Doc, My Feet Itch! Athlete's Foot

With the Super Bowl on the horizon, let’s talk about a foot condition that plagues many athletes. In fact, it is so popular in the locker rooms that it has earned its own sports name. That infamous bug is referred to as none other than Athlete’s Foot.

Athlete’s foot is a fungus that can be transferred from person to person. It thrives in dark, wet, secluded locations such as locker room floors, showers and in between your toes. So, we’ve all heard the drill, we are supposed to wear shower shoes when we are showering in a public restroom. This is because in theory, we are preventing our feet from directly touching the same wet floor that everyone else has had their food on. Unfortunately, that is just not enough. More importantly, you need to very thoroughly dry the spaces between your toes. This is where the fungus takes off typically, because of that perfect environment described above. For some of us though,  the pores of our feet secrete a greater amount of sweat than the average person. For these people, it is especially important to be changing your socks a couple of times a day and drying off your feet to try and reduce the moisture on your feet.

Athlete’s foot can be difficult because it has many different patterns of presentation. There is a commercial out right now that says most athlete’s foot starts between your 3^rd and 4^th toe. Now, although this is true, most people don’t notice it until it has progressed to several of their toes or even a good portion of their foot. Athlete’s foot can range from dry skin to cracked, itchy, burning or even blisters. Due to its wide range of appearances, it can be difficult to diagnose right away. Often times, your physician will start you on some over the counter treatments that will hopefully stop the fungus and kill it off. If this does not work, there are some prescriptions that are more potent and will stop the infection. If none of this works though, your physician may want to do a biopsy of the area to determine what exactly is causing your problem. There are several other dermatological conditions that look very similar to Athlete’s foot. If  you are in the Newburyport, Chelmsford, Lowell or North Andover, Massachusetts area and you are experiencing any of these symptoms, please feel free to contact us and our office staff would be more than happy to help you start a treatment plan and get back up on your feet.

With all of this said, the most important key to Athlete’s foot is prevention. So, make sure you are keeping those toes nice and dry. This will help keep the fungus away and keep you in the game.

The Facts About Skin Biopsies

A skin biopsy is a very useful tool used by your podiatrist. It helps to determine what type of skin condition you are dealing with and allows the podiatrist to figure out what the best form of treatment would be for you.

There are two different types of biopsy that are commonly used. Regardless of which method, the biopsy will be done using sterile, clean, conditions. The sample will then be placed in a container and sealed. There is a punch biopsy and a shave biopsy. A punch biopsy uses a device that takes a small amount of the affected area for examination. Your skin will be numbed so that you won’t feel the part that is being removed and then a few stitches will be put in to close up the incision. The other type of biopsy is a shave biopsy where part of the affected area is shaved off after numbing the area and a Band-Aid is applied. These two different techniques are used for different conditions. A punch biopsy is typically used for flat lesions while shave biopsies are used for raised lesions.

A biopsy is useful when the treatment being used is not working and it is difficult to determine what the cause is. It is also beneficial when your doctor thinks that a particular skin lesion looks suspicious, meaning that the edges are jagged, it has a non-symmetrical shape, or you notice that the lesion has been changing in size or shape. If you have noticed any of these characteristics associated with a skin lesion on your feet or legs, and you live in the Boston, Westford or Wilmington, Massachusetts or the Salem, New Hampshire area, our office staff would be more than happy to help  you determine what is causing your skin lesion. Although we most often hear of biopsy being associated with cancer, this is not its only usage. It is often used for deciphering between conditions that present with the same symptoms. Once the biopsy is taken, it will be sent off to a pathology lab. The pathology lab will examine the sample and send back a pathology report with the diagnosis. At this point the treatment plan that is best for you will be determined. 

There are many issues that occur on the skin of your legs and feet. Some of the ones you have probably heard before are athlete’s foot, psoriasis, dermatitis and skin cancer. The problem with many of these conditions is that they present with very similar symptoms. If present, there are some characteristics that set them apart from one another, but if you do not show these signs, then it may be difficult to determine exactly what you have without a biopsy. Non-invasive methods are always preferred because they provide you with the least discomfort possible. So, depending on the situation, you will usually be given medication first, to try and clear up your condition. If this does not work though, we will go ahead and do a biopsy and get you headed down the right track.

Paula Deen and Diabetes

This past week, Paula Deen made a public announcement that she has diabetes. Although this did not come as a surprise to many people, especially those who watch her show, it has brought a lot of attention to both her and the diabetic community, both positive and negative. The reality of it is, the majority of her recipes, including her Gorilla Bread that contains a full stick of butter, brown sugar, sugar, condensed milk, crescent dough, chocolate chips and bananas are just not diabetic friendly. Now, let’s not give bananas a bad rap for just being a part of this recipe. They are a great source of potassium to strengthen your bones and a healthy source of fiber that serves to keep you regular. However, when they are lumped in with everything else, there positive results are masked by all of the other ingredients. Although Paula Deen preaches moderation for her recipes, the reality is that for a diabetic patient this recipe is just asking for trouble, no matter how little of it you eat.

Diabetes is a condition where a person is not able to properly process sugar. In the case of Type II Diabetes, over time your body develops a resistance to insulin, the molecule that helps your body process sugar. So, as a result, your body still has insulin, but it is just not functioning. So, the medications that are prescribed to Type II Diabetics serve as a sort of jump start to the body allowing the insulin to work, as well as decreasing the amount of sugar that your body takes from the food you eat. Medications are often the last resort though because it has been shown that diet and healthy lifestyle can help control sugar levels in many people. So, this is why that delicious sounding Gorilla Bread is just not the best choice for diabetics.

Now, the harsh reality of it is that most people, who develop Type II Diabetes, develop it later on in life. This means that you have already figured out the foods that you like and will crave these items as a result of human nature. The truth is that one piece of chocolate cake is not going to kill you, but when you add that to the other high sugar meals you want to eat the rest of the week, they just might. Diabetes can be described best as a gateway disease, because once you are diagnosed with diabetes, heart disease, cholesterol problems, eye disease, poor blood circulation, feet swelling and ulcers can be just around the corner unless you control your condition. Losing weight through exercise and healthy eating has been proven to make a huge difference in the condition of diabetics and greatly reduce the risks for all of the aforementioned conditions. But let’s be honest, we are all going to slip at some point, but the key is that the vast majority of the time you must be conscientious of what you are putting in your body so that you can be the very best you.

Serena Williams Battling a Sprain and the Australian Open

Serena Williams took on Barbara Zahlavova Strycova this past Thursday. She reports that her ankle performed better than she expected allowing her to make sharp moves she didn’t expect it to allow, but she says that it is still not back to 100%. She reports that she is doing all things possible to try and get back to her best. However, she says that it is a very bad sprain and that it will take a while to heal.

Many of us have twisted an ankle at some point. It will be painful and cause you discomfort but should heal quickly and not greatly inhibit your lifestyle. A sprain however is a major medical condition that will result in your ankle swelling up and being extremely painful. In this instance, you have stretched and possibly even torn your ligament. In the case of Serena Williams, she says that it is a very severe sprain that is preventing her from playing the way she is used to.

When she says that she is doing many things to try and nurse herself back to health, there are several common treatment plans that are used. One of these is ice and elevation. Initially after the injury, it is important to ice and elevate because this will decrease your swelling and discomfort. It is important to then seek help from your podiatrist because they will be able to instruct you on your next steps. X-rays will be taken to determine the severity of your sprain. After this, you may be put into a cast, wrap or walking boot to keep you immobile while your ligament(s) are healing. During this time period, if your physician okays it, you can start to do some exercises while sitting including tracing the alphabet with your foot in the air and other range of motion exercises. Once you are okayed, you may be sent for physical therapy to help regain any loss of range of motion or strength that may have developed while you were injured.

As with Serena Williams, it takes a long amount of time to recover from an injury like these. So, although you may be back to your daily activities, you will not necessarily reach your full capacity for several months. It is important to remember that although the healing is slow, it is important to keep doing your exercises and strengthening for the best results.

It's all about the Diabetic Shoes

There are many things that need to be considered with a diabetic patient. There is the diet, the medicine and the exercise to consider. However, we can’t forget the shoes! As diabetes progresses, there is the possibility that people can develop peripheral neuropathy. This condition affects the nerves of the foot. Once diabetic neuropathy sets in, it is difficult for a person to feel anything in their shoe. This can be anything ranging from a pebble to the actual construct of the shoe. Therefore, it is important that a diabetic have specially designed shoes to prevent injuring their feet.

A diabetic shoe is specially designed to accommodate the patient’s foot. They are measured to properly fit the foot size and are often a bit wider and deeper to prevent rubbing that many of us experience on our heels or toes. The wider area for the toes prevents the toes from being squeezed together. This avoids any blisters from forming between the toes. Diabetic shoes are often wider so that they can also accommodate diabetic inserts. These inserts are made with softer materials that prevent rubbing and calluses. The material is also breathable which encourages good air circulation to prevent ulcerations and blisters. The shoes also do not have any interior seams to avoid rubbing on their feet.

It is important for a diabetic patient to come into the office and be properly fitted for their custom shoes. Blisters on a diabetic’s foot can quickly evolve into ulcers that take a long time to heal. Due to the reduced circulation within a diabetic’s legs and feet, the cells that aid in healing are not able to get to the site of injury. Due to this delayed healing, it is important to prevent the injury from occurring. These shoe adaptations will help you to reach that goal and help you to stay healthy.

Does Dwyane Wade have Plantar Fasciitis?

The Miami Heat’s point guard Dwyane Wade has sat out the past couple of games due to a foot injury that neither he nor the trainers are quite sure what it is from. In a recent press interview one of the reporters throughout the term plantar fasciitis and the Heat coaches and Dwyane Wade were not able to definitely say whether or not this is the cause. He is currently working with physicians to figure out what exactly is going on but is hoping to get back to the game quickly.

Plantar Fasciitis is a condition that results from inflammation and injury to a sheet of tissue that lies across the bottom of your foot. It extends from your heel and connects to the base of your toes. Typically an injury to this fascia results from micro-tears occurring over a long period of time due to your foot type. You will feel the pain on the bottom of  your heel and it will sometimes extend up your leg. If you have a tendency for your foot to flatten out when you are walking or you sleep on your stomach with your feet flattened out, it can cause a constant stretching and strain on this tissue. Over time, the stretching will cause these tears and result in inflammation causing a great deal of pain. Typically, it is at its worst in the morning when you wake up or after you have been resting throughout the day and then start to move around again.

There are different types of treatment for plantar fasciitis. One of them is laser treatment that can be done by your podiatrist. This is a non-invasive and non-painful treatment. It works by causing your injury to move from a chronic injury back to an acute one. The main point of this is to force your body’s cells that function in healing to start working again. They will be stimulated to move back into the affected area and begin the healing process to fix your injury. It will take some time for you to notice the effects because your body has to recover from injuries that occurred over a long period of time. In the meantime, you may be a candidate for a cortisone shot that will give you quick relief while your body is in the healing process.

So, in summary, if Dwyane Wade does indeed have Plantar Fasciitis, it may take him awhile to recover from his injury. Luckily for him, he is in great shape and his immune system should be working its hardest to get him back out on the court.

The Little Piggy That Didn't Make it to Market: Turf Toe

It’s a Sunday in January and what does that mean? It is time for football! The playoffs are upon us and with them all of the great predictions of who will shine, who will fail and what miracles will happen. This past season has been one that has sparked a lot of interest and will go down in history for sure. Between Tebow and the Bronco's miracle games, the Packers and their unbelievable loss to the Chiefs, the Colts and their failure to impress and the New England Patriots steady march toward the playoffs, it has been an eventful season. But with football comes injuries, and there has been a lot of activity in the press lately concerning “Turf Toe.” So, what exactly is it, and what are the quick facts you need to know?

Turf Toe is an injury resulting from your big toe getting pushed too far up, while the rest of your foot is digging into the ground. So, for a play by play description of this term, here’s the scenario. Player A has his toes digging into the ground with his heel up into the air like the stance of a sprinter before they are about to take off. Player B comes up from behind and either loses their balance or doesn’t see Player A’s foot there and stands on their heel. Player A’s toes further dig into the ground causing an excessive amount of pressure on the joint just behind his big toe. Player A falls on the ground in agonizing pain and the coaches and trainers rush over to see what happened.

So, what can be done for Player A after the injury has occurred? Well, there are three levels of turf toe injury. The first is just a stretch or “strain” of one of your ligaments in that joint and the player will probably be able to stay in the game. The second is a little more severe and is a partial tear of your ligament. This player is going to experience more swelling and pain and will want to protect this joint because their body is telling them they are the verge of a severe injury. The third is your classic game stopping injury where the player has completely torn the ligament. They will have a great deal of swelling, pain and bruising and they will be out for several weeks to heal. In order to decipher which level your injury is at, your podiatrist will do imaging studies to determine how severe the ligament has been damaged. The best way to fix a turf toe is time. You need to prop your feet up and relax, because that ligament needs to have a good long while to reconnect, so that you don’t injure it again. Sometimes a cast or walking boot may be used to isolate that joint to where the ligament has time to heal.

Unfortunately, this makes for disappointed fans. Your big toe is a huge contributor to your walking and running ability. Without it, you are unable to readily push off the ground and propel forward. So, without it working, it will be hard to make the quick movements necessary for a football player to be great. As for that little piggy, although he didn't make it to market, he has made the commercials during football a little bit more entertaning this year.

The Pain that Won't Wane: Metatarsalgia

Do you ever experience pain on the ball of your foot especially when you are walking or exercising? This pain may be related to a condition termed metatarsalgia and is due to the amount of pressure and stress that this part of your foot endures during these activities. Your metatarsals are long bones with one extending from your rearfoot to each of your toes. They work as a unit to assist you during walk and provide the transition from your heel to your toes throughout your gait. If one of these bones is altered in any way, it will impact the other four bones causing this pain that you experience.

Some causes of metatarsalgia include an abnormally long metatarsal, a fracture, arthritis causing breakdown of one of the bones, an enlarged portion of the bone making it wider, sports that put a lot of pressure on the ball of your foot, aging and shoes that are too tight squeezing your bones together. Some of these conditions may have been present since a young age and become exacerbated over time, while others may occur from trauma or environmental conditions. In either case, the pain that it causes is uncomfortable, but do not worry, there are several ways that your podiatrist can treat this condition.

In some instances, the fix may be as simple as providing you with the proper footwear. It is very common for people to wear the wrong size shoe. So, your clinician can measure your foot and make sure that you are wearing a shoe that is wide enough to accommodate your foot. Another option is using orthoses to assist your specific foot type. If there is a lot of pressure being exerted in one location, such as from an enlarged portion of the bone, an orthoses can off weight this area relieving the pain associated with that pressure point. Depending on the severity of the deformity and the underlying cause, surgery may be necessary to correct the alignment of your foot and provide you with relief.

Regardless of the treatment, it is important that you see your podiatrist so that proper imaging studies, including X-Ray, can be done to visualize the cause of your condition. Once the cause is determined, treatment can be performed and the pain caused by your metatarsalgia can be relieved.

Top 5 New Year’s Eve Diabetic Resolutions

#5 Making Dietary Changes

For people with diabetes, it is important to watch your diet very carefully. We all know that diabetics are not supposed to eat a lot of sugar. However, it is very difficult to change your diet so drastically after so many years of eating your favorite foods. Luckily, we live in a day and age where the foot network makes food better than ever. Along with this, they make food alternatives that that are healthy eating and low sugar/sugar free recipes. So go ahead, try some of your favorites in their new revamped style. You will probably love them just as much and make some new favorites.

#4 Starting a Weight Loss Program

As with most conditions, being overweight exacerbates the problems. For diabetes, you often have the initial condition but then progresses to often include high cholesterol, high blood pressure, neuropathy, poor circulation and many other conditions. By losing weight, you reduce your risk of developing these other conditions. Losing weight can be a difficult endeavor because so often you try and go all or nothing. Some of the best weight loss programs stress that it is a life-style change rather than a temporary change. As with anything though, you start slow. Whether this means that you cut soda out of your diet, change your coffee from the fancy kind with the whip cream and caramel and everything else to straight coffee, or replacing a candy bar with an apple, these small changes can lead to big results.

#3 Checking Your Sugar on a Daily Basis

For a diabetic, their blood sugar numbers provide insight into how they are doing. If you do not know what your numbers have been, then you have no idea as to how you are doing. Watching your sugar will allow you to make the necessary adjustments to keep you out of the danger zone. You will then be able to adjust your diet and lifestyle as needed to help you get back into your target zone or speak with your physician to discuss your medications or other treatment plans.

#2 Exercise

Exercise is different than just a weight loss program. It has actually been shown to improve insulin resistance helping your body to better react to glucose. Exercise is another misnomer, because many people think that you need to be a marathoner to get a good workout. Exercise can be something like walking around the block, taking the stair instead of the elevator or playing in the yard with the kids. Anything that you can do to increase your heart rate and get the blood flowing will make a huge difference.

#1 Form a Relationship with your Podiatrist 

Research has shown that diabetics that have a relationship with their podiatrist are much less likely to have an amputation. This is because your feet are being regularly checked to see if there are any open wounds that need to be taken care before they become ulcerations. They will also be able to watch for changes in your feet to analyze blood flow, nerve conduction and your skin health.