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Monthly Archives: October 2014

Splinter Haemorrhages

Splinter haemorrhages are small areas of bleeding under the fingernails or toenails. Splinter haemorrhages run in the direction of nail growth and look like thin, red to reddish-brown lines of blood under the nail. They look like a splinter underneath the fingernail. Splinter haemorrhages can arise from infection of the heart valves, vessel damage from swelling of the blood vessels or tiny clots that damage the small capillaries.

What Causes Splinter Haemorrhages?

– Bacterial endocarditis

– Injury to the nail

– Vasculitis

In the majority of situations, as the nail grows out, the splinter haemorrhage is put on the under surface of the nail plate and will grow out with the nail and the nail bed over a period of time and consequently disappear completely, usually in a period of a few months. However, when splinter haemorrhages occur in larger numbers, which is on many nails, it can become suspicious of being a sign of a systemic disorder.

Certain medications can also prompt someone to develop splinter haemorrhages of the nail bed. One of the most common is aspirin, as it slows the clotting process of the blood and therefore may lead to splinter haemorrhages. If splinter haemorrhages are a result of medication such as aspirin, treatment would simply be to discontinue the use of the medication if possible.

How to treat it?

Treatment depends on the underlying cause. To get rid of the splinter haemorrhage, you will need to simply let it grow out. This usually takes a few months.

If the splinter haemorrhage is due to certain medications, the use of the medication should be discontinued if possible. If the splinter haemorrhage is due to a fungal infection or other underlying problem, then the underlying problem will need to be treated to stop the recurrence of splinter haemorrhages. If the cause is from nail trauma, keeping the nails trimmed can prevent these haemorrhages. And finally, if the toes are squished in a pair of tight shoes, where the toenails may be hitting the inside of the shoe, replacing the shoes for looser and better fitting shoes would help stop causing the splinter haemorrhages to occur.

Charcot Foot

What is Charcot Foot?

Charcot foot is a condition that causes the bones in the foot to weaken, it can occur in people who have significant nerve damage (Neuropathy). The bones are weakened enough to fracture, and with continued walking, the foot will eventually change shape. As the condition progresses, the joints collapse and the foot takes on an abnormal shape.

Charcot foot is a very serious condition that may lead to severe deformity, disability, and it can even lead to amputation. Because of its seriousness, it is important that patients with diabetes – a disease often associated with neuropathy – take precautionary measures and seek immediate medical attention if signs or symptoms appear.

What are the causes of Charcot Foot?

Charcot foot develops as a result of neuropathy, which reduces the sensation and ability to feel temperature, pain or trauma. Because of decreased sensation, the patient may continue to walk, making the injury worse.

People with neuropathy (especially those who have had it for a long time) are at risk for developing Charcot foot. In addition, neuropathic patients with a tight Achilles tendon have been shown to have a tendency to develop Charcot foot.

Symptoms
The symptoms of Charcot foot may include:

– Warm to touch (The affected foot feels warmer than the other)

– Redness in the foot

– Swelling in the area

– Pain or soreness

Diagnosis

Early diagnosis of Charcot foot is very important for successful treatment. To arrive at a diagnosis, the specialist will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays and other imaging studies and tests may be ordered.

Once treatment begins, x-rays are taken periodically to aid in evaluating the status of the condition.

Non-Surgical Treatment

It is extremely important to follow the surgeon’s treatment plan for Charcot foot. Failure to do so can lead to the loss of a toe, foot, leg, or life.

Non-surgical treatment of Charcot foot consists of:

Immobilization. Because the foot and ankle are so fragile during the early stage of Charcot, they must be protected so the weakened bones can repair themselves. Complete non-weight bearing is necessary to keep the foot from further collapsing. The patient will not be able to walk on the affected foot until the surgeon determines it is safe to do so. It may take bones several months to heal, although it can take considerably longer in some patients.

Custom shoes and braces. Shoes with special inserts may be needed after the bones have healed to enable the patient to return to daily activities – as well as help prevent recurrence of Charcot foot, development of ulcers, and possibly amputation. In some cases with significant deformity, bracing is also required.

Activity modification. A modification in activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet.

When is Surgery Needed?

In some cases, the Charcot deformity may become severe enough that surgery is necessary. The foot and ankle surgeon will determine the proper timing as well as the appropriate procedure for the individual case.

Preventive Care

The patient can play a vital role in preventing Charcot foot and its complications by following these measures:

– Keeping blood sugar levels under control can help reduce the progression of nerve damage in the feet

– Get regular check-ups from a Podiatrist

– Check both feet every day- and see a Podiatrist or doctor immediately if you notice signs of Charcot foot.

– Be careful to avoid injury, such as bumping the foot or overdoing an exercise program.

– Follow the surgeon’s instructions for long-term treatment to prevent recurrences, ulcers, and amputation.

 

Koilonychia

Koilonychia is a condition that more frequently occurs in fingernails rather than toenails. It occurs when the normal convex curvature is lost and instead, it becomes slightly concave or spoon-shaped. There is a proven correlation between koilonychia and iron deficiency anaemia.

Signs and Symptoms:

– Nails are ‘spoon shaped’

– Nail plates are brittle, soft and thinning

– Nails are concave

– Nails can be detached

– Nails can come completely off

– Individual shows signs of being malnourished

– Pain if the nail becomes detached from nail bed or if infection is present

– Discolouration underneath the nail

 

Causes:

Several factors can cause the deformity of the nails such as:

– Lupus disease

– Poor function of thyroid hormone

– Reynaud’s Syndrome

– Iron Deficiency

– Poor absorption of iron

– Muscle Skinning

People who are undergoing chemotherapy or radiation can also develop this condition.

 

Treatment:

Koilonychia needs to be managed as soon as possible after diagnosis. Iron supplements are given to the individual and taken as prescribed. To treat and prevent koilonychia, methods are listed as follows:

– For abnormalities because of toenails that are ingrown, wear types of shoes that do not crowd together the toes as well as always cutting toenails straight across the top

– Get more iron and vitamins in the food you consume by more nutrition in your diet

– Use skin softening cream after bathing

– Wear gloves when doing the dishes or being exposed to any chemicals that are harsh

– To prevent koilonychia avoid biting your nails as it may cause inflammation of the nails.

 

 

 

 

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