Over-the-Counter Drugs
Over-the-counter (OTC) products for foot health include pain medicines – such as non-steroidal anti-inflammatory drugs – and products that treat athlete's foot, corns, calluses, blisters, and warts.
Depending on the intended use, some OTC foot products, such as lotions for moisturizing the skin, are considered cosmetics and not drugs. There are medicated powders and creams to treat athlete's foot. For corns and calluses, there are non-medicated pads to improve comfort when walking, as well as medicated pads and patches that work to get rid of dead skin. Similar products are used to shrink warts. These products are typically made of salicylic acid. They should be used with care so that healthy skin isn't harmed, and they should never be used by people with diabetes or poor foot circulation.
Matthew Holman, Ph.D., a scientist in the FDA's Office of Nonprescription Products, says consumers need to pay close attention to drug labels. "Consumers should read the indications, directions, and warnings carefully," Holman says. "A product won't be effective if you are trying to treat a condition that's not on the label. If it says to only use the product on intact skin with no open sores, that's important. If a product isn't working or the condition becomes worse, you need to seek a doctor's advice."
People with heart disease, diabetes, and circulation problems should never self-treat because of the risk of infection.
Prescription Drugs
Prescription drugs for treating the feet include pain medicine, antifungal medicine, and antibiotics for infections. For instance, an ingrown toenail might require antibiotic or antifungal treatment if it becomes infected. For bunions and hammertoes, a cortisone injection might be given to relieve inflammation and pain. Fungal nails make toenails thick, brittle, and discolored to white, yellow, or brown. The fungus grows deep in the nail bed, and it won't go away on its own. It also can spread to other toenails. But discolored nails aren't always from fungus. They could also be from trauma due to exercise or psoriasis. Your doctor might want to take a fungal culture to make a diagnosis.
Penlac® (ciclopirox) is an example of a topical antifungal. It is generally used daily for several months for mild to moderate nail fungus. Side effects include irritation and redness around the nails. Oral medications for fungal infections, including fungal nails and athlete's foot, are Lamisil® (terbinafine) and Sporanox® (itraconazole). These medicines travel through the bloodstream to attack the fungus. The tablets are taken daily for about 12 weeks. It takes about nine months for a healthy nail to grow back in.
The most commonly reported side effects of the oral antifungals are headaches and stomach aches. Both Lamisil and Sporanox have been associated with serious liver problems resulting in liver failure and, in rare cases, death. The FDA and the maker of Sporanox also warned against using Sporanox for those who have a heart condition.
Patients using these drugs should immediately tell their doctor if they have any of the following symptoms: persistent nausea, anorexia, fatigue, vomiting, upper right abdominal pain, jaundice, dark urine, or pale stools. A simple blood test is used to check liver function during treatment.
Foot Surgery and Other Procedures
Common foot surgeries include surgery to correct bunions, surgery for fungal nails when medications don't work, and surgery to reduce arthritis pain. For people who have chronic ingrown toenails, a procedure called matrixectomy might be used to prevent recurring problems. In this procedure, the surgeon will numb the toe and remove the smallest amount of the nail on the side, then either use a chemical to kill the root or remove the root of the nail surgically.
Sometimes, bunions can be treated without surgery. But when bunions limit or affect one's daily activities, bunion surgery might be appropriate. Pain is the big factor. Bunion surgery might also be warranted if there is chronic inflammation and nonsteroidal anti-inflammatory drugs or other conservative treatments don't help.
There are two main components to bunion problems: 1) the pain associated with shoe pressure against the bony enlargement, and 2) a stiff toe joint that causes internal joint pain when the big toe is moved.
Advanced surgical techniques have improved outcomes for bunion surgery. The type of surgery needed depends on the patient's age, activity level, and degree of deformity. In this procedure, the surgeon will not only remove the "bump of bone," but also realign the bone with a surgical screw for stablization. Recovery time is usually about four weeks.
The precision in which the bone is cut, shaped, and realigned is critical for successful bunion surgery. You might see lasers publicized to treat bunions, but lasers can't cut bone or correct bunions. Lasers are also not cleared by the FDA for this treatment.
According to the American College of Foot and Ankle Surgeons, there have also been advances in less invasive foot and ankle surgery. Newer surgical plates and screws let surgeons repair fractures with less trauma. Smaller incisions mean less bleeding and tissue damage.
In ankle arthroscopy, surgeons look at the ankle joint with a fiber optic camera system. This technique has been applied to knee surgery for several years, but now it's being used for bones and joints in the foot and ankle. This type of surgery can relieve inflammation from arthritis and ligament damage, with reduced recovery time as compared to open surgical procedures.
Before considering any surgery, people should always explore the non-surgical options with their doctor, and discuss the benefits and risks of surgery. It is also important to consider the doctor's experience and results with the procedure.
The American Orthopaedic Foot & Ankle Society (AOFAS) has released statements warning about trends in cosmetic surgery to improve the appearance of the foot. "Some women are getting surgeries to shorten toes and narrow their feet so they can fit into fashionable shoes," says Sharon Dreeben, M.D., chair of the AOFAS Public Education Committee
Shock Wave Therapy
The most common cause of heel and arch pain is painful stretching or tearing of the plantar fascia, which runs along the bottom of the foot and supports the arch of the foot. Extracorporeal shock wave treatment is an outpatient procedure in which a medical device uses shock waves to relieve chronic heel pain. A dome filled with water is placed against the heel so shock waves pass through. The shock waves increase blood flow to trigger the healing process so that inflammation and pain subside. |
