5 Tips for Foot or Ankle Surgery Preparation

Guest blogger Brooke Williams talks about preparation for surgery.  She shares some great ideas!

If you have foot or ankle surgery in your near future, you will have to prepare for that surgery in advance to make the recovery as easy as possible.  Here are five tips to help you prepare for foot or ankle surgery.

Tip#1: Understand the Healing Process

Your body has a great healing property and you will want to prepare it to heal itself as best you can.  Your doctors will do some of the repairs, but once you get home, your body will do the rest.  What you need to do in advance is understand the healing process so that you can help it along.  One thing you will need to think about is the nutrition your body will need to heal.  You might want to plan out some meals before the surgery so you can ensure that you will have the right nutrients and vitamins in your diet.  You will also want to think about an exercise schedule to ensure that you don’t get too sore and stiff when you recover.  Understanding what you will have to do to aid your healing will be a great way to start the recovery process before the surgery even occurs.

Tip#2: Study Your Condition

Once you have a diagnosis, you can prepare for your surgery by understanding your injury.  Knowing how you are injured and what the surgeon will do to fix it will help you know what is vulnerable as you recover.  You will then understand what type of activity you can do and what will be more limiting.  The recovery process will go more smoothly if you know what you need to do to avoid hurting the area again.

Tip#3: Know Your Body

No one knows your body better than you do and understanding how it works on a daily basis will help you know when to bring things to your doctor.  If you are able to describe your complaints, notice the differences in your body and understand when you have gong far enough, your recovery process will be much easier.  You are not like any other patient and you need to remember that you are the only one who can fully understand what is going on in your body.  Knowing yourself will help you recover.

Tip#4: Hydration

You will want to stay hydrated before and after the surgery process as well.  Doctors will make sure you get fluids during the surgery, but if you drink before you go in, you will benefit yourself.  Your veins will be easier for the nurses to find and the procedure will be less painful later.

Tip#5: Consider Mobility

It is also a good idea to think about how you will get around after your surgery before it ever happens.  Crutches can be very helpful, but they can also be limiting and they can even hurt.  The good news is there are several other options on the market from Goodbye Crutches.  The Hands Free Crutch, for example, is a device that straps to your leg, allowing you to walk much like normal while retaining the use of your hands.  The Knee Walker is an option on wheels that lets you scoot from place to place using your good leg.  And the Seated Scooter allows you to have somewhere to sit no matter where you have to go.  Examine the options, think about your lifestyle, and then order the best choice for you before the surgery occurs so you can get comfortable and practice with it.

Answers To Toenail Fungus Quiz!

Yesterday, I posted a short quiz on toenail fungus (onychomycosis).  As promised, here are today's answers (along with the questions in case you missed them yesterday):

1. Nail fungus is a sign of bad hygiene.

True or False

2. Nail fungus is commonly caused by the fungus that causes ringworm.

True or False

3. Failure to treat athlete’s foot will increase your chances of developing toenail fungus.

True or False

4. Common places to catch infections are locker rooms, pool sides, etc.

True or False

5. Fungal infection of the nail may destroy the nail.

True or False

Answers:

1. False---Nail fungus is an infective problem. It has no relation with nail hygiene. Nail fungus is caused by a fungus or a type of yeast.

2. True---The fungus of the dermatophyte family that causes ringworm, also causes nail fungus.

3. True---If you don't treat athlete's foot, the infection may reach the nails and infect them.

4. True---Common areas that are infected with fungus like locker rooms, pool sides, etc. are the places where you catch nail fungus infection. Wash your feet after visiting such places, dry them and if you are susceptible to fungal infections, apply an anti-fungal ointment. Wear footwear whenever possible.

5. True---If the infection spreads, the nail may get detached and may fall off.

Unlike when I first began to practice podiatry, there are treatment options for toenail fungus that actually work!  As a new podiatrist, the best options I had available for the treatment of toenail fungus included periodic trimming and grinding down of toenails (which did not resolve the infection) and permanent removal of the affected toenail(s) - not a very popular option. 

Today, however, I can offer three options for treating toenail fungus.  First, for mild cases, there are topical antifungal medications.  I prefer a medication called Formula 3.  It is applied twice daily for one year.  This does take some effort on the part of the patient, and for severe cases, the medication has a hard time penetrating the toenail deep enough to actually kill the fungus.  Formula 3 is available for sale in my office.

The second option available is an oral mediation called terbinafine.  This is the generic version of Lamisil.  Because it is taken internally, the medication becomes incorporated into the toenail, and over a period of several months, the toenail gradually grows out clear.  Over the years, I have seen a lot of success with terbinafine.  However, not everyone is able to take terbinafine.  Some patients cannot take terbinafine due to potential harmful interactions with other medications they are taking.  In addition, those with kidney or liver disease should avoid terbinafine. 

The final option that is now offered at Concord Foot and Ankle Clinic is the use of the PinPointe FootLaser.  This laser was specifically designed to treat toenail fungus, and is FDA approved for the treatment of the onychomycosis.  The PinPointe FootLaser works by gently heating the toenail bed, thereby killing the fungus.  Once the fungus is killed, the toenail gradually grows out clear.  This is a procedure that is done in the office, taking 30 to 60 minutes.  Some patients may experience temorary warmth during the procedure; however, anesthesia is not required.  Because of the gentle way the PinPointe FootLaser works, there are no known side effects, and is a treatment option open to almost everyone.  As with other treatments for onychomycosis, clearing of the toenail takes several months, and is seen first at the base of the nail as new, disease-free nail begins to grow out.  To learn more about the PinPointe FootLaser and to see if it is right for you, visit my website by clicking here.  While there, you can browse through the gallery of before and after pictures.  You may also wish to simply call my office at (574) 875-8698.  We would be happy to answer any questions you might have.

With all the treatments now available for onychomycosis, there is no reason for anyone to continue to suffer with this condition. 

Toenail Fungus Quiz

One of the most common conditions treated by podiatrists is toenail fungus (onychomycosis).  When infected, toenails become thickened and discolored (often yellow, white or brown).   While always unsightly, severe cases can cause considerable pain, especially when shoes are worn.  When I first started practicing podiatry, treatment options were limited.  However, there are now options available to successfully treat the condition.  First though, let’s take a quiz on toenail fungus. 

1. Nail fungus is a sign of bad hygiene.

True or False

2. Nail fungus is commonly caused by the fungus that causes ringworm.

True or False

3. Failure to treat athlete’s foot will increase your chances of developing toenail fungus.

True or False

4. Common places to catch infections are locker rooms, pool sides, etc.

True or False

5. Fungal infection of the nail may destroy the nail.

True or False

How do you think you did?  The answers to the quiz will be given tomorrow, along with a discussion of the exciting new treatment options available.

Why Pain is Good

Really?  How can this be?  To talk to most people, they will do just about anything to avoid pain.  Indeed, I spend a lot of my time treating patients who have pain that keeps them from doing the things they enjoy in life.  Just ask a person with heel pain, or a painful ingrown toenail, and they will tell you how much pain is, well, a pain!  But pain is there for a reason.  Pain lets us know that there is something wrong and needs attention.  Imagine if you were to break a bone in your arm and have no pain.  You would likely not think there was anything wrong.  You would not protect the arm or seek treatment.  And it is likely that the fracture would not heal properly.  This is why pain is good, even though no one likes it.

For my diabetic patients, pain is not only good, but vital.  Problem is, many patients with diabetes develop a condition called peripheral neuropathy.  With peripheral neuropathy, the sensory nerves (primarily in the feet and lower legs) do not function as they should.  The pain signal is not transmitted to the brain.  This leads to some severe consequences.

A patient I saw recently was a perfect example the consequences of peripheral neuropathy.  He was working and stated that at the end of his work shift, his foot felt uncomfortable.  When he took off his shoe, he found that he had stepped on a nail that had gone through his shoe and into one of the bones in his foot.  Now, if I had stepped on a nail, you can bet that I would know right away that something was very much wrong.  I suspect that everyone around me would be aware as well, as they would likely cover their ears from my screaming.  However, this patient likely walked around for at least a few hours with a nail in his foot!  This of course made a bad situation worse.

Most of the time, the problems I see are not as dramatic in their presentation, but have the potential to be equally as devastating.  Quite often, it is not the nail in the foot that causes the ulcer or sore to form, but the constant light pressure from a callus or ill-fitting shoes that causes damage to the skin.  For this reason, I strongly urge all my diabetic patients to inspect their feet daily looking for signs of an ulcer developing.  These signs can include redness, swelling, bleeding.  If calluses are present, darkening of the callus can be a sign of bleeding and skin breakdown.  A best case scenario is to have a spouse, partner or friend inspect the feet, as it can be difficult to fully examine your own feet.  And by all means, if anything is seen that raises a concern, DO NOT DELAY calling your podiatrist to have your feet looked at!  It may save you from a long, difficult healing process.  It may avoid the need to amputate your leg.

To learn more about diabetes and its effects on the feet, please visit my website at http://www.concordfootdr.com/diabetic-foot-care.html

A Success Story!

About 2 weeks ago in my last blog posting, I talked about one of the treatment options for painful morton's neuromas - a cortisone injection.  Those who may remember, the "patient" was myself.  I had been having moderate pain in my right foot from the neuroma, and it was getting worse.  I decided to inject my foot with Kenalog, a type of cortisone.  The purpose of the injection was to help to relieve pain, and hopefully cause some shrinking of the neuroma itself. 

After my injection, I noticed an immediate decrease in pain.  This was expected, since I also had included a local anesthetic in the injection.  After several hours, the local anesthetic wore off, and the pain came back just as bad as before.  This was to be expected, and I was not surprised.  I can see how this can be discouraging to patients though, which is why I warn them that he effects of the cortisone can take a few days to become evident.  When I woke up the next morning, I was pleased to find that my pain level was decreased by about 50%.  The next day, the pain was 100% resolved!  That was a welcome relief!  Since that time, I have not had any pain in my foot whatsoever!

The real question now is this:  How long will this pain relief last?  The honest answer to that question is that I really don't know.  In most cases from patients I have injected for this condition through the years I have been in practice, pain relief will last for several months.  I do have some patients who never have symptoms again, others will come back 6 months later stating the pain has returned.  I have no problem with giving injections a couple times per year on an ongoing basis to control symptoms.  However, if the symptoms come back more quickly, it's time to get more aggressive.  I, like my patients, am hoping for the best!  Look for further updates on this subject in the coming months!

Treating a Morton's Neuroma via a Cortisone Injection

As a podiatrist, I have treated the condition called morton's neuroma many, many times over the course of my 22 years in practice.  However, my latest patient hit much closer to home.  Me!  Turns out I have developed a neuroma in my right foot recently, and have had the opportunity to experience first hand what my patients have been experiencing all these years. 

A morton's neuroma occurs in the forefoot and consists of inflammation and swelling of the nerve.  This will frequently cause pain that will radiate out to the 3rd and 4th toes.  Often there is a tingling, burning or shooting sensation reported.  It is unclear the precise cause of this deformity, but damage to the nerve is suspected.

There are numerous treatment options available to treat this condition.  In my office, I like to start with simpler options first.  In my case, I decided to administer a cortisone (steroid) injection to the nerve.  This can be helpful in decreasing the inflammation and pain in the nerve, although the relief from an injection is often not permanent.  Other treatment options include the use of orthotics, anti-inflammatory medications, icing, decreasing activity levels, and surgery.  Like most patients, I would like to avoid surgery!

For your viewing pleasure, I had my assistant record myself administering the injection.  My experience was like that of many of my patients over the years - the injection for a neuroma is not that painful.  The fact that I was able to give it to myself while standing is a good indication that this was not a traumatic experience.  As I continued with the injection, I could feel the area become numb, since I also injected a local anesthetic with the cortisone.  You may notice that the injection took over a minute.  I have found over the years that injecting slower decreases the pain, since the local anesthetic will numb the area as the injection proceeds.  Typically though, the cortisone will take a few days before patients notice relief following a cortisone injection.

http://www.youtube.com/watch?v=DTMJ4KOqcr8

I will update this blog in the coming weeks to let you know if my injection helped to relieve my symptoms.

When Should I Call My Podiatrist?

Over the years, I have noticed that many of my patients hesitate to call my office for an appointment, wondering if the problem they have will just get better by itself.  Sometimes, that is the correct thing to do – wait a few days to see if it gets better.  If it does get better, then you’ve saved yourself from having to come in to see the doctor.  However, there are some instances when waiting a few days (or weeks) can be dangerous, and you can end up with a very serious problem that could have been treated without too much difficulty had it been addressed sooner.  I would like to discuss a few instances where waiting to see the doctor is a poor choice.

If you have diabetes, and notice any redness, blistering, warmth or open sores on your feet, I personally want to see you ASAP.  We will make room for you on the schedule.  We will stay late.  If for some reason, we can’t see you, we may even recommend you go to the emergency room at the hospital.  It is shocking how fast a little blister on the foot can progress to a large, infected ulcer (sore), leading to possibly loss of the leg itself.  If you have had a past history of a foot ulcer, or have poor circulation, you are at even greater risk.  Please don’t wait to call!

Any injury that causes significant pain, you really should have it looked at.  Often, patients will say that they didn’t think they needed to be seen after an injury because they could still walk.  The ability to walk or move the injured part of the foot, they reason, means it is not broken.  While this may sound reasonable, it is in many cases not so.  I have seen many fractures over the years that were dismissed as a simple sprain just because they could still walk.  Your suspicion for a fracture should be higher if you see significant swelling, pain that persists beyond a few days, or see bruising around the injured site.  And, when you come to my office, I may believe there is a fracture based on my exam of you, but even I won’t know for sure in most cases until an x-ray is taken.  Fractures that are not addressed can lead to poor healing, or in some cases, lack of healing at all.

Ingrown toenails are something that patients will put up with for weeks, and in some cases, months before coming in to see me.  And it is true that mildly ingrown toenails will sometimes work themselves out.  However, I have found that a lot of patients delay coming in to have the ingrown toenail treated because of fear of the minor surgery to remove the ingrown nail.  Let me put that fear to rest.  The vast majority of patients who have ingrown toenails removed say to me afterwards that the procedure was not anywhere near as painful as they had feared, and they express relief at how much better the toe feels afterwards.  Contrast that to the patient I am currently treating.  He has a severely ingrown, infected toenail that has been literally festering for years.  In his case, the infection has gone into the bone, and he now is scheduled to have his toe amputated to remove the infected bone.  This is not something that happens frequently, but had I been able to address his ingrown toenail when it first became an issue, he would have been relieved of years of pain, and he would not be losing his toe.

Finally, heel pain is a problem that patients tend to procrastinate treating.  If a patient were to begin to feel the symptoms of heel pain (also known as plantar fasciitis), I would recommend first using over the counter arch supports.  If the symptoms are not improving in a week or so, I would recommend having the patient into the office to see me to verify the diagnosis, and begin more aggressive treatment of the condition.  Plantar fasciitis is a condition that can almost always be treated successfully using conservative measures.  I have found that those patients who do go on to require surgery, their symptoms have been present for longer periods of time, often without any treatment being received at all.

The list I have provided in this blog is certainly not conclusive.  In short, if a patient feels any concern at all about their feet, I recommend having them come in for an evaluation.  It may be that nothing is wrong.  If that’s the case, you’ll have peace of mind.  However, if something more serious is amiss, we can get you on the road to a full recovery.

How Long is "Too Long" When You Are Waiting to See Your Doctor?

Few things about seeing a doctor are more frustrating than having to wait for long periods of time before you’re seen. In my mind, having to wait for 10 to 20 minutes is acceptable. If you find yourself waiting for more than 30 minutes, that’s too long. Several years ago, I myself waited over an hour and a half before I saw the doctor! Why is it that doctors make their patients wait so long? Does it have to be this way? What can you do to help?

After more than twenty years of running my own office, I have some thoughts as to why we as doctors run behind schedule at times. Let me say that running on time is something we take very seriously at Concord Foot and Ankle Clinic. I don’t like having to make people wait on me any more than they like waiting. And most days, I can proudly say, we see patients on time. But there are “those days…”

First and foremost, seeing a doctor is not like getting the oil changed in your car. We can’t always know ahead of time how long each patient will take to be treated adequately. So, reason #1 for falling behind is because a patient who we expected to have a simple visit turns out to be much more involved and takes more time than expected. An example of this would be a diabetic patient, seen for toenail care, and during the course of examination and treatment, I discover an ulceration, or a sore on the foot. Suddenly the 10 to 15 minute visit ends up taking me 45 minutes! And sadly, patients scheduled after the one needing the extra attention, end up paying the price by having to wait longer to be seen. I have found most patients are very understanding when I explain that an earlier patient during the day required extra care, causing me to run behind schedule. They seem to understand that it could just as easily be them needing the extra care the next time around.

Reason #2: We sometimes fall behind schedule in our office because one or more patients do not show up on time for their appointments. When they do show up, they invariably show up the same time as the next patient. In that case, no matter which patient I see first, the two will take longer than the allotted time for the one patient, putting me behind schedule.

Reason #3: This has to do with patients coming to the office unprepared. For new patients, we send out forms to be filled out ahead of time to streamline the process of checking them in. If they forget the forms, or bring them in not filled out, it affects how long others have to wait.

Reason #4: There are days when I perform surgery, that for a variety of reasons, my case starts late, or perhaps ends up taking longer than I had anticipated. Normally, my office schedules in a “fudge factor” following surgery to account for any delays before patients are scheduled in the office, but sometimes, the delay is more than we had planned.

Reason #5 has to do with overbooking the schedule. This is sometimes the fault of the doctor’s office, and sometimes is unavoidable due to urgent conditions that can’t wait to be treated. In the example I gave above, I was being seen for a fracture in my arm. I was being squeezed into an already full schedule. However, I had to have the fracture treated that day, not next week. And although I did not like waiting, I understood the reason for the long wait.

So what can you do to help? First, show up to your appointment on time and prepared. When you make the appointment, communicate with the scheduler all the reasons you need to be seen so that adequate time can be allotted for your visit. If it appears that the doctor is behind schedule, ask for an estimate of how long the wait will be, and if necessary, reschedule the appointment. Another great idea is to schedule your appointments for the first thing in the morning, or the first patient after lunch. If you find that a particular office is ALWAYS behind schedule, ask to speak to the office manager. Explain your displeasure in having to wait so long to be seen, and if the problem cannot be resolved, it may be time to start shopping for a new doctor.

Tobacco and Your.... Feet?

Everyone is aware of the dangers of smoking to your lungs and heart. But the effects of smoking go far beyond your heart and lungs. Are you aware of what smoking can do to your feet? When I tell patients that smoking cigarettes can affect their feet, many are surprised. But the fact is that smoking can lead to serious problems with your feet.

First, when you smoke, levels of carbon monoxide become elevated in the bloodstream. Carbon monoxide displaces oxygen in red blood cells, and the result is that the blood is not able to carry as much oxygen. Since the tissues in your body (and feet) need oxygen, this is serious. Once oxygen is displaced from the blood cell by carbon monoxide, that blood cell can no longer carry oxygen for the rest of its lifespan (about 3 months).
Secondly, nicotine, which is found in cigarettes, causes the blood vessels to constrict and become narrower. This decreases the amount of blood (that’s the blood that already is carrying less oxygen) that can get to the tissues. The effects of nicotine diminish after two weeks, so quitting can improve circulation in a relatively short period of time.

Thirdly, smoking greatly increases the risk of PAD (peripheral arterial disease). This occurs when the arteries become clogged with plaques, further decreasing blood flow. Of the three main effects of tobacco smoking on circulation, this is the slowest to reverse itself after smoking is stopped (see www.padcoalition.org).

Why should you care if your feet are receiving adequate blood flow? Patients with poor circulation often will develop a condition called claudication, which manifests itself by causing severe pain in the legs when a person walks for short distances. In essense, the pain is a result of the muscles being starved of oxygen. When blood flow is poor, your body’s ability to heal itself (such as if you have an ulcer) is greatly diminished. Bones are also slower and more difficult to heal with a smoker who has poor circulation. In fact, when the circulation is bad enough, healing will not occur at all. This leads to tissue death (gangrene), and ultimately, amputation of a portion of the foot, or even the leg. This is very serious, because studies have shown that the 5-year mortality rate following a major amputation was 68%! This is higher than those diagnosed with colorectal cancer (39%), breast cancer (23%), Hodgkin’s disease (18%), and prostate cancer (8%). Losing a leg is not something to be taken lightly. Lung cancer, as it turns out, has a higher mortality rate (86%), but then again, tobacco is the major cause of that cancer too.

So what can be done? First, if you don’t smoke, please don’t start. I know very few people who are happy about the fact that they’re addicted to cigarettes. Secondly, if you do smoke, talk to your doctor about ways to quit. It probably will not be easy, but will most definitely be worth not only saving a foot, but saving your life!

Seven Questions To Ask Your Podiatrist BEFORE Foot Surgery

You’ve made the big decision to have surgery on your foot. You will likely have an appointment with your podiatrist shortly before surgery to discuss the surgery, and you will also in most cases be asked to sign a consent form. Instead of just listening to your podiatrist tell you about the upcoming surgery, here are some questions you can him/her to make sure you understand all aspects of what will be happening before, during and after surgery.

Question #1: Is this surgery necessary? The follow up question to that is what would happen if the surgery was not performed. In most cases, foot surgery is elective. What I mean by elective is that while there may be good reasons to do the surgery, such as relieving pain, it is not mandatory that the surgery be performed. An example of a surgery that is not elective would be surgery to remove a ruptured appendix. So in the case of your bunion, for example, it may be important to perform the surgery to allow walking and wearing shoes without pain, but people can and do live with bunions. In the bunion example, perhaps your podiatrist will say that not performing the surgery will likely lead to progression of the bunion which will lead to more pain, and a more complicated surgery down the road to correct.

Question #2: What type of anesthesia will be used? For anesthesia, there are a few choices which you may want to discuss so that the experience of foot surgery is as comfortable as possible.

The first choice is local anesthesia, which means the area to have surgery is made numb by given an injection of a local anesthetic. This works very well for simple procedures, and in some instances, may be the preferred method for even more involved cases. It is very safe, and although the injection is uncomfortable, once the area is numb, you will feel no pain the remainder of the surgery. You will be able to hear what is going on, which can be disconcerting to some patients.

The second choice is called monitored anesthesia care. This is the type of anesthesia I usually use for most of my surgeries performed in a hospital or surgery center setting. Medication is given through an IV by an anesthesiologist to put the patient in a light sleep. Once the patient is asleep, the part of the foot that will be operated on is numbed by a local anesthetic. Then, during the procedure, the patient usually remains in a very light sleep. No breathing tube is used – the patient is able to breathe by him/herself. Typically, the patient is unaware of what is going on, hears no sounds, and when the procedure is done, wakes up to a numb foot feeling well-rested.

The third choice of anesthesia is general anesthesia. In this case, the patient is put totally asleep by the anesthesiologist. A breathing tube is put down the throat, and the procedure is done with no chance of the patient ever being aware of what is going on. Recovery following general anesthesia is a little longer, but this too is usually very well tolerated by patients. A sore throat afterwards is not uncommon. If I perform a surgery using general anesthesia, I will generally numb the foot at the end of the surgery so that the patient will have no pain for several hours afterwards.

What anesthesia is best for you? Talk over the choices with your doctor, and the two of you will come up with a plan for what will be best for your particular surgery.

Question #3: What restrictions will there be after surgery? Will you be able to walk on your foot? How much? Will you be able to get the foot wet? Will you have to wear any special shoes or perhaps a cast? If you cannot walk on your foot, what method of keeping weight off your foot will be used? (crutches, wheelchair, etc?)
If you will be using crutches, ask your doctor or his assistant to show you how to use them, particularly going up and down stairs.

Question #4: How long will I be off of work? This question will depend in large part on both the type of surgery performed, and the type of work you do. Someone who sits a desk for work all day will be able to return to work much sooner than someone who does extensive standing or walking as a part of their job. When your doctor gives you an estimate on when you’ll be able to return to work, please understand that it is just an estimate. Perhaps things will go very well, and you’ll be back to work sooner, or perhaps you will take a little longer. The period of time given will usually be an estimate on what most patients experience.

Question #5: How long will it be before I can return to my regular shoes and my normal activities? Again the answer to this question will depend on the surgery performed, the shoes you would like to wear, and the activities you plan on participating in.

Question #6: How will post-operative pain be managed? With any surgery, there will be discomfort in the period afterwards. Pain medication will help to decrease the pain, but will rarely make it go away completely. Ask what you can do to help control pain. This might include icing your foot, keeping it elevated, etc.

Question #7: Under what circumstances should you contact the doctor after surgery? From my perspective, I want patients to call me if there is bleeding that is excessive (coming through the bandage), the level of pain is unbearable, they injure the surgery site, or they get dressings wet that were supposed to be kept dry. However, you should feel free to contact your doctor whenever you have a serious concern.

Surgery is a partnership between the patient and the doctor, and best results are obtained when the patient fully understands the process and is committed to doing his or her part.

Ingrown Toenails

One of the more common problems that causes patients to come see me is for the treatment of ingrown toenails. They are painful, persistent, and can really make life miserable. For some reason, I see a lot of fear on my patients when it comes to the treatment of this problem. I would like to explain what causes ingrown toenails, and what the preferred treatment is for most of my patients.

Ingrown toenails can affect people of all ages. I have seen infants with ingrown toenails, elderly patients, and everyone in between. What causes them to occur? Sometimes it is just the inherited shape of the toenail that predisposes people to develop ingrown toenails. Other times, it can be caused by wearing shoes that are too tight, or an injury to the toe that drives the nail into the surrounding skin. Fungal toenails, because they are often thicker, can also be a factor. Finally, if toenails are cut too short, especially long the sides of the toenail, they can become ingrown as they start to grow back out. Once the problem starts, the surrounding skin will often become infected and inflamed, As it does so, it will cause the entire area around the toenail to be painful.

Treatments at home can and probably should be tried first in mild cases. This includes putting a little bit of cotton under the nail, foot soaks, and avoiding wearing tight shoes. However, if you don’t see results after a week or so, it’s time to let your podiatrist take over. The treatments he can offer range from controlling the infection, to permanently correcting the problem so it does not happen again.

As mentioned above, the toe often becomes infected when the toenail is ingrown. The right antibiotic can treat the infection and greatly reduce the pain. But if that is all that’s done, your relief may be short-lived. Antibiotics do nothing to treat the underlying cause of the problem, namely, the toenail digging into the toe. Under local anesthesia (yes, that does mean a shot!), a portion of the toenail can be removed. Once this is done, the pain is dramatically reduced in most cases, and it also helps to clear the infection. I have found that when just a portion of the nail is removed (as little as 1/8”), the toe heals up within a week or so following the procedure. The one problem with this method is that while the pain is gone, the part of the toenail that was removed will grow back, and often will grow back ingrown.

So what do I do? I have found that for most of my patients, the best alternative is to remove the ingrown portion of the toenail permanently. Not the entire toenail, just the tiny portion along the side that is causing all the problems. Essentially, the same procedure is done as was described above, but I also use a medication to kill the root of the portion of the toenail that was removed. When done correctly, this will prevent the portion of the nail removed from growing back, thus solving the problem for good.

One of the first questions that people ask me is “how much does it hurt to have my ingrown toenail fixed?” Since I believe that it’s best to be straight with patients, I will admit that when the toe is made numb during the injection, there is discomfort. However, that does not last very long, and the rest of the procedure is painless. Afterwards, the biggest surprise most have is how little pain there is once the numbness wears off. Certainly, there is some tenderness, but by far the vast majority of patients tell me when they come back to see me one week later for their follow up appointment that they are happy, they feel much better, and they wish they had taken care of the problem sooner.

Once the toe is healed up completely, the toenail will be a little narrower. Other than the patient herself though, very few will be able to tell that anything had ever been done.

So, my advice is that if you have trouble with a painful ingrown toenail, decide to get it fixed and fixed for good. You’ll be glad you did!

What is a Podiatrist?

What is a Podiatrist?

As a practicing podiatrist for the last 20 years, this is a question that I am frequently asked - What is a podiatrist? Along with that question is the ever-popular "how can you stand looking at feet all day?" To answer these questions, let me start by explaining what it takes to become a podiatrist.

For a person coming out of high school with dreams of becoming a podiatrist, the first step is to go to college. Your major in college is not nearly as important as some might think. You will need to take several required classes regardless of your major though, with a heavy emphasis in the sciences (chemistry, physics, and the biological sciences). Once you near the end of your undergraduate career, it's time to start the application process to one of the 8 podiatry schools. Podiatry school is a 4-year curriculum, which when examined, closely resembles that of a typical medical school. This is especially true for the first two years. It is rigorous, and will test even the brightest of students. The further along students get into podiatry school, the more emphasis is placed on clinical training - as in actually seeing and treating patients. It would be a mistake, though, to think that today's podiatrist only learns about feet. To the contrary, the training is quite broad. In real life, it is impossible to treat foot problems without knowledge of what is going on with the rest of the body. For example, if a patient comes into my office with sudden onset of pain in his foot at the base of the big toe, I would include in my list of possible causes of the pain the diagnosis gout (see http://www.concordfootdr.com/library/1860/Gout.html). Treatment for this systemic disease that presents itself in the foot usually requires oral medication. Medication cannot be prescribed without knowledge of what other medication the patient is taking and how they all interact. Because of this, podiatrists have become experts in treating diseases, injuries and abnormalities of the foot and ankle, but are also able to tailor treatment plans that take the whole patient's situation into consideration.

Following the completion of podiatry school, the training is not yet complete. Podiatrists today must complete residency training that lasts up to 3 years. During this time, further training is received in the many areas podiatrists see in daily practice, including surgery, wound care, biomechanics, podiatric medicine, etc.

On a typical day in my office, I may see and treat any number of following conditions:
Ingrown toenails
Diabetic ulcers
Heel pain
Flat feet
Bunions
Hammertoes
Arthritis
Neuromas
Fungal toenails
Sprains
Fractures
Athlete's foot
Gout
Poor circulation
Neuropathy
Corns and calluses
And the list goes on and on.

So, the next time you think of your podiatrist, be grateful that such trained individuals are there to take care of all your foot care needs.

Oh, and as to the second question, how can I stand looking at feet all day? I look at it this way. If I can have a person come into my office with pain, and leave painfree, there is nothing I would rather do. I brings a great deal of satisfaction to get people back to normal activities... back to being able to walk, run, and work. In short, healthy feet go a long ways to making lives more fulfilling and productive. It's great to be play a part in improving the lives of my patients!