As the winter snow melts away and the sun begins to shine we can rest assure that spring is headed our way and shortly behind it, summer! That’s the time of the year when we hit the beaches, kick up our outside workout routines and picnic at local state parks hoping to catch some rays. As you pack your lunches, fill your water bottle and throw your bathing suits on, don’t forget the sunscreen!!
Sunscreen should be worn daily on your hands and face, even in the winter months, as those areas are always exposed to the sun. However, as we peel off layers of clothing with increasing spring and summer temperatures, it’s important to apply sunscreen to any exposed area of skin and ensure that our kids and loved ones are also slathering up. Exposure to the suns rays without skin protection is the largest risk for the development of skin cancers.
In addition to protecting our skin and decreasing the risk of associated skin problems, we need to remember to check our skin for new freckles and areas of changing color/pigmentation. If you check your skin daily or at least weekly, you can catch areas of changing pigmentation and new freckles that might be concerning before they become a real problem.
The ABC’s of Skin Care are listed below and provide a guideline for those daily/weekly skin checks. If any areas or your skin exhibits signs of A, B, C, D or E it should raise your index of suspicion and prompt you to follow up with a Dermatologist, or Podiatrist if these are areas on your feet.
A – Asymmetry: The lesion is asymmetric if you bisect it and the two halves are not symmetrical.
B – Border: Any border that is raised, scalloped or blurry may be abnormal.
C – Color: If the lesion is more than one shade or several different colors, or if the coloration of the lesion has changed, take notice.
D – Diameter: Any lesions larger than 6mm (the size of a pencil eraser) or a lesion that is growing in size, should raise cause for concern.
E – Elevation: Any lesion that is raised off the surface of the skin is considered elevated, and is worth having your Dermatologist or Podiatrist take a look.
Noticing any of these changes early-on significantly improves your long term outcome should any of the lesions turn out to be skin cancer, and if they turn out not to be skin cancers, you can sleep easy at night knowing that.
Just as a reminder, here are some things you can do to help decrease your risks:
Always apply sunscreen before leaving the house, especially to your face and hands, as they are always exposed to the sun.
NEVER tan in a tanning booth.
Check your skin daily, or at least weekly, using the ABC’s as a gauge of changing freckles or new areas of interest.
Schedule your yearly Dermatologist check-up. They can assure you aren’t missing any skin changes putting your mind at ease.
If you notice any areas of new or changing discolorations on your feet or around your toenails, especially changes that are darkly pigmented, see your Podiatrist for evaluation.
Next week we’ll tackle some of the specific cancers that can be seen on the lower extremities. This information is not intended to scare you or to induce paranoia, but rather to inform you so that you can decrease your risks and live a long, healthy life!
Wednesday, March 9, 2011
Fitness ‘Kicks’
Over the past few years more and more shoe companies have been branding and advertising ‘workout’ sneakers that promise to tone your buttocks and thighs by simply wearing the sneakers during normal daily activities. Consumers have responded favorably to such advertising gimmicks and on any given Saturday at the grocery store, a handful of shoppers can be spotted sporting these rocker-bottom ‘kicks.’
So, how good or bad are these revolutionary toning sneakers for you? Well, the jury may still be out on some of the claims by these shoe companies, but we do know that the have caused some problems in the lower extremities! Below are a few of the claims that shoe companies are using to reel in consumers, followed by some of the problems Podiatrist are seeing in response to such purchases.
The Claim: The sneakers, by design, create an unstable center of gravity that stimulates the muscles in your lower extremity to work harder in order for you to maintain balance.
The Science: Creating an unstable center of gravity does induce the muscles of the legs and core to work harder to overcome that imbalance. Try standing on one leg. When you try to stand on one leg, it takes a few seconds for you to find your balance and you can feel yourself teetering back and forth to maintain an upright position. The leg that remains on the ground has all the muscles in it working hard to keep you standing. This claim and the science behind it make perfect sense.
The Problem: Some patients may not have the muscular strength or the appropriate level of balance for their body to accommodate to the unstable center of gravity that the sneakers induce. Therefore, rather than increasing their muscle strength and stability, they are suffering from injuries such as lateral (outside) ankle sprains and falls! Ankle sprains, depending on the severity, can be very debilitating injuries and especially in older patients, recovery is not always optimum.
The Claim: Walking in these sneakers is like walking on sand. The central portion of the sneaker elevates your foot off the ground and therefore, allows your heel to sink below ground level during normal walking. This forces the muscles in your legs to work harder to overcome that resistance in order to propel you forward for proper gait.
The Science: Picture a stability exercise ball that so many people at the gym use for doing sit-ups. By balancing on the ball alone they are working their core muscles and when leaning backwards, their back, shoulder and head fall below the level of the ball. They are in what is called a “negative position,” which increases the resistance and stability needed to complete a forward sit-up. This increases the workout factor on the body’s core muscles and yields greater results. This same technology is inherent to rocker-bottom workout sneakers. By falling into a negative position where the heel sinks below the level of the foot, the muscles in the legs must work harder to overcome that resistance. This claim makes perfect sense.
The Problem: By placing your foot in a negative position as the heel sinks backwards, stress is placed on the muscles in the back of the leg as they lengthen to accommodate the change. For patients that have tight posterior leg muscles (mainly the achilles tendon made up of the gastrocnemius and soleus muscles), the negative position can create problems! Patients are coming into the Podiatrist office complaining of posterior heel pain and are being diagnosed with achilles tendonitis (inflammation of the sheath surrounding the tendon), calcifications of the tendon (reactive boney growth within the tendon secondary to excessive stress) and retrocalcaneal bursitis (inflammation of the bursa or cushiony sack between the achilles tendon and the bone). None of these diagnoses sound like much fun, and I can assure you they are not! Often patients have significant pain and if not treated in the early stages, patients can suffer an achilles tendon rupture; a very difficult injury to overcome.
Next time you see a commercial advertising rocker-bottom workout sneakers, you’ll be a little more informed about the potential lower extremity problems they can create. If you chose to make a purchase, just use caution. If you start to suffer aches and pains in your feet or legs, discontinues wearing the shoes and see your Podiatrist for evaluation. Happy Walking!
So, how good or bad are these revolutionary toning sneakers for you? Well, the jury may still be out on some of the claims by these shoe companies, but we do know that the have caused some problems in the lower extremities! Below are a few of the claims that shoe companies are using to reel in consumers, followed by some of the problems Podiatrist are seeing in response to such purchases.
The Claim: The sneakers, by design, create an unstable center of gravity that stimulates the muscles in your lower extremity to work harder in order for you to maintain balance.
The Science: Creating an unstable center of gravity does induce the muscles of the legs and core to work harder to overcome that imbalance. Try standing on one leg. When you try to stand on one leg, it takes a few seconds for you to find your balance and you can feel yourself teetering back and forth to maintain an upright position. The leg that remains on the ground has all the muscles in it working hard to keep you standing. This claim and the science behind it make perfect sense.
The Problem: Some patients may not have the muscular strength or the appropriate level of balance for their body to accommodate to the unstable center of gravity that the sneakers induce. Therefore, rather than increasing their muscle strength and stability, they are suffering from injuries such as lateral (outside) ankle sprains and falls! Ankle sprains, depending on the severity, can be very debilitating injuries and especially in older patients, recovery is not always optimum.
The Claim: Walking in these sneakers is like walking on sand. The central portion of the sneaker elevates your foot off the ground and therefore, allows your heel to sink below ground level during normal walking. This forces the muscles in your legs to work harder to overcome that resistance in order to propel you forward for proper gait.
The Science: Picture a stability exercise ball that so many people at the gym use for doing sit-ups. By balancing on the ball alone they are working their core muscles and when leaning backwards, their back, shoulder and head fall below the level of the ball. They are in what is called a “negative position,” which increases the resistance and stability needed to complete a forward sit-up. This increases the workout factor on the body’s core muscles and yields greater results. This same technology is inherent to rocker-bottom workout sneakers. By falling into a negative position where the heel sinks below the level of the foot, the muscles in the legs must work harder to overcome that resistance. This claim makes perfect sense.
The Problem: By placing your foot in a negative position as the heel sinks backwards, stress is placed on the muscles in the back of the leg as they lengthen to accommodate the change. For patients that have tight posterior leg muscles (mainly the achilles tendon made up of the gastrocnemius and soleus muscles), the negative position can create problems! Patients are coming into the Podiatrist office complaining of posterior heel pain and are being diagnosed with achilles tendonitis (inflammation of the sheath surrounding the tendon), calcifications of the tendon (reactive boney growth within the tendon secondary to excessive stress) and retrocalcaneal bursitis (inflammation of the bursa or cushiony sack between the achilles tendon and the bone). None of these diagnoses sound like much fun, and I can assure you they are not! Often patients have significant pain and if not treated in the early stages, patients can suffer an achilles tendon rupture; a very difficult injury to overcome.
Next time you see a commercial advertising rocker-bottom workout sneakers, you’ll be a little more informed about the potential lower extremity problems they can create. If you chose to make a purchase, just use caution. If you start to suffer aches and pains in your feet or legs, discontinues wearing the shoes and see your Podiatrist for evaluation. Happy Walking!
Interesting but Benign!
Many people know what a cyst is, but often times the word “cyst” can ignite fright in people, as it has developed a negative connotation to it over the years. However, when the word ganglion is used as its predecessor, the negative connotation has permission to be dropped. Ganglionic cysts are benign (non-harmful) fluid filled masses or bumps, solely involving the soft tissue that can develop on any area of the body, but of course as Podiatrists, we see them on the lower extremities!
So first, where do these ganglions come from? Well, their exact cause it unknown, but in the lower extremity they usually appear on the dorsal (top) surface of the foot, also known as the extensor surface of the foot. They are typically attached to an extensor tendon, meaning a tendon that travels across the dorsal surface of the foot, and therefore, it has been speculated that ganglions form secondary to pressure along such tendons from shoe gear, prompting the body to protect itself via creation of a ganglion.
In addition to being closely affiliated with an extensor tendon, ganglions typically form near a joint in the foot, which isn’t too difficult as the foot is filled with numerous bones and thus numerous joints. They use the joint as a place to tether themselves to (via a stalk), often making definitive removal more difficult.
For the patient, treatment isn’t sought until one of two things occurs: the ganglion becomes painful and starts to limit activity or shoe wear, or the ganglion becomes so large that patients begin to get worried about what lies beneath! Either way, when presenting to a Podiatrist, you will be evaluated in the same manner, and a diagnoses of Ganglionic Cyst will be made. Podiatrist have several ways to come to such a diagnoses including palpation of the cyst as a freely moveable mass in the first layer of tissue below the skin (subcutaneous) in addition to its location over an extensor tendon. X-rays will most likely be taken to ensure that there is no bone involvement, which with Ganglionic cysts, there typically isn’t bone involved: it’s strictly a soft tissue mass. Finally, if your Podiatrist feels as though it is necessary, you will be sent for an MRI, which can look specifically at soft tissue and determine the exact location of the mass, its attachment to surrounding structures and its overall size.
At this point, depending on the Podiatrist’s treatment choice for ganglions, they may suggest one of three treatment options:
Do nothing. If the ganglion is not painful and is not hindering daily activity it can be left alone. Sometimes they will increase in size to where they will become painful, at which time the Podiatrist will tell you to return for options 2 or 3.
Aspirate. This means that the area will be injected with a small amount of numbing medication, punctured with a sterile needle and the fluid inside, typically gelatinous and pink in color, will be “squeezed” out, flattening the cyst and providing immediate relief. After the fluid has been aspirated a small amount of cortisone will be injected into the area to decrease inflammation and prolong recurrence. However, recurrence is highly likely and in some patients the cyst will return within months, while in other patients it will not return until years later, but non-the-less, in the same location.
Surgical excision. The ganglion can be surgically excised, helping to decrease its risk of occurrence. The procedure is technically easy and requires numbing medication around the site of the ganglion, a small incision over the site and removal of as much of the ganglion as can be teased away from the extensor tendon as well as removal of the stalk. This option provides the least rate of recurrence of the ganglion, but for unknown reasons, it may still return!
Ganglions are interesting soft tissue masses, that are benign and may or may not require treatment. However, it is always best to seek the opinion of your Podiatrist rather than self-diagnose. They can provide several options that may help eliminate or relieve any symptoms you may be experiencing secondary to your ganglion, and knowing what that ‘random bump’ on your foot is, will at least put your mind at ease!
So first, where do these ganglions come from? Well, their exact cause it unknown, but in the lower extremity they usually appear on the dorsal (top) surface of the foot, also known as the extensor surface of the foot. They are typically attached to an extensor tendon, meaning a tendon that travels across the dorsal surface of the foot, and therefore, it has been speculated that ganglions form secondary to pressure along such tendons from shoe gear, prompting the body to protect itself via creation of a ganglion.
In addition to being closely affiliated with an extensor tendon, ganglions typically form near a joint in the foot, which isn’t too difficult as the foot is filled with numerous bones and thus numerous joints. They use the joint as a place to tether themselves to (via a stalk), often making definitive removal more difficult.
For the patient, treatment isn’t sought until one of two things occurs: the ganglion becomes painful and starts to limit activity or shoe wear, or the ganglion becomes so large that patients begin to get worried about what lies beneath! Either way, when presenting to a Podiatrist, you will be evaluated in the same manner, and a diagnoses of Ganglionic Cyst will be made. Podiatrist have several ways to come to such a diagnoses including palpation of the cyst as a freely moveable mass in the first layer of tissue below the skin (subcutaneous) in addition to its location over an extensor tendon. X-rays will most likely be taken to ensure that there is no bone involvement, which with Ganglionic cysts, there typically isn’t bone involved: it’s strictly a soft tissue mass. Finally, if your Podiatrist feels as though it is necessary, you will be sent for an MRI, which can look specifically at soft tissue and determine the exact location of the mass, its attachment to surrounding structures and its overall size.
At this point, depending on the Podiatrist’s treatment choice for ganglions, they may suggest one of three treatment options:
Do nothing. If the ganglion is not painful and is not hindering daily activity it can be left alone. Sometimes they will increase in size to where they will become painful, at which time the Podiatrist will tell you to return for options 2 or 3.
Aspirate. This means that the area will be injected with a small amount of numbing medication, punctured with a sterile needle and the fluid inside, typically gelatinous and pink in color, will be “squeezed” out, flattening the cyst and providing immediate relief. After the fluid has been aspirated a small amount of cortisone will be injected into the area to decrease inflammation and prolong recurrence. However, recurrence is highly likely and in some patients the cyst will return within months, while in other patients it will not return until years later, but non-the-less, in the same location.
Surgical excision. The ganglion can be surgically excised, helping to decrease its risk of occurrence. The procedure is technically easy and requires numbing medication around the site of the ganglion, a small incision over the site and removal of as much of the ganglion as can be teased away from the extensor tendon as well as removal of the stalk. This option provides the least rate of recurrence of the ganglion, but for unknown reasons, it may still return!
Ganglions are interesting soft tissue masses, that are benign and may or may not require treatment. However, it is always best to seek the opinion of your Podiatrist rather than self-diagnose. They can provide several options that may help eliminate or relieve any symptoms you may be experiencing secondary to your ganglion, and knowing what that ‘random bump’ on your foot is, will at least put your mind at ease!
Check Out Those Nails!
A question that I encounter from patients on a near daily basis is: can you really tell the status of a person’s overall health by looking at their nails? The answer, although it seems strange, is yes, to some extent a Podiatrist can understand a lot about a patients overall health just by looking at their toenails and fingernails.
It seems a little bit crazy! How can you possibly know if a patient has liver disease, kidney disease or lung disease just by looking at their nails? Well, for whatever reason, the body communicates its overall health in various ways and one of those ways is through patterns, lines and color changes in the nails.
My hope is that this week you will gain a greater appreciation for the look of a person’s nails, while understanding that the appearance may suggest an underlying disease, but is by no means an absolute. Some people’s nails are just “naturally” discolored, ridged etc. Therefore, it might not be the greatest idea to play ‘Doctor’ and inform innocent bystanders of an illness you think they might have, since you’ll be an ‘expert’ in the category of nail appearance after this week!
Here are a few of the disease conditions that manifest themselves through changes in the appearance of toe- and finger-nails.
Psoriasis:
Psoriasis is an inflammatory disorder that typically manifests on the skin, but as it progresses can lead to Psoriatic Arthritis in many patients. One of the most distinct presentations, which we blogged about in our article on Psoriasis, is nail pitting (small indentations in the nail that are white in color). When found in association with loosening of the edges of the nails (onycholysis) and a yellow-brown discoloration, psoriasis is a likely diagnosis.
Liver Disease (Cirrhosis):
The manifestation of liver disease in the nails most typically comes in the form of what the medical field call’s Terry’s Nails. This nail presentation demonstrates a pink (normal) coloration on the most distal part of the nail, meaning the furthest area from the foot/hand, while the portion more proximal or closer to the foot/hand is completely white in color.
Dehydration:
Splitting of the nails at their very ends signifies dehydration of the nail plate. Drink more water!!
Heart/Lung Disease:
Clubbing involves both the nails and the actual toes and fingers (digits) in its appearance: a generalized enlargement of the digits with curving of the nail. The nail thins out and curves itself in order to remain approximated with the digits as they enlarge. Again, clubbing not exclusive to either heart or lung disease but may suggest such an underlying disorder.
Arsenic Poisoning:
To the CSI and Law and Order Fans out there, this one is for you! Arsenic poisoning in a patient presents as very distinct Mee’s Lines. These are lines across the nail from one side to the other that are white in color and may be single or double in presentation. The next time you’re watching your most favorite episode of a Forensic Science show when they recognize Arsenic poisoning as the cause of death, listen for clues they found in relation to the patient’s nails!!
Peripheral Vascular Disease (PVD):
We had previously blogged about PVD and how it designates a change/alteration in blood flow to the extremities, especially the legs. Changes in blood flow result in a decrease in nutrients and infection fighting cells to the places furthest from the heart, meaning fingers and toes. Therefore, this patient population is more likely to suffer from onychomycosis, which is a fungal infection in the nails, presenting as thickening, deformation and yellow color changes.
Keep in mind that any nail presentation is not an exclusive diagnosis for an underlying disease condition, but it does signal to us as Podiatrist that we need to investigate your over-all health just little bit more. It may prompt us to ask more questions in our history taking to determine if you have any underlying disorders or it may prompt us, as in the case “PVD nails” to have additional non-invasive studies completed to determine how well the blood is flowing to your extremities.
Now that you’re a nail expert go out and observe the public, just be sure not to worry any innocent bystanders with your “diagnosis!”
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