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Peterborough Podiatry

Charles Sayegh
is owner and practiotioner at Peterborough Chiropody..

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Chiropody Services include:-

Nail Surgery back to top

As well as doing simple nail cutting, I also deal with thickened nails, as well as nails that are curled in (involuting). I am also qualified to treat ingrowing toe nails using Nail Surgery and sell/supply specific antibiotics for foot infections

Nail Surgery

Nail Surgery involves removing a section of nail under local anaesthetic followed by a procedure to destroy the nail matrix. I use Radiosurgery to destroy the nail matrix.

As well as having an identical success rate, this method has advantages over phenol

  • Control: it is very precise in what you ablate, there is no risk of accidentally flooding the toe with phenol and burning it, as the probe only touches the part you want it to
  • Improved healing times: between 1-3 weeks
  • With a high-risk patient: diabetic/impaired circulation, or a borderline surgery patient, it is much safer
  • You get a very clean wound with not much exudate. Less dressing is required compared to phenol

Radiosurgery is faster, with the same results, same final outcome, quicker healing time, less risk

nail surgery
above: An electrode being used for matrixectomy

Pre-Operative Advice

You will be having a local anaesthetic in your toe. Therefore:

  • You will not be able to drive home after the procedure.
  • Bring a roomy pair of shoes, slippers or sandals to wear after the procedure.
  • If you are under 16 years of age, you will need a parent or guardian to sign the consent form

After the procedure

  • Go straight home and rest. Put your feet up (ideally foot should be higher than your knee).
  • Keep standing & walking to a minimum. Gently move the toe regularly while sitting.
  • Avoid sports and swimming during the healing period.
  • If you experience any pain, take some painkillers (follow instructions on the containers). Do not take Aspirin. This may cause your toe to bleed.
  • A small amount of bleeding is normal. If blood appears on the tubigauze, do not remove the dressing. Apply another dressing on top and elevate the foot.
  • If the dressing comes off, follow the instructions for “Dressing your toe” below.
  • After the first 48 hours redress your toe daily. If showering or bathing, always redress your toe afterwards.
  • If you experience a great deal of pain or any other problems, please contact the clinic or GP surgery as soon as possible.
  • Dressings can be purchased from the chemist. Please ask for Melonin, Release, Tubinette size 12, micropore/mefix tape.

Dressing your toe

  • Use a bowl or container large enough to immerse your foot. Make sure the bowl/container is clean by rinsing in boiling water or wiping with antiseptic (e.g. Dettol). Wash your hands before and after the dressing.
  • Remove all of the dressing. Bathe the toe for 2-3 minutes in lukewarm water with a heaped tablespoon of ordinary salt added. Soak off the dressing if it appears to be stuck.
  • Allow your toe to “dry” for 10 minutes in air before redressing. Do not use a towel or cotton wool.
  • Apply a Release dressing to your toe and secure at the back of your toe with tape. Over this, apply a double layer of Tubegauze. Measure a piece of Tubegauze three times the length of your toe. Put the first layer on, twist the end twice and apply then second layer. Secure with tape.

Hard Skin, Callous and Corns back to top

corn

Callous are areas of thickened skin that form due to high pressures on your feet, and may be particularly sore. Treatment involves gentle debridement to remove them and the possible use of insoles to take pressure away from certain areas. Please note that such insoles are CUSTOM MADE FOR THE PATIENT, and those purchased from a chemist shop or mail order company for example probably will not work.

Corns (Heloma Durum) or hard corn consists of a small, dense round nucleus of dead skin covered by callus. The nucleus is usually in the shape of an inverted cone. The corn is found over a bony prominence where the skin is intermittently pressed against the shoe, ground or other bones.

helloma_molle

Heloma Molle are soft corns only occuring between the toes. They are completely or partially ring-shaped consisting of white, macerated, rubbery skin. There is usually no clear nucleus. They are caused by one sharp edge of bone in one toe pressing against another sharp edge of bone in the opposing toe. The corn stays soft because of the retention of sweat, which due to the close contact of the toes can not evaporate. They are frequently confused with blisters or warts, because of their often small, round appearance.

 

Heloma Vasculare (HVasc.) and Heloma Neurovasculare (HNVasc.) The vascular corn is a hard corn that contains irregular patterns of small bloodvessels in and around the nucleus. The neurovascular corn is also a hard corn, but contains both irregular patterns of small bloodvessels and nerve endings within the nucleus. Both types of corn are caused by excessive intermittent stress over a bony prominence for a long period of time. They are extremely painful, they bleed easily and are therefore hard to treat.

Heloma Miliare Heloma Miliare (H.Mil.) : Unlike the other corns, Heloma Miliare or seed corn can be found both on pressure and non-pressure sites and are therefore not solely caused by intermittent pressure acting on the skin. They are similar in appearance to the hard corn nucleus, but are not surrounded and covered by callus, unless they are present at an existing site of pressure. They are usually associated with a dry skin type and are normally painless

Treatment for corns involves enucleating (removing them)

What happens if corns are left untreated?

Infection: if the pressure on the corn becomes continuous, the tissue underneath the corn might break down (ulcerate) resulting in an increased chance of invasion by micro-organisms. In most cases the invading micro-organisms are Staphylococci, which tend to produce localized wound infection, whose symptoms are:-

  • hot
  • red
  • swollen
  • painful
  • loss of function

The inflammation might be accompanied by pus production. Fortunately, this infection responds very well to local anti-septic treatment.

On the other hand, if the invading micro-organisms are Streptococci the infection tend to spread causing Cellulitis (diffuse inflammation of the connective tissue). In that case, systemic antibiotics are required to prevent further spreading to the lymphnodes.

Ulceration: If the pressure on the skin becomes continuous, there may be localised tissue death (breakdown). This is usually very painful (except to e.g. diabetics, who are often less sensitive to pain) and could become infected.

A perforating ulcer is where the ulcer goes on to penetrate underlying structures, such as joints or tendon sheaths. Infection could then even spread into the bone (osteomyelitis)

image 1

ulceration

perforated ulcer

perforated ulcer

 

 

 

 

 

 

Testimonials:

Dorothy from Werrington had Marigold for her hard skin. She said that before, "walking was very painful, now much less pain, I'm very pleased.

Taken from the Times newspaper:

It works for me: homoeopathic podiatry

A paste made from marigolds relieved painful bunions by David Mattin Deborah McCallun, 35, first noticed bunions forming on her feet when she was in her mid-twenties. By her thirties, the red, inflamed and painful swelling on the joint of each big toe had become an uncomfortable fact of life. "Having bunions makes you feel like an old lady," says McCallun, a solicitor from southeast London. "You can't find trendy shoes that aren't cripplingly painful to wear, so you end up wearing flat, wide granny shoes."

A bunion (Hallux valgus) is when the joint between the big toe and the foot sticks out abnormally because the foot bone has become misaligned. It is caused by arthritis, or your genes, or by habitual use of tight-fitting shoes. High heels don't help because they load weight on to the front of the foot. The joint usually becomes inflamed, called bursitis, and can be very painful.

By last January, even the sensible 1in heels that McCallun wore to the office were hurting. Years ago a trip to her GP had supplied her with special insoles, but the lumps continued to grow. Surgery to correct the deformity, necessary in extreme cases, wasn't an option: "It takes about six to eight weeks before you can get around again after the operation. I couldn't take that much time off work." So when she read an article about the non-invasive bunion treatment offered by the Marigold Clinic, a homoeopathic podiatry centre at the Royal Homoeopathic Hospital, Central London, she made an appointment.

The clinic specialises in homoeopathic and herbal treatment of chronic foot problems and McCallun saw Dr Tariq Khan, a consultant podiatrist and the clinic's deputy director. "The bunion on her right foot was bad. On a scale of one to ten, it was a seven. As is typical, the big toe was deviated towards the other toes. Left alone, her big-toe joints would eventually become osteoarthritic (where the joint degenerates) and by the time she reached 50, surgery would be the only option," he says.

After an examination, Dr Khan explained that the clinic's bunion treatment centres on topical application of a specially-made marigold paste. "He stuck a plaster pad with a hole in the middle over each bunion," says McCallun, "and applied the marigold paste through the hole on to the bunion, then dressed it in a self-sticking bandage. I was a bit sceptical. What could a paste do to my bunions?"

The special properties claimed for the paste are at the heart of the clinic's non-invasive, natural treatment. The cream is a mixture of crushed marigolds of the Tagetes genus and alcohol, combined according to a formula devised by the homoeopathic podiatry pioneer Dr Taufiq Khan (Dr Khan's father) in the Seventies. Chemical tests revealed two flavanoids in the flower that, Dr Khan claims, are the bioactive compounds responsible for "alleviating soft-tissue inflammation, shrinking the bunion and easing pain".

McCallun was instructed to shower or bath as normal, not to worry about getting the dressings wet, and to keep them in place until her next appointment in seven days. "Dr Khan explained that getting the bandages wet makes the paste more active. They weren't hard to dry, either," she says. "I couldn't wear my 1in work heels with the bandages, so I switched to a pair of loafers.

It was an easy treatment to undergo." When the bandages were removed at Dr Khan's office, McCallun says: "I was surprised at how much smaller the bunions had become in one week. They weren't red any more or as sore. And my big toes felt more mobile." After re-dressing, and a further week wearing the marigold-paste bandages, there was further reduction in swelling. Slipping back into her work heels, McCallun noticed that her bunions didn't rub against the side of her shoes any more, so walking was no longer painful. Dr Khan says: "From a seven, Deborah's worst bunion was now a three; a mild case. That type of result in two weeks is not unusual. Patients can require a further two weeks with the bandages, but that's the maximum."

The treatment was followed by a month-long maintenance programme. McCallun sprayed a tincture on her bunions, then rubbed in an oil, both containing the active marigold ingredients, after every shower. Twice a day she exercised to realign her big toes. She'd sit on the floor with her back against a wall and her legs stretched out in front of her, and a thick elastic band looped around both big toes. Then she'd pull her feet apart against the resistance of the band and bring them back together repeatedly, for two minutes.

Meanwhile, Dr Khan advised her to avoid completely flat shoes, as they don't support the foot. A 1in-1½in heel is best; shoes that appear flat, such as a good pair of trainers, will often have such a heel moulded inside. He recommends Asics sports shoes (www.asics.com). "I'm thrilled to have found a treatment that works," says McCallun. "It's so liberating to be pain-free. My big toes are a bit straighter, so my feet look better. This treatment has rescued me from the need to have surgery. In May, I did a 13-mile charity walk for breast cancer. There's no way I could have done it before going to the Marigold Clinic."

Radiosurgery back to top

Radiosurgery is a modern form of treatment that can be used to treat stubborn/painful corns and verrucas. It can also be used to treat ingrowing toe nails. For this please see section on Ingrowing Toe Nails.

Performed under local anaesthetic, only the affected area is injected with anaesthetic and numbed. The patient is awake throughout the surgery, still being able to feel their foot being moved but no pain will be felt.

There are two types of Local Anaesthetic available:

  1. Those local to the lesion, lasts a few hours, and is suitable for isolated lesions
  2. Nerve block at the ankle: this will give full pain relief for at least 8 hours

Stubborn or painful corns (especially useful for neurovascular corns): if a patient is comfortable for 6 weeks or less, or is never pain free after chiropody treatment, they will probably GAIN BENEFIT from this procedure. With patients who have painful corns that are "that bad", it is generally very successful. A blunt electrode dessicates the upper layer of skin at the dermal-epidermal junction, dessication naturally occurring at the correct level. It dramatically improves the lesion, "resetting" the dermal epidermal junction. The permanent "toothache" type pain goes, and the area heals up. With neurovascular corns, you may get a corn come back, but it will be a corn minus the neurovascular element. The corn will require treatment far less often. As the procedure is self-limiting, there is no risk of scarring (you are not going as far as the dermis). Within a normal healing time of 1 week, 9 out of 10 are healed, the ones that are not may require a few more days. There is minimal bleeding with this technique.

dissection of a corn

Radiotherapy for verrucas: with these, the success rate of pretty much everything is pretty low. In terms of success rate, nothing else touches Radiosurgery for Verrucas. An electrode is used to cut the skin . The cell touching the wire is vapourised, the one next to it is untouched, it is therefore very precise: the lesion is excised. A single fibrous verrucas responds very well, a mosaic one responds less well.

Please note

  1. Radiosurgery is not suitable for extensive mosaic verrucas.
  2. Although the electrode remains cold (Radiofrequency being used to heat the cells up), there is a possibility of scar formation
  3. As a verruca is caused by a virus, there is always a small chance that the verruca can recur.
  4. Healing may take between 2-4 weeks

Verrucas back to top

wart removal

wart removed

TESTIMONIALS FOR RADIOLASE TREATMENTS FOR VERRUCAS

CASE 1:Rachel, aged 26, had had three verrucas on the bottom of her right big toe for 2 years. Previous treatment had included Bazuka and cryotherapy (freezing). A few months after treatment, they were still absent, and no scarring was present.

CASE 2: Nicky, aged 9, has 2 verrucas (one on her right heel, the other one on the apex of her left 3rd toe. Her mother said, “they were causing considerable pain, particularly whilst walking. Nicky hates any kind of injection. Charles was very understanding and helpful. Treatment was successful, within 5 weeks they had healed. We were very pleased and happy with the result and Nicky has not suffered ever since.” The verrucas were still absent after a few months, and no scarring present.

CASE 3: John, 68, had a small verruca at the back of his heel and it was very painful. Two acid treatments had had no effect. After Radiosurgery, the verruca had gone, no scarring was present and there was no pain at all.

CASE 4: Andrew, 42, from Whittlesey, said, “I have suffered from multiple verrucas since 2003. I have tried every over-the-counter preparation available and also an extensive cryotherapy treatment at my Newmarket chiropodist. All these proved to be futile. I contacted Charles, he was extremely thorough in his assessment of my by now, large verrucas. The first Radiosurgery reduced the size considerably. The treatment was also painless. The 2nd Radiosurgery eliminated the remaining verruca tissue entirely. I heartily recommend this treatment as an alternative to acid treatment of freezing-simply because it works. A few months later, although there was scarring present, the verrucas had gone. Andrew had a mosaic verruca.

Diabetes back to top

Many people with diabetes have no problems with their feet and with good care and common sense precautions they can continue to enjoy "good foot health".

At the clinic, diabetic’s feet are tested in accordance with National Institute Clinical Excellence (NICE) standards. This includes a thorough examination of the vascular, neurological, dermatological, joints as well as other risk factors

Diabetic neuropathy is caused by the impairment of nerve function due to increased blood sugars. It produces numbness, burning, tingling and diminished sensation in the feet. Individuals who suffer from this may not be able to feel open sores, infections, or blisters that need treatment. When these slow healing wounds go untreated, infection can set in and the result can be devastating. Podiatry is essential in helping to prevent this scenario.

Facts:

  1. Diabetic foot problems cause more in-patient occupancy than all other medical complications put together
  2. Approximately 15% of diabetics will suffer foot ulcers in their lifetime
  3. 85% of all diabetes related lower limb amputations are preceded by a foot ulcer
  4. Diabetes is the biggest cause of end stage renal failure, blindness.