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Monthly Archives: September 2014

Oedema Of The Legs

Oedema is the medical term for fluid retention in the body.

The build-up of fluid causes affected tissue to become swollen. The swelling can happen in one particular part of the body – for example, as the result of an injury or it can be general.

This is usually the case with oedema that occurs as a result of certain health conditions, such as heart failure or kidney failure.

As well as swelling or puffiness of the skin, oedema can also cause:

– Skin discolouration

– Areas of the skin that temporarily hold the imprint of your finger when pressed (known as pitting oedema)

– Aching, tender limbs

– Stiff joints

– Weight gain or weight loss

– Raised blood pressure and pulse rate

Types of oedema

Oedema can happen anywhere in the body, but its most common in the feet and ankles. This is known as peripheral oedema.

Other types of oedema include:

– Cerebral oedema – affecting the brain

– Pulmonary oedema – affecting the lungs

– Macular oedema – affecting the eyes

Idiopathic oedema is a term used to describe cases of oedema where a cause cant be found.

What causes oedema?

It’s normal to have some swelling in your legs at the end of the day, particularly if you’ve been sitting or standing for long periods.

Oedema is often a symptom of an underlying health condition. It can occur as a result of the following conditions or treatments:

– Pregnancy

– Kidney disease

– Heart failure

– Chronic lung disease

– Thyroid disease

– Liver disease

– Malnutrition

– Medication, such a corticosteroids or medicine for high blood pressure (hypertension)

– The contraceptive pill

Immobility and standing for long periods are the two most common causes of oedema in the legs.

Other possible causes include:

– A blood clot

– Severe varicose veins

– A leg injury or leg surgery

– Burns to the skin

Treating Oedema

Oedema usually clears up by itself. However, your GP may suggest some self-help measures to reduce fluid retention, such as:

– Losing weight (If you’re overweight)

– Taking regular exercise, such as walking, swimming and cycling

– raising your legs three to four times a day to improve your circulation

– Avoiding standing for long periods of time

If an underlying condition is causing the fluid imbalance, it should clear up after the condition has been diagnosed and treated.

Lymphoedema

Lymphoedema is swelling in the legs caused by a blockage in the lymphatic system, or an inherited condition, such as Milroy’s disease, that causes and abnormality of the lymph vessels.

The Lymphatic system consists of a series of lymph nodes (glands) connected by a network of vessels, similar to blood vessels.

Fluid surrounding body tissues usually drains into nearby lymph vessels so it can be transported back into the blood. However, if the lymph vessels are blocked, the fluid cant be reabsorbed and will build up in the tissue.

Unlike oedema, lymphoedema is a long-term condition that can cause discomfort, pain and a loss of mobility.

It cant be cured, but it can be controlled using a number of treatments, including compression stockings, skin care, lymphatic massage and elevation.

Paronychia

Paronychia is a common nail disorder. It is often caused by injury to the toe area, such as, from biting off or picking a hangnail or pushing back the cuticle.

Paronychia can be caused by:

-Bacteria

– Candida (Yeast)

– Other types of fungi

A bacterial and fungal infection can arise at the same time.

Fungal paronychia may occur in persons who have:

– Fungal nail infections

– Diabetes

– Their hands in water for long periods

Symptoms

The main symptoms of paronychia are a painful, red, swollen area around the nail often at the cuticles or at the site of a hangnail or other injury. There may also be puss-filled blisters, especially with a bacterial infection.

Bacteria cause the condition to come on suddenly. If all or part of the infection is due to a fungus, it tends to occur more slowly.

Nail changes may occur. As an example, the nail may appear detached, abnormally shaped, or have an unusual colour.

Exams and Tests

The doctor will most likely be able to diagnose the condition, just by looking at the sore skin.

Pus or fluid may be drained and sent to a laboratory to determine what type of bacteria or fungus is causing the infection.

Treatment

If you have bacterial paronychia, soaking your nail in hot water 2 or 3 times a day helps reduce swelling and pain.

Your doctor may prescribe oral antibiotics. In severe cases, your doctor may cut and drain the sore with a sharp instrument. Part of the nail may need to be removed.

If you have fungal paronychia, your doctor may prescribe antifungal medicine. Keep your hands dry and apply a skin-drying substance, such as Castellani paint (phenol).

Prognosis

Paronychia usually responds well to treatment. However, fungal infections may last for several months.

Possible Complications

Complications are rare, but may include:

– Abscess

– Permanent changes in the shape of the nail

– Spread of infection to tendons, bones, or bloodstreams

Prevention

To prevent paronychia:

– Care for the nails and the skin around the nails properly.

– Avoid damaging the nails or fingertips. Because the nails grow slowly, an injury can last for several months.

– Do not pick or bite the nails.

– Protect the nails from exposure to detergents and chemicals by using rubber or plastic gloves. Gloves with cotton liners are the best.

– Bring your own manicure tools to nail salons.

To minimize the risk of damage to the nails:

– Keep the nails smooth and trim them weekly.

– Trim the toenails about once a month.

– Use sharp manicure scissors or clippers for trimming fingernails and toenails, and am emery board for smoothing the edges.

– Trim Nails after bathing, when they are softer.

– Trim fingernails with a slightly rounded edge. Trim toenails straight across and do not cut them too short.

Heel Pain

Heel pain is one of the most common conditions treated by podiatrists. It is often a message from the body that something is in need of medical attention. Pain that occurs right after an injury or early in an illness may play a defensive role, often warning us about the damage we have suffered.

Who gets heel pain?

The greatest incidence of heel pain is seen in middle-aged men and women. It is also seen in those who take part in regular sporting activities and those significantly overweight and on their feet a lot. Heel pain can also occur in children, usually between 8-13, as they become increasingly active in sporting activities.

Causes of Heel Pain

While heel pain has many causes, it is usually the result of faulty biomechanics (abnormalities in the way we walk). This can place too much stress on the heel bone and the soft tissues attached to it. The stress may also result from injury, or a bruise incurred while walking, running or jumping on hard surfaces; wearing poorly constructed footwear; or being significantly overweight. Systemic diseases such as arthritis and diabetes can also contribute to heel pain.

Common Complications

Heel Spur

A common cause of heel pain is the heel spur, a bony growth under the heel bone. There are no visible features on the heel, but a deep painful spot can be found in or around the middle of the sole of the heel. Approximately 10 per cent of the population may have heel spurs without any pain. Heel spurs result from strain on the muscles of the foot. This may result from biomechanical imbalance, a condition occurring in many people.

Plantar Fasciitis

Both heel pain and spurs are often associated with an inflammation of the long band of tissue that attaches the heel and the balls of the foot. The inflammation of this arch area is called Plantar Fasciitis. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Other causes of heel pain

– Extreme rolling on of the feet when walking

– An inflamed bursa (bursitis), a small, irritated sack of fluid at the back of the heel.

– A neuroma (a nerve growth)

– Other soft tissue growths

– Heel bumps or ‘pump bumps’, a bone enlargement at the back of the heel bone.

– Bruises or stress fractures to the heel bone.

Overcoming the problem

If pain and other symptoms of inflammation, redness and swelling persist, you should limit your normal daily activities and consult your local podiatrist. Your podiatrist may conduct a number of x-rays to look for heel spurs or fractures.

Treatment

Prompt treatment might involve exercise and shoe recommendations, taping or strapping and anti-inflammatory medication (such as aspirin). Taping or strapping supports the foot, placing stressed muscle in a restful state and preventing stretching of the plantar fascia. Other physical therapies may also be used, including icepacks and ultrasounds. These treatments will effectively treat the majority of heel and arch pain without the need for surgery. Only a few cases of heel pain require surgery. If surgery is required its usually for the removal of a spur but may also involved the release of the plantar fascia, removal of a bursa, removal of a neuroma or other soft-tissue growth.

Recovery

Your recover will depend on the cause of your heel pain and your individual health. If you are suffering with a heel spur or plantar fasciitis, it normally takes about six to eight weeks for a healthy individual to fully recover. That is when the injured area is fully rested or properly strapped.

 Preventing future problems

Footwear

Wear shoes that fit well and have shock absorbent soles, rigid uppers and supportive heel counters. Do not wear shoes with excessive wear on heels or soles.

Stretches and exercise

Prepare properly before exercising. Warm-up before running or walking, and do a few stretches afterwards. Pace yourself when you participate in athletic activities. If overweight, try non weight-bearing activities such as swimming or cycling.

Additional Control

Your podiatrist may also use taping or strapping to provide extra support for your foot. Orthoses (shoes inserts) specifically made to suit your needs may also be prescribed.

Ingrown Toenails

When a toenail is ingrown, it is curved and grows into the skin, usually at the nail borders (sides of the nail). The “digging in” of the nail irritates the skin, often creating pain, redness, swelling and warmth in the toe.

If an ingrown nail causes a break in the skin, bacteria may enter and cause an infection in the area, which is often noticeable by drainage and a foul odour. However, even if the toe isn’t painful, red, swollen or warm, a nail that curves down into the skin can progress to an infection.

Causes

Heredity – In many people, the tendency for  ingrown nails is inherited.

Trauma – Sometimes an ingrown toenail is the outcome of trauma, such as stubbing your toe, having an object fall on your toe, or engaging in activities that involve repeated pressure on the toes, such as running or kicking.

Improper Trimming – The most common cause of ingrown toenails is cutting your toenails too short, this encourages the skin next to the nails to fold over the nail.

Improperly sized footwear – Ingrown toe nails can result from wearing socks and shoes that are short or tight.

Nail Conditions – Ingrown toenails can be caused by nail problems, such as fungal infections or losing a nail due to trauma.

Treatment
Sometimes initial treatment for ingrown toenails can be safely performed at home. However, home treatment is strongly discouraged if an infection is suspected, or for those who have medical conditions that put feet at high risk, such as diabetes, nerve damage in the foot, or poor circulation.

Home Care

If you don’t have and infection or any of the above medical conditions, you can soak your foot in room-temperature water (adding Epsom’s salt may be recommended by your doctor), and gently massage the side of the nail fold to help reduce inflammation.

Try to avoid attempting “bathroom surgery”. Repetitive cutting of the nail can cause the disorder to worsen over time. If your symptoms fail to improve, its time to see a foot and ankle surgeon.

Physician care

After examining the toe, the foot and ankle surgeon will select the treatment best suited for you. If an infection is present, an oral antibiotic may be prescribed.

Sometimes a minor surgical procedure, often performed in the office, will ease the pain and remove the offending nail. After applying a local aesthetic, the doctor removes part of the nail’s side border. Some nails may become ingrown again, requiring removal of the nail root.

Following the nail procedure, a light bandage will be applied. Most people experience very little pain after surgery and may continue normal activity the next day. If your surgeon prescribed and oral antibiotic, be sure to take all the medication even if your symptoms have improved.

Preventing Ingrown Toenails

Many cases of ingrown toenails may be prevented by:

Proper Trimming – Cut toenails in a fairly straight line, and don’t cut them too short. You should be able to get your fingernail under the sides and end of the nail.

Well-fitted shoes and socks – Don’t wear shoes that are short or tight in the toe area. Avoid shoes that are loose, because they too cause pressure on the toes, especially when running or walking briskly.

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