Thursday, August 16, 2018

Athletes Foot


                    
Athletes foot, or tinea pedis, is the most common skin condition seen in a podiatry office.  Although very common, tinea pedis can be easily misdiagnosed.  This is because tinea pedis can present in a number of different ways.
                    
The most common way athletes foot presents is between the toes, where the skin becomes moist, red or white, irritated, and often itchy.  Another presentation of athletes foot is the chronic type, where the skin becomes dry, scaly and cracked on the bottom of the foot.  Tinea pedis can also be acute or inflammatory, where the skin becomes rough and red.  Fluid filled vesicles also appear.  
                    
All the types of fungus, ( there are at least three ) thrive in moist, dark warm areas.  This type of environment along with a genetic predisposition, enables the fungus to infect the skin.  This is the reason that there is such a high rate of recurrence with tinea pedis.
                    

In preventing the fungus infection, the environment that allows the fungus to flourish must be eliminated.  The feet must be kept clean and dry, and allowed to "air out".  Shoes should also be allowed to air out for a least 24 hours.  Breathable cotton socks are preferable to nylon.  For those who suffer from excessive perspiration, medicated powder can be effective in controlling moisture.
                    
For the majority of cases, topical antifungal medications are sufficient.  The topical medications are typically used for at least 2-3 weeks.  For those conditions unresolved by topical medications, a course of oral medication may be necessary.
                    
Fungus infections of the feet are more than a cosmetic problem.  Untreated tinea pedis can spread to the toenails, or other parts of the body.  Fungus infections of the skin can lead to bacterial infections, cellulitis and wounds in diabetics.
                    
If you think you have athletes foot, seek the proper medical attention.

Referenced from Podiatry Today, July 2018, Myron Bodman,DPM

Sunday, July 29, 2018

Diabetes and Surgical Risks

                    
Elevated blood sugars increase the risks of adverse outcomes after surgery according to recent study cited in "Clinical Diabetes", summer 2018.  Special attention therefore must be paid to these patients both before and after surgery.  Compared to patients with normal blood sugar, patients with diabetes have an increased risk of mortality 6 months after surgery, and elevated risks of complications that require additional hospitalization.  Studies reveal that the higher the blood sugar, the higher the risk of adverse outcomes.  For those with diabetes in need of surgery, it is very important to consult with the physician controlling diabetes, to determine the best plan to keep the blood sugar control to prevent adverse outcomes.  Ways of decreasing blood sugar levels are losing weight and being physically active.  Losing weight can be achieved by eating smaller servings, try calorie-free drinks or water instead of regular soft drinks or juice,choose baked, grilled, and steamed foods instead of fried, eat more vegetables, whole grains, and fruit, and avoiding high fat toppings.  Walking whenever possible; walk every day for 30 minutes, 5 days a week or split the 30 minutes into two 15 minute or three 10 minute walks.  Try strength training by lifting light weights two to three times a week.  Talk with your health care team about ways to achieve your goals using meal planning, physical activity and medicine.

Below is a link for information related to surgery and diabetes.

Ways to Combat "White Coat Syndrome"


                     
Recently, I read an article the "Sentinel" newspaper written by Vashti Harris about a lecture given by two family practice physicians, Dr. Farrah Fong and Dr. Karen Lin about " White Coat Syndrome".
                     
White Coat Syndrome is an expression for fear of going to the doctor or feelings of anxiety when seeing a doctor.  Up to 20% of the population suffers from this fear.  Many develop this fear as children, who associate going to the doctor with getting vaccinations or other unpleasant things.  Later in life, some people carry over a dislike or distrust of doctors, medical treatments, or body examinations.  There is also fear of diagnosis of a serious illness, and guilt about unhealthy behaviors.  As a result, many people choose the internet over doctors.
                    
Because of the constraints of our healthcare system, doctors are compelled to see many patients in a limited amount of time.  This makes it difficult to build a trusting doctor-patient relationship.  News and internet stories, lawsuits and commercials report about medical errors, along with medication issues and recalls.  This has increased distrust toward the medical community as well.
                    
It is important, according to the doctors lecturing on the topic, to identify exactly what he or she is worried about.  Then one must confront these anxieties and deal with them rationally.  Patients can also find out how they can better control their condition to alleviate feelings of helplessness.  During an appointment, patients should make sure they have their worst concern addressed, and ask for clarification if the don't understand what the doctor is telling them. They should ask for written instructions or resources.  If a patient is afraid or uncomfortable with his or her doctor, they may consider seeking out a new doctor who they could better talk to.  Taking a family member or a close friend to an appointment can often provide support or comfort to the patient.






Low Back Pain

                    

If the foundation of a house is unsound, eventually the upper levels will collapse.  The same is true with the human body.  If one's foot structure is deficient, and there is insufficient support, muscles and tendons may strain to maintain the body in proper alignment.  Eventually, the muscles tire and the upper joints compensate; first the ankles, then the knees, hips and finally the lower back.
                    
Low back pain can be caused by tightness and inflexibility of the muscles of the back of the leg.  This may be a result of the strain from poor foot support.  Low back spasms may result from tight muscle groups.
                    

Exercises to strengthen the abdominal muscles and stretch the lower back muscles are important.  But the pain may not resolve completely if the cause has not been recognized and addressed.
                     
An orthotic or a high quality arch support should provide a good foundation to prevent muscle strain or upper joint pain.  This improved support may actually alleviate some types of low back pain.  If you suffer from low back pain, consider a good foot evaluation.

Evan Kelner, DPM

Tuesday, May 29, 2018

Morton's Neuroma

                    
A neuroma is an enlarged, damaged, and usually entrapped nerve.  The most common area of the foot for a neuroma is between the 3rd and 4th metatarsal bones.  Morton's neuroma is thought to be caused by both foot structure and repetitive trauma.
                    
Symptoms include shooting pain, burning, or tingling that extends to a toe.  Sometimes a shoe with a good support and a wide toe box may keep the condition under control.  More often, a steroid injection to the area as well as orthotics are helpful in relieving pain.  Icing the area and non-steroidal anti-inflammatory may also temporarily help the symptoms.
                     
More advanced treatment includes sclerosing alcohol injections to the area that deactivate the damaged nerve.  Usually between 2-5 injections of sclerosing alcohol are needed to be effective.  Surgical excision of the neuroma is done when more conservative treatments fail.  As with any surgery, the possibility of complications must be considered.
                    
If you or someone you know is suffering from shooting pain or burning extending to the toes, please feel free to contact us.  A conservative solution may be closer than you think.
 
Evan Kelner, DPM







Are Sneakers the New High Fashion?


                    
Recently, while watching TV news, there was a brief segment featuring a variety of women on Manhattan streets wearing sneakers with summer dresses.  The TV reporter asked the women why they were wearing sneakers with skirts and dresses instead of high heels.  Almost all the women responded that they were wearing the sneakers not only for comfort, but also as a fashion statement.
                    
Today's sneakers come in a wide variety of styles and colors.  According to the news report, wearers of Nike, Adidas, and other brands are up 37%, as opposed to high heels, of which sales are down 11%.
                    
At the royal wedding festivities of Meghan and Harry, it was reported that tennis star Venus Williams wore sneakers under her gown.
                    

Is foot comfort taking precedence  over classic shoe fashion?  Are women eschewing high heels in favor of sneakers?  Is this just a fad or is it a true fashion trend?  It may be interesting to see.


Evan Kelner, DPM

Wednesday, May 9, 2018








The Problem with Compression Stockings


                   
                    
Compression stockings are an important part of treating swelling or edema of the feet, ankles and legs.  These prescription stockings control the swelling by being applied the first thing in the morning, before the legs become too swollen.  They are worn all day and then taken off at night before bedtime.  These stockings must be properly fitted to the legs.  Too tight and they cut off circulation; too loose and they are non effective.  The stockings are not only important in controlling edema, but can also prevent the occurrence of leg ulcers.
                    
The problem with compression stockings is that, in order to be effective, they must be very snug.  It is often difficult and time consuming to both put them on and take them off.  Some patients become frustrated, and choose therefore not to wear them at all.
                    
Although there have been some innovations to make compression stockings easier to use, such as zippers and lighter materials, compliance is still a problem.  Recently I expressed this concern to a vascular surgeon.  He told me that he recommends that his patients try yoga pants, leotards or compression socks instead.  Although not as effective in controlling the swelling, these other alternatives are, perhaps, better than nothing.
                    
If you have problems with swelling of the legs, seek medical attention.  The cause of the swelling needs to be identified in order to properly treat it.

Evan Kelner, DPM

Sunday, April 29, 2018

Eccentric Exercises in Conservative Treatment of Achilles Tendinopathy


                    
Recently when reading " Lower Extremity Review", I came across an interesting article written by Jonathan Hook, DPM, and Curt Martini, DPM about the effectiveness of stretching therapy for Achilles tendon injuries.
                   
The authors state,  " Pain in the Achilles tendon is common among athletes, recreational exercisers and inactive people alike".  Achilles tendinopathy is a non-inflammatory cause of pain in the Achilles tendon.  This may be caused by overuse, biomechanical problems or systemic disease. 
                    
Treatments include rest, pain medications, stretching, strength training, heel lifts, footwear changes, night splints and icing the area.  Eccentric stretching involves movement against body weight to both stretch and strengthen the muscle fibers.  A recent study revealed no significant difference between a group who underwent surgery verses a group who only exercises for several weeks.  This may give pause to those recommended surgical correction for Achilles tendon pain.  There may be variations in the effectiveness of stretching exercises, depending on the location of the injury of the tendon.
                    
To prevent recurring injury to the Achilles tendon, one may limit the amount of training, modifying footwear, changing the training surface or wearing orthotics.
                    
If you have chronic pain of the Achilles tendon, contact our office, Eccentric stretching may provide lasting relief.

Evan Kelner, DPM      1398 Highway 35, Ocean     191 Highway 37W, Toms River

Are Orthotics a "Bandaid"


                    
Recently, while listening to a few minutes of a Mets game, the announcers were discussing a player who suffered from plantar fasitiis.  Although the player had orthotics, he didn't want to wear them because he considered them to be a "bandaid', and he wanted a more definative treatment.
                    
I could not help but wonder if it was fully explained to this player how and why orthotics work in controlling heel or arch pain.  Plantar fasitiis is an inflammation of the deep soft tissue layer at the bottom of the foot.  This inflammation is caused by a biomechanical deficiency causing a lack of proper support to the foot.  A good orthotic will maintain the foot in a "neutral position" and support the plantar fascia to prevent the strain that causes the painful inflammation.
                    
Wearing the orthotics will in time allow the deep inflammation to subside and prevent the condition from returning.  This would allow anyone, including the baseball player to resume normal activities without pain-including playing professional baseball.
                    
A foot orthotic of course is no more a bandaid than corrective lenses are to a nearsighted person.  Furthermore, a good orthotic can prevent the condition from deteriorating into a chronic condition requiring surgery.  
                   
If you are suffering from plantar fascitiis, call our office.  Orthotics are so much more than a "bandaid".

Evan Kelner, DPM           (732) 988-0070          (732) 286-9200

Monday, April 9, 2018

Limb Length Discrepancy


                    
An often overlooked cause of foot, leg and back problems is limb length discrepancy.  Limb length discrepancy is when one leg is longer than the other.  This results in an imbalance of the entire body when standing or walking.  The torso tilts in the direction of the shorter limb.  The spine then compensates forming an "S" shape rather than a straight spine.  This can cause lower back pain, hip pain, foot pain, and nerve compression, most notably sciatica.
                    
A measurement of the legs must be taken to determine the extent of the limb length disparity.  If the leg length difference is small, often one or more full length insoles, placed in the shoe of the shorter leg, can compensate for the problem.  This, of course, works much better with a deeper, lace up shoe that affords more room.  If the disparity is significant, then an outersole extension can be applied to the bottom of the shoe.  In this instance, a prescription is needed to have the shoe modified by a shoe repair specialist.  The modification of the shoe is barely noticeable.
                    
Although physical therapy and manipulation may relieve the symptoms of limb length discrepancy, relief is usually temporary.  The symptoms return because the underlying problem remains unaddressed.
                    
If conventional treatments are not providing long term relief for back, leg or foot problems, consider the possibility of one leg being longer than the other, and seek the medical advise of a podiatrist.

Evan Kelner, DPM

Celebrity Foot Problems

                    
Many of us watch events on television, such as the red carpet photo sessions at the Academy Awards, to see what our favorite celebrities are wearing.  We notice the designer clothes, make-up and even their shoes.  What we may not notice though, is their feet.
                    
At the cost of looking stylish, many female celebrities wear very high heeled shoes to accentuate their legs.  Sometimes, the price is higher than they think.  One can 'google" celebrity foot problems, red carpet, to see an array of very unenviable foot problems.  Some of the most beautiful and glamorous women in the world are revealed to have swollen feet, cracked heels, crushed toes and ill-fitting shoes.  There are even photos of stars walking barefoot at the Cannes Film Festival, presumably because their high heeled shoes were too uncomfortable.  Many movie stars suffer from the same bunions, blisters, hammertoes and other problems that many of us easily relate to.
                    
Remember, no matter how glamorous a favorite star may appear, no one is perfect!


Evan Kelner, DPM

Tuesday, March 6, 2018

Achilles Tendonitis


                    
One of the most common overuse injuries seen in runners is Achilles tendonitis.  The Achilles tendon runs from the back of the leg to the heel bone.  Prolonged running can lead to the over-development of the Achilles tendon.  This, in turn, causes shortening of the muscles that comprise the Achilles tendon.  Eventually, the Achilles tendon tightens.  When the body glides over the foot, as it does when running, the Achilles tendon is stretched.  It is sometimes stretched to the point of tearing.  The tendon soon becomes inflamed and causes tendonitis.
                    
Proper stretching exercises may be the only treatment needed to clear up this condition.  Heel lifts in the shoes can also help.  Ice, massage, non-steroidal anti-inflammatory drugs and physical therapy can also be beneficial.  Foot orthotics may also be needed to control abnormal motion of the heel when running.
                    
Remember, don't over train.  Stop if you get sore or tired.  Always wear good, supportive, comfortable running shoes.  Have fun and be careful.

Evan Kelner, DPM
  
 
Diabetic Shoes

                    
An essential part of any comprehensive plan to prevent diabetic foot ulcers is proper footwear.  If the shoe is worn out or not fitting quite right, rubbing can occur.  This repetitive trauma can cause blisters, corns, callouses, infections and ultimately ulcers.  For diabetics who suffer from neuropathy, the lack of protective sensation is an especially dangerous factor in causing diabetic ulcers.
                    
Fortunately for diabetics with documented risk factors, such as poor circulation or neuropathy, Medicare as well as other insurances allow for dispensing of diabetic shoes and heat molded inserts.  These shoes and inserts must be prescribed and professionally fitted by a qualified foot care specialist.
                    
No longer are diabetic shoes exclusively black, bulky and ugly.  Today's diabetic shoe choices include many attractive styles and colors, indistinguishable from other shoes.
                    
The inserts are heat molded to ensure total contact with the feet.  This prevents the rubbing and friction that causes corns, callouses, and wounds.
                    
If you have diabetes and are concerned that your feet are at risk of complications, contact our office.  We provide a comprehensive foot exam and can determine if you qualify for diabetic shoes.  Wearing proper shoes can ensure that you continue to walk through life with healthy and happy feet.

Evan Kelner, DPM                 (732) 988-0070                   (732) 286-9200

Wednesday, January 31, 2018

Stress Fractures of the Feet

                    
Stress fractures are "hairline" fractures brought on by repetitive stress to an area, often a foot.  The most common area for this injury to occur are the metatarsal bones or "long bones".
                    
As opposed to traumatic fractures, where there is separation of bone at the fracture site or joint, there is no displacement of the fracture.  Often the fracture cannot be seen on an X-ray until about 10 days after the fracture occurs.  The fracture is visualized only when a bony "callous" forms to help secure and heal the fracture.
                    
Stress fractures rarely require surgery.  Off-loading weight to the site will allow the fracture to heal over time.  This can be accomplished with either a surgical shoe or a walking boot.  Sometimes a bone stimulator or physical therapy may be needed.  If left untreated, the fracture site may become a source of chronic pain or arthritis.
                    
After the fracture heals, attention should be directed at preventing recurrence.  An orthotic, placed in the shoe, should alleviate the stress to the affected area, and prevent the fracture from happening again.  This is particularly effective for athletes.  
                     
If your are experiencing prolonged foot pain, do not delay- you may have a stress fracture.