Common foot disorders

Abstract

Up to 75% of Americans will experience foot health problems at some point in their lives. Women are 4 times more likely to experience foot problems than men. The most common disorders are corns or calluses; ingrown toenails or other nail afflictions; foot infections, including athlete's foot and warts; and foot injuries and structural problems. Corns are small, raised, sharply demarcated, hyperkeratotic lesions with a central core, usually caused by pressure from underlying bony prominences or joints. They usually present on the bulb of the great toe, the dorsum of the fourth or fifth toe, or tips of the middle toes. A callus has a broad base, with relatively even thickening of skin. They are generally raised, yellow, and found on the bottom of the foot in areas such as the heel, ball of the foot, and toes, and on the sides of the foot. Self-care options to treat corns and calluses include a daily footbath followed by application of an emollient foot cream to help retain moisture and pliability; keeping the feet warm; and instituting moderate exercise daily. Dead tissue should be removed gently with a callus file or pumice stone. Pads or shoe inserts may also reduce pressure on the affected areas. Salicylic acid, a keratolytic agent, is the only nonprescription preparation marketed for the removal of corns and calluses. Three dosage forms are available in various concentrations (6%–17% in a topical gel, 12%–40% in a plaster vehicle, and 12%–27.5% in a collodion-like vehicle). When used in a collodion-like medium, the product forms an adherent flexible or rigid film, prevents moisture evaporation, and aids the penetration of the active ingredient into the affected tissue. Stop treatment and consult an appropriate health care provider if swelling, reddening, or irritation of the skin develops, or if pain occurs immediately with product application. Nonpharmacologic options for corns and calluses include full-shoe inserts to provide cushioning and absorb shock, partial insoles when the patient needs cushioning or support in a certain portion of the shoe, and a heel cup or heel cushion, depending on the location and extent of the pain. Another foot issue that lends itself to self-care is ingrown toenails. Warm water soaks for 10 to 20 minutes several times a day and insertion of small cotton wisps or dental floss under the impinged nail edge are very beneficial nonpharmacologic options. The only over-the-counter pharmacologic option is sodium sulfide 1% gel. This is applied topically twice daily for up to 7 days and relieves pain by softening the nail or hardening the nail bed. Patients may also experience exercise-induced foot injuries, particularly those caused by running, jogging, or other high-impact physical activities. Appropriate footwear is critical. Patients will often ask about other issues that coincide with foot pain such as shin splints, blisters, and ankle sprains. Each of these ailments has self-care options focused on symptom relief while incorporating an element of preventive care. Ice or cold wraps can help relieve shin splint pain. Prevention is key when it comes to blisters, but if one develops it should be covered with moleskin for protection. Application of compound tincture of benzoin or a flexible collodion product before exercise can decrease pain and accelerate healing by promoting re-epithelialization. If blisters break, a first aid antibiotic can be applied to the broken skin to prevent secondary bacterial infection. Treatment of ankle sprains should be started as soon as possible with a compression bandage, ice, and elevation. For these conditions, NSAIDs can be used for pain and inflammation relief. Patients with diabetes or peripheral vascular disease should be referred to their primary care provider as these individuals commonly have factors contributing to a loss of pain/injury perception. Patients should clean and inspect their feet daily for any changes and have a yearly comprehensive foot evaluation assessing any changes in foot appearance or tactile sensation. Recommend patients wear proper-fitting, comfortable shoes; use caution when “breaking in” new shoes; use moisturizing lotion sparingly on the tops and bottoms of dry feet; and allow feet to completely dry before donning shoes to prevent excess moisture buildup. Foot disorders provide great opportunities for pharmacists to help improve patient comfort.