Pregnancy and Podiatry

                    

One would not normally associate pregnancy with the practice of podiatry.  On further examination though, pregnancy does greatly affect the legs and feet.

                    

As the body prepares for delivery, hormones facilitate stretching of the ligaments throughout the body, including the feet.  As the ligaments relax, the foot loses structural integrity and allows the foot to flatten out.  This can cause general foot pain, particularly in the arches.  It may also cause back aches, and pain in the knees and thighs, as a result of faulty foot structure.  These stretched ligaments may require several months to return to normal, after delivery.  Fortunately, arch supports or orthotics may support the feet and provide the proper alignment to prevent the excessive strain that causes the pain.

                    

Other common problems associated with pregnancy include varicose veins, phlebitis and calcium deficiency.  Plantar warts may appear during the first trimester, but soon disappear after delivery.

                    

Walking, compression stockings, supportive shoes and orthotics could alleviate or control many of the foot and leg problems that pregnancy can cause.

Evan Kelner DPM

Arthritis of the Feet

                     

                    

Arthritis of the feet is such a common condition, it is often overlooked or just ignored.  About 80% of people over 40 years of age have arthritic changes in the feet.  For serious inflammatory arthritic conditions of the feet, such as Rheumatoid Arthritis, medications are needed to keep the disease under control.

                    

The vast majority suffer from degenerative or osteoarthritis.  This condition can range from non-symptomatic to disabling.  Most problems due to osteoarthritis involve stiffness or soreness of the joints, lack of motion, formation of bone spurs, hammertoes and bunions.

                    

For most, wearing well cushioned, lace-up supportive footwear can be enough to keep the feet comfortable.  If that is not adequate, stretching exercises, non-steroidal anti-inflammatory drugs, steroid injections, physical therapy, and topical analgesic creams can all help.  For severe instances of osteoarthritis, such as rigid joints, painful bunions and hammertoes, surgical correction may be indicated.

                    

Many of my patients who suffer from painful foot arthritis benefit from arch supports or orthotics.  These devices relieve the pain by supporting the feet in their proper position and alleviating stress and strain to the joints.  Orthotics may provide long term relief for this chronic problem.

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f you suffer from foot pain, call us today.  Relief may be closer than you think.

Evan Kelner DPM, with offices in Ocean Township and Toms River.  We can be reached at (732) 988-0070 or (732) 286-9200

Leg Cramps at Night                                        

                                

(referenced from Yale's Podiatric Medicine)

                    

During an office visit, it's not unusual for a patient to casually ask me if there is anything they can do about legs cramps when they are in bed at night.

                    

Cramps in the legs usually occur as a result of abnormal muscle positions and impaired circulation.  It manifests as involuntary muscular contractions with pain and partial, or complete, loss of function.  Circulation is usually disrupted.  Other causes of night cramps include deformities of the feet, nutritional deficiency-especially vitamin B deficiency and potassium imbalance.  Night cramps are common in pregnancy, calcium-phosphorus imbalance and fatty metabolism.  Excessive urination is also a common cause.

                    

Unnatural anatomical positions, in certain occupations, result in cramps, aching pains, moderate shortening of the calf muscles or hamstrings.

                     

Treatments naturally depend upon the cause.  Often the control of foot strain and pull on the calfs can be relieved with orthotics, proper foot wear and stretching.  Vitamins and minerals may be helpful.  Quinine capsules, muscle relaxants, and tranquilizers may be helpful, as well as antihistamines such as Benadryl.  Large doses of aspirin also appear to help the condition.  For smokers, cessation of tobacco use may also help.  If symptoms persist, blood chemistry studies may be in order.

                    

If you or a family member is suffering from foot or leg pain, relief may be only a call away.

Evan Kelner DPM

(732) 988-0070 or (732) 286-9200

Visiting The Bata Shoe Museum

                    

This past week while on vacation, my wife and I visited the Bata Shoe Museum in Toronto, Canada.  As a podiatrist, I am acutely aware of the shoes my patients wear, so naturally, I thought a trip to the shoe museum would be an interesting diversion.

                    

We were not disappointed.  The museum provided a rich account of, not only the various types of shoes worn around the world and through the ages, but also how footwear was influenced by culture, tradition, art, history, religion, the elements, and yes, style.  From practical to the improbable, the shoes from various regions and time periods provided great insight into their respective cultures.  Examples of displays ranged from primitive grass lined shoes, women's shoes of ancient China, waterproof seal intestine boots of Inuits, boots worn on the moon and platform shoes of rock stars from the 70's.

                    

Although an interesting experience, my wife and I are both grateful to have been born in the time and place we were!

Evan Kelner DPM

 

 

Plantar Warts

                    

Plantar warts, or warts on the bottom of the feet, are a very common condition.  They are also known as verrucae, and are caused by a DNA virus.  Warts usually affect young people and are often brought on by stress.

                    

They are found on the bottom of the foot.  Plantar warts present as round, hard lesions of thickened skin.  They can be easily mistaken for corns, foreign bodies or plugged up sweat glands.  Warts have their own blood supply, so when picked at or cut, they often bleed.  Depending where on the foot it occurs, the area can be painful with walking or standing.

                    

Warts can be very difficult to resolve, and thus there are many treatments.  Some of the methods used are burning the wart out, freezing it, acid applications, oral treatments and excising it.  If left alone, the wart may grow in size and become even more difficult to resolve.

                    

If you, or someone you know, has what may be a wart, see a professional.  Our office takes pride in becoming part of your health team.  We always stress preventive care and explore conservative treatments first.

                    

We are located at 1398 Highway 35, Ocean Township and 191 Highway 37 W, Toms River.  We can be reached at (732) 988-0070.,

Thickened Toenails - Fungus or Not ?

                   

Often a patient presents to my office complaining of thick fungal toenails.  But is it really a fungus ?  Most people are aware that thickened, darkened toenails often mean fungus of the toenails; a condition called onychomycosis.  However, trauma to the toenail, even seemingly minor trauma, can also cause the toenail to become thick and darkened.

                    

Onychomycosis can be caused by one or more types of fungus, causing the nail to become thickened, darkened, and with hard tissue under the toenail.  Treatment consists of either oral or topical medications.  Resolution is slow, even with the most effective treatments.

                    

If the thickened toenail is caused by trauma, conventional fungus treatments won't work.  Thickened or dystrophic toenails may be caused by direct impact trauma, such as dropping a heavy object on the toe.  Sometimes microtrauma can cause damage of the toenails.  This is mild repetitive trauma that is often associated with stop and go actions, causing the toenail to rub on the sneaker.  This is common with runners, basketball players, and tennis players.  A substance, called keratin, forms under the toenail, causing it to become thickened and dark, mimicking onychomycosis.

                    

The only way to definitively make a diagnosis is with a nail culture, which is analyzed by a lab.

                    

If your toenails are thickened, darkened and uncomfortable, call us today. We can diagnose the problem and give you fast relief.  Our offices stress preventive foot health, especially for at risk patients with diabetes and poor circulation.  We are located at 1398 Highway 35, Ocean,and 191 Highway 37 W, Toms River.  We can be reached at (732) 988-0070 or (732) 286-9200.  For more information , log onto our website at www.drkelner.com

Gout

             

Recently, I have been seeing many cases of gout in my office.  Gout mainly affects men and post-menopausal women.  Gout usually occurs within the joint of the great toe, but it can occur in many other joints of the foot and ankle.  Gout is characterized by pain, swelling, redness, inflammation and burning. All pressure to the area and all walking can be extremely painful.

               

Gout is caused by excessive uric acid, which accumulates in the affected joint.  The excessive uric acid is brought on by either over production or under excretion of uric acid in the urine.  Certain rich foods and alcohol can precipitate a gout attack.  Such foods and alcohol may include red meat and their extracts, such as gravies and soups, shellfish and port wine.

               

If gout is treated within the first 24 hours of an attack, colchicine would be the drug of choice.  If gout has been present for more than 24 hours, a non-steroidal anti-inflammatory drug such as indomethacin is commonly used.  Steroid injections to the area often alleviates much of the pain.  After the initial manifestation of gout, your medical doctor may prescribe medication to prevent future attacks.  If untreated, multiple episodes of gout can severely, and permanently, damage the joint, causing arthritic changes.

                

If you experience a red, painful joint in your foot, do not ignore it .  Contact a podiatrist or your primary care doctor as soon as you can.

Evan Kelner DPM

(732) 988-0070

 Is That Mole Dangerous?

The most dreaded finding in a Podiatrist office is the detection of malignant skin lesions. There are a few different types of skin cancer, most with little chance of spreading or metastasizing. By far, the most dangerous kind of skin cancer is malignant melanoma.

               

Melanoma is believed to be caused by excessive sun exposure.  Unfortunately, this even includes exposure from decades before.

               

Although extremely rare in the foot, everyone should be aware of the signs of malignant melanoma.  Characteristics of a melanoma are lesions that have changed color, shape or size. Also, any lesion that has started bleeding for no apparent reason should be considered suspicious. Areas where this can occur are not always in plain site.  Be aware of changing lesions of the toenails or between the toes.

               

If something on the skin does not seem right or has changed, see a dermatologist, or a podiatrist, if it is on the foot.  The doctor will perform a skin biopsy, taking a small sample of the area, that will determine the nature of the lesion.

               

The best way to treat a melanoma is to detect it early.  Don't wait...it could save your life.

If you have a suspicious mole or lesion on your foot, please contact our office for an examination as soon as you can.

Evan Kelner, DPM

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

 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

 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

Preventing Diabetic Foot Ulcers

       -abbreviated from article by Jarrod Shapiro, DPM in Podiatry Management, March 2016

     For people with diabetes, one of the scariest risks they face is the prospect of foot ulcers and subsequent amputation.  The statistics are disturbing:

        - Between 15-25%of diabetics will develop a foot ulcer at some time.

        - 2-6% will develop a wound yearly.

        - 84% of non-traumatic limb amputations in diabetes are preceded by an ulcer.

        - 34% of patients develop a new ulcer within one year of healing their first ulcer.

        - There is a 50% risk of developing a foot ulcer on the opposite limb after major limb                               amputation, and a 50% risk of amputation of that limb within 2-5 years.

        - The survival rate after a major limb amputation is 50% after 3 years, and 40% after   

                     5 years.

    These odd are truly sobering.

    If you are diabetic, and you get an foot ulcer, you are highly likely to have a future one.  If you ulcerate, you're much more likely to have a limb amputation.  If that occurs, your life expectancy is much lower.

    The good news is most of the ulcers can be prevented.

    Naturally, education of the diabetic patient is the first step.  Knowing how to prevent problems enables you to reduce the risk.  A podiatrist can educate you on proper foot care.  But that is not enough.

    Studies have found that prescription therapeutic shoes do, indeed, prevent foot ulcers, compared with non-prescription shoes.  The patients, of course, need to wear these shoes for most steps during the day.

    Regular visits to the podiatrist for routine foot care is a critical action needed to prevent diabetic ulcer.  Aside from debriding thick fungal toenails and callouses, a podiatrist will examine the feet and detect signs of impending problems.

    The old saying, "an ounce of prevention is worth a pound of cure", is more than appropriate in preventing diabetic ulcers.  It may save your life.

    If you are diabetic, feel free to call our office for an appointment to have your feet checked.

732-988-0070

Best Shoes for Seniors

This is an often asked question in my office, and I'm sure in many other podiatrists' offices, as well.  The answer may not be simple, for everyone's feet are different, but there are some useful guidelines.

For many baby boomers, walking may be the only form of exercise they do. Several studies have shown the relationship between regular exercise and longer life expectancy and better health.  That is one reason why finding the right type of shoe is critical for keeping pain-free, active and healthy.

Common foot problems unique to seniors are fat atrophy, arthritis, neuropathy and muscle weakness.  In general, a supportive shoe with a soft innersole or memory type insert is a good start.  Along with muscle strengthening and stretching exercises, lighter shoes can be worn with greater success.

Running shoes for seniors are a good choice since they are lightweight, more "breathable", and have better cushioning and support than conventional slip-on shoes.  Seniors should avoid heavy or bulky shoes, as they can cause tripping, falling or just inactivity.  If the shoes have no stability or support, in the case of slippers or moccasins, patients can loose balance, fall or develop foot or arch pain.  For patients who use walkers or canes, Velcro or Lycra style shoes are usually well tolerated.

Always be certain to buy shoes that are roomy in the toe-box, well cushioned, have a slightly raised heel and an sole that neither "slips" or "grips".  When trying on shoes, they should feel comfortable immediately.  There is no such a thing as "breaking in" shoes.

                       

Our office is always happy to assist in evaluating your foot care needs and keeping you as healthy as possible in 2017!