Peripheral Arterial Disease and its role in the Lower Extremity

In the past few years there has been an increase of awareness of Peripheral Arterial Disease, also known as PAD, but what exactly is PAD? How does it affect the lower extremities? And how can it be prevented and treated?

What is PAD?

PAD, which is sometimes referred to as PVD, Peripheral Vascular Disease, is a blockage in the arteries of the legs and pelvis. The most common symptom is pain in the legs while walking, this pain usually resolved at rest. This is an ambiguous symptom and many times can go undiagnosed for a while. If the disease worsens and is untreated it can lead to cold blue feet, wounds, gangrene, and even amputations.

How do I get PAD?

People who are at high risk include smokers, diabetics, people with high cholesterol and high blood pressure.  In addition, men over 50, who are obese, have had a heart attack or a stroke are at higher risk. Smoking is the number one factor that can be altered in order to decrease the risk of getting PAD.

How do I get diagnosed and how is it treated?

If you are concerned that you have PAD, share your symptoms with you physician. Even if the symptoms don’t fit the exact criteria of PAD it does not mean you don’t have PAD. The symptoms can vary and can be vague. Your physician will begin by ordering a test called an ABI/PVR. This is a painless test, where blood pressure cuffs are placed on the arms and legs and measurements are taken. Based on the results you can be diagnosed with PAD. Other tests can be performed, including an ultrasound, angiography, CT or MRI scan.

The sooner treatment is sought the better the long term outcomes. Quitting smoking, controlling diabetes, high blood pressure and high cholesterol are of essence. In addition, exercise is important to increase blood flow to the legs. If these methods are unsuccessful a vascular surgery consultation is the next step in treatment. There are many different methods and techniques where a vascular surgeon can open up the compressed blood vessels. Different balloons and/or stents can be utilized, but will be determined by the degree of the disease, the patient and many other factors. If the disease is to a point where there is gangrene, then usually an amputation is required. An ulceration caused by PAD is treated by aggressive wound care, but more importantly by increase the blood flow to the area of the wound.

In conclusion, if you have mild symptoms or severe symptoms the earlier treatment is sought the better long term outcomes.

For more information, please visit: http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Peripheral-Artery-Disease-PAD_UCM_002082_SubHomePage.jsp

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Gout- A Red, Hot, Swollen Foot

What is gout?

Gout, which used to be known as a “rich man’s disease”, is more common than thought. Gout is when there is an increased in uric acid crystals in the body that are then deposited in different joints in the body. The most common joint being the big toe joint, followed by the ankle joint.

How do I get gout?

Gout is more common in men than females and starts in the 30-50 age range. This does not exclude someone older or younger than this. If an attack is not treated a second attack at some time in the future is common.  It is recommended that if you have 2 or more attacks to be on medication for the rest of one’s life.

How do I know if I have gout?

An acute gouty attack usually happens overnight. It begins when someone wakes up and their foot is red, hot and swollen. Usually patients say that even the bed sheets cause severe pain to the area. Usually patients are in so much pain they have a hard to walking and usually limp their way into the office.

Can I prevent an attack?

Certain people are prone to attacks based on genetics, other medical problems and diet. A large component of gout is based upon one’s diet. Foods to avoid include shellfish, sea food, wine, beer, organ meats. Lifestyle changes can go a long way in preventing gout. Low BMI, exercise and caffeine are ways to prevent a gouty attack.

How is gout diagnosed?

The most accurate way to diagnose gout is to take the fluid out of the joint that is red, hot and swollen. This fluid is then sent to the laboratory and inspected for gouty crystals. This process many take a few days and therefore, many physicians treat gout based on the clinical symptoms and appearance of the joint.

How do I treat gout?

Acute gouty attacks can be treated many different ways. A cortisone (steroid) injection into the joint that is affected helps with reducing the pain, swelling and inflammation. Different oral medications can help as well. NSAIDs (non-steroidal anti-inflammatory medication), Colchicine, a steroids are a few medications that can be used in an attack. You physician will discuss which medication is the best for you based upon your other medical problems. If someone has more than 2 attacks, consultation with a rheumatologist is recommended. At this point Allopurinol or Probenecid medication is recommended for long term use.

If you wake up with a red, hot, swollen painful foot do not wait and call your doctor an emergency appointment. Your doctor will need to rule out an infection and delaying treating gout can have long term consequences to your bones.

For more information, please visit our website at www.footnj.com

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Toe Nail Fungus and Athlete’s foot: How they are related

On our blog we keep coming back to common topics such as toenail fungus because 7% of adults suffer from this problem. On this blog, not only will I focus on how it is transmitted, how it can be treated, but I will discuss the relationship between toenail fungus and skin fungus.

Toenail fungus, also known as onychomycosis, and tinea pedis (aka athlete’s foot), which is foot fungus are related. Some patients present with either of these problems, but many patients present with both. Both are caused by fungi, which are microscopic, extremely contagious and a challenge to treat. These fungi live in dark, moist, hot environments. If someone sweats in their socks, swims in a public pool, or if they are diabetic, these are some causes for an increased risk in fungus.

How can these two types of fungus be diagnosed?

Athlete’s foot and onychomycosis can be diagnosed by either clinical exam or by microscopic examination. Athlete’s foot can be diagnosed via a skin shaving, which is examined microscopically. Similarly, onychomycosis can be diagnosed via a clipping of the toenail and then subsequent examination at the laboratory. Many times treatment will begin before definitive diagnosis due to the clinical suggestion that a physician is dealing with fungus.

How do I know if I have either of these two fungi?

Athlete’s foot appears as red, itchy patches of flaky skin on the top or bottom of the foot. Athlete’s foot in between the toes appears to be macerated, or soft and white, as well as red and flaky. Toenail fungus may have many different appearances, including thickened, irregular, discolored nails. The nail can appear to be black, yellow, white or green.  

How can I treat these two types of fungus?

Athlete’s foot can either be found between the toes or on the top and bottom of the foot. Despite what type you have these can be easily treated with antifungal creams.

Onychomycosis is more difficult to treat since the fungus imbeds deep into the toenail. It can be treated with oral antifungal medications, which in some patients can have adverse effects on the liver. Antifungal nail lacquers are also used for treatment and are common due to the lack of systemic effects that oral antifungals have. Surgical removal of the fungal toenails is common for someone who has a few infected toenails.

Lastly, laser treatment is the most advanced technology on the market (and its FDA cleared) to treat onychomycosis. At our office we use Sciton ClearSense laser to treat the toenail fungus. Treatment includes 4 easy, pain free treatments. The treatments last about 15 minutes, causes minimum pain and patients tolerate it extremely well. We recommend treatment with antifungal lacquer simultaneously to get maximum results.

Toenail fungus and athlete’s foot have been around a long time and as science and technology becomes more advanced the treatment gets more precise with better results. To date, treatment with laser technology for toenail fungus has gotten the best success rates.

For more information please visit www.scitonclearsense.com.

To make an appointment for a consultation and for more information, please visit our website at http://footnj.com/podiatrist-new-jersey-about-us/23/240-laser-toenail-fungus-treatment

Diabetes and your feet

In a previous blog we have discussed how diabetics should go about caring for their feet, but how does diabetes affect the feet? How can a diabetic prevent themselves from getting into trouble with their feet?

http://footnj.com/podiatrist-new-jersey-about-us/23/232-diabetic-foot-care-and-shoes

Just a little bit of background information….

Type II diabetes mellitus, also known as adult onset diabetes, affects over 280 million people worldwide.  The increase in obesity in the United States is a contributing factor for the increase in the number of people afflicted with this disease. As the disease progresses over time, it affects the eyes, kidneys and feet.

Diabetes affects the feet via peripheral neuropathy. Peripheral neuropathy is when the nerves are damaged. This is caused with either increases or fluctuations in blood sugar levels. As diabetes progresses neuropathy can cause tingling, burning and eventually numbness to the toes and feet. The concern that podiatrists and other medical practitioners have is that if a diabetic can’t feel their feet they may injury or cut their feet and may not feel it. This can then lead to a diabetic foot wound, subsequent infection and possibly even amputation. It is recommended that a diabetic follow up closely by a podiatrist a few times a year for a foot checkup.

Other important factors in relation to diabetes and feet are poor circulation. Peripheral vascular disease, also known as PVD, can cause blockages in the blood flowing to the legs. Someone can have PVD with or without diabetes. A combination of diabetes, neuropathy and PVD can be destructive. If a diabetic has a lack of sensation to the legs, and diminished blood flow to the feet, an open sore can be catastrophic. A diabetic may form an ulceration, which they cannot feel and then with PVD they cannot heal. Due to this it is highly recommended for close follow up for diabetic foot exams.

If I am a diabetic, what are measures I can take to prevent any foot infections?

Besides close follow up by a foot specialist it is recommended for diabetic to do daily foot inspections. By checking ones feet daily a small cut or lesion can be identified and should be immediately reported to ones physician before an infection sets in. It is also recommended to keep the spaces between the toes dry and the skin on the top and bottom of the foot well hydrated with moisturizer. It is recommended to wear white diabetic socks, where one can spot blood or pus, before even realizing they have a sore. Lastly, wearing comfortable protective diabetic shoes is advisable. Diabetic shoes with heat molded inserts are covered by Medicare and most insurance plans. This can be dispensed during a foot checkup.

For more information please visit the American Diabetes Association at http://www.diabetes.org and our website at footnj.com