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

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

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