New Medications to Treat Toenail Fungus in New Jersey EHT

New Medications to Treat Toenail Fungus

In the past few months there have been 2 new topical antifungal medications to become FDA approved. These 2 medications are Jublia and Kerydin, it has been the first time in decades that there have been new FDA approved prescription antifungal medications. These medications are being advertised on TV and in magazines and there have been a lot of patients asking about them. I will take this blog to discuss these medications.

Jublia (efinaconazole)

has been getting a lot of media attention. Jublia has been advertising a toenail with fungus wearing a purple helmet having a boxing match with a fungus and winning. This medication works as an antifungal liquid topical medication. It is applied to the toenails affected with fungus daily for about 48 weeks. Many patients are shocked when I mention that most topical antifungal medication need to be applied for that long. But the fact is toenails grow approximately 1mm per month, so it takes about 9-12 months for the entire toenail to grow from start to finish. Having said that Jublia and all topical antifungal medications need to be applied for about a year.

How effective is this medication and what are the side effects?

There have been many studies to check the efficacy. A complete cure was noted in 15-18% of patients. The nails were “mostly clear” in 23-26% and there a mycological cure (microscopically clear of fungus) in 54% of patients. These percentages are the highest we have seen in this class of mediations.

A big question patients have is what the side effects are. The side effects are in 2% of patients and are minor. They include the following: ingrown toenails, redness, blisters to the surrounding skin, itching, burning and pain.

What about Kerydin (tavaborole)?

Kerydin is a little less effective than Jublia. The complete cure rate is 6.5-9%, the mostly clear percentage is between 15-18%. The mycological cure rate is between 31-36%. Only 1% of patients have side effects and they are ingrown toenails, redness and a skin reaction called dermatitis

Which Medication is best for me:

Each person needs to talk to their physician about which medication is better for them. They are both very similar with slightly different effective rates. Women who are pregnant, may become pregnant or who are nursing should not go these medications.

For more information, please visit our website at http://footnj.com/podiatrist-new-jersey-about-us/23/240-laser-toenail-fungus-treatment

Podiatry in The Media

Lately there have been famous sports players as well as politicians who have complex foot and ankle injuries. I would like to take this blog to review some of their injuries and their road to recovery.

Kim Jong-un

Last week it was revealed that Kim Jong-un, the leader of North Korea was out of the media spot light for the past 6 weeks. There was a lot of speculation as to where he was and what lower extremity alignment he was suffering from. This week it was brought to light that he had a cyst in his tarsal tunnel that was surgically removed. In my past blogs I have discussed tarsal tunnel syndrome. In a nut shell, this syndrome is when the tarsal tunnel, which is a tunnel in the ankle region, can cause pain including numbness or burning. The cause can be multifactorial, including compression of the nerve in the tarsal tunnel with long periods of standing, bulging varicose veins. Sometimes there can be a cyst in the tarsal tunnel, which can cause the above mentioned symptoms. If this occurs the only way to treat this would be surgical removal of the cyst. This surgery is extensive due to the fact that the entire tarsal tunnel needs to be opened and the cyst needs to be meticulously extracted. The recovery consists of 4-6 weeks in a cast, non-weight bearing with crutches. The cyst may reoccur as well as the symptoms, therefore close monitoring of the symptoms is required.

RG III

In September Robert Griffin III of the Washington Redskins had a severe ankle injury which was a dislocated ankle. Luckily there were no fractures noted during MRI tests. He was extremely lucky that he did not have any bony chip fractures, which are usually common with ankle dislocations. Due to the fact that he is in good shape and athletic he is ready to return to his team. Due to extensive physical therapy he will attempt to return to play.

Julius Randle

Last week Julius Randle of the LA Lakers had a devastating fracture of his tibia. The tibia bone, which is one the bones in the leg, is much larger than the bone next to it, the fibula bone. Tibial fractures are less common then fibular fractures, but due to their larger size they tend to be a worse injury. Tibia fractures usually occur from a trauma, car accident and falls. They usually require surgery, which can vary from using plates, screws and other pieces of hardware. This type of injury can take many months, 4-6, at least to recover. Due to the fact that the bone is so large and the fact that it holds up the body weight this injury can take a long time and a lot of physical therapy to recover from.

In conclusion, famous people are not excluded from foot and ankle injuries. Due to the fact that sports players perform excessive amounts of physical activity they are more prone to worse injuries.

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

Hyperbaric oxygen therapy and its role in Podiatry

Hyperbaric oxygen therapy and its role in Podiatry

What is hyperbaric oxygen therapy (HBOT)?

HBOT is the use of oxygen in a highly pressurized room. It is used for many different medical applications. HBOT therapy is performed in a hospital setting; it consists of a patient being placed in a chamber for a few hours where 100% oxygen is being delivered. Approximately 30 sessions are required for treatment, with treatment being 5 days a week. Each treatment lasts up to about 2 hours.

What does HBOT therapy work and what can be treated with HBOT?

HBOT works by increasing oxygen, which in fact increasing the capability of oxygen to be transported in the blood. This in term stimulates growth factors and stem cells to the area being treated, which promote healing.  This allows healing of many different alignments. Initially, HBOT was used to treat decompression sickness, which related to injury during scuba diving. With time and research it has been known to treat many other alignments. In relation to the foot and ankle: diabetic wounds that have a bone infection, gangrene, failed skin flaps, crush or traumatic injuries are examples of what can be treated with HBOT.

What is required to be approved to undergo HBOT?

Medical clearance is required before undergoing HBOT therapy. Your physician will require you to have an EKG, chest x-ray and a physical exam. There is a number of contraindication to HBOT. Patients with cardiac problems, COPD, fever, cancer or middle ear issues are not able to undergo HBOT therapy.

How is HBOT used with other treatments?

Many times HBOT will be used concomitantly with other treatment modalities. For example, if a patient has an infected diabetic wound and bone infection this patient can be treated with HBOT. In addition, this patient will be managed by a wound care specialist to treat the wound, an Infectious Disease specialist to treat the patient with antibiotics and their Primary Care Physician who will be managing their overall care. HBOT in the world of Podiatry is one application to help treat a wide variety of medical conditions.

For more information please visit our website at www.footnj.com and visit Shore Medical Center Wound Care and Hyperbaric Oxygen’s website at

http://shoremedicalcenter.org/departments/wound_care

PRP and its role in Podiatry

What exactly is PRP?

In more recent years PRP (Platelet rich Plasma) has become popular in the world of professional athletes. Many well-known athletes such as Tiger Wood and Koby Bryant have used PRP to help aid in healing different tendonitis and musculoskeletal injures. PRP is the platelets that are extracted from the plasma (which make up a large component of blood). These platelets are rich in growth factors and it is thought that the growth factors are what aids in speeding up the healing process. There is still a lot of unknowns about how exactly PRP works but there has been major strides in the world of sports medicine, oral surgery and fractures with PRP and its role in healing.

How is PRP prepared?

PRP can be done as an in office procedure or during surgery in the operating room. It is a simple procedure with minimal discomfort. It would begin with a phlebotomist extracting blood from a vein in one’s arm. The blood is then mixed in a centrifuge; this process allows the platelet rich plasma to be separated from the entire blood content. The PRP is then mixed with a local anesthetic and injected into the area of injury. The whole process in the office takes less than 30 minutes with minimal discomfort.  After the procedure there may be discomfort to the area for a few days. Icing is recommended if there is mild pain.

What conditions can be treated with PRP?

PRP has been shown in studies to be most effective for chronic tendonitis. In addition it can be beneficial in acute injuries and fractures. In our practice we have been using PRP in an office setting for acute and chronic injuries such as Achilles tendonitis, plantar fasciitis, and chronic pain from ankle sprains. We have had great success and find that within a few days of the procedure many patients are pain free. Sometimes more than one treatment with PRP is required to get the full effects from the PRP.

In conclusion, there are still more studies that are required to determine how exactly PRP works, but to date the results are promising as patients who have been suffering from chronic problems are responding well to PRP injections.

For more information and to schedule an appointment to have PRP done, please visit our website at http://footnj.com/podiatrist-new-jersey-about-us/23/242-platelet-rich-plasma-injections

Foot and Low Back Pain: How they are interconnected

Foot and Low Back Pain: How they are interconnected

Previous to me becoming a Podiatrist I had no idea how interconnected low back pain is related to foot and ankle problems. As a Podiatrist I have good relationships with spine and back physicians since their patients suffer from foot and ankle problems and vica versa.

How is the back related to the foot and ankle?

The anatomy and physiology of the foot and ankle isn’t exclusive to the foot and ankle. As a Podiatrist when I do a foot exam I focus on 4 different components. I focus on the vascular system, dermatological exam, an orthopedic exam and a neurologic exam. These 4 components of an exam are not exclusive to the foot and they need to be investigated further if there is a deficit in one of them.

In relation to back problems, I will usually see a deficit in the neurologic exam in the foot.

What exactly does this mean?

Let’s say a patient has a pinched nerve or disc degeneration in the L4-L5 Lumbar Spine, which is causing them symptoms of pain in their low back. They will most likely have numbness, lack of sensation, weakness or burning in different parts of the foot. Many times a patient with low back pain will complain of pain that shoots from their back to their feet. It is the podiatrist and neurologist job to figure out if the pain is exclusively from the back or if there is a foot component as well.

Many times when I have this dilemma of where the pain is coming from I will order a Nerve Conduction Test and an Electromyography Test (EMG). These tests will be able to determine exactly where the problem is arising from.

How do you treat foot problems related to back problems?

When a patient presents with back and foot problems I am honest with them and I let them know that I will try to cure their foot and ankle problems but they may still have residual problems in their back. Many patients can be helped with their foot problems by changing their shoe gear, wearing a custom orthotics, ice, stretching and even anti-inflammatory medication. Physical therapy is a great modality which can focus on the foot and ankle as well as strengthen the core muscles to help alleviate back problems. In addition, there are medications to help with nerve pain, such as Gabapentin (Neurontin) and Lyrica (Pregabalin).

In conclusion, when a patient presents with symptoms in the foot and the back I like to take a multi system approach. I like to engage the patient, myself, their neurologist or back specialists and a physical therapy. Many patients with these symptoms present feeling that there is no treatment to help them, but with a little effort their pain can be reduced significantly.

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

Lasers and its role in Podiatry

Medical Lasers have many different uses within the medical field; some uses include Lasik eye surgery, cosmetic surgery, tumor removal, dental procedures etc. In the field of Podiatry Medical Lasers can be useful to treat many different conditions. In this blog I will discuss the relevance of lasers to the field of podiatry.

How do Lasers work?

LASER, which stands for Light Amplification by Stimulated Emission of Radiation, work by having an intense beam of light, of a specific wavelength, which then allows the beam to focus on a small area. By having the beam focus on a small area the Laser can be used for surgical work by removing a lesion, burning, destroying or cutting etc.

Are Medical Lasers safe?

Medical Lasers has a source of radiation that is minute, due to the fact that the source of light is so small that it is safe and poses no health risks. Due to the fact that the light is so small it allows a physician to treat specific lesions without destroying the surrounding healthy tissues.

How are lasers used in Podiatry?

In our private practice we utilize 2 different types of laser to combat many different medical conditions.

Our first laser, which is called Sciton Laser, more specifically JOULE ClearSense . This laser is used to treat toenail fungus (also known as onychomycosis) and plantar warts. As per the Sciton’s website, the way the laser works is that the temperature of the laser is high that is heats the nail and decreases the nail fungus and increases the growth of the healthy nail. (http://www.sciton.com/treatments/onychomycosis)

This treatment is painless and takes 15 minutes. We recommend 4 treatments within a 2 month period.

In relation to treating plantar warts, it is a onetime treatment, also using the ClearSense,  that requires a local anesthetic prior to treatment. The treatment of the plantar warts works similarly to the fungal nails, in that is heats the warts and kills the roots.

What about other applications in Podiatry?

We use K laser in our office to treat many different alignments such as plantar fasciitis, Achilles tendonitis, and pain from residual ankle sprains. The way it works is to increase blood flow to an area, which will then increase the oxygen to the area and then increase the healing to the area. We recommend 10 treatments within a 5 week time frame. The treatment is under 10 minutes, is painless and you are able to drive home without sequela.

As technology advances, scientists are finding new ways to treat old conditions. I have had success with these lasers that I have not seen in the past, therefore, I recommend someone with these conditions to try the laser and they will notice the improvement of their conditions.

For more information please visit our website at footnj.com

Heat and your feet eht nj

Heat and your feet

As the summer months approach the topic of sun burns tend to be popular discussions as people spend more times outdoors. I would like to discuss burns in general, and the different degree of burns and how they relate to the foot and ankle.

What are the different levels of burns and how are they treated?

A burn can be caused by many different factors, such as over exposure to the sun, a fire, a chemical burn etc. It is the degree of the burn that will dictate the treatment as well as the outcome.

First Degree Burns

A first degree burn only affects the epidermis, which is the outer most layer of skin. Symptoms include red painful patches to the area affected and this can last up to 10 days until the burn resolves. These types of burns tend to resolve on their own. The most common type of first degree burn is caused by sunburn and as it is well known that sunscreen can prevent these types of burns.

Second Degree Burns

A second degree burn penetrates deeper into the epidermis and the dermal layer of skin. This type of burn can causes extremely painful blisters, which can become infected and cause a skin infection called cellulitis. This may take 3-8 weeks to resolve. Sometimes these types of burns can cause long term scars.

Third Degree Burns

This type of burn penetrates into the epidermis and throughout the entire dermal layer of skin.  This type of burn can cause the skin to look white, yellow or brown. Many times this type of burn requires immediate attention at a burn center. This type of burn can cause severe scaring, require many skin graft surgeries and perhaps even amputation. These types of burns are highly susceptible to infection.

Fourth Degree Burns

A fourth degree burn is so severe in many cases it causes death. This is when the burn extends from the superficial skin to the level of fat, muscle or bone. Most of the times these burns require amputation as a treatment option. In addition, these patients are so medically compromised that infection and death are serious complications.

So how are burns related to the foot and ankle?

This is an easy answer, with the summer around the corner many people forget to put sunscreen on their feet. This can lead to painful burns. In addition, I have treated numerous diabetics who “forgot” a heater was on or fell asleep in the sun and caused severe 2^nd and 3^rd degree burns to the feet.

In conclusion, do not forget to place sunscreen on your legs and feet. Also if you are a diabetic be careful with the heat and your feet.

For more information, please visit our website at footnj.com and visit our NEW location at:

3003 English Creek Avenue, Suite C5

Egg Harbor Township, NJ 08234 

Heel Pain in Children

One of the most common causes of heel pain in young athletic children is something called Sever’s disease or calcaneal apophysitis. In this blog I will discuss what exactly is Sever’s disease, who it affects, how it can be treated and is it avoidable?

What exactly is Sever’s disease?

Sever’s disease, which is also called calcaneal apophysitis, is inflammation in the growth plate of the calcaneus (which is the heel bone). This occurs in a growing child, usually between the ages of 9-11. It presents as heel pain and is usually brought on by an increase in physical activity. If the pain in this area gets severe many times the child will be limping due to the pain. If this worsens it can lead to a red swollen heel.

How is Sever’s disease diagnosed?

Sever’s disease is usually diagnosed by signs, symptoms and clinical exam. A typical patient will be a 9 or 10 year old boy that has been playing a lot of soccer, or basketball, and has pain to the back of his heel while playing sports. He states when he rests the pain resolved. Squeezing on the back of the heel will elicit pain with Sever’s disease. In addition, x-rays can be taken, but are usually normal.

What Causes Sever’s disease?

This is caused by overuse and the stress that it causes to the bone and tendons. Many times with this disease the bones and the child are growing at an excessively quick rate.

How is Sever’s disease treated?

The principles of treatment are RICE, which include rest, ice, compression and elevation. Stretching the tendons attached to the heel (i.e. Achilles tendon, plantar fascia) is very important. Wearing good supportive shoes with custom orthotics will help. If the pain is severe oral anti-inflammatory medications can help.  Physical therapy may help if none of these other treatments resolve the pain. Many times taking a break from physical activity is required until the pain is resolved.

Even if treatment is not sought out it will resolve slowly on its own within a few weeks.

How can I prevent my child from getting Sever’s disease?

Stretching before and after activity is very important, avoiding excessive amounts of physical activity is good to prevent any type of injury. Lastly, wearing the appropriate supportive shoes with orthotics can prevent many different foot aliments.

For more information, please visit our website at http://www.footnj.com/podiatrist-new-jersey-about-us/23/237-heel-pain

How can the Holiday’s affect your feet?

No matter what holiday you celebrate caution should be taken so you don’t have problems with your feet. Most holidays are filled with family, prayer and of course eating too much food.  Many of these activities can lead to problems with feet.

To start off many people go to pray with their family during the holiday, which means people will dress in their Easter best. Most times this means that shoe gear is more about appearance than comfort. I agree that it is okay once in a while to wear stylish, not so comfortable shoes, but if someone isn’t used to this type of shoe they may run into problems. As the weather is warming up and Easter/Passover is upon us many people will wear high heeled open toe shoes. I would like to warn those high heel open toe shoe wearers to be careful about developing blisters or wearing shoes that are too tight. Most importantly, twisting ankles is a common occurrence for the novice high heel wearer. A good suggestion would be to wear comfortable shoes to the event and perhaps change into a high heel shoe once at the location.

The second aspect of a holiday weekend for people to be aware of is the eating aspect of it. Most holidays are centered around families sitting and eating large quantities of food. The two groups of people to be concerned about this are diabetics and people who suffer from gout. Diabetics who over indulge are concerned about elevated blood sugar levels. As I have spoken about in past blogs, long term elevated blood sugar levels can lead to neuropathy, diabetic wounds, infections and a multitude of other problems.

People with gout can exacerbate their condition or bring on a gouty attack with certain foods. Therefore, they should be careful not to eat large quantities of meat, seafood or drink too much wine. If someone with gout has questionable symptoms of an attack they should seek attention with their physician. Remember the most common place for a gouty attack is the big toe joint of the foot.

In conclusion, holidays are times to spend with loved ones, but be careful because anything in excess can cause problems down the road.

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

Medical Foot Wear Podiatrist Shoes Podiatrist shoes 08234

What does warmer weather mean for your feet?

As this long and snowy winter finally comes to an end, everyone cannot wait to get out of their boots and into slippers, sandals and flip flops. But are sandals bad for your feet and what can you do to wear open toe shoes in the summer without any problems?

In the summer most people, including myself, like to expose their feet in some sort of open type of shoe, but before doing this think of the risks that this may involve. If you are a diabetic or have peripheral vascular disease, wearing an open type of shoe can be a disaster. If you are a diabetic with neuropathy (see earlier blog for definition) and you are wearing open toe shoes and get a cut on your foot, it can get infected and by the time you notice it there can be an infected wound. Therefore, it is highly recommended for diabetic and people with PAD to wear closed toe shoes throughout the entire year.

Another problem with wearing open toe shoes is that many sandals and flip flops that are sold in the summertime have no support built into the shoe. Therefore, many people in the summer tend to spend long hours outdoors exercising, walking and doing leisurely activities. This means that people spend more time on their feet with less support than during the winter. If someone wears a shoe with no support for hours at a time they are more than likely to begin to get achy, sore feet. Many patients actually spend weeks of the summer suffering with painful feet and by the time they seek help it is the beginning of fall and they are returning to supportive shoe gear. At the Foot and Ankle Center in Egg Harbor Township, NJ, we have a solution to this problem. We sell Spenco sandals/flip flops. Spenco’s are a sandal orthotic; the orthotic is built into the sandal. This is a great solution because this way you can still enjoy wearing a sandal during the warm months, but you can have support at the same time.

One more thing to consider when wearing open toe shoes in the summer is applying sun screen to your feet. Many people forget to do that and skin cancer can form on the feet. So don’t forget to apply sunscreen before leaving the house.

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

For more information on how to purchase Spenco sandals please call the office at 609-272-1450

Podiatry and the Importance of Utilizing Other Specialties

Many patients present to a Podiatrist with a variety of foot and ankle complaints. As a Podiatrist I like to take a whole body approach to treating patients. I tend to utilize other medical specialist to help with diagnosis, treatment and ultimately to heal patients. I think all physicians should use all the tools that are available to them to help treat patients.

While performing a foot exam I tend to break down the exam into four components. The four components of the foot exam are the dermatological, vascular, orthopedic and neurologic aspects. I think that during an exam it is important to listen, examine and ask appropriate questions in order to get a complete picture of what the problem is. The foot and ankle are connected to the body and even though someone may think their symptoms are in the feet many times it is related to something else going on in the body.

For example, during the winter months many patients come into the office complaining about cold, purple toes. They state that as the weather gets colder they toes change colors, from red to white to blue to purple. It is important to perform a vascular lower extremity exam, but it is also important to ask if they get similar symptoms in their fingers. This disorder can be a variety of things, include Raynaud’s, Chilblains, but what is important is to ask general questions. Once I diagnosis the problem I frequently get other specialties involved in the patient’s care. I will refer the patient to a vascular surgeon, since this is not only a lower extremity problem, but a vascular problem as well.

Another example that I see very frequently is a patient who presents with numbness, tingling and burning to the feet. When a patient presents with neurological problems in the feet the first question I ask is do they have a history of pain back, spinal stenosis or disk disease. Nine out of ten times the patients have low back complaints and nine out of ten times the foot problems are coming from the back. At this time I complete my exam and make my treatment plan. Most times a neurologist consult is recommended. Many people say “well I came to see you because of my feet but you are sending me to a neurologist”. What I explain is that the foot is connected to all other systems of the body.

So whether the foot problem is related to the circulation (vascular), the skin (dermatology), the nerves or the biomechanics I utilize other medical specialists to give my patients a complete and thorough  treatment plan.

With medicine emerging and physicians becoming sub-specialized it is importation for doctors to rely and ask for assistance from their counter parts to help treat their patients.

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

Deep Vein Thrombosis and its relationship to podiatry

Deep Vein Thrombosis and its relationship to podiatry

What exactly is a Deep Vein Thrombosis (DVT)?

DVT is when a blog clot forms in the deep veins, this most commonly occurs in the legs. Symptoms of a DVT can include pain, swelling, redness in the leg. These symptoms can present themselves in different medical conditions, such as infection or lymphedema, therefore, if someone suspects they have a DVT IMMEDIATE medical attention should be sought.

How does a DVT develop?

There are three main risk factors for developing a DVT. They are venous stasis, hypercoagulability and damage to the endothelium. Venous stasis is when the veins are static and not moving. Hypercoagulability is when the blood has a higher change of clotting. Endothelial damage is damage to the blood vessels. Each of these causes has multiple causes. These 3 risks factors together are known as Virchow’s triad. The more risk factors a person has the higher chance of developing a DVT.

Who is at risk for developing a DVT?

Taking Virchow’s triad into consideration the following are some of the risk factors for developing a DVT: immobilization, obesity, surgery, birth control pills, age, cancer, pregnancy, trauma to the leg, infection, HIV and blood clotting disorders etc. There are many other risks factors, but these are the common ones.

How are DVT’s diagnosed and treated?

Immediate diagnosis is critical because if a DVT goes undiagnosed it can travel to the lungs, cause a Pulmonary Embolism and possible death. If a patient has a painful, swollen, red calf an Ultrasound should be performed immediately. There is a blood test that can help rule out a DVT but it is not as sensitive as the ultrasound in diagnosing a DVT.

A DVT is treated with anticoagulation medication, such as Coumadin, Lovenox, or  Xarelto . Treatment is usually required for a few months after a DVT is diagnosed. If someone has a history of DVT a filter can be placed surgically in their veins.

Can I prevent a DVT?

If someone has many risks factors they can take medication for prevention. In addition, exercise, compression stockings and staying active can help.

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

Skin Cancer of the Foot and Ankle

Skin Cancer of the Foot and Ankle

Many people are familiar that skin cancer is usually found on sun exposed areas, for example, the face, back, neck etc. Many people do not realize that skin cancer can appear on the feet and even on areas of the feet that are not sun exposed. In this blog I will discuss different types of skin cancers and how they present on the foot and ankle.

What are the common types of skin cancer that can appear on the foot and ankle?

There are three types of malignant skin cancers that I will discuss.

1.      

Basal Cell Carcinoma

This is the most common type of skin cancer that exists; it is usually localized to one area and does not metastasis. This skin cancer is found on sun exposed areas, it can be on a leg or the top of the foot.  This cancer can appear in a variety of forms, it may appear as an open sore, a pink growth, a bump or a scar. The way to treat this cancer is via excision, or removal. Moh’s surgery, which is a special surgery to remove skin cancer, is the most effective way to completely removal all the cancer cells.

2.      Squamous Cell Carcinoma (SCC)

The second most common type of cancer is SCC. This cancer can metastasis and some patient present first with a pre-cancerous appearing lesion, called Bowen’s disease. In patients that have venous leg ulcerations, a long standing ulcer can develop SCC. Therefore, as a podiatrist when I see a long standing wound I always biopsy it to rule out SCC. This type of skin cancer presents on sun exposed area. It may appear similar to a wart and may bleed. The presentation can vary. Treatment is to remove the lesion and sometimes radiation treatment is needed.

3.      Melanoma

This type of skin cancer is the most dangerous and can spread easily. It can be found on sun exposed areas, as well on the bottom of the feet and the toenails.  When one is concerned about melanoma it is important to follow the ABCs to help with diagnosis.

Asymmetrical, Borders (irregular borders), Color (multicolored), Dimensions (larger than 6mm), Elevation (lesions that are elevated).

If you have a lesion that has any of these characteristics it is important to get it examined.

Melanoma can affect the toenails as well. In Caucasian patients, a dark band that runs along the length of the toenail is concerning. This is usually biopsied to rule out melanoma. If melanoma in the foot is found immediate consultation to an oncologist is recommended for further work up.

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

Sterile Pedicures 08221 08234 New Jersey South Jersey

Last week on ABC’s 2020 there was a segment about the cleanliness at nail salons. The segment discussed how there is a high rate of infections at nail salons. I would like to discuss on this week’s blog about sterile pedicures and their advantage.

In the 2020 segment, ABC went undercover and inspected how certain salons sterilized and cleanse their equipment. Many salons do not disinfect their equipment properly. At our office we provide sterile pedicures. What this means is that all our equipment is sterilized in an autoclave. An autoclave is a machine that cleans medical equipment via steam and pressure. For example, in an Operating Room all surgical equipment is sterilized in this fashion. Using an autoclave significantly reducing the risk of infection since most of the bacteria and fungus is eradicated in the autoclave.

Another common thing to be weary of at a public nail salon is the cleanliness of the water baths. It is difficult to sterilize a water basin that is used for pedicures. The ideal situation would be for a liner in the water basin that can be replaced between each pedicure.

What is the risk in getting an unsterile pedicure?

There are two risks when getting an unsterile pedicure. The first is getting an infection. If the equipment is not clean there is a risk of getting an infection. The second risk is getting an ingrown toenail. Approximately 25% of patients that I see in the office with infected or non-infected ingrown toenails are from nail salons. These patients relate to me that at a salon the technician was trying to get a corner of a toenail out and in the process an ingrown toenail was created. At our office we have medical licensed nail technicians, who have a special certification by podiatrists, who perform our pedicures. They use sterile instruments, new paraffin wax for each patient and cut the toenails across. If the nail technicians are concerned about an ingrown toenail they do not trim the nails and have the patient see the podiatrist.

What is it so dangerous for diabetics to get unsterile pedicures?

Diabetics are immunocompromised, which means their immune system is weakened, and therefore they are at higher risk for infection. In addition to diabetics, patients with Peripheral Arterial Disease are at higher risk of not healing an infection. Patients with these diseases should be careful about getting an unsterile pedicure, if they were to get an infection they would be at high risk of a non-healing wound.  Therefore, it is highly recommended to get a pedicure at our office, where the pedicures are sterile and there is minimum risk for getting an infection.

Recently I filmed “Health Update’ with Robin Stoloff on NBC 40. I discussed the benefits of getting a sterile pedicure. Keep an eye out for the segment to air in the next few weeks.

For more information on sterile pedicures and to schedule one please call the office at 609-272-1450 or visit our website at www.footnj.com

Ball of Foot Pain Part II South Jersey Podiatrist

In last week’s blog I discussed how neuromas and stress fractures can cause pain in the ball of the foot. In this week’s blog I will discuss other causes of metatarsalgia. Just as a review, metatarsalgia is pain along the metatarsal bones. This is a general term and there are many different causes of this type of pain.

What is capsulitis?

A common complaint that many podiatrists hear about is pain along the 2^nd Metatarsal phalangeal joint. This is the joint where the 2^nd toe meets the 2^nd metatarsal. Pain in this area can either radiate to the toe or to the ball of the foot. It is important for the podiatrist to distinguish this with a neuroma, since there can be similar symptoms. Capsulitis is inflammation around the joint, most commonly being the 2^nd toe/metatarsal joint. Many times this can be caused by a patient’s biomechanics. Other times it can be caused by an increase in activity. The 1^st toe/metatarsal joint is programmed to take a significant amount of stress is able to accommodate for the body weight. If there is an excessive amount of activity the stress can shift to the 2^nd toe joint and therefore cause capsulitis. If there is chronic inflammation in the 2^nd toe joint that is not treated it can lead to ligament ruptures. The most common ligament that is ruptured in this joint is the plantar plate. This is the ligament on the bottom of the foot that holds the 2^nd toe and metatarsal in a straight position. If there are even microscopic tears in the tendon the 2^nd toe can begin to drift upward and/or to the side. When this begins to happen this is called pre-dislocation syndrome.  There can be swelling on the bottom of the foot near this joint, sometimes a callus may form in this area. Many patients will confuse this with a hammertoe. A hammertoe is a deformity within the toe joint, whereas pre-dislocation syndrome is a misalignment in the toe/metatarsal joint.

How is pre-dislocation syndrome treated?

This syndrome in the early stages is treated like any inflammation. An x-ray will be performed to rule out a fracture, tumor etc. Anti-inflammatory medications, ice, and rest will help with the symptoms. Orthotics will help in the long run to help support the joint and redistribute the pressure off of the inflamed area.  If conservative treatment fails surgery to repair the ligament and realign the joint may be necessary. Most of the time conservative treatment helps with decreasing the symptoms. If surgery is required your physician will order an MRI or ultrasound to assess the joint and where the damage is. Surgery typically includes repairing the rupture ligament and realigning the toe. Many times a pin or internal hardware is required to fuse the joint into a straight position.  Post operatively orthotics will be needed in order that the dislocation and the deformity do not return.

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

Ball of Foot Pain Egg Harbor Township New Jersey

A very common problem that brings patients to the podiatrists is “the ball of my foot hurts”. This symptom can have many different etiologies. I will take the next couple of blogs to discuss what can cause this type of pain and how it can be treated.

What causes ball of foot pain?

Metatarsalgia, which is defined as pain in the metatarsal region, is known as ball of foot pain. Metatarsalgia is a vague term and therefore it is important for your physician to weed through the symptoms you have in order to diagnose the problem. Many different things can cause metatarsalgia such as a neuroma, stress fracture, tendonitis, capsulitis, fat pad atrophy, gout, rheumatoid arthritis etc. I will discuss each of these disease processes and how to treat them.

What is a neuroma and how can it be treated?

A Morton’s neuroma, which is an enlarged nerve between the third and fourth metatarsals, is a common cause of metatarsalgia. There is a nerve that is “entrapped” and enlarged which sits between the metatarsal. Therefore, shoes and activity can cause compression of the nerve and therefore can cause symptoms. Symptoms typically include sharp, shooting pain, numbness, tingling and burning. The most accurate way to diagnose a neuroma is with an ultrasound. Once it is properly diagnosed usually treatment is via conservative methods. Treatment is aimed at shrinking the size of the overgrown nerve; this includes orthotics and corticosteroid injections. A newer treatment method is a sclerosing alcohol injection; the function of this is to shrink the enlarged nerve. Wearing a wider toe box can also help to relief symptoms.  If conservative treatment fails then surgical removal of the neuroma may be indicated.

What about a stress fracture?

A stress fracture is an incomplete fracture of the bones. Unlike an acute traumatic fracture, this type of fracture may take a few weeks to develop. It is usually caused by over activity and increased stress to the bone. In the foot region the most common bone to have a stress fracture is the 2^nd metatarsal. Many athletes who suddenly increase their activity complain of pain in the ball of the foot. As a podiatrist I am on high alert for a stress fracture in these types of patients. Within the first 10-14 days a stress fracture will not appear on x-ray, and therefore, high clinical suspicion is needed for accurate diagnosis. Applying a tuning fork to the area of concern will cause pain, if there is a stress fracture. Placing a patient in a non-weight bearing immobilizing cast is imperative for healing. Most stress fractures are treated conservatively and do not need surgical correction.

Next week I will discuss other causes of metatarsalgia.

For more information, please visit www.footnj.com

Minimally Invasive Foot Surgery Egg Harbor Township, New Jersey 08234

In the past couple of years Minimally Invasive Surgery (MIS) has become popular in most surgical specialties. For example, within general surgery, laparoscopic surgery is now mainstay. In orthopedic surgery, arthroscopic knee and shoulder surgery is very common. In foot and ankle surgery, MIS is becoming very common and popular. In this blog I will discuss some indications for these type of surgeries and the pros and cons as well.

How is MIS applied to foot surgery?

There are a few types of foot and ankle surgeries that traditionally are performed with MIS techniques. For example, ankle arthroscopy is commonly used to clean out arthritis from the ankle joint. In addition, ankle arthroscopy can be used to remove a talar dome lesion (which is a when a flake of bone gets detached from the talar bone). Traditionally, these 2 types of surgeries were done with large incisions and extensive healing time. Due to arthroscopic ankle surgery, surgery requires a few small stab incisions with a short healing time.

Traditionally, surgery for plantar fasciitis was thru a large incision. More recently it has been replaced with endoscopic surgery. This type of instrument is used to perform the surgery and requires one or two incisions less than an inch long. By using an endoscopic camera and appropriate instrumentation, podiatrist are able to decrease the size of their incision. In addition, there is less damage to the surrounding tissue with this type of surgery.

What are the advantages to this type of surgery?

The most obvious advantage is that with a smaller incision there is a significant reduction in healing time. If bony work is performed that will take the same amount of time to heal, but the skin incisions will heal in a shorter period of time. In many instances these types of surgeries can be performed in a same day surgical suite due to the MIS aspect of the surgery. This type of surgery may have less pain in the post-operative period.

What are the downfalls to this type of surgery?

Due to the fact that these types of surgeries require small incisions, some argue that it can be hard to visualize the appropriate anatomic structures to properly perform the procedure. This can be true in MIS bunion and joint fusion types of surgery. In addition, many times in these types of surgery using x-rays during surgery is typically required. This exposes the patient to more radiation than may be necessary with a larger incision. Some argue that due to small incisions, the surgeon may not be able to see all the vital structures and therefore, there can be damage to important structures during the procedure.

In conclusion, each patient and their surgeon need to discuss what type of surgery is right for them. In addition, there is more data and evidence that certain type of surgeries work better with a large versus small incision and vice versa. Appropriate consultation with your surgery prior to surgery to discuss these matters will determine whether or not you qualify for MIS.

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

Joint Fusions- Part II

In last week’s blog I discussed the details of what is entailed in foot and ankle joint fusion surgery. I discussed the indications, actually surgery and recovery. In this week’s blog I will discuss the pros and cons; I will also discuss when to decide whether or not to have this type of surgery.

What are the pros to joint fusion surgery?

One of the main pros to having this type of surgery is to decrease and hopefully eliminate pain. Many people have severe arthritis or disability from a trauma and have been suffering with pain for years. If this is the case then many times joint fusion surgery will help to eliminate the pain and decreased disability. Joint fusion surgery can help return a patient to a pain free life especially while weight bearing. Another advantage to having this type of surgery would be that most times fusing joints lasts a lifetime and there isn’t a need for a “re do” surgery.

What are the cons to joint fusion surgery?

With joint fusion surgery there is usually close to zero motion at the joint that has been fused. Many patients that have these types of surgeries already have significant decrease in motion in those joints, but by permanently fusing the joints there will be NO motion in that joint. This can be difficult to comprehend until after the surgery is complete. For example, fusing an ankle joint will make it almost impossible to flex the ankle. Fusing the big toe joint will make it difficult to crouch, lunge or go up and down a ladder.

Another disadvantage is that years later there can be residual arthritis that forms in the joints around the joint that was fused. Since the fused joint has no motion the joints around it tend to have increased motion, which may lead to arthritis in those joints.

How does this relate to Lori P?

As I mentioned last week our biller, Lori P., was in a severe car accident in April 2013. She had an open fracture, which is when there is a fracture in addition to bone that is sticking out of the leg. At that time the surgeon was primarily concerned about her losing her leg. When she was medically stable and it was determined that her leg was able to be saved she was in extreme pain. She had severe bone loss and SEVERE arthritis. At that time the decision was made between her and her surgeon that an ankle fusion would be the best option for her long term ability to walk. She went through multiple surgeries, a long recovery, including non-healing wounds and severe pain, but today she is doing great. She walks with a slight limp and on rainy days she complains of arthritis pain in her surgical area. When I told her I was writing this blog about joint fusions she said “the ankle joint fusion saved my life and leg, because of it I am able to walk, live life, work and most importantly, enjoy my grandson”.

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

Fused Joints of the Foot and Ankle- Part I in Egg Harbor Township, NJ

Joint fusion surgery is not very well known about, so I figured I would use this week’s blog to discuss exactly what this produce entails. I was inspired to write this week’s blog because of our office biller, Lori P., who had an extensive ankle injury, and was healed via an ankle fusion.

What exactly is joint fusion surgery and when is it performed?

Joint fusion surgery is a surgical procedure where any joint in the body is fused together as one unit, typically using internal or external hardware. In my profession, fusing joints in the foot and ankle can be done via one, two or even three joints being fused at the same time.  Joint Fusions are usually a last resort treatment option for degenerative arthritis. Many patients suffer from painful arthritis (I have discussed at length in the arthritis blogs) and use many different medical treatments to help with their pain. When all conservative treatments fail and the patient is still in pain, many times the patient and their surgeon opt to fuse joints. Another reason why someone may need a joint fusion is due to trauma, rheumatoid arthritis, infection or other failed ankle surgeries.

What are common foot and ankle joints that get fused?

In the foot, the most common joint to get fused is the great toe joint. Many patients suffer with arthritis in the great toe joint and have significant pain with each step they take. After all conservative treatment has failed many patients opt for a joint fusion.

The ankle is another joint that can be commonly fused; usually ankle arthritis is due to a trauma years prior that did heal well. In the rearfoot (the back of the foot) the subtalar joint, which is the joint beneath the ankle, is commonly fused, to help with severe flatfoot/arthritis.

Keep in mind, whichever joint gets fused, a patient will have zero motion in that particular joint.

What is the recovery like after these types of surgeries?

These types of surgeries require a cast post operatively for approximately 6-12 weeks. During this time being non weight bearing is imperative. At the 12 week mark you will slowly be allowed to weight bear with a below knee removable walker. At this time you will begin physical therapy. Patients should understand that when they get a joint fusion there is zero motion in that particular joint, therefore the joints around that joint will take the brunt of the movement. This fusion will take time for the body to adapt to and physical therapy can help with this transition. Pain is common post operatively but your surgeon will make sure you are prescribed the appropriate medications. Preventing an infection is controlled with antibiotics. Good patient compliance is important to allow for these fusions to heal. Since this is a complex procedure preventing complications is important.

Next week I will discuss the pros and cons of joint fusions and relate them to our biller Lori P.’s ankle fusion.

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

Plantar Warts

What exactly is a plantar wart and how is it caused?

A plantar wart, also known as a verruca, is a form of the Human Papilloma Virus (HPV) that presents itself on the soles, or the bottom, of the foot. Plantar warts are caused by contact with the virus and they enter the skin through tiny cuts or scraps. Due to the fact that many of these viruses are microscopic they are usually present for a few weeks or months before they are noticeable. Many times warts get “pushed into the skin” and a new layer of tissue forms over the wart. This can cause pain with weight bearing, walking and exercise.  On the other hand, some patients have no pain whatsoever but notice a lesion on their feet.

How can a plantar wart be diagnosed?

A plantar wart is diagnosed via clinical exam.  Differentiating a wart from a corn is critical in treatment. Unlike a corn a wart will have small black dots in the center, which are capillaries or the blood supply to the wart. In addition the wart will have pain with direct pressure. Lastly, the skin lines that run on the bottom of the foot will wrap around the wart versus run through the corn.  

How can a plantar wart be treated?

There are many different treatment methods for plantar warts. Different physicians may have different techniques and protocols to treat warts. There are many different topical medications that can be used. Salicylic Acid is a common medication that can be purchased over the counter or prescribed by a physician. Canthrone, which is a beetle juice extract, can be used, which causes a blistering affect, and subsequent removal of the wart. There are different injectables that can be injected to the wart to eradicate the virus.

The warts can be removed via cryosurgery, or the freezing of the warts. Surgical excision, or removal of the warts, can be performed. Laser surgery, which has become more common lately, is another way to treat hard to cure warts.

In general, treating and curing warts is difficult due to the perseverance of the virus. Many of the options listed above take many weeks of treatment. Many physicians have a step wise approach to treating warts. I personally will use Cryotherapy on a younger patient, canthrone on an older patient. I will have the patient apply a medical strength Salicylic Acid during the 2 weeks between appointments. I will typically do 3-4 treatments. For the difficult to treat warts I reserve Laser therapy. Surgical removal of the wart has fallen out of favor due to the many different treatment options available. In addition, surgical removal would require an incision on the bottom of the foot, which is painful and takes a while to heal.

In conclusion, warts are very contagious, easy to contract but difficult to eradicate. Local care by a physician will close follow up and compliance is a great recipe to recovery. If you have a painful or non-painful suspicious lesion on your foot see a physician right away.

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

Charcot Arthropathy

When someone is first diagnosed with this disease their first response is “charcot, like a shark”. Charcot Arthropathy, is pronounced “shark-O” and has a French/German derivative.

What exactly is Charcot and who does it affect?

Charcot is a degenerative process of joints in the foot and ankle and can present in many different ways. It is a slow progressive process and usually presents itself with bones in the foot appearing to have fractures and dislocations. Charcot is a disease process where the joints of the foot and ankle have bony destruction. Charcot is caused by neuropathy, or a lack of sensation, which is primarily caused by Diabetes Mellitus. Other causes can be caused by Alcoholism, syphilis and other causes of neuropathy.

Charcot begins slowly but as the disease progresses it can appear similar to an infection. The joints of the foot that can are affected appear to be red, hot, swollen, deformed and perhaps have an ulceration. There are 4 different stages of Charcot. The first being Stage 0, this is a pre Charcot stage with minimal symptoms. Stage 1 is an acute stage, when a patient will present with the above mentioned symptoms including a red, hot, swollen foot. Stage 2 is the step down from Stage 1 and there is less redness, swelling during this stage. Stage 3 is a dormant stage and happens in between attacks/ Stage 1.

How is this diagnosed?

Diagnosis can be difficult because Stage 1 can represent other pathologies such as infection, gout or septic arthritis. Having neuropathy with Diabetes puts a patient with symptoms at high suspicion for Charcot. Diagnosis can be difficult because when someone presents to their physician with these symptoms the disease has usually been going on for a while. Diagnosis is usually by clinical exam but x-rays, MRIs and CT scans can be taken to aid in the diagnosis.

How is it treated?

Treatment is broken down into surgical or non-surgical options. During the Acute Phase/Stage 1 non-surgical options are the way to proceed. This includes a total contact cast, which is a non-weight bearing cast and doesn’t allow the foot to touch the ground. By using an offloading device it allows the joints to heal.  This phase of the disease can take many months and even up to a year to heal. Surgical treatment is recommended for Stage 3, which includes foot and ankle fusions and reconstruction. Not all patients are candidates for surgical treatment, since there are a lot of complications and a long recovery time from these surgeries.

What are the long term complications from this disease?

Even with early treatment and compliance this disease has flare ups. Flare ups cannot be predicted and as the disease goes on there can be increase bony destruction. As the disease progresses there can be a collapse of the foot with prominent bones that appear to be “sticking out of the bottom of the foot”.  This type of foot is known as a rocker bottom foot. At this stage certain shoes and orthotics can be custom made to help with support of this foot.

In conclusion, Diabetic neuropathy with Charcot can have devastating consequences for a patient. If you are a diabetic it is recommended to see a Podiatrist every few weeks to do a diabetic foot exam. Seeing a Podiatrist regularly can prevent some of these complications.

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

We are now on ZockDoc

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Arthritis Take 3

In this blog I will discuss a less commonly known type of arthritis. Psoriatic arthritis (PA), which affects 15-30% percent of people with psoriasis, can affect the foot and ankle. The skin disorder known as psoriasis is more common than the arthritis associated with it.

What are the symptoms?

PA is more common between the ages of 30-50 and it affects men and women equally. Like some of the other arthritic diseases we discussed in the past few blogs, people with PA can present with an array of symptoms. Systemically, patients can present to the physician being fatigue and lethargic.  Common symptoms are red, hot, painful and swollen joints. PA tends to affect the feet and ankles more than most other joints in the body. Patients can presents with large red toes, also known as sausage toes. Pain in the Achilles tendon and/or plantar fascia is a common symptom in this disease. Other common symptoms would be discoloration and separation of the toenails. In addition to have these symptoms a patient would have to be diagnosed with the psoriatic skin disorder in order to be diagnosed with PA. There is a genetic component to the disease, but there is little that is known about the exact cause.

Below are two pictures depicting the “sausage toe” and the separation and splitting of the toenail.

How do I get diagnosed with PA?

Just like some of the other rheumatologic disease, a Rheumatologist should be consulted to confirm or deny the diagnosis. There are no specific tests to diagnose a patient with RA, but other diseases can be ruled out.  A telltale sign to differentiate this disease from RA would be it affects the distal knuckles in the toes and fingers.  X-rays, MRI, CT scan or Ultrasounds can be performed to assess which joints are affected and the severity of the disease.  

How do I get treated for PA?
Just like the other rheumatic diseases, anti-inflammatory medications and the disease modifying antirheumatic agents are the common ways to treat it. Locally, corticosteroid injections into the affect joints can be performed as well. Exercise is important so that joints do not get stiff and cause long term disability.

This concludes the series of arthritis and the lower extremity. In conclusion, there is a lot of overlap with the symptoms and diagnosis of arthritis in the lower extremity. You should not ignore symptoms and should see a physician as soon as possible.

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

Arthritis Take 2

Last week I discussed osteoarthritis and how it can affect the foot and ankle, but that is only hitting the surface when it comes to rheumatologic diseases and the foot. Rheumatoid arthritis, psoriatic arthritis, and other connective tissue diseases are just a few that can affect that foot and ankle. In this blog we will discuss these diseases, how they affect the feet, how they are diagnosed and most importantly how they are treated.

Rheumatoid Arthritis

Rheumatoid arthritis, also known as RA, is an autoimmune disease that affects synovial joints. It is a painful disease and without treatment it can cause severe disability. 85% of people with RA have symptoms in their ankle and foot joints. Joints with RA appear to be swollen, painful, warm and may become fused over time.  Below is a picture of RA in the hands, which causes severe swelling in the joints.

RA is different from osteoarthritis in that classic RA there appears to be stiff joints in the morning, whereas with osteoarthritis there are stiff joints throughout the entire day. With Osteoarthritis it gets worse over time and then becomes stable, RA becomes worse over time to a point where one cannot function or do daily life tasks.

Diagnosis is made with a multitude of test and via clinical exam. An x-ray of the feet during the mid to late stages of the disease may show subluxed/dislocation joints. In addition, there is decreased space within the joint and an increase in swelling around the joint. A blood test to test for Rheumatoid Factor can be performed, but a positive test doesn’t always mean there is RA and vica versa. During the course of diagnosis it is crucial to see a Rheumatologist, who can help rule out other autoimmune and rheumatologic diseases.

Treatment involves prolonging the disability that comes with the disease. Anti-inflammatory medications as well as disease-modifying antirheumatic drugs (DMAIRs) drugs are the mainstay of treatment. A Rheumatologist will prescribe and monitor these medications. Exercise is also important to help to decrease the symptoms and the disability of the disease.

RA in the foot causes lateral subluxation of the toes, this means that the toes tend to drift to the outside of the foot. Below is a picture where this can be seen.

This foot deformity can be prevented as the physician begins to see the toes are drifting. Once the deformity has occurred the best way to treat this is via surgery. The surgery will re align the joints that are causing the foot to deform. A foot like this can cause a great amount of pain, callus build up and can be very difficult for someone to find shoes.

In conclusion, rheumatoid arthritis is a systemic autoimmune disease that can affect all systems of the body and all aspects of one’s life. Early diagnosis is crucial to prevent long term problems. Concomitant care by your physician and by a rheumatologic specialist is critical for proper early treatment.

For more information on RA, visit http://www.arthritis.org/conditions-treatments/disease-center/rheumatoid-arthritis/

Next week I will conclude these series with Psoriatic arthritis and the feet.

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

Arthritis and your feet

Many people visit their physicians with compliant of foot pain that they contribute to arthritis. Many people think that as they age arthritis is “normal” and that it is okay to be suffering with this pain. The truth is there are many different types of arthritis that affect the foot and ankle, and people don’t have to suffer with pain sine there are many different treatment options.

Osteoarthritis

The most common type of arthritis to affect the foot and ankles is osteoarthritis. Osteoarthritis affects over 27 million Americans and as the population ages the numbers will continue to rise. Osteoarthritis is a degenerative process where the cartilage in the joints becomes eroded. This may lead to pain, stiffness, swollen joints, hearing cracks in the joints while walking, feeling like joints “are about to give out” and decreased in daily activities of life. This type of arthritis is related to an increase in age, trauma, genetics, and other medical conditions. Diagnosis is made by clinical exam and/or by x-rays, MRI, and CT.

What type of treatment options are there for me?

Osteoarthritis in the foot and ankle is usually treated with conservative measures first. Decreasing one’s weight and increasing one’s activity may reduce the symptoms of osteoarthritis. Exercise, which is not destructive on the joints, is good to help with the pain, such as swimming. Anti-inflammatory medications help with pain reduction but are not always a long term solution. There are different types of anti-inflammatory medications depending on the severity of the osteoarthritis. Some of the anti-inflammatory medications have gastrointestinal side effects. In addition, there are topical anti-inflammatory medications, which have no systemic gastrointestinal effects. Injections of steroids into the affected joints, will help with short term pain reduction, but will not help with cartilage loss.

If all of these measures fail, surgery is the next step in treatment. Depending on where the osteoarthritis is located and what the exact symptoms are, will determine what type of surgery is required. If the ankle is affected, arthroscopic surgery is performed as first line therapy. If that does not help an ankle fusion or replacement may be required. There are many other foot joint, such as the subtler joint, that can be affected by arthritis. If this is the case fusion of that joint is necessary. Prior to surgery your physician will order an MRI or CT to determine the extent of the arthritis and the cartilage loss. The recovery from these surgeries is a few months in a cast with no weight to the leg. Due to the extent of the surgery and the recovery, this option is a last resort for the really debilitating cases of arthritis.

Osteoarthritis is the most common type of arthritis to affect the foot and ankle, in next week’s blog other forms of arthritis, such as rheumatic and psoriatic, will be discussed.

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

Foot Wounds: How to avoid them and how to treat them

There are many different types  of wounds that may appear on the foot and/or leg. The most common ones seen by podiatrists is a diabetic wound, which are caused by neuropathy (which is damage to the nerves, [see earlier blog on diabetes]). Many of these patients do not feel their feet, and therefore, present to a physician with an infected wound. Other types of common leg wounds are pressure wounds, the most common location being the back of the heel. These types of wounds would be found on bed bound patients. Another common type of leg wound is an arterial wound which is caused by Peripheral Arterial Disease (see earlier blog for more on PAD).  Another leg wound is a venous wound, when the veins in the legs don’t work properly and a wound develops on the inside of the lower leg. Despite what type of wound one has proper wound care, in addition to close supervision  by a trained physician in the field of wound care is critical to healing wounds.

Why are wounds so hard to heal?

Many times wounds are not treated until they are large in size. Many people with wounds many attempt, with good intentions, to treat the wounds by themselves. Usually wounds need to be treated with a multi team approach, including podiatrists, vascular surgeons, plastic surgeons etc. Many wounds tend to take a long time to heal due to other underlying medical conditions. For example, a diabetic wound can take a while to heal due to poor control of blood sugar, peripheral neuropathy and possible lack of circulation. Once all these issues are addressed the wound may have become chronic. In addition, wounds that are caused by arterial or venous disease need close supervision and many times surgery by a vascular surgeon. Without enough blood flow a wound will not heal. Many wounds that are caused by the venous disease take a long time to heal due to severe leg swelling, known as lymphedema. If the swelling is not controlled the wound will not heal.

Where do I seek treatment for a wound?

The best place to seek treatment wound be a wound center. Many hospitals around the country have a wound healing center, which employ the necessary multi specialties to help with wound healing. Internists, Infectious Disease Specialists, Podiatrists, Vascular and Plastic Surgeons are the type of physicians that wound work at a wound center. Many wound centers contain Hyperbaric Oxygen chambers, which are machines with high levels of oxygen, which help accelerate wound healing. In addition, there are many specialty, advanced wound care products, dressings and grafts, that can only be found at wound centers.

How Can I prevent a wound?

Patients that are high risk for wounds include diabetics with neuropathy, people with PAD, people with severe varicose veins with swollen legs, people with sickle cell etc. These patients should carefully inspect their feet daily to make sure there are no small cuts or openings. On the first site of an open lesion they should contact their physician. In addition, if a patient has an area on their foot that many be more prominent and perhaps be a pressure point, proper orthotics and offloading shoes can be dispensed by a podiatrist.

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