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The wart can be removed by cutting it out, by curetting after softening by special ointments, by burning with electric diathermy or by freezing with liquid nitrogen.

Ingrown toenails are painful. This involves the big toenail on either or both sides. The nail should be cut straight across and not rounded as this may encourage the edge to dip in, and grow, cutting into the tissue at the side.

In the acute state, the offending piece of nail may be cut away by the sufferer, the doctor or the podiatrist.

Persistent or recurrent ingrown toenails do well with operation. This is done under local anaesthetic and usually involves wedge resection. The edge of the nail and the nail bed are removed and the wound allowed to heal.

If both sides are involved, a wedge resection on each side of the nail is possible, resulting in a nail narrower than before. When both sides are involved, the nail may be totally removed, along with the nail bed, so it cannot regrow.

Flat feet are often blamed for causing pain. The sole is flat at birth and the arch does not develop until the child begins to walk.

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Inflammation or infection in the urethra can occur from the pressure exerted on this tube by a baby during childbirth. Sexual intercourse may also cause pressure. Sometimes the pelvic congestion due to retained fluid before a period may lead to congestion and inflammation in the urethra.

The urethra is derived from the same embryonic tissue which forms the reproductive organs and, like them, is influenced by the hormone oestrogen.

After the menopause, when the amount of oestrogen is greatly reduced, the urethra can become thinned and more easily infected or damaged. For this reason, post-menopausal women often develop bladder irritation following intercourse.

Fortunately, treatment is effective. Oestrogen, given either by tablets or as a local cream or pessary, reverses the changes in the urethra and stops the recurrence of symptoms.

For those woman who suffer repeated attacks of bladder irritation every few months, the best means of prevention may be taking small, regular amounts of antibiotics to prevent infection in the urethra.

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How important are these statistically significant differences to real live people? This is a question that many doctors neglect to ask themselves or to allow their patients to decide. I have heard doctors claim that a treatment involving five different injections which caused nausea, low blood counts, hair loss and many other unpleasant side effects was ‘better’ than a treatment consisting only of tablets with very few side effects. The first treatment was ‘better’ because it produced a statistically significant improvement in the average length of life— three months longer than with the tablets. So when your doctor recommends a certain treatment, telling you that research has shown it to be the ‘best’, make sure you find out just what this means and what the alternatives are. Given all the information about each treatment, you may or may not agree with your doctor’s conclusion.

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