1.)  A permanent line is left across the toenail (until it grows out) which indicates the presence of a 7-10 day fever.

2.)  A slow return to it’s normal pink color upon squeezing of the nail, indicates poor circulation.

3.)  If your entire nail is blue, this can indicate repetitive trauma caused by the shoes (perhaps improperly fitted).

4.)  A portion of the toenail turning blue indicates general trauma.

Source: Beck Wright, Standard-Examiner [11/30/09]

Many signs such as:  absence of hair growth on the digits, loss of sensitivity (which can be determined by your podiatrist with the use of a special filament), the color and temperature of the skin, all can add up to the risk factor that each diabetic patient faces.  Your podiatrist can even recommend the use of a pedal thermometer.  When your foot temperature gets above a certain level, that would not be the day to go on a long hike.

This definitely falls under the category of what the patient can do.  The doctor can only evaluate what is in front of him/her.  It is up to the patient to make that appointment.

Prevent This Diabetic Ulcer

What is good, in my opinion, is that the procedure is practically non-invasive.  It can be done with a tiny stab incision, and patients need not worry about longer healing times.

The principal behind which Topaz treatment works is to increase blood flow to the area, and to break up nocioceptors (a sensory receptor that responds to pain).

One important thing to remember about the treatment is that afterwards, you are NOT to use ice or other anti-inflammatories such as Motrin.  The treatment is attempting to accelerate this response, not slow it down.  It is that process that helps to open up blood flow to the area.

An infection that once was caught mainly in hospitals (you’d be amazed how much you can pick up in a hospital), has now branched out to many athletic groups and locker rooms.  MRSA infections also, interestingly enough, are misdiagnosed as spider bites.

This is not a Spider Bite

When I first started practicing, the talk about MRSA was strictly educational, and was good for the occasional multiple choice question on tests.  Now, however, all clinicians better know how to treat it, and notice it’s signs so that a culture can be taken.

Culturing out MRSA from a wound is truly a medical emergency.  Depending on it’s severity, and the medical condition of the patient, an automatic regimen of Bactrim is called for.  Getting antibiotics through IV (intra-venous) may also be necessary.

It is gaining attention simply because it works.  What better healing factor than the very healing factors present in your own blood could there be?

It has gained some attention in the media because football players such as Hines Ward, and Troy Polamalu, both from the Pittsburgh Steelers have used it.  Both players used it for treatment of their medial collateral ligaments in their knees.

In my practice, I have recently started using it for the treatment of plantar fasciitis and achilles tendonitis.  In the past, we were limitted to the use of steroid injections for these injuries.  And with regard to the achilles tendonitis, really had no other alternative injection therapy.  The blood is seperated into it’s two major components:  red blood cells, plasma, and the platelets.

I then take this mixture of PRP, and inject it directly into the area of maximum pain.  Sometimes, I use ultrasound to help guide my placement.

The results have been very encouraging.  Medicine and technology are a wonderful mix!

Hines Ward and PRP

The corollary to that question is always, “why did you want to become a podiatrist”?  I dont know why-but some people just consider working with feet distasteful for some reason.  My answer to that has always been, “do you know what a proctologist is”?; and if they do, that always ends the questioning.

To become a licensed podiatrist in the state of California, you need to complete four years of podiatry school, complete an approved residency, and pass an oral boards showing your competency to the state board.

We are fully licensed to write prescriptions, admit patients to the hospital, perform surgery in hospitals of our choice, and do pretty much whatever an MD can do.  Our major restriction of course is that our treatment is limited to maladies of the foot and ankle.

In California, you need to have a special ankle certificate to be licensed in that area.  I have that certification.

There has been talk over the past five to ten years of incorporating the MD degree along with what we currently have (a DPM degree).  Whether this ever comes to fruition is anybody’s guess.

For now, we’ll suffer along with the Jerry Seinfeld jokes, but we’ll know that when it comes to the foot; we are the specialists.

Fungus be gone!

One visit to a podiatrist’s office and thirty minutes later-you’re done!  Painless, and without all the side effects that come with oral pills.  The results are not immediate; and as the nail grows out in 9-12 months-you can look forward to showing off your toenails once more.

The manufacturer is claiming 88% effectiveness.  This is much greater than any topical, anti-fungal treatment on the market today.

The cost of the treatment, when you line it up against the cost of anti-fungal pills, and MULTIPLE trips to the doctor’s office-it’s pretty reasonable.

Want some social proof/buzz?  Check out here or here.  Call your podiatrist now if you’re outside the Southern California area to reserve your space.  If you live in the Southern California area, I am a licensed practioner of this product.  Call 909-627-6364 to schedule your appointment, or you can access my office website by clicking on the link to the right.  The unit will be delivered and ready in the last week of June.

Not to put too fine a point upon it, is also interesting that news of the swine flu outbreak came shortly after the President Obama trip to Mexico. Is there any connection?

Nowadays, for obvious reasons wars are not fought on the battlefield. Modern-day weaponry makes that a bad idea. Who wants to conquer a country that’s in smoldering ruins? People fight wars now on the economic front.

Perhaps Obama administration was not too happy with some of the negotiations that went on during his visit there. Perhaps this whole swine flu pandemic story was orchestrated to punish Mexico economically. Imagine how many billions of dollars Mexico has lost from the tourism industry alone. Many cruise ships have been rerouted away from Mexico to areas like Catalina and San Diego.

So next time you get the sniffles, don’t be overly worried. You probably just have the flu.

Would Temperature Monitoring Have Avoided This?

Lack of sensation the feet cause pressure sores to occur. Whether normal person without diabetes would notice and adjust, a person with diabetes would fail to notice. Diabetics have literally walked on a nail or coin to the point of ulceration.

A study recently conducted by Diabetes Care in 2007 showed that patients with a greater than 4° difference in temperature on the bottom of their feet (right versus left), showed a higher propensity toward developing ulcers. As a matter of fact, patients and a group that monitored their foot temperature were four times less likely to develop an ulceration. What these patients did was monitor six different sites on the foot as compared to the other foot.

These patients actually did better than those who simply inspected their foot with a mirror.

The special thermometer is an infrared thermometer. Along with frequent blood checks to rmonitor your glucose, this thermometer should be considered essential in your bag of tricks to combat the effects of this dread disease.

I remember the old Fram oil filter commercials where the technician slams the cash register door and others those famous lines,” you can pay me now, or you can pay me later.” Bunions are very much the same way. Caught early enough. It can be a very simple procedure with little time to recover.

Once a bunion gets severe at this picture shows, it is often necessary to do more extensive work during surgery. If the bunion is caught soon enough all the work is done at the head of the metatarsal. If the angle between the first and second toe gets large enough (and this angle is about 18°), work must then be done at the base of the metatarsal further up the foot.

This is called a base wedge osteotomy and requires up to six weeks in a walking cast. If only needs to be done at the head of the metatarsal than a walking cast is not necessary postoperatively.

Also two other things to consider: 1.) Your insurance coverage and 2.) your vascular status. If either of these become less than ideal,

This bunion requires work at the base--> longer recovery.

you may not be able to have the surgery at a later date.