PRP Injection – A Non-Surgical Option For Foot & Ankle Pain

Plantar-Fasciitis

PRP Injection – A Non-Surgical Option For Foot & Ankle Pain

During the past several years, much has been written about platelet-rich plasma (PRP) injection and its potential effectiveness in the treatment of various injuries. Many famous athletes — Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP injections for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with cortisone injections, medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition. I am performing more and more PRP injections, in place of cortisone, for a variety of foot and ankle issues.

What Is Platelet-rich Plasma (PRP)?

Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) Platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries. PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual. The PRP injection is derived entirely from the patients own blood, no foreign substance or chemicals, and injected back into the patient in the area of the injury or pain.

Where can PRP injection be used?

Injuries: Many foot and ankle injuries occur when people are playing sports, exercising or repetitively overusing a body part. Accidents, lack of warming up properly or stretching before activities, poor sport training and not being in shape can cause these injuries. One of the most common areas of the body that are affected by sport injuries are the feet and ankles. PRP is extremely effective in the healing of a variety of foot and ankle injuries.

Arthritis: Arthritis is basically inflammation of one or more joints. They are many different forms of arthritis. One of the most common is osteoarthritis, which is a degenerative condition due to age, trauma or infection of the joint. The pain associated with “arthritis” is usually constant and can create strains on the muscles connected to the affected joint.

Tendonitis: Tendons are the fibers that connect muscle to bone and allow us to move. There are two types of tendon injuries. Tendinitis is when the tendon is inflamed and tendinosis is when there are tiny tears in the tissue in and around the tendon, which is usually caused by overusing the tendon over a long period of time, common in the foot and ankle. An Achilles tendon injury can be caused by not stretching enough before strenuous physical activity, overuse, flat feet, wearing high heels and sports. Symptoms are usually pain, swelling, difficulty flexing or pointing your toes, stiffness and a popping noise during an activity. People who suffer from flat feet often have pain at a tendon called the posterior tibial tendon, located on the inner side of the arch and ankle area.

Plantar Fasciitis: Plantar Fasciitis is when you experience pain on the bottom of your arch and/or heel. The plantar fascia is the ligament that connects your heel bone to your toes. If you strain the plantar fascia it can cause tiny tears which lead to pain and swelling. It is more likely to happen if you are overweight, stand or walk for long periods of time, or wear shoes that don’t fit correctly or support your feet adequately. Classically, the worst pain is the first step out of bed or after periods of inactivity.

Ligament Injury: Ligaments are the fibers that hold your bones together which in turn stabilizes the joint and range of motion. When ligaments are damaged, they are no longer able to provide the same support thereby causing joint instability, weakness and pain. Typically, I see patients complaining of pain following an ankle sprain and PRP is utilized to treat this nagging problem.

How is PRP performed?

A small amount of blood is taken from the patients arm and processed either in the office or the operating room. The processing requires approximately 20 minutes. Platelets are separated out, concentrated many fold, and includes the patient’s own immediate and delayed growth factors to be ready for injection back into the painful or injured area or areas.   This stimulates a healing process. Unlike steroids or cortisone shots, PRP stimulates and modulates the necessary healing within the body. Steroids or cortisone are potent anti-inflammatories; however, most issues that require medical intervention are chronic and not inflamed. Steroid or cortisone injections may provide short-term relief, but cause weakening of the tendons and ligaments over time. PRP eliminates the need for prolonged physical therapy, surgery and may restores normal function. PRP does not result in an “instant fix” even if the pain is improved or resolved. The healing process takes time, usually 6-8 weeks, and patients will be monitored for a return to full, unrestricted activities. It is very important to avoid anti-inflammatory medications such as Motrin, ibuprophen or Aleve as they can interfere with the healing process. Generally, immediate activity after the procedure is similar to what the patient’s pain limited them from doing before the procedure. Approximately a month after the procedure a short course of physical therapy may be initiated.

Benefits of PRP

  • Eliminates the need for prolonged physical therapy
  • Eliminates the need cortisone injection
  • Restore normal function
  • Eliminate the need for Surgery
  • Avoid Inactivity and Deconditioning

I am finding, as patients become more education regarding treatment options, many are inquiring about PRP as an option and most have heard of it, and I am performing this simple and effective procedure quite frequently. PRP injection is moving to the forefront of treatment for a variety of foot and ankle conditions. For more information, or to make an appointment for a consultation, please call our office at 201-261-0500.

 

 

State of the Art Stem Cells Provide Relief of Foot Pain

 

 

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State of the Art Stem Cells Provide Relief of Foot Pain

Foot and ankle pain is the most common complaint I treat on a daily basis. Many of these problems are caused by a new or old fracture or sports related injury, tendonitis, plantar fasciitis, acute and degenerative arthritis or scar tissue. I have been utilizing a relatively new and exciting treatment option, which is now available to treat many of these conditions, which would typically require surgery in the past. Injecting the patient’s own stem cells into the injured or painful area has become an exciting, safe and very effective, non-surgical treatment.

The use of stem cells in joint, bone, tendon and soft tissue injuries is one of the most exciting developments in medicine in recent memory. The promise of repairing damaged tissue with the patient’s own normal functioning cells instead of scar tissue is amazing. Stem cell research is occurring in most major medical centers in the U.S and around the world for conditions such as rheumatoid arthritis, ALS (Lou Gehrig’s disease), spinal cord injuries, multiple sclerosis, type 1 diabetes, COPD (lung disease) and many others.

What is a stem cell?

The human body is made up of cells. A heart muscle cell looks and functions differently than a nerve or muscle cell. Initially they all came from a one-celled embryo that divided and changed. As the body formed this initial cell grew into separate and different cell types. Stem cells are remnants of those early cells with the potential to become any of the specialized cells that make up a human body and are found in our bone marrow.

Why stem cells?

The promise of stem cells is that once collected from you and re-injected into your injured or damaged area, the cells will alter the local cell environment and they can be used to fix damaged tissue. Different tissues have different ability to repair itself, however if they cannot, the best the body can often do is form fibrous scar tissue. If you have cartilage damage that causes arthritis, stem cells can potentially change into new cartilage. If you have a chronic tendon injury or tear, the tendon can heal itself with new tendon cells versus scar tissue.

Where do the stem cells come from?

Stem cells come from you! Not a company, donor or laboratory. To date, stem cells can be derived from bone marrow, fat tissue and blood. Typically cells are collected by a simple blood draw (similar to having a blood test) or from a small needle into the heel bone.

 

Where can stem cells be used?

Stem cell injections are used for many foot and ankle conditions, including;

Non-healing fractures

Tendon injuries

Chronic ankle sprains

Ligament injuries

Tendonitis

Achilles tendonitis

Plantar fasciitis

Joint arthritis

Wound healing

 

I have been using stem cells that are derived from the patient’s own bone marrow because they have been shown to provide the greatest healing potential. Once obtained, the blood is placed into a machine, similar to a centrifuge, which “spins” the blood and separates the stem cells. The stem cell rich portion is then injected into the injured or damaged area where they almost immediately begin to multiply and flourish. Stem cells have been found to replicate themselves and nearby cells begin to mimic them making healing possible and producing an anti-inflammatory effect that can help reduce pain. Additionally, stem cell injections contain hyaluronic acid (a naturally occurring protein), which lubricates joints and tendons, easing pain and helping restore mobility. It is a procedure that can be done comfortably under local or twilight anesthesia and takes 30-40 minutes.

Feel free to call the office at 201-261-0500 for an appointment to see if your condition can be treated by stem cell injection.

Toenail polish caused my fungus?

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Many women can’t resist treating themselves to a holiday themed toenail design. While it might look festive, something may be lurking beneath. I am often asked, “does nail polish cause a nail fungus?” Using toenail polish in and of itself does not cause the problem, however it doesn’t help either. Fungus is a naturally found on your skin and nails, especially on the foot, but doesn’t usually cause a concern. Fungus is an opportunist and given the right set of circumstances will cause an infection in the nail. Fungus thrives in dark, moist environments and can be made worse in some nail salons after the feet have been soaking and the nail is treated aggressively and then polish is applied, trapping moisture in the nail.

Most nail polishes contain damaging chemicals, such as formaldehyde and toluene and nail polish remover contains acetone. All of these damage the toenails and cause the white streaking that many women experience when removing their polish. This damage weakens the toenails and makes them more susceptible to developing a fungus.

Many over-the-counter medications and preparations are available, as well as popular home remedies, which rarely cure the nail fungus. There are several topical and oral medications as well as laser treatment to address toenail fungus. Choosing the correct treatment option depends on a combination of medical and personal issues. I will discuss these with a patient and together we can select the most appropriate method for eliminating toenail fungus

Here are several things to consider in an attempt to prevent toenail fungus.

Wash your hands and feet regularly and keep your nails short and dry. Wash your hands and feet with soap and water, rinse, and dry thoroughly, including between the toes. Trim nails straight across and file down thickened areas.

Wear socks that absorb sweat. Fabrics effective at wicking away moisture include wool, nylon and polypropylene. Change your socks often, especially if you have sweaty feet.

Choose shoes that reduce humidity. It also helps to occasionally take off your shoes or wear open-toe footwear.

Discard old shoes. If possible, avoid wearing old shoes, which can harbor fungi and cause a re-infection. Or treat them with disinfectants or antifungal powders.

Use an antifungal spray or powder. Spray or sprinkle your feet and the insides of your shoes.

Don’t trim or pick at the skin around your nails. This may give fungus access to your skin and nails.

Don’t go barefoot in public places. Wear sandals or shoes around pools, showers, and locker rooms.

Choose a reputable nail salon. Make sure the place you go for a manicure or pedicure sterilizes its instruments properly. Instruments should be autoclaved or steam sterilized. Better yet, bring your own and disinfect them after use.

Give up nail polish and artificial nails. Although it may be tempting to hide nail fungal infections under a coat of pretty pink polish, this can trap unwanted moisture and worsen the infection. If you are going to an event or on vacation and “must” have your nails polished, consider removing it once the event is over. This will allow the nails to “breath” and any fungus to be treated.

Wash your hands after touching an infected nail. Nail fungus can spread from nail to nail.

Understanding Diabetic Foot Problems

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Diabetic Foot Problems and Treatments

What Are Diabetic Foot Problems?

Foot problems are a leading cause of hospitalization for the twenty nine million people in the United States who have diabetes mellitus. Medical costs related to diabetic foot problems total hundreds of millions of dollars annually. It is estimated that 15% of all diabetics will develop a serious foot condition at some time in their lives and twenty percent of all hospital admission for people with diabetes are for a foot related complication. Common problems include infection, ulceration, or gangrene that may lead to amputation of a toe, foot or leg. Most of these problems are preventable through proper care and regular visits to Dr. Giacalone. His office can provide information on foot inspection and foot care, proper footwear and early recognition and treatment of foot conditions.

Causes: Foot problems in people with diabetes are usually the result of a combination of three primary factors: neuropathy, poor circulation, and decreased resistance to infection. Also, foot deformities and trauma play major roles in causing ulcerations and infections in the presence of neuropathy and poor circulation.

Neuropathy (Nerve Damage): 
Ironically, neuropathy can be both painless and painful. Painless neuropathy is more common and often occurs without notice and causes your ability to feel sensations, pain or minor injury to be diminished or absent. With this, simple injuries can go unnoticed and untreated for a period of time, resulting in infection and worsening of the problem. The painful type of neuropathy may cause burning or sharp pains in feet and interfere with your sleep. The painful neuropathy may occur in combination with a loss of sensation. In addition to affecting sensation, neuropathy can also affect the nerves that control the muscles in your feet and legs. This “motor” or “muscle” neuropathy can cause muscle weakness or loss of muscle strength in the legs, and feet, leading to the development of hammertoes, bunions, and other foot deformities. In addition, neuropathy can affect your balance and result in an increase risk of falling.

Poor Circulation
: Patients with diabetes often have a circulation disorder called peripheral arterial disease or PAD. Symptpoms of PAD can range from no symptoms at all to cramping in the calf or buttocks when walking. These symptoms can progress to severe cramping or pain at rest, with associated color and temperature changes (the feet may turn bright red or blue when hanging down and constantly feel cold). Also, the skin may become shiny, thinned and easily damaged. A reduction in hair growth and a thickening of the toenails might also be present. Poor circulation, resulting in reduced blood flow to the feet, restricts delivery of oxygen and nutrients that are required for normal maintenance and repair. Healing of foot injuries, cuts, scrapes, infection or ulcerations may be delayed or impaired by this reduction in circulation. In these cases peripheral arterial bypass operations may be needed to avoid an amputation.

Infection: 
Patients with diabetes are generally more prone to infections than those without diabetes. Due to deficiencies in the ability of white blood cells to defend against invading bacteria, diabetics have more difficulty in dealing with and mounting an immune response to the infection. Infections often worsen and may go undetected, especially in the presence of diabetic neuropathy or peripheral arterial disease. Often, the only sign of a developing infection is unexplained high blood sugar, even without fever. The combination of fever and high blood sugar often warns of a severe infection requiring hospitalization. Lesser degrees of infection are often treated on an outpatient basis, however serious or more complicated infections will require hospitalization.

Foot Deformities: Foot deformities such as hammertoes, bunions, and metatarsal disorders have special significance in the diabetic population. Neuropathy places the foot at increased risk for developing corns, calluses, blisters and ulcerations. If these are left untreated, serious infections may result. A particular deformity can occur in persons with neuropathy and good circulation, called Charcot joint. A Charcot joint, resulting from trauma to the foot with reduced sensation from neuropathy, causes the foot and arch to collapse and widen. This destructive condition is often first noted with persistent swelling and redness, mild to moderate aching, and an inability to fit into your usual shoes. If this occurs, it is important to stay off the foot and see Dr. Giacalone immediately.

Ulcers of the Foot: An ulceration or ulcer is usually a painless sore at the bottom of the foot or top of the toes, resulting from excessive pressure at that site. Ulcers frequently underlie a corn or callus that was allowed to build up too thick. Trauma from heat, cold, shoe pressure, or penetration by a sharp object are also potential causes. Neuropathy allows the lesions to develop because the normal warning sense of pain has been lost and these problems go unrecognized. Continued pressure or walking on the injured skin creates even further damage and the ulcer will worsen. The open sore will frequently become infected and may even penetrate to bone.

Treatment relies on early recognition of the ulceration, avoidance of weight bearing activities such as walking, avoidance of wearing “closed-in” shoes, and early intervention. Besides local wound care, dressings and antibiotics, other measures may be necessary to adequately relieve pressure on the area. When use of crutches, a wheelchair, or rest is not feasible, fiberglass casts, specialized boots, braces, healing sandals, or orthoses (special shoe inserts) can be used to protect the foot while it heals. If circulation is inadequate to allow healing, you may be referred to a vascular surgeon for appropriate evaluation and possible vascular surgery. Once an ulcer has healed, it is important to continue to see Dr. Giacalone regularly. Special footwear and inserts may be recommended to protect your feet and prevent new or recurrent lesions from developing.

Foot Surgery in the Diabetic Patient: Realizing the potential danger of foot deformities in the diabetic patient, corrective foot surgery is an option when you are in good health, maintain proper blood glucose and have appropriate circulation. Most foot deformities worsen over time as do the effects of neuropathy and vascular or circulatory disease. When foot deformities cannot be managed effectively with conservative care such as shoe modification, surgery may be indicated. Podiatric surgery is often “same day” surgery under local anesthesia to minimize potential complications. In some cases, such as in the presence of an active ulceration, hospitalization may be necessary to properly monitor your postoperative progress. Surgery may also be required to heal an ulceration or to treat an infection, especially if the infection involves bone. Your cooperation is an important part of your care. You must guard against injury and provide the daily care necessary to maintain the health of your feet.

Footwear Guidelines: Shoes must always fit comfortably and have adequate width and depth for the toes. Leather shoes easily adapt to the shape of your feet and allow them to “breathe.” Athletic shoes, jogging shoes and sneakers are usually excellent choices if they are well fitted and provide adequate cushioning. Dr. Giacalone may recommend “extra depth” shoes or custom molded shoes to adapt to your particular needs, or diabetic orthotics to provide cushioning and support. Always check your shoes for foreign objects or torn linings before putting them on. You should wear two or three different pairs of shoes each day so that one pair is not worn for more than four to six hours. New shoes should be worn for only a few hours at a time and you should take care to inspect your feet for any points of irritation. Socks should be well fitted without seams or folds. They should not be so tight as to interfere with circulation. Well-padded socks can be very protective if there is an abundance of room in your shoes. Avoid wearing open-toe shoes or sandals until you have discussed this with Dr. Giacalone. Above all else, do not walk with bare feet.

Foot Care Guidelines

  • Inspect your feet daily for blisters, bleeding or lesions between your toes.
  • Use a mirror to see the bottom of your feet and heels.
  • Do not soak your feet unless the temperature of the water is lukewarm, not as hot as you can stand it. (95°-100° Fahrenheit).
  • Avoid temperature extremes – do not use heating pads on your feet.
  • Wash your feet daily with warm, soapy water and dry them well, especially between the toes.
  • Use a moisturizer daily, but avoid getting it between the toes.
  • Do not use acids or chemical corn removers.
  • Do not perform “bathroom surgery”
  • Have a podiatrist evaluate your feet for future care needs.
  • Contact your podiatric surgeon immediately if your foot becomes swollen or is painful, or if redness occurs.
  • Do not smoke.
  • Learn all you can about diabetes and how it can affect your feet.
  • Have regular foot examinations by Dr. Giacalone.

Dr. Giacalone has been trained specifically and extensively in the diagnosis and surgical treatment of foot disorders. Dr. Giacalone has been board certified by The American Board of Podiatric Surgery since 1995 and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Giacalone practiced for 10 years at the Diabetes Foot & Ankle Center at the Hospital for Joint Diseases in New York City. Dr. Giacalone performs surgery at Hackensack University Medical Center (HUMC) in Hackensack, HUMC @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.

Soccer, A Contact Sport?

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Soccer, a contact sport!

In the U.S. 60 million children between the ages of 6 and 18 years old, participate in some form of organized sports, with 44 million participating in multiple sports and more than 15.5 million who play organized youth soccer. Despite an increase in softer turf fields and better equipment, the U.S. injury rates in youth soccer is higher than in many other contact sports, especially injuries of the lower extremity. Several studies have demonstrated that soccer has a higher injury rate than many contact/collision sports such as field hockey, rugby, basketball, and football. Participants younger than 15 years tend to have a higher risk of injury and greater prevalence of injuries compared with older players.

Indoor and outdoor soccer environments have a similar relative risk of injury, however, knee injuries are more prevalent in outdoor soccer. Field surface and shoe characteristics can affect injury risk, especially on outdoor fields. Field conditions, specifically holes, rocks, twigs or other irregularities, can increase lower-extremity injuries. More specifically, uneven playing surfaces can result in improper landing, resulting in knee and ankle injuries. Inappropriate footwear can lead to either too little or too much frictional force, which can increase the risk of knee or ankle injury.

Commonly overuse injuries are seen in younger players, especially during growth spurts, such as muscle sprains, Achilles tendonitis, calcaneal apophysitis (Severe’s disease) and shin splints, attributable in part to play on hard fields with cleats that have insufficient or lacking arch support. Ankle injuries account for 16% to 29% of all soccer related injuries. Contusions and sprains of the lower extremities are the most common injury types; more sprains are seen as an emergency than either contusions, abrasions or fractures, which account for less than 10% of soccer injuries.

Causes of lower extremity youth soccer injuries generally stem from improper training, strengthening, and stretching as well as lack of warm-up and cool-down and inappropriate or lack of proper foot/arch support or foot gear.

Here are some tips to help prevent youth soccer injuries

  1. Pre-season training and conditioning;

Podiatrist tend to see more injuries at the beginning of the season when kids are trying to do too much too soon without proper conditioning. Players should participate in a program of leg, core, and endurance strengthening exercises before the season begins to prepare their bodies for the soccer specific muscle movements they will use during play.

2. Proper stretching

Tight muscles are more prone to soccer injury. Assuring that the hamstrings, quads, hips, lower legs and ankles are stretched properly before games and practices is paramount, while post game / practice stretching is equally important.

  1. Knee injury prevention

Knee injuries, including ACL sprains and ruptures, are among the most common youth soccer injuries, especially for girls. Studies show that specific exercises designed to increase knee strength and range of motion have reduced the occurrence of knee injuries in adolescent and adult female soccer players.

4. Protective gear

Shin guards protect the vulnerable tibia from painful and debilitating contusions. Proper fitting cleats protect the foot and provide much needed traction. Make sure they fit properly to help prevent blisters and incorrect running and kicking form, which could cause foot or ankle injuries. Proper custom orthotics will often provide the appropriate support to reduce the risk of many foot, ankle and lower leg injuries.

  1. Proper heading

Although in soccer, head injury is most often the result of a player colliding with another player or being hit in the head with a ball, proper heading form will prevent some injuries to the head and neck. US Youth Soccer recommends waiting to teach heading until a player is old enough to understand the lesson and has the necessary strength to do it correctly, usually about 10 years of age. Soccer specific protective headgear can absorb some of the shock of head contact and reduce the risk of serious injury.

  1. Field Maintenance

It is estimated that up to 25% of all youth soccer injuries are the due to poor field conditions. Officials are technically responsible for this, but parents, coaches and players should all play a role in checking the field for holes, puddles, rocks, and debris. Also, make sure goalposts are properly secured. While injuries from falling goalposts are rare, they are among the most serious.

  1. Fair play

Soccer is a contact sport, and as such, players are vulnerable to injury from rough or overly aggressive play. Adherence to fair play standards by players and coaches and enforced by referees helps reduce contact related injuries.

  1. Previous injuries

Re-injury is more likely to occur when a player gets back into a game or practice too soon. This is particular dangerous when you’re dealing with a soccer head injury. Sustaining a second concussion after the first is fully healed can lead to brain swelling and more serious complications.

 

 

 

 

 

Toenail Fungus, Yikes!!!!

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Yikes! Toenail Fungus!

Fungal toenail infections are a common foot health problem. Studies estimate that it afflicts 3-5% of the population; however, podiatrists believe that percentage is low because so many cases go un-reported and the incidence is much higher. Podiatrists treat approximately 2.5 million people annually, but that’s less than a quarter of the cases estimated by medical studies. The prevalence of fungal toenails rises sharply among older adults to 20 – 30%. The disease, characterized by a change in a toenail’s color and thickness is often considered ugly and embarrassing. Nail polish is an easy solution for many women, rendering the problem “out of sight, out of mind”, however this only makes the problem worse in the long run.

Over-the-counter topical nail fungus treatments can range from $20 to $50 per bottle and do not have controlled clinical trials supporting their effectiveness. Natural home remedies’ include the use of vinegar (apple cider and white), tea tree oil, baking soda, bleach, oil of oregano, Listerine, Vicks Vapor-rub, coconut oil and orange oil. While these options may be helpful for minor or early fungal toenail changes, they are rarely helpful in more advanced cases. Medical treatment options include the use of prescription topical medication such as Penlac, Jublia and Kerydin and oral medication like Lamisil and Sporanox. In office topical laser treatment is a non-medication option for the treatment of fungal toenails. Laser treatment involves 2-3 fifteen-minute non-painful treatments, each approximately one month apart. Theses methods carry the distinct advantage of medical trials to support their efficacy. Choosing which treatment option is best suited for a patient often depends on a combination of current medical and medication history, patient preference and cost.

However prevention is always preferred to treatment. The fungus, which causes the problem, is everywhere, especially in damp environments, causing the fungus to spread. Here are some tips in order to prevent fungal toenails from taking hold of your toenail. Limit or avoid toenail polish as it can trap moisture in the nail, don’t share shoes, don’t try on shoes without socks or stockings, keep your feet dry with the use of powder and or moisture absorbing socks, don’t go barefoot in public places and don’t cut your toenails too short.

Yikes! Toenail Fungus?

 

Yikes! Fungal Toenail?

Fungal toenail infections are a common foot health problem. Studies estimate that it afflicts 3-5% of the population; however, podiatrists believe that percentage is low because so many cases go un-reported and the incidence is much higher. Podiatrists treat approximately 2.5 million people annually, but that’s less than a quarter of the cases estimated by medical studies. The prevalence of fungal toenails rises sharply among older adults to 20 – 30%. The disease, characterized by a change in a toenail’s color and thickness is often considered ugly and embarrassing. Nail polish is an easy solution for many women, rendering the problem “out of sight, out of mind”, however this only makes the problem worse in the long run.

Over-the-counter topical nail fungus treatments can range from $20 to $50 per bottle and do not have controlled clinical trials supporting their effectiveness. Natural home remedies’ include the use of vinegar (apple cider and white), tea tree oil, baking soda, bleach, oil of oregano, Listerine, Vicks Vapor-rub, coconut oil and orange oil. While these options may be helpful for minor or early fungal toenail changes, they are rarely helpful in more advanced cases. Medical treatment options include the use of prescription topical medication such as Penlac, Jublia and Kerydin and oral medication like Lamisil and Sporanox. In office topical laser treatment is a non-medication option for the treatment of fungal toenails. Laser treatment involves 2-3 fifteen-minute non-painful treatments, each approximately one month apart. Theses methods carry the distinct advantage of medical trials to support their efficacy. Choosing which treatment option is best suited for a patient often depends on a combination of current medical and medication history, patient preference and cost.

However prevention is always preferred to treatment. The fungus, which causes the problem, is everywhere, especially in damp environments, causing the fungus to spread. Here are some tips in order to prevent fungal toenails from taking hold of your toenail. Limit or avoid toenail polish as it can trap moisture in the nail, don’t share shoes, don’t try on shoes without socks or stockings, keep your feet dry with the use of powder and or moisture absorbing socks, don’t go barefoot in public places and don’t cut your toenails too short.

Teachers, Stand on Your Own Two Feet!

According to several studies, the average person takes between 6,000 and 10,000 steps per day, but if you’re a teacher, it can feel like a million.  The rigors of being in front of eager minds all-day, walking, standing and speeding along the halls, can take its toll.  Many of our teachers are in early and stay late participating in extracurricular responsibilities, making for a very long day on their feet. These “occupational hazards” result in of a variety of foot ailments, such as heel pain, arch pain, tendonitis and neuromas.

 

Heel pain, sometimes referred to as heel spur syndrome, often causes pain on the inside bottom of the heel, primarily in the morning or after periods of sitting or rest. Arch pain, also called plantar fasciitis, is an inflammation of the ligament on the bottom of the foot called the plantar fascia. The classic symptom of plantar fasciitis is pain in the arch with the first few steps in the morning and gets worse throughout the day. Tendonitis, an inflammation of a foot tendon, causes a variety of pains in various locations. Tendon pain tends to increase with use throughout the day. A neuroma is a “pinched nerve” in the ball of the foot, causing numbness, tingling and or burning on the ball of the foot and into the toes, typically the 2nd, 3rd or 4th toes.  These conditions are commonly the result of lack of appropriate foot support and “abnormal” foot mechanics.

 

The more immediate treatments for these painful conditions are aimed at reducing pain and inflammation. This can be accomplished via a combination of oral anti-inflammatory medications, ice, stretching, physical therapy, immobilization or cortisone injections. However, more often long-term treatment is brought about by the use of custom-made foot orthotics.

 

Orthotics are custom shoe inserts that are intended to correct abnormal foot mechanics or an irregular walking pattern. They perform functions that make standing, walking and running more comfortable and efficient.  I prescribe orthotics as a conservative approach to many foot problems, resulting in a highly successful, common and practical treatment option.  Orthotics improve foot function, minimizing stressful forces that can ultimately cause foot deformity and pain. Foot orthotics fall into three broad categories: those that primarily attempt to correct foot function, those that are protective in nature, and those that combine functional control and protection. Orthotics are available in different styles, depending on your activities, shoe type and lifestyle.

 

Foot pain is not normal. If you are experiencing foot pain to any degree, it is worth a visit to find out if custom foot orthotics can help your ailing feet.

 

 

“A teacher affects eternity: they can never tell where their influence stops.” – Henry Adams

Wound Care

Dr. Vincent Giacalone

Dr. Vincent Giacalone

Podiatric Medicine & Surgery

466 Hook Rd., Suite 24D, Emerson, NJ 07630

Phone: 201-261-0500

Wound Care

What is a Diabetic Foot Ulcer?

A diabetic foot ulcer is an open sore or wound that occurs in approximately 15 percent of patients with diabetes and is commonly located on the bottom of the foot. Of those who develop a foot ulcer, 6 percent will be hospitalized due to infection or other ulcer related complications. Diabetes is the leading cause of non-traumatic lower extremity amputations in the United States, and approximately 14 to 24 percent of patients with diabetes who develop a foot ulcer will require an amputation. Foot ulceration precedes 85 percent of diabetes related amputations. Research has shown, however, that development of a foot ulcer is preventable.  

Causes

Anyone who has diabetes can develop a foot ulcer.  People who use insulin are at higher risk of developing a foot ulcer, as are patients with diabetes related kidney, eye, and heart disease. Being overweight and using alcohol and tobacco also play a role in the development of foot ulcers.  Ulcers form due to a combination of factors, such as lack of feeling in the foot, also known as peripheral neuropathy, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration of diabetes. Patients who have diabetes for many years can develop neuropathy, a reduced or complete lack of ability to feel pain in the feet due to nerve damage caused by elevated blood glucose levels over time. The nerve damage often can occur without pain, and one may not even be aware of the problem. Your podiatrist can test feet for neuropathy with a simple, painless tool called a monofilament.

Vascular disease can complicate a foot ulcer, reducing the body’s ability to heal and increasing the risk for an infection. Elevations in blood glucose can reduce the body’s ability to fight off a potential infection and also slow healing. 

Symptoms

Because many people who develop foot ulcers have lost the ability to feel pain, pain is not a common symptom. Many times, the first thing you may notice is some drainage on your socks. Redness and swelling may also be associated with the ulceration and, if it has progressed significantly, odor may be present.

When to Visit Dr. Giacalone

Once an ulcer is noticed, seeing Dr. Giacalone immediately is very important. Foot ulcers in patients with diabetes should be treated quickly in order to reduce the risk of infection and amputation, improve function and quality of life, and reduce health-care costs.

Diagnosis and Treatment

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The faster the initial treatment and healing, the less chance for an infection.

There are several key factors in the appropriate treatment of a diabetic foot ulcer:

  • Prevention of infection
  • Taking the pressure off the area, called “off-loading”
  • Removing dead skin and tissue, called “debridement”
  • Applying medication or dressings to the ulcer
  • Managing blood glucose and other health problems

Not all ulcers are infected; however, if Dr. Giacalone diagnoses an infection, a treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

To keep an ulcer from becoming infected, it is important to:

  • keep blood glucose levels under tight control;
  • keep the ulcer clean and bandaged as directed;
  • cleanse the wound daily, using a wound dressing or bandage as directed; avoid walking barefoot.

For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-loaded.”  You may be asked to wear special footgear, walking boot or a brace, specialized castings, or use a wheelchair or crutches.  These devices will reduce the pressure and irritation to the area with the ulcer and help to speed the healing process. Dr. Giacalone has specialized training in off-loading ulcers on the foot. The science of wound care has advanced significantly over the past ten years. The old thought of “let the air get at it” is now known to be harmful to healing. We know that wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and moist. The use of full-strength betadine, hydrogen peroxide, whirlpools, and soaking are not recommended, as these practices could lead to further complications.

Appropriate wound management includes the use of dressings and topically-applied medications. Products range from normal saline to advanced biological growth factors, ulcer dressings, and skin substitutes that have been shown to be highly effective in healing foot ulcers. For a wound to heal, there must be adequate circulation to the ulcerated area. Dr. Giacalone can determine circulation levels with noninvasive tests.

Tightly controlling blood glucose is of the utmost importance during the treatment of a diabetic foot ulcer. Working closely with your medical doctor or endocrinologist to control blood glucose will enhance healing and reduce the risk of complications.

Dr. Giacalone has performed several clinical trials on a variety of specialized advances biological wound healing treatments. He also lectures nationally on diabetes related foot complications and wound healing strategies.

Surgical Options: A majority of non-infected foot ulcers are treated without surgery; however, if this treatment method fails, surgical management may be appropriate. Examples of surgical care to remove pressure on the affected area include shaving or excision of bone(s) and the correction of various deformities, such as hammertoes, bunions, or bony “bumps.” Healing time depends on a variety of factors, such as wound size and location, pressure on the wound from walking or standing, swelling, circulation, blood glucose levels, wound care, and what is being applied to the wound. Healing may occur within weeks or require several months.

Prevention

The best way to treat a diabetic foot ulcer is to prevent its development in the first place. Recommended guidelines include seeing Dr. Giacalone on a regular basis as he can determine if you are at high risk for developing a foot ulcer and implement strategies for prevention.

You are at high risk if you have or do the following:

  • Neuropathy
  • Poor circulation
  • A foot deformity (e.g., bunion, hammer toe)
  • Wear inappropriate shoes
  • Uncontrolled blood sugar
  • History of a previous foot ulceration

Reducing additional risk factors, such as smoking, drinking alcohol, high cholesterol, and elevated blood glucose, are important in prevention and treatment of a diabetic foot ulcer. Wearing the appropriate shoes and socks will go a long way in reducing risks. DR. Giacalone can provide guidance in selecting the proper shoes.

Learning how to check your feet is crucial so that you can find a potential problem as early as possible. Inspect your feet every day, especially the sole and between the toes, for cuts, bruises, cracks, blisters, redness, ulcers, and any sign of abnormality. Each time you visit a health-care provider, remove your shoes and socks so your feet can be examined. Any problems that are discovered should be reported to DR. Giacalone as soon as possible; no matter how simple they may seem to you. 

The key to successful wound healing is regular podiatric medical care to ensure the following “gold standard” of care:

  • Lowering blood sugar
  • Appropriate debridement of wounds
  • Treating any infection
  • Reducing friction and pressure
  • Restoring adequate blood flow

Dr. Giacalone has been trained specifically and extensively in the diagnosis and medical and surgical treatment of foot disorders.  Dr. Giacalone has been board certified by The American Board of Podiatric Orthopedics and The American Board of Podiatric Surgery since 1993 and 1995 respectively and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Giacalone performs surgery at Hackensack University Medical Center in Hackensack, Hackensack University Medical Center @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.

Plantar Warts

                                       Dr. Vincent Giacalone

Dr. Vincent Giacalone

Podiatric Medicine & Surgery

466 Hook Rd., Suite 24D, Emerson, NJ 07630

Phone: 201-261-0500

Plantar Warts

What are plantar warts?
Plantar warts, also called verrucae (ver-ook-kay) are one of several soft tissue conditions of the foot that can be quite painful. They are caused by the human papilloma virus, which generally invades the skin through small or invisible pores, cuts and abrasions. They can appear anywhere on the skin, but, technically, only those on the sole of the foot are properly called plantar warts, as the word plantar means the bottom of the foot. Children, especially teenagers, tend to be more susceptible to warts than adults.

Identification Problems
Most warts are relatively harmless, even though they may be painful and are often mistaken for corns or calluses. The wart, however, is a viral infection. It is also possible for a variety of more serious lesions to appear on the foot, including malignant lesions such as squamous or basal cell carcinomas and melanomas. Although rare, these conditions can sometimes be misidentified as a wart. It is wise to consult with Dr. Giacalone when any suspicious growth, lesion, mass or eruption is detected on the skin of the foot, ankle or leg in order to ensure a correct diagnosis.

Plantar warts tend to be firm and sometimes bumpy, with a rough surface with well-defined borders; warts are generally raised and fleshier when they appear on the top of the foot or on the toes. Plantar warts are frequently skin color, white, gray or brown (the color may vary), with a center that appears as one or more pinpoints of black.


Source of the Virus
The plantar wart is often contracted by walking barefoot on surfaces where the virus is. The virus which causes plantar warts is the human papilloma virus (HPV). There are many types of HPV, however the types which specifically cause plantar warts are the HPV number 1 and sometimes numbers 2,3,4,27,29 and 57. The virus thrives in warm, moist environments, making the virus a common occurrence in and around pools, jacuzzi’s, health clubs, gyms, locker rooms, karate facilities, dance classes, hotel rooms, etc. The virus can survive on floors and other surfaces for a long time. Normally, antibodies in the blood kills the virus, however some people are more susceptible to the human papilloma virus than others and HPV takes refuge in the skin.

If untreated, warts can grow to an inch or more in circumference and can spread into clusters of several warts; these are often called mosaic warts. Like any other infectious lesion, plantar warts are spread by touching, scratching, or even by contact with skin shed from another wart. The wart may also bleed, another route for spreading. Rarely, warts can spontaneously disappear after a short time, and, just as frequently, they can recur in the same location.

When plantar warts develop on the weight-bearing areas of the foot, such as the ball of the foot or the heel, they can be the source of sharp, burning pain. Pain occurs when weight is brought to bear directly on the wart, although pressure on the side of a wart can create equally intense pain. A plantar wart is similar in structure to an iceberg. The part on the surface is a small fraction of the entire lesion.

Tips for Prevention

  • Avoid walking barefoot, especially around pools or locker rooms.
  • Change shoes and socks daily.
  • Keep feet clean and dry.
  • Check children’s feet periodically.
  • Avoid direct contact with warts—from other persons or from other parts of the body.
  • Do not ignore growths on, or changes in, your skin. 

Self-Treatment
Self-treatment is generally not advisable. Over-the-counter preparations contain acids or chemicals that destroy skin cells, and it takes an expert to destroy abnormal skin cells (warts) without also destroying surrounding healthy tissue. Self-treatment with such medications should be avoided especially by people with diabetes and those with cardiovascular or circulatory disorders. Never use them in the presence of an active infection.

Professional Treatment

Dr. Giacalone will prescribe and supervise your treatment plan. There are several different techniques for treating plantar warts:

Acid: One of the methods used is a mild acid applied topically to the wart. This effects the viral cells and allows healthy skin cells to replace them. Multiple (6-8) applications over the course of several weeks may be required. You may be asked to apply an acid patch on a daily basis to assist in the therapy and see Dr. Giacalone weekly to bi-weekly for treatment and debridement (removal of the dead skin) of the wart.  This treatment may take 6-12 weeks. Also a cream called Aldara may be used alone or in combination with other treatments. 

Cryotherapy: Freezing wart with a very cold applicator can kill the virus over the course of 6-8 weekly treatments. Cryotherapy is sometimes ineffective on plantar warts because the cold may not penetrate far enough to kill the virus completely. This treatment is usually used in combination with the acid treatment noted above, Aldara cream and debridement of the wart.

Surgical Excision: In this technique, Dr. Giacalone uses a scalpel to remove the warts under local anesthesia in the office. It is not the preferred method give the high success and lower pain associated with laser treatment noted below.

Laser Treatment: The major advantage to laser treatment of plantar warts is the fact that it is quick, relatively painless and simple to perform. The laser targets the blood vessels within the wart, causing it to shrink and heal over a period of several weeks.  The laser is non-invasive and is not used to “cut-out” the wart.  Most warts are resolved within 1 to 2 treatments, 2 to 3 weeks apart.  Although this is not a surgical procedure Dr. Giacalone performs the laser treatment at the Surgery center in Oradell.  There is no bleeding, cutting of skin or stitches/sutures and no bandage or dressing is required other than a simple band-aid. Patients can return to work or school immediately after the treatment.  Laser treatment can be performed as a first treatment option or if other in-office treatment are unsuccessful.

Complications: Warts can return after treatment, indicating that the virus is still in the skin. The virus that causes plantar warts can spread to other parts of the body. Blood from a wart contains the virus and can cause a new wart to grow in an area it touches. Therefore, it is important to treat warts and eliminate them as quickly as possible.

Dr. Giacalone has been trained specifically and extensively in the diagnosis and medical and surgical treatment of foot disorders.  Dr. Giacalone has been board certified by The American Board of Podiatric Orthopedics and The American Board of Podiatric Surgery since 1993 and 1995 respectively and is a Fellow of the American College of Foot and Ankle Surgeons. Dr. Giacalone performs surgery at Hackensack University Medical Center in Hackensack, Hackensack University Medical Center @ Pascack Valley in Westwood and Surgicare Surgical Center in Oradell.