Wednesday, December 11, 2013

Plantar Warts: Symptoms, Causes & Treatment!

Plantar Warts

Plantar Warts
(Verruca)

What is it?
Warts are the manifestation and growth of a contagious virus (HPV, the Human Papillomavirus) that invades the skin through small cuts or abrasions on its surface – even through openings that are too small to be seen with the naked eye. Once inside the skin, the virus can grow and spread, stimulating the rapid generation of cells on the surface of your skin. There are over 60 different strains of HPV. Technically, warts may appear anywhere on the skin, but only those that appear on the soles of the feet are known as plantar warts.

What to look for:
If you see a bump on the sole of your foot that changes over time, suspect plantar warts. Both plantar warts and common warts (those occurring on other areas of the body) may be flesh-colored, white, tan or pink. Plantar warts are often grey or brown. Some warts may develop an uneven surface and a cauliflower-like texture over time, or they may acquire black spots or streaky lines. The black dots or lines are characteristic of plantar warts, and are caused by the bleeding of small blood vessels into the tissue. Warts also can bleed profusely when accidentally scratched or cut.
Warts start as small bumps, but can grow to an inch or more if left untreated. They can spread to other parts of the body, or form clusters.
A wart may or may not be painful, depending on its location. Warts on the ball of the foot or the heel, for example, where weight and pressure are brought to bear, may cause the patient great pain.

Other notes:
Plantar warts (and warts in general) are not caused by toads. (That’s an old wives’ tale – toads simply have bumpy skin; they don’t carry HPV). Only people can pass warts to other people – either from direct skin-to-skin contact or from inadvertently leaving the virus somewhere where others can pick it up. For example, the virus can be spread when one person with plantar warts walks barefoot on ground where others do the same. The virus can also be spread if a patient with plantar warts loans shoes or socks, which have not been washed, to an uninfected person.
Warts can easily be spread to areas around the body other than the feet, such as when the patient touches the plantar wart, and then touches another area of his or her body, such as the hands, face, genitals, scalp, arms, legs, ears – you name it. If the wart bleeds (such as when it is nicked or cut accidentally), this creates an ideal avenue for infection of another part of the body, or another person.
Warts are also stubborn and frustrating. They may disappear for a while, and then recur in the same place. They may go away with treatment and then come back – or they may never recur. Children seem to be more prone to warts than adults, leading some medical experts to theorize that as they age, some people can develop immunities to the virus that causes warts.

What it means to you:
Plantar warts (and all warts) are often unsightly and sometimes painful, but not life-threatening. That said, however, it is important to note that there are various lesions of the skin on the foot, including corns, callouses, moles – and even a few rare cancerous growths – that have similar or identical characteristics. It’s best to have a Podiatric Physician at Advanced Foot & Ankle Center examine any growth on your foot to ascertain that it is indeed a wart. Many common warts can be addressed with over-the-counter medications; however, it depends on the specific type of wart, and how far it has progressed.

What causes it?
You acquire the wart virus through direct contact with an infected person, or by coming into contact with an infected surface, such as a shower room floor. The virus lives in a warm, moist environment. It’s generally difficult to tell when or where you came into contact with the organism, however, since the incubation period for the HPV can be up to three months, although a wart itself can lie dormant for years.

What cures it?
IMPORTANT: If you have diabetes, you should see your Podiatric Physician at Advanced Foot & Ankle Center, at the first sign of any problems with the skin of your feet or toes, no matter how minor you may think they are. The following precautions and steps may be recommended by your podiatric physician, but should not be undertaken without his/her supervision and consent.
Plantar warts are stubborn, and most of the time, will require a podiatric physician’s intervention before they’ll go away. Sorry to disappoint those who believe in home remedies, but this is not the time to try holistic medicine, your Grandmom’s favorite wart remover, a pumice stone or anything else your doctor didn’t recommend.
There are various preparations on the market which can be used to treat warts. However, it is essential to receive confirmation from your healthcare professional that the lesion you want to treat is, in fact, a wart, and not something else. By self-diagnosing and treating without medical supervision, you may actually do yourself more harm than good. Plus, since some of the remedies on the market contain acid, they can irritate, damage and scar normal skin, or worsen a condition that is not a wart.
A podiatric physician, upon diagnosing a plantar wart, may recommend a prescription medication (or in some rare cases, an over-the-counter remedy) designed for warts. If, however, the condition looks fairly entrenched – and plantar warts are known to be very stubborn – several other methods may be used to treat it.
  • Because a wart is a virus, the goal of the professional is to remove the affected area that contains the warty skin cells, while keeping damage to the surrounding tissue to a minimum. In this case, the doctor may choose one of several methods: Freezing the wart (also known as cryotherapy): In this procedure, the doctor destroys the wart by treating it with liquid nitrogen. The patient will notice that the affected area develops a blister, which falls away within a week to reveal unaffected tissue underneath. This is generally many doctors’ first choice of treatments, since it is conservative and causes very little tissue damage or pain. Unfortunately, repeated treatments may be needed, should the entire wart not be removed the first time.
  • Injection of medication: A doctor may choose to inject the wart with a drug that will attack the virus. Bleomycin and interferon-alpha have been used with success in these applications.
  • Surgical procedures: Your podiatric physician may choose to use a technique that involves cutting away the wart via a process called electrodesiccation and curettage, which uses an electric needle. Some patients find this procedure painful, and scarring can result; however, it is an effective form of treatment that often results in long-term wart removal. Note: Do not try to cut anything you suspect to be a wart off of your own skin. This is extremely dangerous and can lead to infection and scarring, among other problems.
  • Laser surgery: There are two procedures for laser wart removal; your podiatric physician can decide which is best. One type of laser cuts away the growth; another cauterizes the blood vessels that feed it so that the wart dies and falls away on its own. Laser surgery may also be painful and may require a longer healing time.
  • Chemical removal. Your podiatrist may choose to use one ore more chemicals to remove the wart.
Your podiatric physician will be best able to recommend a treatment method based on your specific condition; listen to his/her recommendations, and do not be afraid to ask for a second opinion if you are concerned.

How can plantar warts be prevented?
The best way to prevent a plantar wart is to keep your feet clean, and to keep them away from surfaces on which the HPV might be lurking. Avoid walking barefoot, and wear sandals or some kind of foot covering at pools and in locker rooms and other warm, moist communal areas where people go barefoot. Change your shoes and socks daily, and allow your shoes to dry thoroughly between each wearing. Do not wear the shoes or socks of others, not even those of your closest friends. Wash socks after each wearing. (In this case, it’s the same kind of preventive medicine that is advised for athlete’s foot – another infection that can be picked up in public areas)
Keep your feet clean and dry, and since children are prone to warts, encourage them to do the same, and to follow the above rules as well. Check kids’ feet periodically and report any suspicious bumps, growths or lesions to your pediatrician. Remember that kids are easily frightened by medical procedures, and the earlier a wart is diagnosed, the easier it will be to get rid of it.
If a wart is diagnosed, do not pick, pull or try to snip at it, and don’t try to rub it with a pumice stone or with any kind of lotion. Don’t ignore it, either! Put a band-aid over the area to discourage contact with it and see a doctor. If it’s a wart, you’ll have caught it early. If it’s not a wart – well, you’ll still have caught it early, no matter what it turns out to be. Wash your hands carefully after caring for the affected area, and do not touch yourself anywhere before you wash those hands!
Remember that HPV is a highly contagious virus, and that it will spread if not treated. Don’t give it a fighting chance. If you or your children notice a wart – on your feet or on any part of your body – reduce the risk of it spreading while it’s being treated. Avoid brushing, clipping, shaving or combing the area over and around the wart in order to avoid nicking or cutting the wart and causing it to bleed. Don’t use the same nail clipper or file on hands or feet that have warts as you do on hands or feet that don’t.

Thursday, December 5, 2013

Flat Foot Reconstructive Surgery

Flat Foot Surgery Relieves Pain, Restores Function

Surgical advances have dramatically improved the ability to alleviate the pain and decreased function that millions of Americans experience due to flat feet. Nevertheless, many patients and even some physicians remain unaware of the new procedures, which are best performed by a foot and ankle specialist who has the applicable training and experience such as the Podiatrists at Advanced Foot & Ankle Center!

Indications and Outcomes for the Procedure
As with most surgeries, patients and physicians should consider the surgery only after other, less invasive treatments have proven unproductive. Indications for surgery include:
  • Pain
  • Inability to function
  • Failure to improve after a six-month course of specific, directed physical therapy
  • Failure to improve after using arch supports, orthotics, or ankle and foot bracing
Once patients are at that point, the good news is that the procedure has considerably better outcomes than more traditional flat foot surgery. 

How It's Done

The procedure involves cutting and shifting the bone, and then performing a tendon transfer.
  • First, the surgeon performs a calcaneal osteotomy, cutting the heel bone and shifting it into the correct position.
  • Second, the surgeon transfers the tendon. Surgeons reroute the flexor digitorum to replace the troublesome posterior tibial tendon.
  • Finally, the surgeon typically performs one or more fine-tuning procedures that address the patient’s specific foot deformity.
    • Often, the surgeon will lengthen the Achilles tendon because it is common for the mispositioned foot to cause the Achilles to tighten.
    • Occasionally, to increase the arch, the surgeon performs another osteotomy of one of the bones of the midfoot.
    • Occasionally, to point the foot in a straightforward direction, the surgeon performs another osteotomy of the outside portion of the calcaneus.
Podiatrists offer both pain relief and the chance to regain a range of motion to patients suffering from this condition.

Tuesday, December 3, 2013

Myths About Bunion Surgery

6 Myths About Bunion Surgery


A bunion is a structural problem of the big toe joint causing a boney prominence. Surgery is commonly performed to correct the problem. Some people simply avoid surgery because they may have "heard" some misnomers that guide their decision. 

Surgery for bunions involves more than just simply shaving the boney protrusion. It typically requires that the deviated bones to be structurally realigned. Milder bunions are corrected with bone cuts close to the big toe joint. Larger bunions typically need a more "involved" bone cut or a fusion procedure to completely realign the structural problem. It takes approximately six weeks for the bones to mend in the corrected position.

Myth #1: Bunion Surgery Is Excruciatingly Painful

Bunion surgery is not particularly "more" painful than other surgeries. Foot surgery, in general, can lend itself to increased pain post-operatively because the foot is below the level of the heart and blood can rush to the area, causing a throbbing feeling. Also, the foot does not have much soft tissue surrounding the bones, so moderate postoperative swelling can aggravate the nerves, causing pain. Most patients find that the postoperative discomfort is tolerable with pain medication and a program dedicated to pain relief. 

Myth #2: Bunions Come Back Even After Surgery

A majority of patients are satisfied with their outcome after bunion surgery. Recurrence is possible, but not particularly likely. And, return of a bunion is not necessarily a complication, but something that can happen over time. Some patients have excessive motion in the foot that may predispose them to recurrence. Another possible reason for recurrence occurs when a procedure that was performed did not best suit the severity of the particular bunion -- so it's important to have the surgery tailored for your particular bunion.

Myth #3: Bunion Surgery = Cast and Crutches 

While this was true years ago, more modern techniques have allowed surgeons to mobilize patients quicker. Mild bunions typically involve walking in a surgical shoe for six weeks. Surgeons consider casting with crutches with larger bunions because setting the bones is more complex. Some surgeons have moved away from bone cuts and instead perform a fusion procedure that allows for realignment of the entire deviated bone. This fusion procedure is called the Lapidus Bunionectomy, and contemporary approaches allow for early protected walking at two weeks postoperatively. Recent technological advances in medical implant devices have also helped surgeons modify their techniques to get patients moving quicker.

Myth #4: You Have To Be Off Work

This is simply not true, and a function of the demands of your workplace. A patient can return to a sedentary desk job within two weeks of the surgery, and varies based on surgeon protocol and type of bunionectomy performed. Jobs that require excessive walking, standing and physical activity may require a medical leave of absence -- which can be up to two months depending on healing and job requirements. Getting around can be difficult and driving may be off limits if you have your right foot operated on and/or drive a manual.

Myth #5: Don't Fix A Bunion Unless Painful

The concern with surgically correcting a non-painful bunion is that the surgery can result in longstanding post-operative pain that may not have been there prior. However, people do have surgery for non-painful bunions if the bunion interferes with activity, continues to become larger, or if they have difficulty wearing certain shoes and/or if the bunion is simply unsightly. Surgeons strongly prefer (or require) that patients have a painful bunion before they consider surgery. Fortunately, pain is the most common reason people seek treatment. 

Myth #6: Healing After Bunion Surgery Results In Unsightly Scars
Surgical healing is part of the process with any surgery, and bunion surgery is no different. Incisions can be minimized, or alternate surgical approaches may be used to hide surgical scars. Bunion incisions are either located on the top of the foot or on the side of the foot, and technique varies based on surgeon. A surgeon may perform a plastic surgery-type closure to keep scaring minimum. 
Bunion surgery, just like any surgery, has its share of myths. Because not all bunions are treated the same, information that may apply to someone with a large bunion may not apply to someone with a small bunion. Take the time to sort out what is truth vs. myth for your particular problem. Obtaining medical information your Podiatrist at Advanced Foot and Ankle Center would be advisable!