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Thickened and problematic toenails can develop for several reasons, most commonly due to trauma, pressure, or fungal infection. Thickened nails (onychauxis) occur when the nail plate becomes excessively overgrown, often as a result of repeated pressure from footwear, age-related changes, or previous injury to the nail. Fungal toenails (onychomycosis)are caused by dermatophytes or yeasts that infect the nail, leading to discoloration, brittleness, separation from the nail bed, and a crumbling or distorted appearance. Other conditions, such as ingrowing toenails (onychocryptosis) or damaged nails (onychodystrophy), may also contribute to pain, inflammation, or difficulty cutting the nails. Symptoms can include thick, discoloured, flaky, or irregular nail shape, tenderness around the nail edges, or buildup of debris beneath the nail plate. Treatment depends on the cause and may involve careful nail reduction (thinning the nail), professional trimming, cleaning of debris, and pressure relief. For fungal infections, long-term management may include topical antifungals, advice on hygiene and footwear, and regular debridement to improve nail condition and comfort. Consistent foot care helps restore nail health and prevents symptoms from worsening.

Corns are areas of localized hyperkeratosis (thickened skin) that develop in response to friction or pressure, and they are classified into several types. Hard corns (heloma durum) typically appear on the tops or sides of toes or on weight-bearing areas of the foot; they are dense, compact, and can feel like a small stone pressing into the skin. Soft corns (heloma molle) form between the toes where moisture keeps the skin softer, leading to a whitish, rubbery appearance that can be particularly painful. Seed corns (heloma millare) are tiny, superficial corns often found on the heel or sole, usually causing a sharp, pinpoint discomfort when walking. Symptoms may include tenderness, a burning sensation, or pain when pressure is applied, as well as noticeable thickening of the skin. Treatment typically involves removing the hardened skin through careful enucleation (debridement), reducing the underlying pressure, and addressing the cause with padding, toe separators, footwear advice, or orthotic support. Regular foot care and pressure management help prevent recurrence and keep the skin healthy.

Callus, known medically as callus formation due to diffuse hyperkeratosis, is a broad area of thickened, hardened skin that develops in response to repeated pressure, friction, or abnormal gait mechanics. Unlike corns, which are localized, callus tends to form over larger surfaces such as the ball of the foot, the heel, or along the sides of the toes. Symptoms can include a dry, rough, or yellowish appearance, reduced skin elasticity, and discomfort or aching when walking or standing for prolonged periods. In some cases, callus can become painful if the pressure continues or if underlying foot structure—such as flat feet, high arches, or joint deformities—contributes to excess load. Treatment involves gentle debridement to remove the thickened skin, followed by moisturisation to restore suppleness, and the use of pressure-relieving methods such as cushioning, orthotic devices, or footwear modification. Ongoing management helps correct the causes of friction or pressure, reducing discomfort and preventing callus from returning.

Verrucae, commonly known as plantar warts, are lesions caused by the human papillomavirus (HPV) that infects the outer layer of skin, typically on weight-bearing areas of the foot. Because pressure forces the lesion inward, verrucae often appear as small, rough, grainy growths with pinpoint black dots (thrombosed capillaries) and may be surrounded by hard skin. Symptoms can vary from mild discomfort to sharp, pressure-related pain when walking or standing, and sufferers may notice a change in skin texture or a disruption of normal foot function. Verrucae can be mosaic (multiple clustered lesions) or solitary (individual lesions), and may spread if untreated. Treatment aims to destroy or stimulate the immune system to clear the virus, and may include gentle debridement, acid-based therapies (such as salicylic acid), cryotherapy, needling, or other clinic-based methods depending on suitability. Regular monitoring, pressure management, and maintaining good foot hygiene help support resolution and reduce the risk of recurrence or spread.

Diabetic foot care is a critical aspect of managing diabetes, as elevated blood sugar levels can lead to peripheral neuropathy (loss of sensation) and peripheral vascular disease (reduced blood flow), both of which increase the risk of foot complications. People with diabetes are at risk of developing ulcers, infections, thickened nails, callus, or fissures, often without noticing due to reduced sensation. Symptoms can include numbness, tingling, burning sensations, changes in skin colour or temperature, swelling, or slow-healing wounds. Effective diabetic foot care focuses on prevention, early detection, and management of these risks. Treatments include regular foot examinations, debridement of callus or thickened nails, wound care, infection control, and advice on footwear or orthotics to reduce pressure and protect vulnerable areas. Education on daily self-inspection, maintaining skin hydration, and prompt reporting of changes is essential to prevent serious complications such as ulcers, infections, or, in severe cases, amputation. Comprehensive diabetic foot care helps preserve mobility, comfort, and overall health.