Dealing with Diabetic Foot Ulcers

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© Healthwise

A diabetic foot ulcer is the result of skin tissue breaking down from constant pressure and forming an open sore or wound, typically on the bottom of your foot. People with chronic conditions, such as diabetes, are particularly susceptible to foot ulcers. In fact, about 15 percent of all people with diabetes will develop a foot ulcer at some point in their lives.

In most cases, one of the first signs a patient notices with a foot ulcer is drainage from their foot, but it’s also common to notice swelling, irritation, and/or odor from one or both feet. If you start to notice any of these symptoms, it’s important to consult a podiatrist immediately, as not all signs of foot ulcers are obvious; some may initially resemble a callous or blister with fluid underneath, with red or yellow tissue at the base. If an infection has already set in, it’s common for a toe or part of the foot to turn black due to the absence of healthy blood flow.

Common causes of diabetic ulcers:

  • Poor Circulation
  • Diabetes
  • Nerve Damage
  • Irritated or Wounded Feet
  • History of Smoking
  • Peripheral Neuropathy

During an initial evaluation, your podiatrist will assess the wound and your circulation, in order to determine the best course of action. Depending on the severity, there are several treatment options including debridement, which is the removal of dead or infected tissue from the ulcer, dressings, which are the application of special materials, solutions, or ointments to the wound, and off-loading, which is the use of casts or boots to help decrease pressure at the ulcer site.

The best way to prevent an ulcer on the foot from forming, however, is to treat the underlying health problem, have routine visits with your podiatrists, and follow these important steps:

  • Inspect your feet daily. Holding a mirror up to the soles of your feet will make this easier, but if you’re unable to, ask someone to check your feet for you and ask yourself these questions:
    • Is there any new pain or throbbing?
    • Does your feet feel hotter than usual?
    • Are there any new areas of redness, inflammation or swelling?
    • Is there any discharge?
    • Is there a new smell from your foot?
    • Do you have any flu-like symptoms?
  • Keep your feet clean. Wash your feet every day in warm water and dry them well.
  • Keep your feet soft. Put a thin layer of lotion on the tops and bottoms of your feet (not between your toes). Dry skin can easily crack and peel, making it a target for infection.
  • Nail Maintenance. If you’re diabetic, it’s important to have your nails cut properly by a podiatrist every 2-3 months. 
  • Don’t go barefoot. Always wear socks and shoes to avoid the risk of stepping on something and make sure your shoes fit perfectly to avoid blisters.
  • Stop smoking. Smoking decreases blood flow to your feet, which delays wound healing.

“It’s important to seek care as soon as possible for any cut or wound on the foot,” Dr. Marc Borovoy, a podiatric physician at Associated Podiatrists PC, recommends. “Most wounds have the ability to heal with proper treatment, but a small problem can quickly escalate into a major one if left untreated.”

If you or someone you know is diabetic and/or believes they may have an ulcer, it’s important to have frequent visits with your podiatrist. Our podiatrists, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing. Feel free to contact our office at (248)348-5300 or request an appointment on our website.

Seahawks CB Richard Sherman Ruptures Achilles Tendon

Last week, Seattle Seahawks cornerback, Richard Sherman, was forced to exit the game after suffering a season-ending Achilles tendon rupture during the third quarter.

“I’ve put a lot of stress on it,” Sherman said during a post-game conference, revealing that his Achilles had been bothering him all season. “Think it would have gone eventually.”

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Christian Petersen/Getty Images

The Achilles tendon—a tendon that connects the lower leg and calf to the heel of the foot—is the strongest tendon in the body and essential for making movement possible. The most common types of injuries are Achilles tendinitis and ruptured tendons, which often result in inflammation, severe pain, swelling, and in certain cases, complete immobility.

Through a physical evaluation, your podiatrist will be able to confirm the diagnosis through radiological testing and develop a plan of treatment. Depending on the severity of the injury, there are surgical and non-surgical options (such as Zimmer/Radial Shockwave Therapy, which is available in our office for tendinitis/tendonosis), but for athletes such as Sherman, surgery is usually the first choice of treatment. The advantage of a surgical approach includes a decreased risk of re-rupture and a higher likelihood of return to physical activities.

If you or someone you know is dealing with an Achilles tendon issue, it’s important to see your podiatrist immediately. Our podiatrists, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing. Feel free to contact our office at (248)348-5300 or request an appointment on our website.

The Facts About Morton’s Neuroma

If you’ve ever felt like you were walking around with a rock in your shoe, then you might be familiar with the symptoms of one of the most common types of neuromas—a Morton’s neuroma.

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A neuroma is a thickening of nerve tissue that frequently develops between the metatarsals as a result of compression and irritation of the nerve. Symptoms tend to build up gradually, and may even go away temporarily if certain activities are avoided, but over time, the symptoms are likely to become more intense as the neuroma enlarges and becomes permanent.

While the exact cause of a neuroma’s development is unclear, there are several different factors that can contribute to their formation such as:

  • Wearing shoes with a tapered toe box or high-heeled shoes
  • Certain foot deformities such as bunions, hammertoes, high arches or flatfeet
  • Activities that involve repetitive irritation to the ball of the foot, such as running or sports
  • An injury or other type of trauma to the foot

Common symptoms of neuromas include pain in the forefoot and between the toes, tingling/numbness, and swelling. “If you start to notice any of these symptoms, it’s important to see a podiatrist as soon as possible,” Dr. Marc Borovoy says. “If you’re able to catch it early in its development, you’re more likely to treat it with conservative treatments and avoid surgical intervention.”

Treatment options will vary based on the severity of each neuroma, but the primary goal is to relieve the pressure on the areas where the neuroma has developed. The most common types of treatments include:

  • Laser – A non-operative technique
  • Padding and Taping – Provides support to help lessen the pressure on the nerve and decrease compression
  • Medications/Injections – Used to reduce pain and inflammation
  • Orthotics – Custom inserts to help reduce pressure
  • Surgery – An option for patients who have not responded to nonsurgical treatments

If you or someone you know believes they may have a neuroma, feel free to contact our office at (248)348-5300 or request an appointment on our website. Our podiatrists, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing.

How to Handle A Hammertoe

A hammertoe is a contracture deformity caused by a muscle and tendon imbalance of the joints in the 2nd-5th toe(s), which causes the middle joint to bend and become stuck in a curled position. There are two types of hammertoes: flexible, which means they are still movable at the joint, and rigid, which means the tendons have become tight, making surgery the usual course of treatment.

Common causes of hammertoes:

  • Inherited genes
  • Arthritis
  • Injury to the toe(s)
  • Ill-fitting shoes
  • Aging

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Common symptoms of hammertoes:

  • Pain/irritation when wearing shoes.
  • Corns and calluses.
  • Inflammation, redness or a burning sensation.
  • Contracture of the toe.
  • In more severe cases of hammertoe, open sores may form.

Although hammertoes are readily apparent, they’re also progressive, too, which means they will not go away by themselves and usually get worse over time.

Conservative Treatments:

  • Trimming/padding corns and calluses.
  • Changes in shoewear.
  • Orthotic devices.
  • Injections/medications to reduce pain and inflammation.

If you have a hammertoe, it’s important to seek medical attention from a podiatrist quickly. Depending on the severity of your hammertoe(s), conservative treatments or a surgical route will be suggested in order to help relieve the pain and discomfort that has developed.

To learn more about hammertoes or to make an appointment with one of our podiatrists, please feel free to contact our office at (248)348-5300 or request an appointment on our website. Our physicians, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing.

Battling a Bunion?

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Medigo

A bunion (also known as hallux valgus) is an enlargement of the joint on the side of your big toe, which forms as a result of either an inherited faulty structure or excessive stress on the feet. In the initial stages, a bunion may not be painful, but as the big toe continues to move out of its normal position and lean toward the second toe, it will throw the bones out of alignment, thus producing the bunion’s bump.

Symptoms:

  • A protruding bump on the outside of the base of your big toe
  • Painful inflammation, redness, or soreness around your big toe joint
  • Development of corns or calluses
  • Persistent or intermittent pain
  • Restricted movement of your big toe

If a bunion is treated in the early stages, there are several conservative treatment options that are used to help ease the pain of a bunion, but it will not correct the issue. These treatments include felt pads to relieve pressure, properly fitted shoes with a wide toe box, custom molded orthotics, icing/medications, and changes in your daily activity (i.e. avoiding high heels, limit standing for long periods of time, etc.).

In cases where the bunion has grown beyond the point where conservative measures can be effective, a surgical removal of the bunion and realignment of the bones is necessary.

If you or someone you know believes they may have a bunion, feel free to contact our office at (248)348-5300 or request an appointment on our website. Our podiatrists, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing.

Thinking Ahead: How to Prepare for Your End of the Year Surgery

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As deductibles continue to increase year by year, patients are finding that their deductibles and out of pocket expenses are being met much later in the year, thus resulting in patients holding off on their health care, and delaying elective surgeries until the last quarter. If you are anticipating having an elective surgery by the end of the year, our office strongly suggests scheduling an appointment promptly, so we can secure the date(s) you are interested in.

Not sure where you’re at with your deductible and out of pocket expenses for the year? Let us help! Give us a call at (248)348-5300 or send us an email and we’ll look into your insurance benefits for you!

Toenail Fungus Treatment: PinPointe Laser

Toenail fungus, which affects about 35 million people, can be very difficult to treat for a variety of reasons, most notably the fact that the warm, moist, and dark environment inside your shoes is an ideal growing habitat for the tiny microorganisms. Fortunately, there are several methods to go about treating toenail fungus, including PinPointe Laser, which has been used successfully in our office for over 6 years!

Signs of Nail Fungus:

  • Thickening
  • Discoloration
  • Brittle, crumbly or ragged
  • Appearance of debris under the nail
  • Foul smells when nails are wet
  • Occasional lifting up of the nail

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The patented PinPointe Laser is a specially designed laser beam that goes through the toenail and safely kills the organisms embedded in the nail bed that cause Onychomycosis, more commonly known as toenail fungus. Also, even though the existing nail will not become clear immediately after treatment, the new nail growth will appear normal, as the fungus will no longer be present.

One of the advantages of this breakthrough procedure is that there is no down time. Patients walk in, walk out, and have no physical limitations following treatment. The laser procedure usually takes a couple of minutes depending on the number of nails and the severity of the condition. Additionally, since most fungus is usually killed after one treatment, but also commonly found in one’s environment, our podiatrists will strongly recommend post-procedure care that will greatly reduce the possibility of reinfection.

How to Prevent Repeat Toenail Infections

  • Use antifungal spray in your footwear.
  • Air out your shoes, and don’t wear the same shoes every day.
  • Make sure to wear shower shoes or flip flops in locker rooms, showers, and pool areas.
  • Schedule routine visits to your podiatrist to monitor progress.

If you or someone you know believes they may have a fungal infection, feel free to contact our office at (248)348-5300 or request an appointment on our website. Our podiatrists, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing.

 

 

Now Available In Our Office: Radial Shockwave Therapy

What is Radial Shockwave Therapy?

Radial Pulse Shockwave Therapy is an FDA cleared technology proven to increase the rate of healing for soft tissue tendon or fascial injuries. It is the most advanced non-invasive and highly effective treatment method that enhances blood circulation, and accelerates the healing process causing damaged tissue to gradually regenerate.

What conditions can be treated with RSWT?

  • Plantar Fasciitis
  • Achilles Tendonitis
  • Retro Achilles Heel Pain (Spurs)
  • Posterior Tibial Tendonitis
  • Peroneal Tendonitis
  • Shin Splints
  • Partial Tendon Tears

How does RSWT work?

The ballistic sound waves of the shockwave penetrates deep through your soft tissue, causing a microtrauma or new inflammatory response to the treated area. Once this occurs, it then triggers your body’s natural healing mechanisms. The energy emitted also causes the cells in the soft tissue to release bio-chemicals that intensify the body’s natural healing process. These bio-chemicals allow for the building of an array of new microscopic blood vessels in the soft tissue.

What do studies show?

There have been extensive studies done on Low Energy Shockwave Therapy over the past 20 years. These studies show between a 72% – 90% success rate.

How is RSWT performed?

The system is a small machine with an applicator that looks like an ultrasound. It is administered every few days for a series of 5 treatments. Each treatment takes approximately 5 minutes depending on the size and number of areas treated. All treatments are performed by experienced professionals who apply the applicator to the area and administers the ballistic waves by moving over the affected area in a very slow, circular motion. During the treatment, there may be some minor discomfort. Painful areas are helpful in isolating the truly injured areas.

Why consider Radial Shockwave Therapy?

RSWT has a proven success rate that is equal to or greater than that of traditional treatment methods, including surgery, without the risks, complications, and lengthy recovery periods. There are no incisions and no risk of infection, or scar tissue, like with surgery. There is no need for anesthesia to be administered during the treatment. Patients treated with RSWT may be active immediately and resume their normal routine the same day. Many patients find a significant and immediate reduction in their pain. Some patients will feel results gradually after each treatment.

What are the possible side effects?

There have been very few side effects reported. In rare cases, skin bruising may occur, and patients may feel soreness to the area for a day or two afterward, similar to a strenuous workout.

To learn more about shockwave therapy or to find out if you’re eligible for this innovative procedure, please feel free to contact our office at (248)348-5300 or request an appointment online. Our podiatrists, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing.

Children’s Shoe Shopping Advice

One of the most important purchases on any parent’s shopping list should be a pair of proper fitting shoes for their child. The podiatrists and staff of Associated Podiatrists PC would like to share several important factors that parents should consider while back to school shopping:

Children’s Feet Change with Age. Shoe and sock sizes may change every few months as a child’s feet grow.

Shoes That Don’t Fit Properly Can Aggravate the Feet.  Always measure the child’s feet before buying shoes, and watch for signs of irritation.

Never Hand Down Footwear. Just because a shoe size fits one child comfortably doesn’t mean it will fit another the same way. Also, sharing shoes can spread fungi like athlete’s foot and nail fungus.

Examine the Heels. Children may wear through the heels of their shoes quicker than outgrowing shoes themselves. Uneven heel wear can indicate a foot problem that should be checked by a podiatrist.

Take Your Child Shoe Shopping. Every shoe fits differently. Letting a child have a say in the shoe buying process promotes healthy foot habits down the road.

Always Buy for the Larger Foot. Feet are seldom precisely the same size.

Buy Shoes That Do Not Need a “Break-In” Period. Shoes should be comfortable immediately. Also make sure to have your child try on shoes with socks or tights, if that’s how they’ll be worn.

Consider Closed Toe Shoes. Covering the child’s toes allows for more protection.

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If your child is experiencing foot pain or you have other concerns, please feel free to contact our office at (248)348-5300 or request an appointment on our website. Our podiatrists, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing.

 

Sculptra Injections for Fat Pad Atrophy

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If you’ve ever experienced pain in the ball of your foot, commonly known as metatarsalgia, then it’s possible you may be experiencing fat pad atrophy (FPA), or the wearing down of the plantar fat pad in your feet. Due to the natural thinning that occurs as we age, FPA is more common in elderly patients, but it also occurs in people who frequently wear high heels, walk barefoot, wear thin-soled shoes, have high arches, or are overweight.

The main function of the plantar fat pad is to protect the underlying structures from pressure, so without the padding, the weight from your body shifts onto these bones and can lead to pain, inflammation and over time, pain under the ball of your foot.

Symptoms of fat pad atrophy can include:

  • Sharp, aching or burning pain
  • Pain that worsens when you stand, run, or walk barefoot
  • A feeling of having a pebble in your shoe

“Fat pad atrophy is extremely common among our elderly patients, but I see it in patients who play high impact sports, too,” says Dr. Marc Borovoy, a podiatric physician at Associated Podiatrists PC. “The more pressure applied to that area of your foot, the faster your natural padding will break down.”

Currently, the conservative treatment(s) for FPA consist of cushioning pads or shoe inserts, however, depending on the severity, can only provide patients with minimal relief. If left untreated, FPA can cause significant pain and limitation of function, but may also lead to pain in other parts of the body, such as the knees or lower back, due to altered gait.

“Sculptra is a quick, safe, and biocompatible solution that replaces the areas that have atrophied over the years,” Dr. Borovoy continues. “It allows the patient to bear weight the same day, and depending on the level of atrophy, can allow patients to remain active and pain-free for up to a year.”

To learn more about Sculptra injections or to make an appointment for this innovative procedure, please feel free to contact our office at (248)348-5300 or request an appointment on our website. Our podiatrists, Marc A. Borovoy, DPM, and John D. Miller, DPM, are experts in all areas of foot and ankle care, and will be happy to assist you with any problems you may be experiencing.