I am a 21-year-old girl. Over the past two months, I have been suffering from severe pain in my big toe of both feet. I don’t see any wound or anything but it just hurts a lot. Can you please tell me what the problem is?

The problem you are facing is seen in a lot of people and is of ingrown nails. It is a common form of nail disease. It is a painful condition in which the nail grows or cuts into one or both sides of the nail bed. While ingrown nails can occur in both the nails of the hand and feet, they occur most commonly with toenails, specially with the big toe nails as in your case. Some of the most common causes include:

*Poor maintenance, like cutting the nail too short, rounded off at the tip or peeled off at the edges (versus being cut straight across),  which is likely to cause ingrowth;

* Ill-fitting shoes, like those that are too narrow or too short, can cause bunching of the toes in the developmental stages of the foot (frequently in the under 21s), causing the nail to curl and dig into the skin;

* Trauma to the nail plate or toe, such as can occur by stubbing the toenail, dropping things on the toe and 'going through the end of your shoes' in sports, can cause the flesh to become injured and the nail to grow irregularly and press into the flesh;

*Predisposition, like abnormally shaped nail beds, nail deformities caused by diseases, and a genetic susceptibility to nail problems can mean a tendency to ingrowth.

The most common place for ingrown nails is in the big toe but ingrowth can occur on any nail. Ingrown nails can be avoided by cutting nails straight across; nails should not be cut along a curve, nor should they be cut too short. Also, avoid wearing tight shoes that press on toenails, especially sports shoes (keds), over long periods of time. As we age, the arch of the foot gets flatter and the shoe size may change, so make sure your shoe size is right.

Home care

In mild cases, soak your feet in warm water and some salt every day. Follow this with an application of a mild antiseptic cream. This might allow the nail to grow out so it may be trimmed properly and the flesh to heal.

A simple yet extremely painful procedure for mild ingrowth (i.e., where infection is absent) requires small scissors to trim the nail completely along the nail margin down to the lateral base. This hopefully allows the embedded piece of nail to be pushed back and out from the toe tissue. However, avoid doing this yourself at home, you may injure yourself and worsen the situation. This kind of procedure is generally done by expert pedicurists to give relief to ingrowths. Make sure you go for a good pedicure to an expert once in two weeks. It is also advisable to walk around barefoot so that air has a chance to circulate. Infections often become more painful when they are not exposed to air because bacteria grows more quickly in warmer conditions eg. when the foot is impacted tightly in a shoe.

These home remedies work well for initial cases of ingrowth where there is no visible infection and swelling though. In serious cases, i.e. when the flesh is far too swollen and infected, it will not allow for these procedures to work. For severe cases please consult a surgeon who can treat the problem with mild surgery.

I am a business woman. I look after myself well, but my main problem is I have bad foot odour. When I remove my shoes I cannot bear the foul smell. Is there anything I can do about this?

Foot odour is a common problem, caused by excessive perspiration and the growth of bacteria on the feet. Even the most fastidiously clean people can suffer from foot odour. There is a range of simple treatments available to address this problem. To reduce the growth of bacteria and to treat the problem, the sweaty warm conditions around the foot should be eliminated. Mild antiseptic solutions or soaps can be useful. You can also sprinkle your feet and shoes with powder in the morning and evening.

Methylated spirits applied once or twice a day (especially between the toes) can help dry the skin.
Avoid synthetic socks and wear shoes that allow good air circulation and allow the foot to breathe (leather is good). Change your shoes regularly to allow them to dry and air.

Topical (applied to the skin) or oral (by mouth) antibiotics may be prescribed, in severe cases, to kill off the bacteria.

If these treatments fail, contact a podiatrist.