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

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

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

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

High Arches; when high is too high

Recently during a patient encounter the patient said to me “Doc I was told I have high arches, but aren’t having arches a good thing”. I responded that although having an arch in the foot is good there is a point when arches become too high that it turns into a problem.
An excessive high arch, also known as Pes Cavus, literally translates in Latin to a “hollow foot”.  A cavus foot type is less common that the flat foot type, with about 10% of the population having this foot type. Despite the rarity, people that have this foot type can have just as many symptoms in the foot and ankle as people with flat feet.
How does someone get a Cavus foot?

A cavus foot can either be passed down through genetics or acquired during one’s life. Genetically there are rare neurological disorders that can be represented with a high arch foot. These disorders tent to have multiple other symptoms throughout the body. A cavus foot can be acquired whether due to muscle weakness that can cause the development of the high arch or a clubfoot deformity that was not fixed correctly. There can be many causes of high arch feet and amongst the literature there is still some ambiguity as to cause in some instances.

What are the symptoms of a Cavus foot?

The symptoms of this type of foot can vary and are hard to predict. Depending on what type of shoe gear someone wears will also predict their symptoms.  Symptoms can include pain in the metatarsal region, constant ankle sprains with weak ankles, Achilles tendonitis, difficulty with shoe fitting, stress fracture, and knee pain, just to name a few.  Formation on of hammertoes is a common side effect of a long lasting cavus foot type.

How does one treat a Cavus foot?

If someone if diagnosed with this type of foot and they have minimal pain or no pain the goal is to prevent symptoms in the future. Proper fitting shoe gear is essential. That would include a shoe with a build in arch. High heel shoes will put more pressure on the toes and metatarsals and can cause more discomfort and even metatarsal stress fractures. Custom molded orthotics can be built for a high arch foot which can prevent foot pain.

If cavus feet are causing severe symptoms surgery can be performed. Before undergoing surgery your surgeon will determine where in your foot is the deformity coming from. This can be performed by a simple test, which includes standing on a block and seeing if the deformity disappears. Once surgery is decided upon there are many options of how to fix the deformity. You and your surgeon will decided what procedure is most suited for you.

Don’t ignore a high arch just because you may think it is normal. If you are having any foot discomfort please see your physician for treatment.

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

The “Ins” and Outs of Ingrown Toenails

How do people develop ingrown toenails?

http://footnj.com/podiatrist-new-jersey-about-us/23/236-ingrown-toenails
In grown toenails, also known medically as Onychocryptosis,  are caused when the edges of the nail grow into the skin and cause pain. Many times this is caused by incorrect trimming of nails, tight shoe gear or nail disease. Onychomycosis, also known as  fungal nails, is a common cause of ingrown toenails. A fungus will cause the toe nail to thicken and subsequently to grow into the nail corners, causing pain. If someone has an ingrown toenail that is not treated pain can intensify to a point where shoe gear is not tolerable. If an ingrown toenail remains untreated an infection can develop. When an ingrown nail becomes infected is called a paronychia.

How do I treat an ingrown nail to prevent an infection?
Proper nail trimming is the key to prevention. Podiatrists recommend cutting nails straight across and not into the corners. Many adolescents tend to be “pickers” and this is a common age group for infected ingrown toenails. If someone is developing an ingrown it is recommend seeing a physician as soon as possible. The physician has proper instrumentation to help relieve the pressure an ingrown nail may be causing.

How do I know if I have an infection and how can it be treated?
If an ingrown nail is untreated an infection can develop. The signs and symptoms of an infected toenail, also known as a paronychia, are redness, swelling, pus, increased pain and an odor. If one is suspicious that they have an infection it is recommended to see a physician as soon as possible. If it truly is an infection your physician will recommend removing the offending nail border and draining the infection. This will require local anesthesia to the toe, which can be done in the office with minimal post-operative pain. Once the infection is drained you will most likely be placed on antibiotics for a few days. You will be given instructions on how to dress the wound and follow up with your physician in a few days.

What if I continue to get infected ingrown toenails?
If you tend to get infected toenails a few times a year it is recommend to remove the cause of the problem. This would be done via a procedure called a matrixectomy, where the root of the offending nail is permanently destroyed.  This  surgical procedure can be performed in the office with local anesthesia to the toe. Once the toe is anesthetized the physician will remove a section of the nail that has been causing the problem. At that time a chemical can be placed over the nail root to kill the root. One can also have a similar procedure where the nail root is physically removed from the body. There are different methods of removing/destroying the nail root. Whichever method you and your physician choice will determine your post-operative course. Most patients are completed healed within two weeks.

In summary, ingrown toenails and infection are preventable. If they do develop seeking medical attention is necessary, which can prevent worsening of the problem in the present and in the future.

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