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