Tag Archives: Fungal nail

Do lasers work on nail fungus? An in depth review.

Do lasers ‘cure’ fungal nails?

Lasers have been a part of podiatry practice for a number of years.

Papers discussing the potential use of lasers in clinical practice started to appear in the 80s, focusing on the high powered carbon dioxide (CO2) systems available at that time.

Evaluation was around nail bed removal, treatment of onchomycosis (nail fungus) once the nail had been removed, and nail fenestration (making a hole or ‘window’ in the nail) to facilitate more effective treatment by topical applications such as curanail.

However the small number of machines in use remained in the hands of specialists, and mainly in the United States. As the years passed, new systems were introduced with varying levels of success but the main prohibition to their use in clinical practice was their cost.

In 2009, for the first time a surgical laser system advertised in the UK Podiatry magazine Podiatry Now was claimed by one user to be ‘possibly the most radical development in the treatment of onychomycosis our profession has ever seen’.

Concerns were raised at the time as these were unproven claims for expensive equipment and in the years since little evidence has been put forward demonstrating their effectiveness despite their increasingly wider use.

Lasers are attractive for the public and practitioner alike for a number of reasons.

Although oral medications have shown effectiveness and remain the most studied treatment for onychomycosis(fungal nail), concern is always expressed about their safety. Antifungal drugs are contra-indicated in patients with active or chronic liver disease and are often declined by patients wishing to avoid potential side-effects.

Topical applications also have drawbacks with long term application, questionable efficacy, and issues with patient compliance.

Lasers, however, capture the imagination as a safe, effective quick fix for a number of conditions. However, how they work remains unclear.

Laser systems in near infra-red spectrum (780 nm – 3000 nm wavelength), which are commonly used in onychomycosis, directly heat target tissues and by using a pulsed beam instead of continuous one, they can deliver a “selective photothermolysis”

Appropriate intervals between pulses allows for tissue relaxation and cooling causing little collateral damage to surrounding structures. Lasers for nail disease have been approved by the Food and Drug Administration (FDA)in America but only for their ability to temporarily clear nail growth in mycotic nails.

An immediate problem with the studies was the variety of study procedures which made comparison difficult.

12 papers published between 2010 -2014 reflected the novelty of the technology with four studies stated they were “preliminary” or pilot studies.

10 papers investigated the 1064 nm neodymium: yittrium-aluminum-garnet laser system (Nd:YAG) (long and short pulse types). 1 paper used an 870/930 nm dual band system and another investigated the use of an ablative carbon dioxide laser as a means to fractionate nails to improve the penetration of topical anti-fungal agents.

In one randomized controlled trial, 36 patients with proven onychomycosis (nail fungus) were randomly allocated to either a laser treatment or control sham device.

All patients were treated at day 1, 14, 42 and day 60. Independent assessors reviewed photographic evidence at various stages to judge and record any changes at 6 months, when 34 patients (37 toes: 26 treated and 11 controls) were valid for analysis.

Visually, only 2 treated nails had completely or markedly improved and slight to moderate improvement was seen in 18 treated nails versus 3 control nails with 6 treated nails unchanged along with 6 control nails.

The study was funded exclusively by a laser manufacturer and employees of the company were shown as co-authors of the paper.

In another randomized controlled trial 27 patients with onychomycosis received either 2 laser treatments two weeks apart or no treatment. After 3 and 12 months all patients were re-assessed by culture and measured nail clearance.

At 3 months, 33% of the laser treated group had a negative culture versus 20% in the control group and had more proximal (new uninfected growth emerging from the bed) nail clearance at this time, although there was no statistically significant difference between the two groups.

At 12 months, there was no difference in measured nail clearance between the treated and control group.

One conclusion was that laser may only have a temporary effect in onychomycosis.

Another study of 8 patients suggested 7 showed distinct improvement 4 months after 2–3 laser treatment 3 weeks apart. However, it was a small group, pre and post assessment was vague and patients were encouraged to use daily anti-fungal agents applied to the nail during treatment.

Another study in 2012 study looked at 13 subjects (37 toe nails). Nails were treated two or three times 4–8 weeks apart. At the end of the study (week 16) 19 nails (51%) showed complete clearance (clear nail and negative microscopy) with 30 nails (81%) showing from moderate to complete improvement.

Equipment for the study had been loaned from the manufacturers but it is not known if the results were independent of the company.

A more recent study looked at 43 toenails and 12 finger nails that underwent laser 5 treatments at four week intervals. At 24 weeks nails were assessed for surface clearance and negative cultures. 1 month after the final treatment 30 of the 43 nails were clear of fungus. 4 nails achieved a complete cure. 8 patients were reported to have achieved better than 80% clearance and 31 nails showing a substantial improvement.

The Pinpointe™ Laser was used on two randomly assigned treatment groups comprising 33 patients with 154 fungal nails given 8 treatments at 1 week intervals (group 1) or 4 treatments at 1 week intervals (group 2).

At 24 weeks there was no significant difference in the cure rates between the groups. What was interesting was the reported re-occurrence of fungus reported on 10 nails (5 patients) within a 2–4 months, suggesting that laser may only inhibit growth rather stopping it altogether.

A more involved study used three types of laser light on 21 patients. Each nail was treated with 10 minutes of laser light and received 4, weekly treatments and were assessed at 1, 3 and 6 months. Tissue temperature was recorded to suggest what effect the laser was having on the treated area and although the results appeared good, it was a small sample. However, it is possible 46 degrees Centigrade is a lethal temperature for nail fungus

A larger study of 131 patients underwent 2 treatments, 30 days apart with a review at two months. The review at 2 months suggested a good initial success rate but there was no long-term follow-up to determine re-growth rates.

Another study of 12 nails treated by laser concluded that it was no better than topical nail lacquer therapy based on the cure rates achieved. Again, a study of 10 patients (18 nails) with onychomycosis could not show significant improvements in mycological or clinical cure rates after a 24 week program using laser.

In another group of 10 nails, clinically only 4 cases had shown visible improvement. This last study unsurprisingly concluded that mild superficial fungal nail infections are more likely to respond than well established infections that have penetrated under the nail.

This review highlights a number of issues.

  • From early results it is clear that there is no agreement on the effectiveness of laser with conflicting results. This, in part, is due to the differences in study design.
  • Although all papers reviewed fungal nails in adults, selection criteria varied.
  • Most focused on older adults reflecting the fact that onychomycosis (fungal nail) is a disease are more prevalent in this age group.
  • There was no standard test to confirm onychomycosis with a large number of tests used of varying reliability.
  • How a ‘cure’ is measured or defined with no agreed standard.
  • Visual appearance in some studies was based on patient satisfaction, whilst others measured clear nail emergence or simply measured the changes in the amount of nail plate surface affected and its associated changes.
  • Variation in length of study from 12 weeks to 1 year.
  • No account is taken of differences in nail growth rate with age, or that fungal nails grow more slowly in the first place. In adults, toenails grow approximately 1.0 mm/month however in the elderly, the rate of nail growth decreases by approximately 0.5% per year between 25 to 100 years of age.
  • A greater study period is required as the longer studies hint at re-occurrence being an issue, although this could be due to outside factors such as contaminated footwear. This suggests topicals such as Curanail/Loceryl being a useful addition to a successful treatment regime.
  • There were variations in nail thickness and some used a nail drill to reduce the presence of diseased nail prior to treatment.
  • With four main types of onychomycosis, what was being treated also varied.
  • The cost a long term study is expensive and sponsorship can effect outcomes or interpretation of findings, only one paper disclosed what could be a conflict of interest
  • There is no actual single protocol for laser toenail fungus treatments.
  • there have been no solid studies to prove that the laser can cure toenail fungus.

In later studies by Jager, Oesterhelt, Et Al, they found that no patient had a fungal cure in 12 months of treatment and follow-up.

In 2016, in Podiatry Today, Tracey Vlahovic, DPM, a leader in Podiatric Dermatology noted that laser is not a reliable monotherapy for toenail fungus.

In 2019, Harvard University noted that “there is still little information about its long-term safety and effectiveness”. In the Journal of Fungi, Liddell and Rosen concluded that with laser therapy for toenail fungus, “The evidence to date has not indicated superior outcomes in long-term endpoints to standard of care systemic therapy and postulated anti-fungal mechanisms remain unverified’.

There is a scarcity of peer-reviewed literature investigating this topic and with so many types of lasers and so many different treatment protocols, there truly is no way of knowing which types of lasers have better results and which protocols are best.

Further, there are no true studies to confirm the laser treatment effectiveness, although there is much marketing material making the claim. When you combine all of that with the cost, it is difficult to recommend laser for toenail fungus at this time.  As noted in the studies above, traditional treatments were often as good or better than laser therapy alone, and there are many other treatments available to help with this condition.

At Maidenhead Podiatry, we will wait to see if new evidence supports the use of laser. At this time, we have found that it may not in your best interest to seek laser treatment and we will continue to offer traditional treatments for toenail fungus.

The review itself cannot have been exhaustive, may not have included all relevant papers and only looked at studies in English.

Ten reasons why your nails might change colour

My toenail is changing colour. What can be causing it?

The function of a toenail is protection of the tip of the toe. If we are lucky, we will progress through life with few changes to their appearance, but that isn’t always the case.

We all have a good idea of what we consider a ‘normal’ nail, but sometimes all or part of the nail can start to change colour. In this blog we look at how and why this can happen.

brown-black discolouration (occasionally red)

Although uncommon, the first condition to eliminate is (subungual – under the nail) melanoma. Speak to your podiatrist or GP if you are concerned. In reality, there are numerous benign causes.

Longitudinal melanonychia

This is a term used to describe a  strong and noticeable pigmented band – normally brown – that runs down the nail from the bed to the tip. This condition normally affects more than one nail at a time.

This is quite common in Black-skinned, Asian, Hispanic, and Middle Eastern individuals who frequently have benign/harmless longitudinal pigmented bands. This is due to the naturally occurring pigment cells or melanocytes that make their skin darker.

The number and width of the bands tend to increase with age.

However, the presence of a new, single – only occurring on one of ten nails –  dark coloured band in an adult could represent a melanoma and should be checked immediately.

There are additional uncommon causes including systemic disease and medication to numerous to list here.

Subungual haematoma (bruise)

Following trauma – kicking something, dropping something on the toe – blood can accumulate in the space between the nail bed and nail plate. It can  also happen following vigorous exercise/dancing when you don’t remember ‘bashing it’.

The discolouration is often accompanied by considerable pain due to the pressure created under the nail. If you visit a Podiatrist as soon as possible after the injury occurs, it is possible to painlessly drain the fluid and bring immediate relief.

Yellow/white discolouration (occasionally orange)

Onychomycosis (fungal nail)

Nail fungus usually cause a yellow-white discolouration, but occasionally it can be black or orange.

Nail fungus usually starts at the tip or sides of the nail and work their way upwards towards the nail bed frequently following trauma.It is very common for patients to report that fthe fungus appeared after damaging the nail.

If caught early, infected nail can sometimes be trimmed away to prevent spread.

If allowed to become established, treatment can be difficult and lengthy. For further information https://maidenheadpodiatry.co.uk/what-can-i-do-about-my-fungal-nail/

Some medications can also produce similar discolouration.

Cream, Dark yellow or white-yellow nails

Trauma

When nails have experienced trauma, the protective mechanism can be triggered, and they increase in thickness. That increase in thickness causes the colour of the nail to darken and take on a changed appearance. The nail will also grow more slowly.

Psoriasis

This condition can occur just on nails with no history or occurrence on the skin. The changes can be similar to, and are often mistaken for, a fungal nail infection and it is important to establish which you have, to allow appropriate treatment

Paronychia

Or infection of the nail bed. This can lead to a change in appearance as pus builds up under the nail. This condition can require release of the pus and prescription of anti-biotics, depending on severity.

Some medications can also produce similar discolouration.

Yellow Nail syndrome

This is a very rare condition characterised by very curved, transversely thickened, smooth, yellowed nails and is associated with lymphoedema, pleural effusion, and (usually) ascites.

White nail discolouration

Minor trauma

A common cause, and tends to produce small localized areas of whiteness, like white spots on the nail.

There are a number of other systemic conditions that can also lead to white nails but they are too uncommon and numerous to be listed here.

Green/blue nails

Pseudomonal nail infection

Pseudomonas infection is often found on the underside of a nail (it can also be found on the skin) which has already lifted, often due to trauma or previous infection. It is characterised by green-blue, or occasionally black, discolouration. This infection is relatively harmless in healthy adults. If you are immune compromised you should seek advice.

Some medications can also produce similar discolouration.

If you would like more information or to make an appointment with one of our Podiatrists, call 01628 773588 and speak to one of our friendly reception team.

Ten things you need to know about treating your fungal nail

We are open – call 01628 773588 today for and appointment.
So many people have fungal nails and become increasingly frustrated by the lack of progress using commonly available over the counter treatments. So how do you go about treating your fungal nail?
In this blog we will address infection mechanism and treatment and listed below are ten important things you should know about treating your fungal nail.

1. Generally but not always infection of a nail follows damage.

Treating your fungal nail can be a right pain in the foot.
Nail fungus is an opportunist and normally (but not always) infects following damage to a nail – which is why it often doesn’t spread to the next door healthy nails.
This is why runners often have multiple fungal nail infections because of the damage done to nails by ill fitting and poorly laced running shoes especially when running downhill.

2. You have may caught your fungus from someone else.

The dermophyte responsible for athlete’s foot is naturally occurring on most feet. It is when it reproduces unchecked that we experience the familiar itching, redness and macerated tissue between the toes and changes to the nails.

The fungus may initially been ‘caught’ or transferred to the foot from a communal surface such as a changing room floor, a hotel bathroom, a swimming pool surround, a family member and so on.Biomechanics Image
Having acquired the fungal spore(s) it can be carried in footwear for sometime without becoming active waiting for conditions for activation and propagation to present themselves.

3. Fungus loves shoes.

The warm, dark and moist conditions found inside your shoe when your foot is in it is an ideal environment for a fungus.
Athletes foot is often already present. If you see an infection between the toes it is likely that you already have it on the sole of your foot. And it doesn’t always itch.

4. Fundamental to any fungal treatment is sanitising footwear.

Think about it.

Our footwear is the only article of clothing that we wear day in day out and never clean apart from the occasional polish. Certainly not the inside.
Footwear must be treated at the same time as a fungal infection for comprehensive eradication or re-infection will follow.

5. Don’t just treat your nails.

In addition to treatment of the skin and nails of the foot, anti-fungal spray such as Daktarin Spray should be used every time you change shoes.
Wrapping your shoes in a plastic bag and putting them in the freezer for 24hrs will kill most micro-organisms and give you a head start.
Fungal spores don’t survive above 37degreesC and so wearing socks once and washing them in a 40degreeC wash will sanitise them.

6. Nail fungus is very difficult to eradicate with over the counter products.

First and foremost when a Podiatrist is going to apply an otc (over the counter) product they will remove all of the fungal nail as a starting point.
This will be done far more comprehensively than you will be able to achieve at home and is usually painless as the nail being removed is already lose and not attached to the nail bed.
This allows direct application of the product into the site of the infection.

7. Not all the discolouration you see is ‘live’ fungus. 

A fungal nail infection is like a forest fire – it is easy to see where it has been but it is only active at the leading edge and the ‘leading edge’ of a fungal infection is usually quite a way up underneath the nail towards the matrix – i.e. where it grows from.
This is one of the reasons that fungal nail tests can come back negative  – because the fungal nail clipped from the edge is dead and therefore nothing is produced by a culture.
Clippings need to be taken from high up the nail and include skin scrapings from the same place too. Get your Podiatrist to do it for you.

8. So, what can you do?

So. Having cleared the dead fungal nail away and exposed the site of the infection there is a plethora of products on the market that make various promises which should see them referred to trading standards under the trades description act as unsustainable.
Generally you have fungi-stats such as amorolfine and products which change the pH of the nail – in theory a fungus can’t grow in an acidic environment.
Neither and none appear to be better than any other, clinical evidence of efficacy is patchy and even if they are successful could take several years of assiduous application.

9. What about tablets?

Oral medication is an option and usually (but not always) successful. You will need to speak to your GP about this and they are frequently reluctant to go down that route as there can be side effects. Terbinafine Hydrochloride or lamisil tablets appear the most effective.
If you would like to read more about oral medication and possible side effects – click here.
‘Google’ the subject and educate yourself ahead of a visit to your GP so you can have an informed discussion. You will see liver damage mentioned repeatedly but this is a rare side effect (1 in 50,000 to 1 in 120,000, and if you feel unwell or fail a liver function test then stop taking them!
You will need to be on them for four to six months until a reasonable amount of new nail grows. You can then stop as the remaining fungal nail will be dead and will just grow out.

10. .…….and afterwards?

Two things you should bear in mind if you do get rid of the infection.
  1. getting rid of it does not confer immunity and you could get it again in the future
  2. nail fungus is an opportunist and normally infects a damaged nail so if in the future you damage the nail that is the time to be most vigilant for re-infection.

maidenheadso

Finally, it is generally accepted that lasers are very expensive and results are inconsistent although you will see much on the web to the contrary.

For more information or to make an appointment with one of our Podiatrists, please:

Call:                01628 773588

Email:             info@maidenheadpodiatry.co.uk

Visit:               www.maidenheadpodiatry.co.uk

Oral medication (terbinafine) has been recommended for my fungal nails – is it safe?

Terbinafine and fungal nails

There are too many topical anti-fungal preparations currently on the market to list them all here. Their success also varies enormously and is covered in another blog. click here to read.

Having visited your Podiatrist or GP and had your nail infection confirmed as fungal, there are three main options.

  • Do nothing
  • Try an over-the-counter or prescription anti-fungal topical application
  • GP prescribed oral medication

There are two mainly used oral anti-fungal medicines – itraconazole and terbinafine. This blog will look specifically at terbinafine (hydrocloride) because at Maidenhead Podiatry we are frequently asked about its potential side effects.

Liver problems were only reported in 0.1% of patients. 1 in 1000; but only 1 in 50,000 to 1 in 120,000 were serious

What is terbinafine (hydrochloride)?

Terbinafine is an allylamine drug, meaning it works by inhibiting squalene epoxidase, an enzyme involved in the synthesis of ergosterol, a component in fungal cell walls.

Terbinafine is available as cream, gel, spray and, of course, tablets for oral administration at the time of writing.

What is the history of terbinafine?

It is used in the treatment of onychomycosis or fungal nails (as well as a range of fungal skin infections). Terbinafine has been available since the early 1990s in the UK and the late 1990s in USA, but there has always been some reluctance regarding its potential side effects particularly those affecting the liver when taken orally.

When terbinafine was first deployed as a new antifungal, the choices for treatment of fungal nails were limited. Topical treatments were often, and remain, disappointing.

Until the 90s, oral griseofulvin and ketoconazole were the oral drugs of choice, indicated for dermatophyte or fungal nail infection, but they were far from effective. Generally, they required long courses with a narrow spectrum of activity leading to many patients giving up when they experienced unpleasant side effects.

The idea of a new, modern, antifungal drug was appealing with subsequent studies suggesting it had twice the success rate of griseofulvin and it became widely used in the treatment of dermatophyte nail infections.

How is terbinafine metabolised?

As with many drugs, terbinafine is metabolised by the liver and excreted by the kidneys, consequently a reduction in function of either of those two organ systems could result in serious problems and correct prescribing is crucial.

Terbinafine is highly lipophilic (combining with or dissolving lipids) and tends to accumulate in hair, skin, nails, and fatty tissue where it inhibits fungal growth..

What about terbinafine and liver damage?

The possibility of liver disease (hepatotoxicity) with terbinafine has long been known and drug manufacturers have highlighting that it should not be prescribed for patients with liver disease. Terbinafine, like nearly all classes of medications, has been shown to be able to induce idiosyncratic liver injury or drug induced liver injury (DILI), but that doesn’t mean it will.

The causes of DILI are many, although pre-existing liver disease may play a part. In otherwise healthy individuals it’s cause and reason for development is unclear, although genetic susceptibility may be responsible. As a consequence, The British National Formulary advises it should not be used in patients with known liver disorders. For those that are prescribed the drug, they should have liver function tests before starting and periodically after 4–6 weeks of treatment to assess liver function.

The test monitors the levels of liver enzymes present in the bloodstream. Elevation of these enzyme levels can signal early changes in liver function. Tablets are often prescribed a month at a time, the next month being prescribed only following a successful test.

Is terbinafine safe?

Hepatotoxicity or liver function problems are rare but the more common side effects in patients taking the drug include

  • gastro-intestinal upset,
  • taste disturbances,
  • headache
  • rashes

Further, liver problems may not be as common as is perceived. A 1996 British study reviewed 9879 patients who had taken the oral terbinafine. Half of these had other illnesses and conditions and were taking other medications at the same time. 14% reported various side effects but only half of these were thought to be related to the terbinafine as reported by their physicians.

Liver problems were only reported in 0.1% of patients. 1 in 1000

(14 cases) of which 10 cases were classified as minor and transient elevations in liver enzymes. In addition, some of these patients were found to have pre-existing history of liver disease (gall bladder disease, alcohol related changes, hepatitis and cirrhosis).

There were no terbinafine associated deaths.

The National Library of Medicine Liver Toxicity Database report on terbinafine shows less than one percent of patients see an increase in liver enzymes in the bloodstream and most resolve with stopping treatment. It estimates the probability of developing elevated liver enzymes levels requiring stopping treatment is about 0.31% for 2 to 6 weeks’ treatment and 0.44% for treatment lasting longer than 8 weeks.

It concludes that clinically apparent liver injury from terbinafine occurs rarely, in around 1 in 50,000 to 120,000 prescriptions.

How do I decide?

Remember,

  • no drug can ever be 100% effective for everyone so success isn’t guaranteed
  • successful resolution doesn’t mean you can’t get it again
  • re-infection within 12 months is not only possible but likely
  • successful resolution must be followed by an anti-fungal regime
  • leaving a fungal nail untreated rarely causes problems

As with most classes of drugs, terbinafine can potentially lead to liver problems. However, the data from the above control suggests that oral terbinafine is safer than perhaps it is perceived, and minor side effects are far more likely for most patients than serious liver damage.

Data from studies suggest the risk of serious liver injury to be between 1 in 50 000 and 1 in 120 000

Despite its rarity, patients taking terbinafine who exhibit any of the symptoms of liver problems (nausea, vomiting, abdominal pain, fatigue, anorexia, general itching and dark urine) should urgently be referred for further assessment.

If you would like more information , or to make an appointment with one of our Podiatrists, call on 01628 773588 or email info@maidenheadpodiatry.co.uk.

Ever thought about visiting a Podiatrist and wondered what they do?

 

Have you ever thought about visiting a Podiatrist and wondered what they do?

And what is the difference between a Chiropodist and a Podiatrist? Read on to have our most commonly asked questions answered.

How many Podiatrists are there at Maidenhead Podiatry?

We currently have eight Podiatrists working at the clinic. Not everyone works at the same time or same number of hours but between us we provide clinic based treatments, home and nursing/care home visits.

Which governing bodies are our Podiatrists a member of and how are we regulated?

Our Podiatrists are all HCPC registered and Insured Members of the College of Podiatry. The HCPC is our government regulating body and the College of Podiatry provides our professional registration and insurance. It is vital to ensure that anyone who provides you with such an essential service is qualified, insured, registered and regulated.

What is a Podiatry?

Podiatrist comes from the Greek ‘pod’ meaning foot and ‘iatreia’ meaning healing, hence one who heals feet. The term originated around 1914 in an attempt to separate an emerging profession from its perceived humble roots. Chiropody developed as a profession in the UK while being called Podiatry in almost every other country. In the mid-1990s, our profession changed it’s name from Chiropody to Podiatry to bring us in-line with the rest of the world, but the skill set remained the same.

In the last thirty years, Podiatry has developed considerably as a profession with today’s Podiatrists capable of providing a wide ranging and comprehensive service in every health care aspect of the lower leg and foot.

Podiatrists are skilled healthcare professionals who have been trained to degree level to prevent, diagnose, treat and rehabilitate abnormal conditions of the feet and lower limbs. We can also prevent and correct deformity helping to keep people mobile, active and relieve pain.

What symptoms can you help treat?

Podiatrists can help a number of common conditions including but not limited to

  • gait analysis
  • bio-mechanical assessment
  • musculo-skeletal assessment
  • corns
  • callus
  • shockwave
  • verrucas
  • fungal nails
  • ingrown  nails
  • cryosurgery – verruca freezing
  • flat foot
  • hammer toes
  • diabetic assessment
  • heel pain
  • foot pain
  • Swift verruca microwave

What could your clients expect on their first visit?

Every patient journey at Maidenhead Podiatry begins with a consultation.

We take a comprehensive history including underlying medical conditions and medication. We then discuss the reason for attending followed by an examination. At this point treatment options are presented and following informed consent, we formulate a treatment plan and proceed with the best solution.

Depending on your reason for attending, your treatment plan could include

  • treatment
  • diabetic assessment
  • modalities such as Shockwave and Swift
  • advice
  • rehabilitation
  • sonography
  • surgery
  • ongoing assessment
  • onward referral

What do you use for assessment?

Most important are visual clues such as hair growth pattern and colour of the skin. Depending on patient requirement, we could use any of the following

  • observation
  • examination
  • palpation
  • 10g monofilament – to test for neuropathy
  • 128Hz tuning fork – for sensation testing
  • reflex hammer
  • Doppler – to help assess blood flow
  • Tip Therm – for assessing temperature perception

Who could benefit from a Podiatry visit?

Anyone who has feet. Our youngest patients are under 1yr old and our oldest is over 100yrs old.

Different age groups tend to present with different issues because of the effects of the ageing on the feet but conditions such as diabetes can affect all ages.

How accessible is the Maidenhead Podiatry?

We have our own private car park immediately next to the clinic, with wide, flat, no threshold doorways for easy wheelchair and disabled access. We have two treatment rooms downstairs. If you have any special access requirements, please let us know and we will make every effort to accommodate them.

What do I do now?

For more information about Podiatry or to make an appointment, please call: 01628 773588 or email  info@maidenheadpodiatry.co.uk. 

Need help with your feet or back – use our search bar.

Use our search bar the find what you are looking for

Many people visit our website for help or information on Podiatry or Chiropractic.

Both Podiatrists and Chiropractors offer a range of treatments and skills to benefit their patients but sometimes all you need is to be informed.

Below we describe what Podiatry and Chiropractic are and explain many of the treatments and services we offer but if you know what you are looking for then use the search bar in the top right hand corner of the screen.

A large part of what we provide for patients is help, advice and education and this website contains information on definition, diagnosis and treatment of a wide range of conditions and all can be accessed through the search bar.

It doesn’t matter if you are looking for something specific or just curious. Give it a go. Find what you are looking for in our education pages and previous blogs. Click on the search bar.

Podiatry

Podiatry is defined as the diagnosis and treatment of foot disorders; however, we assess, diagnose and treat from the knee down. We also treat warts on hands.

Chiropractic

Chiropractic is the management consists of a wide range of manipulative techniques designed to improve the function of joints, relieve pain and ease muscle spasm.

Chiropractors don’t only treat backs and can help with any soft-tissue or structural issues.

What is Podiatry?

Podiatry like many health care professions has general practitioners and specialists.

A general practitioner will treat anything from corns to verrucas and from plantar fasciitis or heel pain to ingrown toenails. We are all licenced to use local anaesthetic, perform minor surgeries such as ingrown nail removal and dispense antibiotics, if and where appropriate.

We provide vascular assessment and diabetic screening as a matter of course when requested or required. We have Podiatrists with special interests in areas such as diabetic care and biomechanical assessment and gait analysisGait analysis includes being filmed on a treadmill followed where appropriate by prescription of custom moulded orthotics together with an integrated exercise and rehabilitation program.

Seven Podiatrists and two Chiropractors trained in using the latest treatment and cutting-edge technology for a range of common conditions.

Cutting edge technology

Shockwave, which is a percussive mechanical treatment for chronic, or long-term, soft tissue pain such as heel pain, Achilles pain, hip pain and of course plantar fasciitis although it can be used anywhere in the body. It is used by both Podiatrists and Chiropractors

We were one of the first clinics in the country to use Swift, a microwave generator for the treatment of verrucas. We also offer salicylic acid, freezing and needling.

We offer all general foot care too including fungal nails, athlete’s foot, splits, fissures and infections. We also provide foot care in nursing and care homes as well as a domiciliary/home visiting service.

Contact us

Hopefully you have found what you are looking for but just in case you haven’t, give us a call on 01628 773588 and let us educate you. To find us follow the map and directions or put SL6 5FH into your sat nav.

We have our own free car park directly outside the clinic. Our premises are disabled friendly with no door thresholds and easy access throughout the ground floor. Let us know if you have any special requirements.

If you would like more information or to make an appointment give us a call on 01628 773588, and speak to one of our friendly receptionists or arrange a call back from one of our Podiatrists or Chiropractors.

And, we will of course cut your toenails too.

What is a Podiatrist?

What is a Podiatrist and what can they do for me?

This article will guide you through the many and varied aspects of Podiatry and help you find the foot care that suits you best. To assist in stopping the development of preventable foot problems and advise you in self care.

To offer a better understanding of the foot care options available to an individual we have split this blog into sections starting with the simplest or self care and escalating to the most complex or podiatric surgery as an end point.

  • Self care and footwear

 

Not everyone needs to become a patient. Many foot conditions can be safely and appropriately managed with the right equipment, skills and confidence.

Many foot health advice leaflets are available through the NHS and the Society of Chiropodists and Podiatrists and your Podiatrist will be happy to give you advice and guidance.

Poor choices in footwear can cause significant foot problems and seeking and following advice to make good choices of appropriate footwear can prevent development of new conditions, aggravation of existing ones and prevention of falls. Again, your Podiatrist will be happy to give you advice and guidance.

  • Footcare

Simple footcare is defined as nail cutting and skin care including the tasks that healthy adults would normally carry out as part of their daily personal hygiene routine.

Of course this doesn’t apply to everyone but it is an important aspect of footcare that ensures many individuals check their feet regularly while still mobile and pain free.

For those who do attend clinic regularly for simple footcare, examination of the feet during a routine appointment acts as an early detection system ensuring prompt intervention and prevention of developing more serious foot health problems.

PODIATRY

  • Core Podiatry
  • Nail surgery
  • Warts and verrucas
  • Fungal nails
  • Long term and neurological conditions

 

Core Podiatry is defined as ‘the assessment, diagnosis and treatment of common and more complex lower limb pathologies associated with toe nails, soft tissues and the musculo-skeletal system with the purpose of sustaining and improving foot health. (Farndon 2006).

The main foot conditions affecting older people (as opposed to children) requiring core podiatry are -nail problems, corns, callus, toe deformities, and falls prevention.

These conditions can be managed successfully by Podiatrists in the NHS and Private practice using a range of treatments including sharp debridement (scalpel), pharmacology (creams, tablets, steroid injection) and therapies (often in conjunction with footwear advice and and prescription of orthoses where appropriate0.

Although the call for Nail surgery is small – approximately 8 per 1000 GP patients – there is certainly a need for an effective, non-recurring treatment.

Since the 1970s partial or total nail avulsion has become a standard Podiatry procedure where part (the sides) or all of the nail are removed painlessly to the nail bed under local anaesthetic to resolve recurring problems with ingrown nails.

The likelihood of regrowth is reduced to almost zero (0.5%) with the application of  phenol to the nail bed.

Warts and verrucas are small skin growths caused by the human papilloma virus. Verrucas are warts on the feet, common in children and although harmless they can be painful.

Most verrucas will clear up without treatment within two years but there are numerous treatments available through your Podiatrist including

Fungal nails are very difficult to treat successfully. There are numerous topical applications available as well as GP only prescribed oral medication. Your Podiatrist will discuss your best options and agree a treatment plan.

Long term and neurological conditions include conditions such as Diabetes, rheumatoid arthritis, stroke and Parkinson’s and a Podiatrist’s management often involves management and prevention of potential escalation of foot problems.

Core podiatry is essential in maintaining the integrity of the feet of people whose medical condition places them at risk of developing complex problems.

Falls prevention. Foot problems in older people are often associated with impaired balance and mobility and where there is a history of multiple falls there are usually more foot issues.

The existence of a corn, bunion or poor footwear choices are often at play and podiatry intervention can moderate the risks.

ORTHOTICS

  • Orthotics, footwear and Musculo-skeletal provision
  • Podopaediatrics
  • Sports injuries
  • Footwear

Orthotics, footwear and Musculo-skeletal provision. Bio-mechanics and bio-mechanical assessment are an essential part of podiatry provision and the discussion of findings and correction of underlying issues with orthoses can have positive implications across the breath of podiatry services.

Many patients present with musculo-skeletal pain caused by bio-mechanical problems which can involve foot, knee, hip and lower back affecting gait (the way they walk).

Often the most cost effective and appropriate treatment is the provision of orthoses (specialist insoles) which modify and correct the bio-mechanical problem.

There are a number of different orthoses that can be prescribed by your Podiatrist depending on presenting condition and patient need. Orthoses range from a simple heel raise or cushioned insole to specific complex custom devices.

Podopaediatrics focuses on provision of Podiatry for children. This ranges from treatment of warts and verrucas to early identification of foot deformities. From gait assessment to prescription of orthoses.

Sports injuries often occur due to abnormal rotation and deformation of joints and/or muscles. Podiatrists target improvement and resolution through bio-mechanical assessment and prescription of orthoses combined with strengthening exercises and footwear.

Footwear choices can directly affect foot conditions. Podiatrists offer advice from correct choices when buying shoes to measuring for custom made footwear depending on requirement.

SPECIALIST PODIATRY

– relates mainly to long term conditions and may or may not be provided within a general podiatry clinic.

  • Diabetes
  • Systemic musculo-skeletal disorders
  • Dermatology
  • Advanced technology

Diabetes care is one of the basic provisions of any Podiatry practice and your podiatrist can offer regular foot health assessment as part of good diabetic control and patient education.

Early detection of foot problems can ensure correct management and reduce the likelihood of critical long term changes.

Systemic musculo-skeletal disorders such as rheumatoid arthritis (RA) increase the need for a range of basic foot care services. Up to 90% of people with RA have some kind of foot involvement sometimes leading to the formation of callus corns and occasionally ulceration.

Early Podiatric intervention can improve long term outcomes.

Dermatology can be considered part of core Podiatry as many of the common skin problems seen on the feet are amenable to Podiatric treatment. From tinea pedis (athlete’s foot) to melanoma.

From verrucas to cellulitis you can ask your Podiatrist for advice.

Advanced technology is becoming more a part of day to day Podiatry provision. At Maidenhead Podiatry we use Swift – a microwave treatment – for verrucas, Shockwave for chronic soft tissue pain and Cryopen for freezing warts and verrucas.

EXTENDED SCOPE PRACTICE

Podiatrists who work in extended scope practice usually work in the NHS although they can be available in larger private practices and have undertaken additional training in their clinical areas  and may actively engage in the following –

  • non-medical prescribing
  • requesting blood tests
  • requesting scans
  • interpretations of test results
  • injection therapy
  • advanced vascular investigations

PODIATRIC SURGERY

Podiatric surgery is surgical treatment of the foot and associated structures carried out by a Podiatric Surgeon often as a day case and under a local anaesthetic.

In Conclusion good foot health has a fundamental link to health and well being. Poor foot health can have a significant impact on mobility, independence, and quality of life.

If you would like more information or to make an appointment with one of our experienced Podiatrists then give us a call today and make an appointment on 01628 773588 or email info@maidenheadpodiatry.co.uk and help lay the foundations of a healthy lifestyle.