Footpodiatrist

26/07/2021

Nail surgery, as a treatment option for nail fungus.

As a podiatrist I regularly do surgery on toe nails, usually to get rid of ingrown toenails, either by removing part or all of the nail. Recently I have been doing more surgery for treating nail fungus and patients have been pleased with the results.
Nail fungus is a very common condition in the feet and can be slow and sometimes difficult to treat. Fungus occurs usually following damage to the nail, this can be acute damage like stubbing your toe on something, or chronic damage caused by footwear. When this happens the nail will often separate from the skin and fungus can enter that space and start eating away at the nail making it crumbly, and discolored.
Common treatments can involve removing as much infected nail as possible and treating with a lacquer or liquid, this can be slow as the nail has to grow out while being treated. Systemic antifungals ( tablets like Lamisil) which can be effective but are not without potential side effects (particularly with liver and kidneys) and still take some months to work. Laser can be effective although an expensive option, my experience is that it works brilliantly on finger nails but is not consistent enough on toe nails to always justify the expense.

Here in Spain where many people wear open shoes for the majority of the year. Nail fungus can be embarrassing and unsightly. I am finding people are keen to try surgery as an option.
The surgery is performed under a local anesthetic known as a ring block. This is a little nerve block which makes the toe numb from the base all the way to the tip.
For fungus there are two ways of doing the surgery. The first one involves removing the whole nail and treating the bed of the nail with a very strong caustic (phenol) which basically kills the nail bed so it doesn't grow back. This is fail safe and is often used when the nail is very thick and damaged but it means you no longer have a nail just the outline of where it was. It also takes longer to heal and requires a dressing for 5-6 weeks following surgery. Although patients can still shower swim and lead a normal life they need to change the dressing each time it gets wet and bathe it in salt water.
The other approach still involves removing the nail but then no caustic is applied and once healed (in this case much quicker 4-5 days) the bed of the nail is treated with an antifungal while the nail grows back to kill the fungus deep in the nail bed.
If you would like to know more about these procedures why not drop me an email with your phone number and we can discuss the procedures in more detail.
philipmann@footpodiatrist.com clinics in Moraira, Albir, Benissa, Calpe and Javea.

14/04/2021

Poor circulation in feet.

Something of great concern to many of my patients is poor circulation in feet. Certainly as we get older our circulation to the furthest part of our body can change and poor arterial circulation ( the blood rich in oxygen coming from the heart) is more common. Diseases like diabetes and peripheral vascular disease can also affect circulation in the feet and smoking can reduce blood flow. The consequences of poor arterial circulation can be serious with pain, ulceration and even gangrene and amputation in some cases.
Assessing blood flow is an important part of any podiatrist’s work and Doppler is a great tool here. A Doppler machine is an ultrasound probe, Doppler ultrasound works by measuring sound waves that are reflected from moving objects, such as red blood cells. This is known as the Doppler effect. In the clinic I use a hand held doppler very similar to the machine that is used to hear a baby’s heart beat when someone is pregnant. A water based gel is placed on points over the arteries of the feet which helps transmit the ultrasound waves which the machine amplifies so I can hear the flow of the blood.
This gives a very accurate picture of the blood flow and I can tell if the circulation is normal for the individual's age or if it is poor or even if there is a blockage.
Although Doppler is important, it is only part of a vascular assessment, visual assessment and manual examination are also required. Questions about general health, activities and symptoms are also vital to create a complete picture of the vascular status of the feet and lower limb.
Diabetic patients should have a vascular assessment on an annual basis, and in my clinics this is included in routine care.
What happens if I do have poor circulation? Often patients simply require advice and reassurance, that may be specific advice on how to deal with symptoms or direct treatment for wounds, ulcers or more general advice on exercise and lifestyle. Occasionally it could involve onward referral for medication to help or even to a vascular surgeon for specialist intervention.
In my clinics vascular assessment is part of a routine appointment therefore no additional charge for this type of examination. I work in Javea, Calpe, Benissa, and Albir or why not come and visit the new clinic on the Moraira to Calpe coastal road.
Philip Mann Podiatrist/Chiropodist 686912307

02/09/2020

Good Morning,

some of you may already be aware that I am moving from where I practice in Moraira to a new location in Moraira. The aim is to be up and running by Tuesday the 15th of September, which means my first day there should be Wednesday the 16th of September all being well. Although I will of course miss working with the team at the International clinic, I feel the new clinic offers a lot to my patients in terms of location and parking and will be very well suited to meet the current challenges facing us all at the moment.

Located on the coast road between Calpe and Moraira, the new clinic will be a purpose built Dental and Medical clinic, (K.Sud Dental and Medical Clinic). The new clinic will have dedicated parking for patients in front of the clinic. We hope to have GP and Physiothapist (Marta) and possibly other medical specialists in the future.

I will still be in Moriara on a Wednesday afternoon but will also now be there on a Wednesday morning too, both in the new location. If you already have an appointment booked on a Wednesday afternoon your time will be the same but in the new premises. If you have a Wednesday morning appointment ( previously in Calpe) on or after the 16th of September it will now be in the Moriara clinic. I think this may suit some of my Calpe patients who struggle with parking in Calpe, as the new clinic is only just past the Benissa turning on the coast road if you are coming from Calpe. But of course if you still wish to attend clinica La Alegria I will still be there on a Tuesday afternoon.

I will be updating you with the location and some pictures in the coming days. If you have any queries you can either respond to this email or give me a call if you would like to know more.

Kind regards

Philip

686912307

30/09/2019

Metatarsalgia
I often have people come into my clinics telling me they have been diagnosed with metatarsalgia. Which I always find a little surprising as Metatarsalgia just means pain or inflammation in the metatarsal area (front of the foot before the toes) rather than a diagnosis in itself. It is little like saying you have been diagnosed with headache, you want to know what is causing it, is it a hangover or a brain tumor ? Likewise with Metatarsalgia there can be many underlying causes or diagnosis. So I thought I would cover some of the most common.
Morton’s Neuroma, not surprisingly discovered by Dr Morton, this causes pain under the foot sometimes with numbness/tingling/altered sensation into the 3rd and 4th toes. It is caused by the nerve to the toes getting thickened as it passes between the metatarsals and is often exacerbated by narrow shoes. Treatment usually involves some kind of domed pad behind the metatarsals and I often use low level laser to reduce the pain and inflammation, footwear advice and insoles in the longer term will also help to resolve the problem.
Capsulitis is usually an overuse injury, it refers to the capsule of the joint and in ‘metatarsalgia’ this means the joint where the toes join the foot. What happens her is the joint capsule gets inflamed often caused by hiking, sports or loss of the fatty padding on the underside of the foot as we age. Treatment involves padding to reduce pressure under that metatarsal, and of course in my clinics I like to use low level laser to reduce pain and inflammation. Some patients will require an insole to further reduce pressure under the area others will recover without.
Sesamoiditis, the Sesamoid bones are the most forgotten and neglected bones of the foot, that is until they become inflamed! Sesamoids are as the name suggests are like sesame seeds and are actually in the tendons which run under the first metatarsal head (behind the big toe) they help the tendons run in the groves in the bone of the first metatarsal. Treatment is virtually identical to that of capsulitis with off weighting, laser and sometimes insoles.
Stress fractures, most commonly seen in the second and fourth metatarsal heads these small cracks in the bone are usually due to repetitive motions such as sports or in people with bones weakened by osteoporosis. Often it is difficult to pick these up via x-ray especially initially before the bone starts to repair itself but MRI is very good here. Treatment usually involves cessation of the activity that caused it and reduction of stress to that area, I favor aircasts which are a sort of plastic boot which can be inflated to reduce pressure under the foot but sometimes a custom insole will be enough.
Also under stress fractures I should mention Sesamoid fracture which although fairly rare can occur, diagnosis and treatment are similar to stress fractures.
This is by no means a comprehensive list of metatarsal problems which come under the umbrella of ‘Metatarsalgia’ but a taste of the more common metatarsal problems that I encounter in my clinics.
Philip Mann Podiatrist 686912307 or philipmann@footpodiatrist.com

09/07/2018

A short video on how to redress toes following nail surgery

How to redress toes following nail surgery

26/03/2018

** Climbers and Walker ́s feet **

This time of year I tend to see a lot of walkers and rock climbers, it ́s easy to forget that this is one of the best areas for winter rock climbing in Europe, which also means it ́s good for hiking too.

Although climbing is usually associated with upper body injuries 50% of injuries involve the lower limb or foot. Broadly speaking, climbing injuries come from falls or footwear.

Falls can either be wall falls or collisions or ground falls. Ground falls produce obvious brakes like Calcaneus (heel) and ankle breaks and sprains. While wall falls due to the high impact (rope often has the effect of pulling the climber into the wall) produce brakes, contusions and haematomas.

Modern climbing shoes generate some specific foot problems, due to their design they usually incorporate downturn and asymmetry enhancing the climbers ability to stand on friction with straight toes and on edges with bent toes and increasing pressure on the great toe.
This and the fact that the majority of climbers wear their shoes too small to further increase control, leads to problems with ingrown toe nails, haematomas and corns, not just on the toes but also under the nails.

Just a quick note on Haematomas, this is where there is a bleed under the nail caused by acute trauma smashing it against the wall, or hitting a rock, or even walking down hill for an extended period of time and the toe hitting the end of footwear. Initially the whole toe is inflamed and very sore.

I always feel that it is a shame that I don ́t see more at this stage as treated now it can be drained which stops the pain instantly and often saves the nail. Left untreated expect 3 weeks of pain until the blood dries behind the nail and it goes black and eventually comes off, usually later still.

Walkers tend to present with a slightly different set of injuries, although falls can still lead to breaks and sprains, hiking injuries are more often overuse type injuries. Heel pain from plantar fasciitis, achilles tendonitis, tendonitis in any of the foot or leg tendons, shin splints ligament damage and of course the old favourites of corns, haematomas and even blisters.

Advice wise, well trying to advise rock climbers to wear bigger shoes would be like trying to advise my 15 year old daughter on foot ware, so I am not going to attempt that!

But for hikers, here are a few suggestions:

Wear boots rather than shoes, just because it is dry here you still need ankle protection from rocks and sprains. High lacing is more likely to prevent your foot sliding into the end of the shoe on long downhill sections.

Make sure your boots fit well, when you buy them go at the end of the day when your feet are at their most swollen and sensitive and try them with the socks you intend to wear them with. There should be at least a fingers width of space at the end of the boot. Don ́t shop by number (size) but by feel.

Socks without seams are always good and the double socks, ones which have two thin layers significantly reduce friction and therefore blistering.

Philip Mann Podiatrist/Chiropodist
www.footpodiatrist.com
686 912 307

12/03/2018

WOMEN HAVE 4 TIMES AS MANY FOOT PROBLEMS AS MEN.

That painful fact is often attributed to wearing heels.

Ironically, Western women started wearing heels to effect a more masculine look: European men adopted the look from Persian warriors in the 17th century, and women soon followed suit.

25/02/2018

Particularly this time of year I seem to spend a lot of time doing vascular assessments. The colder weather often exacerbates poor circulation resulting in cold feet, colour changes, chilblains, discomfort and in some cases ulceration to the feet.

18/02/2018

FEET ARE ONE OF THE MOST TICKLISH PARTS OF THE BODY.

There’s a good reason for that: Humans have nearly 8000 nerves in our feet and a large number of nerve endings near the skin. Having ticklish feet can be a good sign: reduced sensitivity can be an indicator of neuropathy.