Foot, Ankle & Lower Leg Center: May 2012

Thursday, May 31, 2012

Doctor Warns Of Pedicure Risk

Posted on: CBS Detroit News (WWJ-TV)

DETROIT (WWJ) - Pedicures are seen as the must have summer beauty treatment by many people, but not checking the cleanliness of your salon may lead to a MRSA bacterial infection.

Jeffrey Frederick, a podiatrist at NorthPointe Foot & Ankle in Berkley, said that a MRSA infection is far worse than a normal infection.

“We all have staff bacteria on our skin, but over the last few years this super bacteria has come to light and it makes the symptoms of a normal infection far worse,” said Frederick. “… If you’ve gone for a pedicure and [see] some redness on the side of your nails it may be a MURSA infection …”

If you notice any of these symptoms you should talk to your doctor immediately. Because MRSA is resistant to many penicillin antibiotics, the infection may be difficult to treat with standard antibiotics.

“You can’t just say go home and soak your toe and it’ll go away,” said Frederick. “It needs to be managed with antibiotics appropriately that’ll kill the MRSA bacteria.”

The MRSA bacterium seems to be everywhere and the problem can be passed along by anyone sharing footwear or a bed. The likelihood of contracting a MRSA infection is greater in a nail salon because of close contact with skin that may be carrying the MRSA bacterium.

Please call the Foot, Ankle & Lower Leg Center office in Las Vegas anytime @702-878-2455 between Monday – Friday and we would be happy to set up an appointment for you. Please visit our website @ www.FallCenter.com. The Foot, Ankle & Lower Leg Center has Diagnostic imaging: Digital X-Rays, Ultrasound or Advanced Imaging will be used to aid in the diagnosis.

Dr. Anthony Ricciardi at the Foot, Ankle & Lower Leg Center has completed training in endoscopic/minimally invasive surgery for chronic heel pain and nerve pain, foot and ankle joint replacement for restoring pain free motion, arthroscopic surgery, bunion surgery, fracture repair, flat foot correction, external fixation for complex deformities and extensive experience in peripheral nerve surgery including diabetic peripheral neuropathy and reconstructive surgery of previously failed foot surgical procedures. In addition to his surgical training Dr. Ricciardi focuses on sports medicine of the foot and ankle through regenerative techniques using the patient’s own blood/platelets for healing chronic foot and ankle problems (pain) as a result of repetitive sport injuries. This cutting edge technology enables patients to continue training with little or no down time. Dr. Ricciardi continues to be active in teaching and training other podiatric surgeons on innovative surgical techniques in foot surgery. Dr. Ricciardi is Board Certified by the American Board of Podiatric Surgery, a Fellow of the American College of Foot and Ankle Surgeons and Fellow of the Association of Extremity Nerve Surgeons. Dr. Ricciardi’s vision is to bring each patient the most current State of the Art Technology and personalized treatment options to meet their Foot and Ankle needs (from conservative care to surgical options). Dr. Ricciardi believes in quality service and puts his patients first!

Wednesday, May 23, 2012

Fishy Beauty Trend: Spa Pedicures May Spread Disease

By MyHealthNewsDaily Staff | LiveScience via Yahoo News

Fish that are used in trendy spa treatments to clean feet may not be so clean themselves, a new study suggests.

In "fish pedicures," the fish, called Garra rufa, exfoliate clients' feet by nibbling on them. During a session, clients immerse their feet, or sometimes their entire bodies, in water with the fish, allowing the fish to feed on dead skin for cosmetic reasons, or to control skin conditions, the researchers said.

The researchers found that supplies of these fish from Indonesia destined for spas in the United Kingdom harbored potentially harmful bacteria. The researchers intercepted and tested the fish upon their arrival at a U.K. airport.

The fish carried a diverse range of bacteria, some of which are capable of causing soft tissue infections in people, the researchers said. The bacteria were resistant to a variety of antibiotics, the researchers said.

One type of bacteria found, Vibrio vulnificus, can cause wound infections and septicemia, a condition with high mortality rates, especially among people with conditions such as liver disease, diabetes or impaired immune function, the researchers said.

Another type, called Streptococcus agalactiae, is a common cause of skin and soft tissue infections, especially in older adults and those with chronic diseases such as diabetes. Although the particular strain identified in the study does not generally cause human disease, it could evolve after repeated exposures to people, the researchers said.

There have been very few reports of people being infected with bacteria after a fish pedicure, the researchers said.

"However, our study raises some concerns over the extent that these fish, or their transport water, might harbor potential zoonotic disease pathogens of clinical relevance," the researchers wrote in the June issue of Emerging Infectious Diseases, a journal of the Centers for Disease Control and Prevention.

People with conditions such as diabetes or immunosuppression should be discouraged from undertaking these treatments, especially if they have breaks in the skin, the researchers said.

Spas that offer fish pedicures should consider using only disease-free fish reared in controlled facilities with high standards, the researchers said.

The study was conducted by researchers at the Center for Environment, Fisheries & Aquaculture Science Weymouth Laboratory, in Weymouth, United Kingdom.

Pass it on: Fish used in "fish pedicures" may harbor harmful bacteria.

Monday, May 21, 2012

Maggots' growing medical role in wound treatments

Published in South Wales Evening Post

YOU would not associate them with cleanliness or treatment but maggots are playing an important role at one of Swansea's major hospitals.

Due to the amount of infections now becoming resistant to antibiotics, maggots are being increasingly used to treat wounds at Morriston Hospital.

The treatment involves placing a pouch filled with maggots over a wound, wrapping it in protective gauze and bandaging the area, allowing the little creatures to clean the wound by eating away all the damaged tissue.

Rosalyn Thomas, deputy head of Podiatry at Morriston Hospital, who uses maggots to treat wounds, said: "Patients are always shocked when I ask them to consider maggot therapy instead of surgery, but they soon come round to the idea.

"These tiny blind legless creatures eat nothing but the dead flesh from around the wound and leave the healthy flesh alone."

Ms Thomas added the use of maggots was also a cost-effective way to treat wounds.

She sad: "This is a really cheap, cost effective way to treat patients.

"Before this treatment we would take the patient into surgery and cut away the dead flesh, but to ensure we had all the infected area, we may cut away some healthy flesh too.

"The maggots are very precise and only eat away the dead tissue.

"With surgery patients would stay in hospital to recover, but with maggot therapy they are in and out within the hour, patients can go home and carry on as normal."

After the initial treatment is carried out patients return to the hospital a few days later and have the maggot pouch removed.

The wound is then cleaned and redressed before being left to heal naturally.

One of the patients currently being treated with the maggot therapy at the hospital also gave their seal of approval.

They said: "It's strange when they are first placed on the wound, you can feel some sensation, but not much.

"I think it's marvellous that I don't have to have surgery.

"The maggots are little miracle workers."

The treatment has been used at Morriston Hospital for the past 10 years.

Previously, maggots had been used in medical treatment for centuries before falling out of fashion thanks to the advent of antibiotics.

Monday, May 14, 2012

Pay attention to your feet

Podiatrist tells how to toe the line on foot health

Published in the Chicago Tribune Health

With warmer weather, out come the sandals … and neglected feet. The scaly heels, yellowed nails and thick calluses that have been under wraps all winter are now on full display. No wonder there are a half-dozen "I Hate Feet" groups on Facebook.

We brought a long list of common foot problems to Dr. Leonard Vekkos, a podiatrist who has been practicing since 1984. He treats patients at Adventist Bolingbrook Hospital, among other local hospitals.

Q. Why do toenails seem to thicken as we get older?

A. As we age, several factors can contribute to changes in nails. The most common issue is the development of a fungus infection called onychomycosis. People need to realize that fungus is present in everybody's environment. Aging may also result in decreased circulation to the toenails, and diabetes or other medical conditions put people in an immuno-compromised state which makes them more susceptible to these infections.

Q. For the treatment of fungus, what treatments are available?

A. The thickness caused by fungus can cause skin infections that can lead to serious problems. In general, many fungal infections can be treated by debridement (trimming and cleaning) in order to relieve discomfort.

There are prescription topicals such as Penlac and prescription oral medications, such as Lamisil. Both have advantages and disadvantages. With topical medication, there are no side effects, but the disadvantage is that it requires nail debridement on an almost daily basis. Additionally, patients are unable to utilize any nail polish. With the oral medications, it requires liver function tests prior to starting treatment. But the advantage is that a patient can continue using nail polish. It also works on a systemic basis, so that the fungus is addressed from the inside out. There is no cure for fungus infections.

Q. Can flats be as harmful as stiletto heels?

A. Obviously high heels can cause issues over a long period of time because the gait is affected, causing issues in the front part of the foot with the toes. On the other side of the spectrum, wearing of flats or non-supportive shoes such as flip-flops can also result in heel pain, arch pain, leg and back issues. Everything is related to the type of foot that you have. That's why it's important if there are any problems to see a podiatrist for an evaluation.

Q. Do you see a lot of problems with un-sanitized instruments from pedicures?

This is actually a very important issue that we as a podiatry community have been dealing with in our educational blogs. In my own experience, I have had my fair share of women who have pedicures suddenly developed changes in the nails that are consistent with a fungus infection. There may be instances in which certain pedicurists are not properly cleaning and sanitizing their instruments between clients. They don't necessarily have to be sterilized as much as cleaned properly and placed into a sanitizing solution.

Q. What is the best way to treat a blister?

A. Blisters are a result of friction and end up becoming filled with a fluid. In general, the fluid from the blister needs to be removed in order to reduce pain and pressure. The hole in the blister should be large enough so as to not allow fluid to re-accumulate. The roof of the blister will then be covered with a topical salve or antibiotic ointment and a Band-Aid. After several days, the roof of the blister will become loose and can be removed. I am a big believer in utilizing vitamin E oil once the blister has come off to allow for proper healing.

Q. Are ugly feet an inevitable part of aging, like gray hair or wrinkles?

A. Obviously, our feet are not immune to the changes that occur with time. Addressing these issues depends on the symptoms and how much it impacts quality of life. I am not a believer in performing cosmetic foot surgery because of the potential complications. But if cosmetic issues such as bunions and hammertoes become painful, then addressing them through some sort of correction would be appropriate. It is important that people take care of their feet on a daily basis. Such simple things as cleaning between the toes, seeing a foot specialist when pain begins, these are all important aspects of keeping your feet healthy throughout life.

Q. What is the one thing you wish people would do to take care of their feet?

A. Pay attention to them. But because they're at the end of our body, no one thinks about them until they hurt.

Monday, May 7, 2012

Athletics not the lone culprit in creating foot problems

Published on: Delaware Online

There are many common foot problems that runners may come across during years of repetitive impact. The most commonly known issue is called plantar fasciitis, which is a tightening or inflammation of the plantar fascia, the tendon that supports the arch. It is painful and sometimes difficult to resolve.

However, runners and athletes are not the only ones who are affected by foot problems, especially uncommon ones. Anyone who deals with foot pain knows that even the thought of getting out of bed and taking that first step, each and every day, can ruin a day that hasn't even started yet. Some issues are a direct result of athletics, but many are more an issue of ill-fitting footwear or just plain genetics.

Athlete's foot, which is also known as ringworm of the foot, is a fungal infection of the skin that causes scaling, itching and flaking of the affected area. It is caused by fungi and is typically transmitted in moist areas where people walk barefoot, such as showers and locker rooms. Athlete's foot mostly affects the feet, but it can spread to other parts of the body, including the groin area.

The fungi that cause athlete's foot can live on shower floors, wet towels and footwear, and it spreads with contact. Hygiene plays a big role in managing athlete's foot, so wearing flip flops in a public shower or locker room and avoiding the sharing of towels are good preventive steps.

Athlete's foot is usually treated with a topical medication and has a high rate of cure along with keeping the feet dry and practicing good hygiene. Severe cases may require the use of an oral antifungal. The use of anti-itch creams is not recommended, as the symptoms may be alleviated, but the high moisture content of the cream will exacerbate the fungus.

A bunion is when your big toe points toward the second toe. This causes a bump to appear on the outside of your foot on the big toe. Bunions are more common in women and can run in families. Many times, they are caused by wearing high-heeled, narrow-toed shoes.

The symptoms of a bunion include red, calloused skin along the inside edge of the big toe and a bony bump at the site. There is pain over the big toe joint, which is made worse by pressure from wearing a shoe. Again, the big toe will turn toward the other toes.

Wearing wide-toed shoes may solve the problem and alleviate the need for more treatment. There are also foam pads that protect the bunion and spacers that separate the first and second toes -- such products are available in many drugstores.

For relief when walking around the house, you can cut a hole in the side of an old pair of comfortable shoes so there is no pressure on the bunion site. Finally, a podiatrist will know if surgery is recommended. Surgery reduces the pain for many, but not everyone. Even after surgery, you will need to be judicious about shoe choices.

A neuroma, commonly known as Morton's neuroma, is a painful condition that affects the ball of your foot, usually the area between the third and fourth toes. It may feel like you are standing on a pebble. This is because the neuroma involves a thickening of the tissue around one of the nerves leading to your toes. It causes a sharp, burning pain in the ball of the foot, and the toes may also sting, burn or feel numb. The neuroma may also occur in response to an irritation or injury.

Common treatments for neuromas are changing footwear and using arch supports, but if these do not help, you should see a doctor. The doctor may prescribe corticosteroid injections to reduce inflammation or even surgery. Doctors do not completely understand what causes Morton's neuroma, but they do know that there are certain high-risk factors: wearing high heels and ill-fitting shoes; certain high impact sports, such as running and jumping, or sports with tight shoes, like skiing and rock climbing; and foot deformities like bunions, hammertoes, flat feet or excessive flexibility.

Finally, plantar warts are a form of the human papilloma virus occurring on the sole or toes of the feet. They are usually self-limiting, but treatment is recommended to lessen the symptoms and pain.

Like athlete's foot, infection occurs from walking on moist surfaces. The virus enters the skin by direct contact, through tiny cuts or abrasions. Those most commonly affected are children and teenagers and people with weakened immune systems. Diabetics should see a doctor.

A plantar wart looks like a tiny head of cauliflower with black spots in the center, and it may be painful when standing or walking. There are several methods of treatment, including acid peels, topical chemotherapy, laser treatment and surgical removal. Duct tape has not been proven to be effective. Most plantar warts do not require treatment and go away in a couple of years.

Taking care of your feet is one way to ensure a happy life. If your feet hurt, you are reminded of it every step of every day.

Sunday, May 6, 2012

Plantar Wart Prevention for Competitive Dancers

Contemporary dance shoe

Published by: Yahoo Sports

If you count yourself among the legions of competitive dancers who use Dance Moms as their weekly guilty pleasure, you may recall that Paige (one of the young dancers at the Abby Lee Dance Company) ended up with a nasty case of plantar warts during the show's second season. The poor girl could barely walk, much less dance with such painful plantar warts on her feet. So she had them removed before proceeding to dance through the equally painful post-surgery period. And all was happy again at the Abby Lee Dance Company. Or as happy as things are going to get on a drama-laden reality show.

Plantar warts are an unfortunately common occurrence in dance studios. These warts are caused by a specific strain of the human papillomavirus. Spread through direct contact, plantar warts affect a full ten percent of the U.S. Population.

While not exactly life-threatening, plantar warts can be very painful, often putting competitive dancers on the sidelines for weeks at a time. For this reason, prevention is absolutely key. The easiest way to prevent plantar warts is to wear a pair of sandals any time you visit a locker room or pool deck. HPV thrives in these moist environments.

Plantar warts can also be spread at the dance studio itself. A lot of dancers prefer to dance barefoot or with minimal-coverage thong-style shoes. Inside the studio, this should probably not be too hazardous. Wood and marley floors are not as conducive to the breeding of HPV as tile and grout. However, if your studio has a locker room or bathroom, you'll want to take extra care to wear sandals in these areas. And if you are practicing in a high school gym, you may just want to suck it up and wear full-on jazz shoes. Gym floors are generally not cleaned as often (or arguably, as well) as the floors at dance studios, and what's more, the other people using those gyms may very well be tracking in every virus or fungus in the book.

If you are one of the many competitive dancers who prefers to dance barefoot, be sure to clean off your feet when you're finished with practice. You may want to invest in some foot wipes or another product aimed at keeping feet clean and healthy. By taking this simple step, you can continue to dance barefoot without worrying about painful plantar warts.

S. Gustafson grew up in the dance studio and spent four years as a member of a nationally ranked college dance team.

Wednesday, May 2, 2012

Why Your Feet Hurt

It’s probably due to one of these ailments. Here’s how to treat them. For serious pain, see a podiatrist or a podiatric surgeon.

Published in Real Simple Magazine

1. Plantar Fasciitis

Feels like: A sharp pain in your heel (or heels), that’s at its worst when you get out of bed.
What causes it: Inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of your foot from the heel to the toes. People with all arch types―high, medium, or low―can be prone to this type of irritation, says Carly Robbins, a podiatric surgeon in Columbus, Ohio. Wearing shoes with very flat or very high heels can worsen the problem. “If a shoe doesn’t support the arch, the fascia will be stretched, and that can cause inflammation,” says Robbins. And if your Achilles tendon often feels tight, it can exacerbate the issue.

Treatment strategies

· Wear structured shoes. Look for pairs that support the arches and enclose the heels. Avoid going barefoot or wearing ballet flats or flip-flops.

· Stretch your Achilles tendons in the morning. “The plantar fascia is in a relaxed position when you’re sleeping,” says Jacqueline Sutera, a podiatric surgeon in New York City. “Then it gets a jolt of tension when you put weight on it.” Before hopping out of bed, wrap a towel or a T-shirt around your feet and pull the toes back to stretch the tendons.

· Reduce swelling. Fill a plastic bottle with water, freeze it, and roll it under your foot for a few minutes to soothe the pain.

· Consider custom orthotics. A podiatrist can make inserts that are molded specifically for your feet, which will control their motion and decrease strain on the plantar fasciae when worn inside shoes.

2. Ingrown Toenail

Feels like: A throbbing sensation, usually on the side of a big toe. It might look red and swollen.
What causes it: This often occurs when the nail edge grows sideways into the skin of the toe. The pressure on the nail jabs into the surrounding skin, causing discomfort. Wearing shoes that are too tight or too narrow can exacerbate the problem. Cutting toenails incorrectly can also be a culprit.

Treatment strategies

· Wear pointy-toed shoes infrequently. And if you’ll be walking a lot, carry them and wear shoes with roomy toe boxes until you reach your destination.

· Keep feet well moisturized. When the skin on your toes gets inflamed, a callus can develop, causing more pressure on the ingrown nail. Keeping skin soft helps alleviate this problem.

· Cut toenails straight across. And don’t file the corners down. If you get pedicures, be sure the technician follows these rules.

· See a podiatrist if you suspect infection. Signs include significant swelling and redness. “Don’t try any bathroom surgery,” says Robbins. “Digging around the nail and trying to cut out the ingrown part can lead to more irritation.”

3. Bursitis

Feels like: A bump, usually on the back of a heel.
What causes it: “This condition can occur when you have a genetically enlarged heel bone,” says Marlene Reid, a podiatric surgeon in Naperville, Illinois. “It’s often called ‘pump bump’ because the bone can become irritated from wearing a shoe like a pump with a stiff back.” When the unforgiving shoe rubs against the bone, you can inflame the bursa, the protective sac of fluid in the tissue.

Treatment strategies

· Switch to shoes with open backs (or at least with more give) until the irritation subsides.

· Use a donut pad. Try Dr. Scholl’s Foam Ease Callus Cushions ($4.50 at drugstores). Place one over the bursa to alleviate pressure. At the end of the day, ice the area to soothe the inflammation.

· Consider seeing a doctor. If the problem causes chronic pain, a podiatric surgeon can remove the bursa and the enlarged part of the heel bone.

4. Stress fracture

Feels like: A tender area, often on the front part of the foot, at the second or third metatarsal (the metatarsals are the long bones in the midfoot).
What causes it: Repetitive stress on a bone, like walking or running on hard surfaces, especially in shoes that aren’t designed to absorb shocks. “Every summer, I see fractures in women who walk the city sidewalks all day in flip-flops,” says Sutera. High heels can also make you more susceptible to stress fractures, because the heel’s tilt distributes your weight over your foot unevenly.

Treatment strategies

· See a doctor no matter what. A podiatrist will give you a surgical shoe to wear as you heal (it has a hard bottom that doesn’t allow the affected bones to bend) or advise you to wear some other kind of rigid shoes.

· Slow down. Stress fractures take four to eight weeks to heal. During that time, you’ll need to stop running and limit your walking to what’s absolutely necessary.

· Prevent recurrences. Maintain a healthy weight and wear supportive, well-cushioned shoes.

5. Bunions

Feel like: Sensitive, protruding bumps, typically at the heads of the big-toe joints.
What causes them: Bunions are thought to be hereditary, and you can develop them if you have low arches or if you overpronate (your feet roll inward). “As the bump gets bigger, it’s actually your bone moving,” says Robbins. Wearing certain shoes―such as those with narrow, pointy toes and high heels―won’t cause bunions to form, but they can speed their progression.

Treatment strategies

· Choose the right shoes. Specifically, pick pairs with a wide toe box and a low heel.

· Try gel pads. Place them over the bunions to help cushion the areas and reduce pain.

· Consider surgery. If your bunions continue to get worse, become very painful, or begin to affect your feet’s mobility, a podiatric surgeon can realign the joints and shave off the protruding bones.

6. Neuroma

Feels like: A shooting pain in the ball of the foot.
What causes it: Pressure on the nerve tissue in the underside of the foot, usually between two adjacent metatarsals. This pressure irritates the nerves, and the area swells. “Narrow, pointy shoes can put added pressure on an already irritated nerve,” says Robbins.

Treatment strategies

· Wear shoes with a wide toe box. And stick to those with low heels.

· Employ anti-inflammatories. Take ibuprofen, or if that’s not enough, see a podiatrist and ask about a cortisone injection, which should bring down the swelling of the nerve immediately.

· Consider surgery. For a stubborn Neuromas that won’t go away with less invasive treatments, a doctor can use cryotreatment, a surgical technique in which a probe is inserted to eradicate the problem nerve.