pain free experience with most patients reporting little to no pain after the procedure and being able to walk freely.

Minor surgery such as Partial Nail Avulsion and Nail Wedge Excision provide approximately 95% success rate in permanently resolving ingrown toenails. The procedure allows a quick recovery with a return to normal activities on the same day and minimal post-operative discomfort.

Do I need follow-up care?

Patients are advised to attend a follow up dressing change in the days following the procedure and are required to be seen again one week later to assess the progress of the nail and the surrounding tissue. After the procedure, it is recommended you do not drive and whilst you are able to return to work or school, you may require an open toe shoe / sandal and will be required to keep the area clean and dr

What are the potential complications?

All nail procedures have been associated with a slight chance of recurrence. Infection whilst the wound is healing can also be an issue. We will advise you and manage these and any other complications that may occur.

How can we help?

Mullins Podiatry can manage and prevent ingrown toenails, alleviate pain, and help keep you on your feet and mobile.