Thursday, April 27, 2017

Treatments For Fungus Toenails

One of the most common complaints seen in any podiatrist's office is the problem of fungus toenails or onychomycosis.  This is also one of the most frustrating conditions for not only the patient, but for the treating doctor also.  Success in treating onychomycosis has been elusive. Even with successful treatment, re-infection is common.
Unlike skin fungus, fungus of the nails is deep within the toenail, and thus it is difficult for a topical medication to reach it.  Most of the older topical medications and over the counter medications have been proven to be ineffective.  Home remedies are widely used, but I have not seen much improvement with them in my practice.  Newer prescription topical medications such as Kerydin and Jublia are much more effective in treating onychomycosis.  These medications must be applied to each affected toenail daily for at least 9-10 months.
The most effective way of curing onychomycosis is with oral medication.  Lamisil has been used for many years and is still considered the gold standard.  The concern with Lamisil therapy is that, in a small percentage of people, the liver enzymes can be affected.  It is for this reason that blood tests are required both before and during the three month course of treatment.
There is a new drug for onychomycosis currently awaiting final approval by the FDA.  This drug is called Viamet.  The exciting aspect of this drug is that it does not affect the liver.
With new medications on the horizon, the prospect of getting rid of toenail fungus has never been better.
If fungus toenails are a concern, please call us so we can explore the possibilities of an effective treatment.

Evan Kelner DPM

Saturday, April 15, 2017

 Ingrown Toenails

One of the most common conditions seen in a podiatrist's office is the ingrown toenail.  An ingrown toenail is a condition in which a side of the toenail grows into the flesh.  This can be a painful condition, both with and without pressure to the area.  If ignored, the toenail border can penetrate the skin, causing a bacterial infection.
Ingrown toenails are mostly a hereditary condition.  The toenail generally follows the shape of the bone beneath it.  Ingrown toenails can also be caused by improper cutting of the toenails. The condition may be exacerbated by wearing tight shoes.
Soaking the area, followed by dressing changes, may temporarily slow the progression, but ultimately, the ingrown portion of the toenail must be cut out.  This should be done by a podiatrist. If there is an infection, local anesthesia may be needed.
If the problem becomes recurrent, a permanent removal of the ingrown part of the toenail can be achieved by a simple office procedure.  A chemical is used to destroy the cells that make only that part of the toenail grow.  No sutures are needed.  Normal skin soon fills the area and there is an acceptable cosmetic result.

                                Some Tips for Preventing Ingrown Toenails:

1) Always cut toenails straight across or along the contour of the toenail
2) Do not dig into the ingrown toenail or perform "bathroom surgery"
3) Avoid tight restrictive footwear.

If you have an ingrown toenail, seek attention as soon as you can.  They tend to get worse as time goes by!

Evan Kelner DPM

Monday, April 10, 2017

 Advanced Treatments in Wound Healing

 As our population ages, the prevalence of diabetes in on the increase.  One of the most worrisome consequences of diabetes is the formation of diabetic ulcers.  Many of us know someone who's life has been drastically changed by diabetic ulcers.

There are several reasons these ulcers develop, and that is why these wounds are so difficult to heal.  There are wound centers all over the country whose sole mission is to treat these dangerous wounds.
Over the years, many wound care treatments have come in and out of favor.  The newer treatments now focus at the cellular level.  Wound care products now include components of human umbilical cord, amnionic membrane, extracellular matrix, human growth factors and purified collagen matrix, just to name a few.  These newer treatment have saved many limbs and have prolonged lives.
Of course, the best way to combat diabetic ulcers is to prevent them.  Because of advanced treatments with a multi-disciplined team approach, treatments for diabetic and other wounds have never been better, and continue to improve.  If you are diabetic, and have not had a medical professional check your feet, do so soon.  If you believe you are developing a foot wound, see a podiatrist without delay.

Evan Kelner DPM