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What Our Nails Can Tell Us About Our Health

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Did you know that Bob Marley died as a result of a melanoma under his toenail? Sadly he refused treatment & the melanoma eventually spread to his brain & lungs.

Thankfully melanoma of the toenail is rare – but any black/brown lines along the length of the nail, or marks/discolouration that doesn’t disappear as the nail grows, or that spreads, should be investigated. If caught early, this serious condition is treatable.

Any changes to the shape of the nail plate can also indicate various health problems:

‘Spooning’, where the nail has a scooped-out appearance like a spoon, is often a sign of iron deficiency anaemia.

‘Pitting’, where little holes appear over the nail, could be a sign of psoriasis.

‘Clubbing’, where the nail curves over the enlarged tip of a finger or toe is often seen in lung or respiratory disease, the nails often have a bluish appearance too.

Horizontal lines or marks across the nail can be an indicator of a restriction in the growth of the nail, as result of tight footwear or acrylic nails, but also often seen following a heart attack or serious illness, where the blood supply to the nail bed has been interrupted.

Some illnesses or drugs can also cause nail problems, for instance thyroid disease can cause discolouration or lifting of the nail plate.

Fungal infections can cause white/yellow/thickened & crumbling nails & often starts when fungal infection in the skin spreads to a damaged nail.

All of these things can affect fingernails as well as toenails so if you notice any changes in the shape or appearance of your nails please visit your podiatrist for a check up.


Verruca – To Treat or not to Treat That is a Question!

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If a verruca is not causing any pain or disability should it be treated at all?

Most doctors in the UK now won’t treat a verruca on the NHS as, unless painful, it is considered a cosmetic problem which may get better spontaneously without any intervention at all.

A verruca is a wart found on the feet, caused by a strain of Human Papilloma Virus (HPV), if you do a quick internet search you may come to the conclusion that it is a highly contagious virus that is rife in gym changing rooms, swimming pools etc & that it can easily be picked up by walking around barefoot.

If this was the case we would be inundated with people from the same place coming for treatment, in fact in our clinics we rarely see members of the same family with warts or verrucas! It may be that they are not as contagious as once thought (my view), or it may be that some people have better immune systems & have good immunity to HPV. It will be interesting to see if the introduction of HPV vaccination schemes for cervical cancer have any effect on reducing skin warts (although caused by a different strain of HPV).

Another internet search will find lots of different treatments for verrucas none of which are guaranteed to work, in fact just keeping them covered with duct tape is one way which has
had some success. See:

http://www.nhs.uk/Conditions/Warts/Pages/Treatment.aspx

One theory is that sometimes the treatment causes irritation & inflammation of the area which switches on the immune system & triggers an immune response & then verruca starts to get better.

Some treatments are more aggressive – e.g. freezing with liquid nitrogen or surgical removal under local anaesthetic, both of which may be very painful, inconvenient, as the foot will need to be kept covered & dry & may cause permanent scarring. (Still no guarantee of success).

A recent study showed that conservative treatment using over the counter salicylic acid preparations (Bazooka/ Salactol etc) & keeping the lesions covered with a waterproof dressing -blister plasters are ideal, repeating daily, (similar to the duct tape method but prettier!), had similar success as freezing with liquid nitrogen at the end of the 12 week study.

I personally feel that unless the verruca is really causing pain or stopping you from doing anything it would be unethical to cause more pain & disability with aggressive treatment.

My advice would be to seek a professional opinion from a podiatrist, have treatment to remove overlying skin, discuss all treatment options fully & understand what is involved, & be prepared to follow the treatment through, before making a decision.

Don’t forget to boost your immunity too with good healthy food containing antioxidants & zinc & get plenty of sleep.


KISS—Keep It Simple, Stupid!

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Anyone who is medically trained probably had the acronym KISS indoctrinated into them by their tutors, a while ago I had an example of why this is so true.

A patient presented at the surgery with a very sore foot, she felt she must have stood on a piece of glass which had become ingrained. I examined her & although there was really nothing visible, the area under the ball of her foot was very tender & slightly swollen.

Diagnosis
The woman in question is a professional dancer & was very concerned as she has been chosen to dance at the closing ceremony of the 2012 Olympics & needed to be fit & well for rehearsals.

I ran through a whole list of diagnoses in my head: stress fracture, neuroma, referred pain from a previous back injury – you name it, I thought it! I sent her away with padding for her foot, advice to use ice & anti inflammatories, although I was really unsure as to the cause.

Cured!
I saw her again today with no real improvement & I decided to use padding in her footwear & as I was checking the existing insole in her shoe, discovered a tiny, but very sharp stone embedded into the area of the insole that corresponded to the painful area of her foot! Result – one very happy dancing girl!

I don’t know why I didn’t check the first time – I am usually very good at the keeping it simple rule – I won’t forget in future!