Feet are on my mind this week. They appreciate fresh air and sunlight, and being cooped up in footwear during the wetter, colder months can lead to a range of problems that mean many people are reluctant to put theirs on show. And this is the time of year when we get them out. So if you are embarrassed by the state of yours, here is a brief guide to looking good this summer.
Fungal toenail infections
The most common complaint GPs see is probably thickened and discoloured toenails. There are a number of causes, but they are often the result of fungal infection, which is hard to eliminate. Fungi like damp, dark, warm places, and nails are a perfect home for them because the dead keratin is beyond the effective reach of our immune system. As always, prevention is better than cure. Don’t wear the same pair of shoes two days running, so they can dry out properly, and expose your feet whenever possible. If you run into trouble seek expert guidance — ideally from a podiatrist or chiropodist — to confirm the diagnosis before deciding what to do about it.
My preferred treatment is topical antifungal nail lacquer (you have to pay for this over the counter), but be warned, it will take at least six to nine months to eliminate the infection. And even then it doesn’t always work. Some of my patients have had similar success by applying tea tree oil or Vicks VapoRub to their nails, and there is evidence to support both. If all else fails, file the nails down and cover them with varnish to hide the discolouration.
• Read more advice from Dr Mark Porter on The Times
Bunions
Where the big toe leans towards, and sometimes across, the other toes — are trickier. One in three adults will develop bunions, most of them women. They become more common with age, tend to run in families and are associated with spending too long in constricting footwear, particularly high heels. Mild cases may just be unsightly, but more advanced ones can cause marked discomfort and troublesome sores, with surgery to break and straighten the toe often being the only option. This is available on the NHS, but while the latest techniques are less invasive, surgery is used only as a last resort. For more on managing bunions, visit cks.nice.org.uk/topics/bunions.
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Athlete’s foot
This is another common complaint, but the classic soreness between the toes is easy to diagnose, and treat with over-the-counter antifungal creams, so I won’t dwell on this. However, pitted keratolysis (PK), a much less common complaint, is easily confused with athlete’s foot, and is worthy of mention. PK causes smelly, cratered, mushy white areas on the sole of the foot in people who spend long periods in unventilated footwear such as wellies and work boots (I see it in younger people who wear trainers a lot too). It is caused by bacteria rather than fungi, so will not respond to the over-the-counter creams used to treat athlete’s foot. You will need an antibiotic version on prescription. For more details, and some gory photos, visit dermnetnz.org/topics/pitted-keratolysis.
Verrucas
Like warts elsewhere on the body they are caused by infection with the human papillomavirus (HPV) and often disappear on their own without treatment. This spontaneous resolution — thought to be because of the immune system latching on to the infection — typically occurs in around half of cases within 12-18 months. However, that means half of warts are unlikely to go away any time soon on their own.
• How to get rid of verrucas — topical gels, freezing and more
My preferred technique is to freeze them and/or apply a topical acid to burn them away. Both probably work by causing an injury that attracts the attention of the immune system. Your local pharmacist will be able to advise further, but bear in mind that over-the-counter “freezing” sprays are not as cold as the liquid nitrogen used in dermatology clinics so may take a few applications to get the desired result.
You could try the duct-tape method. Cut a piece of tape to fit exactly over the wart. Stick it on and leave for six days. If it falls off, replace it. After six days remove the tape, soak the area in warm water and then file away any dead white skin with an emery board or pumice stone. Leave open to the air overnight/for 12 hours, then repeat for another six days. And if all the above fail, try to ignore them, or wear socks with your sandals. On second thoughts, please don’t.
Should I pay for a private Covid vaccine?
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There has been an increase in Covid infections recently, but the rate looks to be similar to this time last year, and well below the peaks in October and January. And while there are new variants out there, it’s too early to tell whether they pose any more risk.
There is likely to be another NHS booster campaign before the winter — uptake was only just over 60 per cent last time — but the vaccine will probably be offered only to the over-75s, residents in care homes and anyone over six months of age with a weakened immune system.
You can get a private vaccine (Boots charges £98.95), and only you can decide if that is worthwhile. I would have a free NHS booster were I eligible (I am not, even as a healthcare worker), but would not pay for a private one. My view may change if cases soar again or worrying variants emerge, but if either happens I suspect the NHS criteria would change too.
