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Monthly Archives: August 2015

Cellulitis

 What is Cellulitis?

Cellulitis is a common bacterial skin infection. Cellulitis may first appear as a red, swollen area that feels hot and tender to the touch. The redness and swelling often spread rapidly. Cellulitis is usually painful. In most cases, the skin on the lower legs is affected, although the infection can occur anywhere on your body or face. Cellulitis usually affects the surface of your skin, but it may also affect the underlying tissues of your skin. Cellulitis can also spread to your lymph nodes and bloodstream.

If cellulitis is not treated, the infection might spread and become life-threatening.

Cellulitis Causes and Risk Factors

Cellulitis occurs when certain types of bacteria enter through a cut or crack in the skin. Cellulitis is commonly caused by staphylococcus and streptococcus bacteria. In 50 to 60 percent of cases, skin injuries such as cuts, insect bites, or surgical incisions are the cause of the infection.

You are at risk if you have:

  • Skin conditions that cause breaks in the skin, such as eczema and athlete’s foot
  • Trauma to the skin
  • Diabetes
  • Circulatory problems

Symptoms of Cellulitis

  • Cellulitis symptoms may include:
  • Pain and tenderness in the affected area
  • Redness or inflammation on your skin
  • Skin sore or rash that appears and grows quickly
  • Tight, glossy, swollen appearance of the skin
  • A feeling of warmth in the affected area
  • Fever

Symptoms such as drowsiness, lethargy, blistering, and red streaks could signal that cellulitis is spreading. If any of these symptoms occur, you should see your podiatrist immediately.

Treating Cellulitis

It is best to see your podiatrist if you are experiencing any of the above symptoms, for them to diagnose you and give you the best treatment options. Antibiotics will usually be prescribed after diagnosis. While taking antibiotics, monitor your condition to see if symptoms improve. In most cases, symptoms will improve or disappear within a few days. In some cases, pain relievers are prescribed. You should rest until your symptoms improve. While you rest, you should raise the affected limb higher than your heart to reduce any swelling.

Cellulitis should go away within seven to 10 days of starting antibiotics. Longer treatment could be necessary if your infection is severe. This can occur if you suffer from a chronic disease or if your immune system is not working properly. People with certain pre-existing medical conditions and risk factors may need to stay in the hospital for observation during treatment.

Onychocryptosis (Ingrown Toenails)

Onychocryptosis, also known as ingrown toenail is a condition in which, a spike or serrated edge of nail has pierced the epidermis (superficial layer of skin) of the sulcus and penetrated the dermal tissues. It occurs most frequently in the big toe of male adolescents and may be unilateral (affecting one side) or bilateral (affecting both sides). Initially, it causes little inconvenience, but as the nail grows out along the sulcus the offending portion penetrates further into the tissues and promotes an acute inflammation in the surrounding soft tissues which often becomes infected.

Causes of Ingrown Toenails

The most common predisposing factors are faulty nail cutting, hyperhidrosis (excessive sweating of skin) and pressure from ill-fitting footwear, although any disease state which causes an abnormal nail plate due to fungal nail infections for example, may promote piercing of the sulcus tissue by the nail.

If a nail is cut too short, the corners cut obliquely, or if it is subjected to tearing, normal pressure on the underlying tissue is removed and without that resistance the tissue begins to protrude. As the nail grows forward, it becomes embedded in the protruding tissue. Tearing of the nails has a similar effect to cutting obliquely across the corners of the nail plate. Both are likely to result in a spike of nail left deep in the sulcus, especially if the nail is involuted. Any spike left at the edge of the nail increases the risk of sulcus penetration as the nail grows forward.

Maceration of the sulcus tissue is commonly due to hyperhidrosis (excessive sweating of skin) in adolescent males but may also arise from the overuse of hot footbaths in the young or elderly. Moist tissue is less resistant to pressure from the nail such as that caused by lateral pressure (side pressure) from narrow footwear or abnormal weight-bearing forces, for example pronation (collapsed arches or the rolling in of the feet), and as compression forces the lateral nail fold to roll over the edge of the nail plate, the sulcus deepens and the nail may penetrate the softened tissues.

Treatment of Ingrown Toenails

If the ingrown toenail is uncomplicated by infection, the penetrating splinter may be located by careful probing and then removed with a small scalpel or fine nippers. The edge of the nail can be smoothed with a small nail rasp to reassure that there is no remainder of the serrated edge of nail. The area is then irrigated with sterile solution and dried thoroughly. It should then be packed firmly with sterile cotton wool or gauze, making sure that it is inserted a little way under the nail plate to maintain its elevation. An antiseptic astringent preparation, such as Betadine, is applied to the packing and the toe is covered with a non-adherent sterile dressing and tubular gauze. If there is associated hyperhidrosis, this requires an appropriate regime while the ingrown toenail is being treated.

When the ingrown toenail is complicated by infection and suppuration (pus) is present, it is imperative to remove the splinter of nail, facilitating drainage and allowing healing to take place. Hot footbaths of magnesium sulphate solution or hypertonic saline solution may be used to reduce the inflammation and localize the infection before removal of the splinter is attempted.

If conservative treatment does not provide long term relief, nail surgery will invariably be necessary. Partial nail avulsion (PNA) is a minor procedure that permanently removes a section of nail plate. Firstly, this involves two injections of local anaesthetic at the base of the affected toe. The offending section of nail is then removed and the nail matrix/root (cells responsible for nail growth) is burnt using a chemical technique. This prevents the section of nail from regrowing. Finally, a thick, absorbent aseptic dressing is applied. As no sutures are required for this procedure, in most cases minimal pain is experienced post-operatively.

Subungual Corn (Heloma)

A subungual heloma are corns that develop underneath the nail plate. They can be found in the groove at the side of the nail plate, where the nail interacts with the skin tissue as the foot is moved about. The corn growth detaches the nail plate and causes painful pressure. It is impossible to get the corn with the nail still in place. As this is the case, to treat the subungual corn, the podiatrist will usually cut back the nail sufficiently to expose the corn. However, in some cases, the whole nail might have to be removed.

Once the nail has been cut back or completely removed, the corn can be removed with a scalpel. To prevent the corn from recurring, our podiatrist can also use a caustic agent such as silver nitrate to destroy the corn tissue. If the corn can be destroyed, then it may not be necessary to remove the nail again.

The podiatrist may require you to return to get your nail reviewed every 2-3 weeks to check on the progress of the nail growing back, ensuring it is healthy and that there is no recurrence of the corn. It very is important to treat a corn if you have one to relieve pain and pressure on the toe.
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