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One morning you wake up and notice that one or many of your nails is undoubtedly discolored. Over the past few months you have watched as your nail has become a yellow color, which started at the end of the nail and is now approaching the middle portion. You notice that your nail is becoming progressively thicker and is getting impossible to cut with a regular nail nipper. This is when you realize that you may have a fungal nail infection, most commonly referred to in medicine as Onychomycosis.
 
Onychomycosis affects up to 6-8% of the adult population. Organisms such as: dermatophytes, candida, or mold cause this disorder. Dermatophytes were made common knowledge to the public with a TV advertisement by the Lamisil drug company who introduced digger the dermatophyte to the world. Digger is an organism called Trichophyton rubrum, and is the cause for 90% of the total cases of onychomycosis.
 
Onychomycosis can be divided into 5 subtypes:
-Distal Subungual Onychomycosis
-White superficial Oncyhomycosis
-Proximal subungual onychomycosis
-Candidal onychomycosis.
-Total Dystrophic onychomycosis.
 
Distal subungual onychomycosis is the subtype that most patients will experience at some point in their lives. Fungus, yeasts, and molds are all common inhabitants of one’s shoes. Unlike the commercials, these organisms cannot just lift up the nail and sneakily climb under. Rarely do they cause a problem unless there is a type of trauma that allows the nail to separate from the skin This can include tight shoe gear which causes chronic damage to the nail plate, an event that caused some sort of nail destruction, and dirty instrumentation found at nail salons. Patients with athletes foot, a fungal infection of the skin of the foot, have a high risk of developing these infections seeing as the organism can easily spread from the skin to the nail.
Kicking digger the dermatophyte out is harder then it appears on TV. The cure rate for treating nail fungal infections is less then 50%, and 10-20% of people will contract onychomycosis again in their lifetime. A human nail grows between 1-2mm per month, and it takes 12-18 months to grow out a toenail completely. The decision to treat this condition takes dedication, commitment, and lot of personal time. 
 
There are three types of treatment for nail infections: topical solutions, oral pills, and surgery. Surgical treatment consists of removing the entire nail and treating the nail bed with a topical antifungal. This type of procedure can be painful, invasive, and very traumatic. Most patient choose to begin treatment with topical drugs such as:
-Ciclopirox (Penlac)
-Rinnovi (Quinnostik)
-Fungisil
-Fungoid Tincture
-Vick’s vapor rub
-Topical Lamisil
-PGULA solution
 
When using the topical solutions one should keep the nail filed down on the top to help the topical solution absorb.
 
Oral Medications Include:
-Lamisil
-Itraonazole (Sporanox)
-Fluconazole (Diflucan)-Off label use.
-Griseofulvin (GRIS-peg)
When using the oral medication it is important to consider the interactions with other drugs and the many side affects. The main side affect of Lamisil is that it can have a damaging effect on the liver. Most Podiatrists will have lab work drawn to check the liver enzymes before this medication is prescribed. The treatment of Onychomycosis is a challenging task, but can be done with the guidance of your Podiatrist.
June 26, 2013
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The first Labor Day was celebrated on September 5th, 1882, and has continued to be honored the first Monday of September for the last 127 years. This holiday was created in admiration of the hard working Americans that have long contributed to the successful economy of the United States of America. The greatest myths that accompanies this holiday is the saying “you shouldn’t wear white after labor day”.
 
The exact origin of the story that forbids white fashion before Easter and after Labor Day is uncertain. Two theories of fashion seem to be the most quoted through out the Internet database. The first stems from the increase in the number of middle class women in the 1950’s. Rules were given to these women who were new to the higher fashion realm, in order to allow them to fit in with the people of the higher economic class socially. The second theory comes out of the Southern states of America, and has been part of the fashion code there for a long time. Fashion codes south of the Mason-Dixon line tend to be more formal and followed then in the North, East, or West of the country.
 
Currently, the trend of fashion designers is to deliver a fall fashion line that has darker, warmer colors. This year’s fall fashion trends include deep shades of gray, purple, berry, blue, and animal prints. A white pump or flat shoe may not match as well with these colors in fall, and may not be popular amongst designers for this very reason. This rule of white tends to include other fashion items such as handbags and clothing, although in previous years winter white outerwear and boot shoe gear has been making a comeback. Climate has also been a determining factor in this myth. White is a color that is said to reflect all other colors of the rainbow, whereas the color black is said to absorb them. Many people feel that in cooler climates white may also be to cold for their feet for the outdoors. White shoe gear is also known for getting dirtier in the winter mush, and is difficult to keep clean. Ladies, feel free to wear your white shoes, clothing, and accessories at your own accord in the cold winter months.
Summer is rapidly coming to an end, and where there is sun there is also the risk of getting malignant melanoma. Malignant melanoma is a cancerous disease that originates from the pigment producing cells in our skin called Melanocytes. Melanoma is often a malignant disease, spreading the disease to other areas of the body as it grows under the skin. Melanoma is easily treated in the early stages of the disease. Melanoma may go unnoticed in the foot and ankle in the earlier stages, which accounts for a higher mortality rate when the disease is discovered after reaching advanced stages. Knowing the ABC’s of malignant melanoma may help save you or someone else’s life.
 
Asymmetry-Divide the growth in question into two halves. Compare the halves to one another to make sure they are equal in size. An asymmetric growth may indicate melanoma.
 
Borders-A skin growth should have a clear, noticeable, and regular borders. Skin growths that have irregularly shaped borders that are ragged and blurred may indicated melanoma.
 
Color-A skin growth with multiple blended colors such as: brown, white, black, red, may be indication of melanoma.
 
Diameter-A regular mole on human skin should not measure more then 5-6 millimeters. It the diameter is larger, one should suspect Melanoma.
 
Elevation-A skin lesion that is raised from the skin may indicated malignant melanoma.
 
Malignant melanoma may appear on any part of the body. Lesions that appear to be getting larger in shape, look like they are bleeding or scabbing, have accompanying redness and swelling in the affected areas, or itch and are painful should seek medical attention immediately. Keeping out of the sun and using sunscreen can help deter this horrible invading disease.
June 26, 2013
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This summer Macy’s introduced a new brand of sandals that promised to act as a gym and increase lower extremity muscle tone called the Fitflop. This sandal has been designed by engineers to help tighten and tone leg muscles as one walks in them. A study done by Dr. David Cook in London has shown that Fitflops can:
 
-Improve posture
-Increase lower extremity muscle activity and muscle load
-Increase lower extremity muscle tone.
 
One day I am walking in Macy’s and I see this new sandal and like most women are enticed by the promise of toned legs with minimal exercise. I decided to plop down $60 dollars for a pair of the Electra style, the black ones with the flashy sequence on the top. I wasted no time in putting them on. I was surprised at how great my feet felt. I have been suffering from a persistent plantar fasciitis for a few years, and in the Fitflop sandal I had no heel pain. The sandal design has a thick heel cup and a large arch support. Whether or not the muscle tone in my legs has improved in the two and a half months I’ve been wearing these sandals has yet to be seen. But I can recommend these to any woman looking for a comfortable sandal to wear. I have worn these for 8 hours of walking at a time and have felt no pain. I would recommend these to anyone who is looking for a comfortable, yet fashionable sandal to wear.
 
As the cold months are approaching it is time to my Electra Fitflops away. The good news is that this fall/winter the Fitflop Company is introducing house slippers, clogs, and a whole line of boots. For more information on this brand of shoes go to http://www.fitflop.com/
June 26, 2013
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Ranging from meek discomfort to incapacitation, heel pain affects over 2 million
American every year. The most frequent cause of heel pain is inflammation of the connective tissue band that runs on the bottom of the foot called the plantar fascia. When this band is inflamed, torn, or ruptured it can cause a significant amount of pain which medical professionals deem “Plantar Fasciitis”. The plantar fascia supports the arch of the foot, and is susceptible to calcifications called heel spurs. A common misconception is that the heel spur is the cause of the heel pain. In about 50% of cases people with heel spurs have no symptomatic heel pain. 
 
There are many causes of plantar fasciitis. Individuals who run or stand for long periods of time on hard surfaces or have a tight Achilles tendon and calf muscle are susceptible for strain and micro tears of the plantar fascia. Patients that are over weight, have high or flat arches, or wear poorly fitting shoes may also strain the plantar fascia. The key symptom of plantar fasciitis is pain on the first steps in the morning, called “Postatic dyskinesia”. Pain often occurs after long periods of rest, standing for long periods of time, and being very active throughout the day. Pain of the heel bone closest to the arch when pressed on is positive for plantar fascial irritation. A combination of patient history and clinical exam will be enough for most doctors to diagnose plantar fasciitis.
 
There are other foot diseases that may manifest as heel pain. These include calcaneal stress fractures, tarsal tunnel syndrome, fat pad atrophy, posterior tibial tendonitis, and Subtalar joint arthritis. Radiographs, therapeutic/diagnostic injections, nerve conduction velocity tests, or MRI studies may rule many of these diagnoses out. Once the diagnosis has been made there are many ways to treat the heel pain caused by plantar fasciitis. Part 2 of this entry on Monday will explore these options.


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