Skin Cancers of the Feet

What are Skin Cancers of the Feet?

Skin cancer can develop anywhere on the body, including in the lower extremities. Skin cancers of the feet have several features in common. Most are painless, and often there is a history of recurrent cracking, bleeding, or ulceration. Frequently, individuals discover their skin cancer after unrelated ailments near the affected site.
Causes

We often view the sun’s harmful rays as the primary cause of skin cancer, due to the fact that the condition is often found on parts of the body that receive the most sun exposure. While this may be true of some bodily skin cancers, it does not hold true for those that arise on the skin of the feet. Skin cancers of the feet are more often related to viruses, exposure to chemicals, chronic inflammation or irritation, or inherited traits. Unfortunately, the skin of the feet is often overlooked during routine medical examinations, and for this reason, it important that the feet are checked regularly for abnormalities which might be indicative of evolving skin cancer.

Types and Symptoms

Some of the most common cancers of the lower extremity are:

Basal Cell Carcinoma: Basal cell carcinoma frequently is seen on sun-exposed skin surfaces. With feet being significantly less exposed to the sun, it occurs there less often. This form of skin cancer is one of the least aggressive cancers in the body.  Basal cell cancers may appear as pearly white bumps or patches that may ooze or crust and are similar in appearance to an open sore. On the skin of the lower legs and feet, basal cell cancers often resemble non-cancerous skin tumors or benign ulcers.

Squamous Cell Carcinoma: Squamous cell carcinoma is the most common form of cancer on the skin of the feet. Most types of early squamous cell carcinoma are confined to the skin and do not spread. However, when advanced, some can become more aggressive and spread throughout the body. This form of cancer often begins as a small scaly bump or plaque, which may appear inflamed. Sometimes there is a history of recurrent cracking or bleeding. Occasionally, it begins as a hard, projecting, callus-like lesion. Though squamous cell cancer is painless, it may be itchy. Squamous cell cancer may resemble a plantar wart, a fungal infection, eczema, an ulcer, or other common dermatological conditions of the foot.

Malignant Melanoma: Malignant melanoma is one of the deadliest skin cancers known. Nonsurgical treatments are rarely effective and many remain experimental. This type of skin cancer must be detected very early to ensure patient survival. Melanomas may occur on the skin of the feet and on occasion beneath a toenail. They are found both on the soles and on the top of the feet. As a melanoma grows and extends deeper into the skin, it becomes more serious and may spread through the body through the lymphatics and blood vessels.
When to Visit a Podiatrist

Learn the ABCDs of cancer. If you notice a mole, bump, or patch on the skin that meets any of the following criteria, see a podiatrist immediately:

•Asymmetry - If divided in half, the sides don't match

•Borders - They look scalloped, uneven, or ragged

•Color - They may have more than one color. These colors may have an uneven distribution

•Diameter - They can appear wider than a pencil eraser (greater than 6 mm). For other types of skin cancer, look for spontaneous ulcers and non-healing sores, bumps that crack or bleed, nodules with rolled or "donut-shaped" edges, or discrete scaly areas

Diagnosis and Treatment

The investigation for skin cancer will be done through clinical examination and skin and/or punch biopsy. A skin biopsy is a simple procedure in which a small sample of the skin lesion is obtained and sent to a specialized laboratory where a skin pathologist examines the tissue in greater detail.  If a lesion is determined to be malignant, your podiatrist will recommend the best course of treatment for your condition.

If you or someone you know has a questionable lesion, please give the office, 440-946-5858, for further evalaution and treatment.




Informatoin provided above can be found at APMA and/or BAKO Labs.

Rare Fleshing Eating Bacteraia

With the Georgia graduate student, making headlines with a rare bacterial infection, I felt in this week's blog I would discuss necrotizing fascitis.  This type of infection destroys muscles, skin, and underlying tissue. The word "necrotizing" refers to something that causes body tissue to die.

Many different types of bacteria can cause this infection. A very severe and usually deadly form of necrotizing soft tissue infection is due to Streptococcus pyogenes, which is sometimes called "flesh-eating bacteria."

Necrotizing soft tissue infection develops when the bacteria enters the body, usually through a minor cut or scrape. The bacteria begins to grow and release harmful substances (toxins) that kill tissue and affect blood flow to the area. As the tissue dies, the bacteria enters the blood and rapidly spreads throughout the body.

Symptoms include:

• Small, red, painful lump or bump on the skin
• Changes to a very painful bruise-like area and grows rapidly, sometimes in less than an hour
• The center may become black and die
• The skin may break open and ooze fluid

Other symptoms can include:

• Feeling ill
• Fever
• Sweating
• Chills
• Nausea
• Dizziness
• Weakness
• Shock

Your doctor may diagnose this condition by looking at your skin. You may be diagnosed in an operating room by a surgeon. Tests that may be done include:

• CT scan
• Blood tests
• Skin tissue biopsy

Immediate treatment is needed to prevent death. Treatment includes:

• Powerful, broad-spectrum antibiotics given immediately through a vein (IV)
• Surgery to drain the sore and remove dead tissue
• Special medicines called donor immunoglobulins (antibodies) to help fight the infection in some cases

Other treatments may include:

• Skin grafts after the infection goes away to help your skin heal and look better
• Amputation if the disease spreads through an arm or leg
• 100% oxygen at high pressure (hyperbaric oxygen therapy) for certain types of bacterial infections

How well you do depends on:

• Your overall health (especially if you have diabetes)
• How fast you were diagnosed and how quickly you received treatment
• The type of bacteria causing the infection
• How quickly the infection spreads
• How well treatment works

This disease commonly causes scarring and skin deformity.
Death can occur rapidly without proper treatment.

If you or someone you know, have a soft tissue infection, please go to the ER immediately and/or call our office, 440-946-5858, for an appointment.

Hammertoe Correctional Surgery

Many people seek the help of their doctor in hopes of fixing their hammertoes. It is common for podiatrists to receive patients who want to do something about their “ugly toes.” In truth, hammertoes can also be quite uncomfortable when they lead to such thing as corns, calluses, and swelling. The good news is surgery can be performed if necessary.

Depending on what stage the deformity is in, a hammertoe can be either flexible, semi-rigid and/or rigid. When they become painful, normally, after they have the reached the rigid state, hammertoe surgery will be necessary to alleviate the problem.

Different Types of Hammertoe Surgery

Surgeries to correct hammertoes do not require an overnight stay at a hospital. The procedure can be done as an out-patient, where you go home after completion of the procedure. Prior to the procedure, local anesthetic and/or mild sedation is administered to allow you to sleep through the procedure. The surgery entails a small incision on the top of the toe and either a soft tissue correction, digital arthroplasty (removal of a small piece of bone), and/or digital arthrodesis (joint fusion).

Soft tissue corrective surgery redirects the tendons and joint capsule of your toe which will correct the position.

 Digital arthroplasty involves correcting the soft tissue and removing a piece of bone in order to straighten the toe.

Digital arthrodesis techniques involved fusing two bones together in order to straighten the toe.

Often hammertoe surgery requires a mental wire or other implant to be inserted into the toe that will hold it into place while it heals. The end result will be a straightened toe.

How Long Does it Take to Recover from Hammertoe Surgery?

Recovery is patient dependent and compliance dependent, on average  most people wear a surgical shoe for approximately 3 weeks.

It seems to be that time of year when people are becoming more active,engaging in sports and working hard to get in shape for the summer season. In our Mentor office, we have seen a recent increase in stress and overuse injuries over the last month or so, likely attributed to this increase in exercise and activity. Therefore, in the blog below we will discuss some of the most common injuries seen and preventive measures to keep you healthy and active.

Common stress and overuse injuries of the foot and ankle:

Sever’s Disease

Most commonly seen within children between the ages of 10 and 14.  This condition invovles heel pain that is due to inflammation of the growth plate at the back of the heel. The Achilles tendon, which is the largest and strongest tendon in the body, inserts into the back of the heel bone, just behind the growth plate. Kids in track, soccer, gymnastics and other sporting activities, who are spending several days a week in these activities will often develop this condition, know as “Sever’s disease” or “calcaneal apophysitis.”

Stress Fracture
Runners training for a marathon, or those walking on a treadmill several times a week can both develop a stress fracture. This often happens when someone abruptly increases their mileage or number of times per week they are exercising. A stress fracture is usually an overuse type of injury that produces acute bone swelling leading to a crack in the bone. It is due to either normal amounts of stress to a weakened bone (as in the cases of osteoporosis), or abnormal amounts of stress to a normal bone (such as with increased mileage). Pain is usually worsened with increased or repetitive activities. Stress fractures are usually not seen on initial x-rays, and sometimes require an MRI or a bone scan to confirm the diagnosis. They are treated with a period of non-weight bearing to the affected area, and usually require crutches and a cast and/or cast boot until the bone heals.
Tendinitis

Tendinitis, similar to a stress fracture, can develop with an increase in mileage or with any repetitive activity. In the foot and ankle, we commonly see tendonitis develop in the Achilles tendon, or on the inside or outside of the ankle depending on the foot type and mechanics. If you have an area of your ankle that swells up with activity, and becomes very sore, you most likely have a case of tendonitis. Controlling foot mechanics with the proper shoes and possibly with arch supports or custom orthotics, can often prevent or be used to treat a case of tendonitis.

Prevention of overuse injuries is the smartest approach. The following are some tips to keep yourself active and exercising, and will help you avoid a period of recovery.

• Foot and ankle stretching excercises are very import before and more importantly, after exercising.

• Appropriate shoes for your activity

• Make sure your shoes are not too worn

• Ease into an exercise program (going from no exercise to 7 days a week all of a sudden is unwise)

• Ice the affected area after a work-out

If you or someone you know if suffering from any of the above aliments, please give our office a call for evaluation and treatment, 440-946-5858.

Achy Feet?????

It's not uncommon to experience foot pain after a long day of work or a vigorous sport activity, especially as we age. A long day of shopping or yard work can leave feet tired, heavy, swollen and achy: A problem we can all relate to at one time or another.

Some factors which contribute to achy feet, include:
-Age
-Gender
-Dehydration

Some causes which contribure to this condition include:
-Strenuous walking or standing for long periods on your fee
-Ill-fitting, poorly padded shoes
-Tight socks, stockings and/or garters
-Reduced blood circulation to the ankles and feet also causes tired aching feet.

5 Simple Ways to Relieve Tired, Aching Feet:
1. Elevate your feet to heart level for 15-20 minutes
2. Soak your feet in warm water with epsom salts if possible for 15-20 minutes
3. Massage your feet or have someone massage your feet for you
4. Exercise your feet, to tones muscles, strengthen the arches and stimulate blood circulation
5. Wear OTC and/or custom insoles in your shoes. Please see your podiatrist for their recommendation.

When foot pain persists, it's important to visit our podiatric office for a thorough examination. The cause of your foot pain may be more serious than simple stress and over work and we will work with you to determine a treatment plan that will put an end to your tired, achy feet for good!

Achilles Tendon Injuries

There are many issues relating to the Achilles tendon. It does not always result in the wince-inducing highlight reels from professional sports. While the tears and ruptures are the most notable and produce the best stories, there are other types of injuries that are just as common and not as severe. Many go undiagnosed as basic soreness and temporary injuries.

The Achilles tendon is the largest and toughest tendon in the body and it connects the heel to the calf muscles. Because it connects those two, it is responsible for moving the foot up and down, which is a motion used in just about every movement of a standing body. Because of its usage, it is very susceptible to injury, but also usually easy to diagnose and treat.

There are three basic types of Achilles tendon injuries:

Achilles Tendinosis:
There are many different words used to describe this condition. It has been referred to as tendinosis and tendinopathy. In this condition, the terminology which will be used is a degenerative tendinopathy. This term is used because it is a chronic condition, and is associated with gradual degeneration of the Achilles tendon.

There are times when the Achilles tendon does not function correctly because of multiple, minor microscopic tears of the tendon and the limited ability of the tendon to heal and repair itself. The blood circulation to the Achilles tendon in some patients is not always as good as it should be and microscopic tears begin to occur inside the tendon approximately six-centimeters from the attachment on the heel bone. Because of poor blood supply, the ability to heal these microscopic tears is limited and tearing of the tendon continues. Eventually, the tendon begins to thicken and weaken, and gets quite painful.

Achilles Tendonitis:
This injury is a result of continual stress on the tendon over time and can affect athletes and those not-so-athletic. Tight calf muscles, bone spurs, and increased physical exertion can lead to increased pain in the heel.

Achilles Tendon Rupture:
This is the Achilles injury that is often seen sidelining professional athletes. This is when the tendon tears partially or completely, and can result in inability to walk or even stand. It is often a result of Achilles tendonitis.

If you or someone you know has any questions and/or is seeking treatment for an Achilles tendon injury please give the office a call, 440-946-5858, for a consultation.

Got Heel Pain?????

Heel pain is a common presenting complaint causing patients to seek a foot and ankle surgeon or doctor. One of the most common etiologies of heel pain is mechanical and/or repetitive overuse injury causing inflammation of the plantar fascia, termed Plantar Fasciitis.

Symptoms of Plantar Fasciitis can include:
• Pain on the bottom of the heel
• Pain in the arch of the foot
• Pain that is usually worse upon arising
• Pain that increases over a period of months
• Swelling around heel

Causes for Plantar Fasciitis Include:
• Repetitive loading or exercise
• Change in activity level, duration, or training surfaces
• Recent activity/long walking in un-supportive shoes or sandals
• Faulty structure of the foot.
• Recent weight gain or obesity
• Acute trauma or injury

Conservative treatment options for Plantar fasciitis include:
• Stretching of the Achilles tendon and plantar fascia complexes
• Avoid going barefoot.
• Ice.
• Limit activities.
• Custom orthotics or over-the-counter orthotics
• Supportive and comfortable shoes
• Oral anti-inflammatories
• Physical therapy modalities
• Heel injections
• Night splints

Plantar fasciitis generally resolves with conservative management, however, certain cases can fail 6 months of conservative treatment, therefore, require surgical intervention to help alleviate the symptoms. Podiatry Research has demonstrated that chronic injury and inflammation to the plantar fascia leads to micro-tears and degeneration of the plantar fascia, termed plantar fasciosis. Plantar fasciosis lacks acute inflammatory tissue, accordingly, rendering conservative options unsuccessful at times.

Surgical options for Recalcitrant Plantar Fasciitis and Plantar Fasciosis can include:
•Topaz (ArthroCare) Microdebrider
•Platelet Rich Plasma injection
•Shockwave therapy
•Open and Endoscpoic Realease

Topaz Coblation Microdebrider procedure is a minimally invasive surgical technique utilizing small holes to break up the scar tissue and attempt revascularization of the plantar fascia. By "burning holes" into the ligament, the Topaz will turn a chronic process into an acute inflammatory process to cause an influx of inflammatory healing cells directly into the ligament.

The procedure is performed in the operating room. The anesthesia team will administer sedation medications and then a local nerve block is performed by the foot surgeon. The surgeon will then mark the area of the plantar fascia and make holes in the skin. The topaz probe is then placed through these holes into the plantar fascia. The patient is then placed into a walking boot for a period of 2 to 3weeks during the healing process.

The procedure only requires small holes compared to a larger open incision and surgery. This lends to quicker healing and less pain and scar tissue and faster recovery.

Think the Topaz procedure might help you? For help with your heel pain, please contact our office, 440-946-5858, to set-up a consultation.