Dr.

Amal Kanti Deb

POSTDOC
(Materials Science and Climate Change, UoN, Australia)
PhD
(Materials Science & Environmental Remediation, UoN, Australia)
MPhil (ACCE, DU), PGD (LGM, India), [Link]. (LE, DU)

Associate Professor
ILET, DU
Email: [Link]@[Link],
[Link]

COOPERATIVE RESEARCH CENTRE FOR CONTAMINATION ASSESSMENT AND REMEDIATION OF THE ENVIRONMENT
 Foot Problems
• Skin Lesions
• Arch Problems
• Toe Problems
• Children Foot Problems

Dr. Amal Kanti Deb

 Foot Composition
Number of Bones 26
Foot Muscles and tendons 19
Leg Muscles and tendons 13
Ligaments 107
Foot Pulses 2, one is behind the instep, the other is behind
the Achilles Tendon
The Joints 38
The Arches 4, two is true and two is false arches
Sweat Glands 60,000
The blood system Carries from 15 to 25 gallons of blood flowing
through each foot daily.

Dr. Amal Kanti Deb

 Bones Structure

Front and Inner view of the Human Foot

Dr. Amal Kanti Deb
 • The skin of the foot is under pressure or stress during wearing
footwear.
• The foot is covered with shoes 2/3 of the lifetime of the average
person.
• Moreover the hard walking surface, foot perspiration, excessive
standing or walking, heat, shoe abrasions etc. can also affect the foot
skin.
• Consequently some common skin lesions or problems such as
calluses, blisters, corns, planter warts, and athlete’s foot are usually
seen in many cases.

Dr. Amal Kanti Deb

Dr. Amal Kanti Deb
 Skin Lesions
A corn is a small, circular, thickened area found in the skin of the foot.
This buildup of skin can be found on the top, side, or end of the toe, or
between two toes.

Dr. Amal Kanti Deb

 Corns: Corns are three types; hard, soft and seed.

• Soft Corns: They are white and damp and

found between the web of the 4th and 5th toes.
They also have cores and can be painful.
• Causes: by constant squeezing together of the
toes as a result of shoes too short or narrow at
the toe.
• Remedy: commercial ‘corn cures’ seldom work
satisfactorily but better to remove by a
podiatrist. Soft corn also usually comes back
unless the toe squeezing cause is removed.

Dr. Amal Kanti Deb

• Hard Corns: A hard thickening of the red skin with a central core or
nucleus at a point where pressure is excessive. The tip or point of the
nucleus penetrates into the nerves of the under skin and cause sharp
pain. They form mainly on the outside of the little toe but can be
formed on the other places where there are steady pressure and
abrasion.
• Causes: Excessive pressure or friction in area narrow and tight fitted
shoes.
• Remedy: a simple wafer pad with a hole in the centre can relief but
no cure. Better to be removed by a podiatrist. Hard corns will usually
return after treatment unless there is some corrections in the shoe.

Dr. Amal Kanti Deb

 Seed corns
• Seed corns are a particularly small type of foot corn that can form on the foot due
to excess pressure or friction. They typically form on the soles of the feet and are
associated with dry skin. Seed corns usually appear as hard, circular, well-defined
spots of skin, and they are smaller than other types of corns.
Remedy
[Link] thick, cushioned socks.
[Link] wide, comfortable shoes with a low heel and soft sole that do not rub.
[Link] soft insoles or heel pads in your shoes.
[Link] corns in warm water to soften them.
[Link] use a pumice stone or foot file to remove hard skin.
[Link] to help keep skin soft.

Dr. Amal Kanti Deb

 Calluses
• A type of skin buildup, are usually located on the bottom of the toe or
on the ball of the foot. When your foot rubs repeatedly against your
shoe or sock, the friction and pressure can cause the skin to produce
a thick layer of protective skin called a callus. A callus can vary in size
and does not have the hard center the corn has, so it may not be as
painful as a corn.
• Cause
The outer layer of the skin becomes hard and thick due to the natural
protection of the tissues below from steady abrasions or pressures from
above. This is also caused by intermittent pressure, often around the
edge of the insole at the seat of the shoe.
• Remedy
In severe case, calluses may be removed by a podiatrist. In early stage it
can be relief by soaking and rubbing off with a soft towel or buffer. The
pressure can also be removed by replacing the footwear.

[Link]. AKDKanti Deb

Amal
 Blisters
Blisters are fluid-filled pockets that develop in the top layer of the skin in
response to injury or infection. Blisters usually occur over damaged areas to
cushion them from further harm.

Cause: Frictions evolved by rough seams in shoes or hosiery, lumps in the

sole or inside the shoe, too loose shoe which clips around on the foot, too
loose stockings or heavy seams in socks or stockings.
Dr. Amal Kanti Deb
 Remedy
• Use properly fitted shoes.
• Select shoes with light and good finished
seams inside the shoes of stockings.
• New shoes should be used less time for a
couple of weeks to get adjustment.
• Using a bandage to cover a blister may be a
recommended treatment.
• Apply antibiotic ointments or creams gently
to the blister and surrounding skin

Dr. Amal Kanti Deb

 Planter Warts
• Plantar warts are tough, horny growths that
develop on the soles of the feet. These are
contagious. Plantar warts are harmless and can be
left untreated, but in many cases they're too
painful to ignore.

• Causes: they're caused by a virus entering through

broken skin, and often spread via public pools and
showers.

• Remedy: Topical salicylic acid may help, while

burning, freezing, laser therapy and surgical
removal are more aggressive options for more
severe cases.

Dr. Amal Kanti Deb

 Ingrown Nail
• Toenail that has grown into the skin, an ingrown
toenail can result in pain, redness, swelling, even
infection. It usually occurs on the big toe.
Causes: Cutting nails too short or not straight across,
injury to the toenail, and wearing tight shoes are
culprits. A steady squeezing together of the toes so that
the 2nd toe presses against the nail edge of the big toe,
forcing the nail to grow inward into the flesh and
infecting it.
Remedy
• For mild cases, soak the foot in warm water, keep it clean,
and wedge a small piece of cotton under the corner of the
ingrown nail to lift it off the skin.
• Avoid wearing too short or narrow or pointed shoe. Minor
surgery can remove all or part of the nail.
Dr. Amal Kanti Deb
 Fungal Nail Infection
A fungal infection can make nails thick,
discoloured and brittle. If left untreated, the nail
infection won't go away and can be hard to
treat. Thriving in warm, wet places, the fungi can
be spread from person to person.

Occurred when microscopic fungi enter through a break

in the nail

Remedy
Topical creams may help mild cases but antifungal pills are best chance of curing a
severe infection.

Dr. Amal Kanti Deb

 Athlete's Foot

• A fungal infection that can cause peeling, redness,

itching, burning, and sometimes blisters and
sores, athlete's foot is mildly contagious, passed
by direct contact or by walking barefoot in areas
such as locker rooms, bathrooms or near pools.
The fungi then grow in shoes, especially tight ones
without air circulation.

Remedy
Athlete's foot is usually treated with topical antifungal lotions
or oral medications for more severe cases.

Dr. Amal Kanti Deb

 Planter Fasciitis
• One of the most common causes of heel pain.
• It involves inflammation of a thick band of tissue
that runs across the bottom of each foot and
connects the heel bone to toes (planter fascia)
• It is more common in runners, overweight people
and people between the ages of 40-60
• Typically causes a stabbing pain in the bottom of
foot near heel.
• The pain is usually the worst with the first few
steps after awakening, although it can also be
triggered by prolong standing or when get up
from sitting.
Remedy
Recover in several months with conservative treatment including icing the
painful area, stretching, and modifying or avoiding activities that cause pain.
Medications includes pain killer.
Physical therapy or using special devices (orthotics).
Heel pad as orthotics
Dr. Amal Kanti Deb
 Dry Skin
Often appears on the heels and sides of the feet
and between the toes
The affected area may feel itchy, tight and even
painful
Causes
Continuous wearing of closed shoes/boots that create
hot and humid environment for the feet
Failing to wash excess soap off the feet that contain
harsh chemicals
Aging and certain medications
Remedy
Simple foot soaks, moisturizers and regular exfoliation can reduce dry skin on the
feet, remove areas of dead skin and calluses, and prevent them from returing.

Dr. Amal Kanti Deb

 Arch Problems
Pes Planus

It is also called flat foot or fallen arch, with the entire sole of the
foot coming into complete or near-complete contact with the
ground.

Causes:
The inner longitudinal arch flattens as the oscalcis and astragalus
tip forward and the forepart turns out due to the stretching of the
ligaments and muscles.
Sometimes it can be caused by the foot having extra weight e.g.,
after a long illness or during pregnancy, but usually this is
congenital.
Dr. Amal Kanti Deb
 Effect: These feet become misshapen: extremely
depressed arch, a rolling in and down of the inner
ankle, a severe pronation (outward rotation) of the
heel, a pronounced outswing of the forefoot. These
are chronically aching, or painful feet forced to walk
with a shuffling, dragging gait and endure chronic
fatigue.

Flat foot orthotics

Remedy: No consistently successful
treatment or correction has yet been
found. These feet can be relief by the
use of orthotics and other means.
Dr. Amal Kanti Deb
 Pes Cavus

• This is an abnormally high-arched foot, and the

inner longitudinal arch is extremely high.
• The arch, or instep, runs from the toes to the heel on
the bottom of the foot.
• It is also called claw foot because the toe tendons
are abnormally short and taut, keeping the toes
drawn back in a clawed position.
• These feet frequently develop thick and sore
calluses under the ball because of constant heavy
pressure there and arch strains.

Dr. Amal Kanti Deb

 Remedy

Surgery may be successful at the growing

ages. Shoes with a high waist, generous in-
step girth and cushioning under the arch
required.

Dr. Amal Kanti Deb

 Arch strains
• Arch pain (often referred to as arch strain) refers to an
inflammation and/or burning sensation at the arch of
the foot.
• A variety of problems affecting the long arch and
symptoms such as steady aching or soreness, or fatigue
are caused by excessive foot strain from day-to-day
standing on hard floors.
• It is the result of imposing a steady overload on the
muscles, tendons and ligaments of the foot.

Remedy
• Soft arch support, cushion insole, resilient outsoles and special shoes are required.
• Treatment by medical practitioner is required in severe case.

Dr. Amal Kanti Deb

 Metatarsalgia
• This is the pain or ache under the metatarsal
heads caused by dropping of the heads of the
central metatarsals.
• This is often caused by an over loading of the
forepart, e.g., wearing of high heel, operating a
machine with a foot pedal badly positioned or
wearing narrow shoe cramping metatarsal
heads.
• There are other causes as well, including foot
deformities and shoes that are too tight or too
loose.
• A callus may form under the central metatarsal
heads, thus increasing the pressure.

Dr. Amal Kanti Deb

 Remedy
• Avoid the wearing of high heel and tight/loose shoe
• Metatarsal pad can be fitted in the shoes to provide a cushion under the central
metatarsal heads.

Dr. Amal Kanti Deb

 Foot fatigue
• Foot fatigue is caused by the inability of the
muscles, tendons and ligaments to bear their
workload.
• They lose their elasticity and tire out.
• It is not a problem but only a symptom of some
other foot problems.
• A shoe of faulty fit can prevent normal foot
function and contribute to foot fatigue.
• Foot fatigue can also be caused by other foot
conditions such as flat feet.
• Swelling, achiness, cramping and pain are the
symptoms.

Remedy: Medical attention should be sought if it becomes continuous.

Dr. Amal Kanti Deb Dr. AKD

 Burning or hot feet

• A burning sensation in your feet may be caused by nerve damage in the

legs, also called neuropathy. Although many medical conditions can
cause burning feet, diabetes is the most common.

• It causes when walking on thin soles on hard pavements or floors,

especially in high heels or habitually wearing non-breathable shoe
uppers or constant wearing of shoes with tacky or traction soles which
adhere to the ground with each step.
• Some dyes in hose affect feet and can cause a burning feeling.

Remedy:
Remove the causes known. Severe burning indicates the
symptoms of some other problems and medical attention
should be sought.
Cold water therapy reliefs the effect to some extent.
Most burning feet treatments focus on preventing further nerve
damage and reducing pain.

Dr. Amal Kanti Deb

 Rigid feet
• Rigid or stiff feet are usually seen in older person.
• These often are arthritic feet where there has been some fusing or
calcification of the joints.
• The loss of joint movement results in rigid feet. Because these feet lose some
of their natural flexibility, the step loses some of its natural springiness, and
the gait itself becomes slower and more cautious.

Remedy: Cushion insoles offer some relief. Special rocker-type rigid or

platform soles have brought excellent results.

Dr. Amal Kanti Deb Dr. AKD

 Aching in calf

• This occurs mostly with women, and especially when those habitually
wear high heels try to walk in low or flat heels.
• This cause shortening of calf muscles and Achilles tendon.
• When the low or flat heel shoes are worn, this stretches or strains the
shortened calf muscles and tendon with consequent soreness and
aching.

• Remedy: Special exercises prescribed by doctor are fruitful to stretch

the shortened calf muscles and tendon.

Dr. Amal Kanti Deb Dr. AKD

 Toe Problems
Hallux Valgus
• Hallux means big toe and valgus means turning
outward. Thus, a hallux valgus is a big toe
excessively bent outward towards the other toes.
• The 1st metatarsal bone angles slightly toward the
other toes, resulting a V– shape angle at the inner
side of the great toe joint.
• The constant rubbing of the side of the protruding
great toe joint sets up an inflammation and
swelling that becomes very painful.
• The protruding joint also forces the shoe out of
shape as the shoes are difficult to fit feet due to the
toe deformity.

Dr. Amal Kanti Deb Dr. AKD

 Cause
• It is often hereditary or genetic. Habitual wearing of
short or narrow or pointed-toe shoes causes hallux
valgus.
• In the juvenile and adolescent hallux valgus,
heredity seems to play a major role. Coughlin (1995)
found a 72% rate of maternal transmission in
juvenile hallux valgus patients.

Remedy
• In the childhood correction should be taken.
• Broader toe shoes should be worn.
• Toe separator is useful to improve alignment.
• Surgery is required in adulthood.

Dr. Amal Kanti Deb

 Bunion

This is a severe inflammation of the side of the great

toe, with swelling and pain or soreness. Sometimes
it is accompanied by some extent of hallux valgus.

Cause: It is happened by a constant abrasion of the

shoe against the bursa sac at the side of the great toe.

Remedy: These feet are extremely sensitive to shoe

pressure and hence require special care in the type of shoe
worn and fitting.
Stretching of the shoe in this particular area offers some
relief. However, treatment by a podiatrist should be taken.
Dr. Amal Kanti Deb
 Tailor’s bunion
• The symptom is similar to bunion, but it is small size and also called bunionette.
• It occurs on the outer ball i.e., at the side of the 5th metatarsal head. It is very
painful when shoe exerts pressure on it .
• It is called tailor’s bunion because of the old-time tailors sitting crossed-leg on a
table while sewing, so that the outer ball of the foot continuously pressed against
the table.

Remedy: In fitting shoes, it’s very helpful if a pocket is made for the sensitive
area with a ball-and-ring device. An extra width in size with a blucher style is of
further help.

Dr. Amal Kanti Deb Dr. AKD

 Hallux Rigidus
• Hallux rigidus gets its name from hallux, or big toe, and rigidus, which translates
to stiff. In the simplest terms, hallux rigidus is a stiff big toe.
• Hallux rigidus develops as a result of Osteoarthritis. As the metatarsophalangeal
(MTP) joint breaks down over time, often due to repetitive use, the body
responds by creating bone growth as a defense mechanism.
• As the area becomes increasingly crowded with bony outgrowth, one loses
flexibility in their big toe, and the condition worsens as the first long bone
(metatarsal) in the forefoot begins to rub against the first bone of the big toe.
• There is little or no movement on the big toe joint. In sever case the toe is flexed
down permanently.

Cause: It occurs by continual stubbing on the end of short or narrow shoes.

Dr. Amal Kanti Deb Dr. AKD

 Remedy
• A metatarsal bar fitted beneath the metatarsal heads under the sole
allows a more normal gait.
• Physical therapy, proper orthotics, avoiding aggravating exercise, and
strengthening the surrounding muscles that relieve pressure on the
joint can all improve quality of life.
• More invasive options include surgery, including fusing the two
bones, and a Cheilectomy, which is a surgical procedure to remove
excess bone from the joint of big toe.

Dr. Amal Kanti Deb Dr. AKD

 Hammer Toe
• This is claw like toe resembling the head of a
hammer. It usually affects the second toe and
sometimes the third toe.
• The tendon on the top of the toe is over-extended
while the tendon beneath the toe is permanently
taut.
• The result is bowing of the toe. This can become
quite painful as a result of the crest of the bent toe
rubbing against the shoe.
• A painful corn usually develops at the top surface of
the toe.
• The bent toe causes an unsightly bulge at the top of
the shoe toe or vamp and a back ward-downward
pressure on the metatarsal head.

Dr. Amal Kanti Deb Dr. AKD

 A hammertoe has an abnormal bend in the middle joint of a toe. Mallet toe
affects the joint nearest the toenail. Hammertoe and mallet toe usually occur in
your second, third and fourth toes.
Causes
Hammertoe and mallet toe have been linked to:
• Certain shoes. High-heeled shoes or footwear that's too tight in the
toe box can crowd your toes into a space in which they can't lie flat.
This curled toe position might eventually persist even when you're
barefoot.
• Trauma. An injury in which you stub, jam or break a toe can make it
more likely for that digit to develop hammertoe or mallet toe.
• Abnormal balance of the toe muscles. The imbalance leads to
instability, which can cause the toe to contract.
Remedy: Surgery requires. Right size and type of shoe with a deep toe box and
an assist from a ball-and-socket stretcher to make a pocket for the sensitive toe.
Dr. Amal Kanti Deb
 Children Foot Problems

Dr. Amal Kanti Deb Dr. AKD

 Heel pain and Severs Disease

Heel pain and Severs Disease is actually not a

disease and is common in children.
The Achilles tendon which attaches the calf
muscle to the heel, changes from cartilage to
bone as children grow.
If there is strain from sports, increasing weight,
growing and changing ligaments or growing
bones, the symptoms most often present as heel
pain.
Severs disease will often resolve itself with
time.

Dr. Amal Kanti Deb Dr. AKD

 Ingrown Toenails
The scientific name for ingrown toenails is
onychocryptosis, not a word often comes across! Onycho-
nail, crypto-hidden which is hidden nail.

Causes
•Cutting your toenails too short – they should be over the
skin, not nestled into the skin
•Rounded nail edges – these have more opportunity to
grow into the skin
•Tight fitting shoes – causing the toes to rub against the
shoe
•Stubbing your toe and injuring the nailbed
•Repeated activity that creates constant friction on the toe
such as running or ballet
•Genetics – this can also determine whether you get
ingrown toenails due to the shape of the nail and nailbed

Dr. Amal Kanti Deb Dr. AKD

 Remedy
For prevention:
• Trim the nails straight across so that the edges protrude from the skin
• Don’t trim the nails too short, leave them a little longer so they don’t lay directly into the nailbed
• Wear proper fitting shoes and avoid any friction or rubbing on the toes
For pain relief:
• Soak your toenail in Epsom salts or soapy water for 15 minutes, this reduces swelling and
inflammation
• Apply an antiseptic or antibacterial cream to the toe
• Tuck bits of cotton or dental floss underneath the ingrown toenail to lift the corner of your nail
and help it grow outward
• Wear loose fitting shoes to give the toe plenty of room
• Wear a toe protector which provides a cushion for the big toe against anything that might rub it
make the ingrown toenail worse. You can buy these from the chemist.

Dr. Amal Kanti Deb Dr. AKD

 Fungal Nail Infections
• Teenagers especially will go through many
hormonal changes which means they sweat
more. Closed and sweaty shoes become a
perfect breeding ground for fungal infections
increasing the incidence of tinea or Athlete’s
Foot (flaking and itching of the skin) and
bacterial infections resulting in smelly feet.
• This fungus is caught from direct contact
with surfaces contaminated by the fungus.
This includes public showers, around Athlete’s Foot is an infection in the feet
swimming pools, in change rooms floors and caused by a fungus and is usually found
anywhere else that provides a warm and between the toes. It’s also called tinea of
moist environment for the fungus to grow. the foot or tinea pedis.

Dr. Amal Kanti Deb

 Plantar warts
• Plantar warts develop on the soles of the feet and
are caused by a virus. They can be mistaken for
corns and callouses because they look round,
slightly thickened and are painful when standing on
them.
• They can also occur on other parts of the foot but
the sole is the most common as if the skin is
slightly broken, it provides an entry point for the
virus. We use a variety of treatments depending on
the size and location of the wart. For example we
may use Salicylic acid, cryotherapy, chemical
treatments and we may advise on laser or surgery
to remove the wart

Dr. Amal Kanti Deb Dr. AKD

 Bunions
These are either caused by the shape of your
foot which you may have inherited from your
parents. Badly fitting shoes will force the big
toe to move inwards toward the second toe. The
foot is misaligned making it prone to
developing this bony protrusion at the base of
the big toe which we know as bunions.

Dr. Amal Kanti Deb Dr. AKD

 Ankle sprains

• Ankle sprains are common and with RICE therapy (Rest, Ice,
Compression and Elevation), they will heal naturally with time.
However some kids experience recurring ankle sprains and these
will cause scarring in the ankle ligaments, making them looser and
unable to effectively support the ankle, which in turn leads to
more ankle sprains. If an ankle sprain has had inadequate
rehabilitation, the muscles surrounding the ankle joint become
weaker and cause further proprioceptive loss.

Dr. Amal Kanti Deb Dr. AKD

 The ankle has three main ligaments which
connect the foot with the lower leg and their
role is to keep your ankle stable by preventing
too much movement. However, when these
ligaments are overstretched or torn due to a
sudden movement, the ligaments and
surrounding tissues become inflamed and you
have a sprained ankle.
Ankle sprains are most common in people
playing sports or running, but may also become
a recurring problem in simple daily activities if
you’ve previously experienced particularly bad
sprains.

Dr. Amal Kanti Deb Dr. AKD

 Prevention

• Use tape or other means to support your ankle. We’ll show you how
to do it yourself at home prior to any sport or activity here at the
clinic.
• Wear supportive shoes that help your feet to remain stable during the
exercise or activity you are doing.
• Make sure you warm up prior to exercise to loosen the muscles
around your lower legs and ankles.
• Strengthen the ankles with appropriate therapy and exercise at home.
Our podiatrists will show you exercise you can do at home every day
which will strengthen your ankles and reduce proprioceptive loss.
Dr. Amal Kanti Deb Dr. AKD
 Treatment
The best treatment at home is the RICE method:
• Rest – take the pressure of the inflammation to give it time to heal
• Ice – to lower blood flow and reduce swelling and redness, and
warmth. Ice can prevent inflammation if you do it quickly after the
injury.
• Compression – with an elastic bandage or wrap which can
reduce swelling. Take care not to wrap too tightly as you can cut off
blood circulation.
• Elevation – keep your ankle elevated above your heart to help your
body absorb extra fluid.

Dr. Amal Kanti Deb Dr. AKD

 Flat Feet
Flat feet are feet with low arches or none at all.
They are a common concern for parents but
sometimes are also a normal part of
development for younger children, and they are
known to correct with time.

Physical therapy or biomechanical therapy is

helpful to support the foot and correct the
alignment while your child’s feet are still
developing and growing.

Dr. Amal Kanti Deb Dr. AKD

 In-toeing (pigeon toeing)

• When the foot turns inwards while

walking, this is known as pigeon toeing.
Often this occurs when children are
learning to walk and is short lived as their
bones grow and their posture develops.
However if this has not corrected itself
past five years of age, it is recommended
to visit a clinic so that specialist can assess
your child’s feet.

Dr. Amal Kanti Deb Dr. AKD

 Toe walking

• Toe walking is common and mostly normal before

the age of three. However if it continues past the
ages of three to five years old and with resistance
from your child to walk on the full sole of their
foot, then they may need some assistance to help
them walk correctly. In the clinic assessement will
perform whether there are any underlying
development conditions preventing the foot from
making proper contact with the ground.

Dr. Amal Kanti Deb Dr. AKD

 Growing Pains
• Children’s feet, ankles and legs are growing
and developing all the time. Growing pains
are natural and often occur in the muscles
following greater than normal activity. These
pains could also be due to tight muscles or
hypermobility.
• Usually, the pain resolves itself but if it
doesn’t, then diagnosis is needed to
determine if there are any underlying
problems. Prevention is better than cure and
many issues can be detected to help correct
problems in feet before they become
permanent.

Dr. Amal Kanti Deb Dr. AKD