Thomas MJ, Roddy E, Zhang W et al. The population prevalence of foot and ankle pain in middle and old age: a systematic review. Pain 2011;152(12):2870–2880. doi: 10.1016/j.pain.2011.09.019 Scher RK, Tavakkol A, Sigurgeirsson B et al. Onychomycosis: diagnosis and definition of cure. J Am Acad Dermatol 2007;56(6):939–944. doi: 10.1016/j.jaad.2006.12.019 Skin between the toes may appear macerated, the soles of the feet may become dry and flaky (‘moccasin distribution’), which can be a significant risk factor for acute bacterial cellulitis of the leg [21] because oral medications come with some side effects and risks, and may not be suitable for everyone. Pharmacists and healthcare professionals should refer patients to a podiatrist or GP for antifungal tablets, which include griseofulvin, terbinafine and itraconazole. The latter two are more effective than griseofulvin [11] Athlete’s foot, also known as tinea pedis, is a cutaneous fungal infection caused by dermatophyte infection, which thrives in warm, humid conditions. Athlete’s foot affects around 15% of the population [15]

For any bleeding or discharge from an infection, or even excessive healing flesh (hypergranulation tissue) around the nail, antibiotics will be prescribed to manage the infection as well as having the offending spike removed If conservative management fails, there is surgical correction. Procedures now make use of cuts in bone, which are intrinsically stable, and many internal fixation devices are available to maintain alignment leading to early mobilisation. This is often carried out as a day case. Lifestyle advice Owing to the large number of the general population suffering from foot problems and the increasing burden of an ageing population, this article will describe the important role of pharmacists and the pharmacy team in engaging patients in preventative care; advising on the correct self-management of common foot-related conditions; and the appropriate referral of patients to allied health professionals for additional treatment and advice. Fungal foot infections

Szepietowski JC, Reich A, Garlowska E et al. Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: a survey of 2761 patients. Arch Dermatol 2006;142(10): 1279–1284. doi: 10.1001/archderm.142.10.1279 At the initial signs of an ingrown toenail, before the nail pierces the skin, patients can use a nail clip and spray that helps to train the nail to grow straight. However, once the nail has pierced the skin, effective treatment can involve either partial or total nail removal and, if the condition is recurrent, either ablation or excision of the nail bed may be required. When to refer Around half of verrucae in children disappear on their own within a year, and two-thirds resolve within two years, but they can take many years to resolve in adults (see Infographic). Put a piece of a cotton ball or dental floss under the ingrown edge of your toenail. This may help it grow out properly. Take the cotton or floss out if it makes your pain worse or you see any signs of infection, such as pus.

A singular orclustered appearance (sometimes forming a mosaic ranging from 1mm to over 1cm in diameter); A small amount of acid (called phenol) is often put on the exposed part of the nail bed. This helps to stop the edge of nail regrowing and causing another ingrown nail. If healing capacity is reduced we may recommend a surgical procedure without the chemical known as Winograd or Zadeks procedure, performed by a Podiatric surgeon or an orthopaedic consultant. How do I look after my toenail after surgery?Other treatments, such as bleomycin and imiquimod cream, are available on prescription and have an increased success rate, but there can be associated sensitisation [32], [33] Shemer A, Trau H, Davidovici B et al. Onychomycosis: rationalization of topical treatment. Isr Med Assoc J 2008;10(6):415–416. PMID: 18669135