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Feet First

From ingrown toenails to fungal infections, it pays to be aware of these stubborn foot problems.

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Summer’s a time when barefoot children run around parks, ride bikes, rollerblade, skateboard and spend time at the local pool. But these pursuits may be fun, they can also put children at risk of foot infections and other problem foot conditions. 

Swimming pools and changing rooms can be breeding grounds for fungi and viruses that are transmitted through contact. And minor foot wounds, cuts, grazes, blisters, and cracked skin – which tend to be more prevalent during the summer months – can lead to infection. Spotting foot problems in children, and correctly treating them, begins with awareness for all concerned.

Common problems

Simon Jones is a specialist in paediatric podiatry, working as orthotics service lead, and podiatry musculoskeletal clinical lead at Stockport Foundation Trust. He says that while children with walking issues (in-toeing, out-toeing, not walking) constitute most of his work as referrals, the most common problem he sees is ingrown toenails. 

‘The children are doing sport, the nail breaks and a spike grows and digs into the toe, or they or their parents trim down the nail, which in turn leads to a spike growing into the toe,’ he says.

Ingrown toenails are often red and inflamed, and parents may take their children to the GP who may prescribe antibiotics. ‘Then we’ll see the children weeks down the line when the antibiotics haven’t worked, because they haven’t got an infection.’

Children under two may suffer from nails that are red and inflamed, although this is often just the nails forming. The condition will resolve itself, he says, and will benefit from following the suggestions in the box below. 

The second most common foot problem in children is veruccas. ‘All the evidence we have says we should leave veruccas alone,’ says Simon. ‘They are viral and will self-resolve, unless the patient is immunosuppressed.’ 

If the child is suffering pain when standing on the area affected by a verucca, it’s not owing to the verucca itself, he says, but to overly hard skin around it. The hard skin can be filed down with a pumice stone, so that the area is level. 

Athlete’s foot can be a problem, but it’s not as prevalent as it was, and that goes for foot infections across the board, says Simon. This is owing to better awareness of foot problems, better footwear – particularly sports shoes – and better hygiene. ‘Veruccas tend to be picked up on holidays abroad, so it’s a foreign strain of the virus.’ These can be treated by a remedy from the pharmacy; however, if they persist, they would need to be tested by the GP. 

Hand, foot and mouth disease may be an issue; the viral disease can beset an entire community. ‘I’ve seen it about three or four times in the past five years,’ says Simon. He says that health visitors and nurses can refer children needing treatment to the podiatry department as most NHS trusts will accept referrals from health professionals. Not all trusts have a paediatric podiatry department, so consult your local trust for rules and conditions.  

Growing pains

Foot wounds are less common these days, and improved sports footwear has helped greatly. However, the importance of children wearing well-fitting and suitable shoes cannot be overemphasised. More than a quarter of British children could be wearing the wrong size of shoe according to a survey of 2000 parents, which also reported that 55% of the children had suffered damage to their feet such as blisters, bruises and calluses by wearing unsuitable shoes (The College of Podiatry, 2017).

Stewart Morrison, a podiatrist at the University of Brighton, says the findings are very worrying. ‘Wearing the wrong size or type of shoe in the short term can cause blisters, bruising, calluses and rubbing. In the long term it could affect their foot development and lead to musculoskeletal issues.’

Children’s feet are still growing and are more susceptible to damage than adult feet, he points out. However, they often don’t say if their shoes are too tight or are causing pain. ‘This is why we encourage parents to check their children’s feet regularly, have them measured and have everyday shoes fitted by a professional.’ He says it’s recommended that children aged one to three have their feet measured every two months, and older children every three to four months (for further information, visit feetforlife.org).

Children aged one to three should have their feet measured every two months, and older children every three to four months

But if a child needs a podiatrist, how easy is it for them to be referred, and are podiatry services being eroded? Writing in The Guardian, Polly Toynbee commented on the fact that the number of podiatrists employed and in training is falling. ‘The profession reckons the NHS in England needs 12,000 practitioners but only has about 3000... [this year] podiatry trainees, like nurses, will no longer receive state bursaries, so fewer will apply. Already student places have been cut by nearly a quarter in five years.’ 

Speaking of his experience at Stockport Foundation Trust, Simon Jones says: ‘Our resources in podiatry have not been cut, although generally we’ve been made more efficient.’ He adds: ‘I love the NHS, and I believe it provides excellent services.’

In most areas of the UK, podiatry is available on the NHS free of charge. However, NICE has not released any guidance for foot health provision that is not associated with a long-term condition. Therefore, each individual clinical commissioning group decides what to make available on the NHS, and that will depend on local need.

Simple suggestions for healthy feet

References

EndWarts. (2017) Warts in children. See: endwarts.co.uk/warts/warts-in-children (accessed 20 July 2017).

NHS. (2017) Fungal nail infections. See: beta.nhs.uk/conditions/fungal-nail-infection (accessed 20 July 2017).

NHS Choices. (2016) Warts and verrucas. See: nhs.uk/conditions/Warts/Pages/Introduction.aspx (accessed 20 July 2017).

NHS Choices. (2016) Hand, foot and mouth disease. See: nhs.uk/conditions/hand-foot-and-mouth-disease/Pages/Introduction.aspx (accessed 20 July 2017).

NHS Choices. (2015) Athlete’s foot. See: nhs.uk/conditions/Athletes-foot/Pages/Introduction.aspx (accessed 20 July 2017).

The College of Podiatry. (2017) A quarter of children wear wrong sized shoes. See: scpod.org/contact-us/press/press-releases/a-quarter-of-children-wear-wrong-size-shoes (accessed 20 July 2017).

Toynbee P. (2016) Feet first, our NHS is limping towards privatization. The Guardian, 16 Aug 2016.

 

Image credit: iStock

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