Leukoderma
Leukoderma or vitiligo as it is sometimes called, is a chronic skin condition that causes loss of pigment leading to pale spots of skin. Leukoderma can be described as an autoimmune skin disease where the body destroys its own pigment cells, melanocytes. After the pigment disappears, small or even larger areas of skin become white with sharp margins where they join unaffected parts of skin. The hair in these areas also grow white rather than pigmented. Leukoderma is more noticeable during summer when the normal skin darkens. The causes for leukoderma could be a combination of genetic and environmental factors. Inheritance seems to be a dominant trait for this condition.
Leukoderma may also occur at sites of injury to the skin and may show itself as scars or burns. Recent studies suggest that leukoderma could be caused by the development of an antibody to an enzyme in the pigment cell. Leukoderma may be caused due to several other factors as well - congenital as in tuberous sclerosis, partial albinism and Piebaldism and Waardenburg's syndrome. The immunological causes of leukoderma are Vitiligo and Halo mole. Thermal burns, Dermatitis or eczema and Psoriasis may also result in leukoderma. Infectious conditions such as Pityriasis versicolor, leprosy, lichen planus and syphilis could also result in leukoderma. Some occupational hazards that could cause leukoderma are exposure to depigmentation agents such as tertiary butyl phenol and exposure to chemicals.
The spots can spread, shrink or remain the same. It is often noticed that patches occur in symmetrical fashion across both sides of the body. Some times mild trauma to an area of skin can cause new spots as around ankles caused by friction due to shoes or sneakers. Corticosteroid ointment or cream of appropriate strength is used depending on the site involved. Normally a mild steroid is used on the face and a stronger one for the trunk and limbs. A specialized form of light treatment PUVA is also of value to some patients.
Hammertoes
Hammertoes, as the name indicates is a deformity caused as a result of contracture or bending of the second, third, fourth or the fifth toe in the foot. As a result of this abnormal bending of the toes, the person might experience pain while using shoes due to the pressure caused to the toes. Hammertoes by and large arise due to imbalance in the muscle/tendon thereby ensuing in the bending of the toes. This deformity occurs predominantly due to structural changes in the foot. Another major reason for hammertoes is inappropriately fitting shoes; shoes that lead to crowding of the toes. Other major reasons leading to this deformity are former injuries caused to the toe and sometimes heredity. Hammertoes begin gradually, as a tiny abnormality and over time worsen. If left untreated, it can cause inflexibility to the toes and will require surgical correction. Corns are another major problem for people suffering with hammertoes and these corns can never be got rid off even with frequent trimming.
Symptoms of hammertoes
- Pain or soreness in the affected toes while wearing shoes.
- Development of corns due to frequent friction caused to the toe by rubbing against the shoes. Corns can occur either on top of the toe, side of the toe, ends of the toe or in between two toes.
- Calluses can arise either on the underneath the toe or on the ball of the foot.
Hammertoes can be treated according to the severity of the deformity; the foot/ankle surgeon will be the best person to decide on this.
Non-surgical methods
- Trimming of the corns and calluses: The best way to get is done is through your foot/ankle surgeon, as they know how and where exactly it needs to be trimmed. Self trimming might lead to infections.
- Padding corns and calluses: Again the foot/ankle surgeon is the best person to decide on the right type of pad your foot will require. Over the counter pads might contain acid that may add on to the irritation to the already existing irritation in the corns and calluses.
- Orthotic device: A made-to-order orthotic device when placed in the shoes can help control the imbalance in the muscle or the tendon of the foot.
- Injection therapy: Pain and inflammation can be kept under control by injecting corticosteroid injections.
- Strapping/splinting: Straps/splints as prescribed by the ankle/foot surgeon can be used to try and realign the bent toe.
Surgical methods: With more severe cases of hammertoes, surgery is required to correct the deformation of the foot caused.
Haglund's Deformity
Haglund's deformity is a bony growth along the posterior lateral border of the calcaneus or the heel bone surrounded by a tender tissue. Haglund's deformity primarily springs from bone enlargement at the back of the heel bone in the area where Achilles tendon attaches to the bone. Hence it is also called pump bump. It is also called as 'retroocular bursitis and 'calcaneal exotosis'. Bursitis is an inflammation of the sacs (bursae) that contain small amounts of lubricating fluid to help the joints move smoothly. The syndrome is usually found to occur in females in their teens who often use high heels causing irritation of the rigid heel counter of the shoe rubbing up and down on the back of the heel bone. However, the deformity can also occur among runners and athletes. Common symptoms include red painful area in the back of the heel and swollen area at the back of the heel bone. There is irritation in the Achilles tendon. Repeated blistering on the back of the heel leads to callous formation.
Haglund's deformity is identified by physical examination and x rays. The doctor correlates the physical symptoms of redness and pain in the area with findings in x-ray studies, bone scans and MRI. Haglund's deformity can be present at birth or may be acquired by injury over the patient's lifetime. Shoe gear is the primary reason for Haglund deformity. Haglund's deformity can be caused by bursitis or pressure against the shoe.
The treatment for Haglund's deformity depends upon the severity and cause of the disease. During the initial stages when the disease is mild, applying ice followed by moist heat and compression will help ease discomfort from pump dump. Changing the type of shoes can stop the injury and consequent redness and swelling from developing. The pain can also be alleviated to some extent by placing a heel lift inside the shoe so as to lift the Haglund bump above the part of the heel counter of the shoe that rubs it. A doctor may also prescribe anti-inflammatory drugs to reduce pain. Soaking the foot may also soothe the area. In mild cases, a doctor may also recommend padding of the area. Normally corticosteroid injections are given to relieve the pain but for long term complication this injection cannot be recommended as it can weaken and cause rupture to the Achilles tendon. In severe cases of deformity, surgery may be necessary to remove or reduce the bony growth.
Bibliography / Reference
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