SKIN TAGS OF THE FEET

Skin Tags of the feet

skin tag is a small piece of tissue that hangs off the skin by a connecting stalk. Skin tags are usually not dangerous but they should be evaluated and monitored by a foot and ankle specialist and in some cases tested to determine whether or not further treatment is required. They can be found anywhere on the body including the neck, chest, back, armpits, under the breasts, the feet or in the groin area.  Skin tags are most commonly seen in women and the elderly.

Skin tags usually don’t cause any pain. However, they can become irritated if anything rubs on them.

How Are Skin Tags Treated?

While most skin tags are harmless, if they do become irritated and painful the treatment of choice is removal of the lesion. The foot and ankle specialists at Foot Care Centers are experts in evaluating and treating skin lesions of the feet and lower legs and can remove a skin tag in the office.  If you think you may have a skin tag on your feet, ankles or lower legs please call the Foot Care Centers today to schedule an appointment.

Picture courtesy of WebMD

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Tailor’s Bunion (Bunionette)

What Is a Tailor’s Bunion?
A Tailor’s bunion, also called a Bunionette, is a bony bump that involves the “head” of the 5th metatarsal bone near the base of the little toe.  While Tailor’s bunions have similar symptoms and causes to that of traditional bunions that occur on the inside of the foot,  they are less common.

Tailor’s bunions derived their name centuries ago, when tailors sat cross-legged all day with the outside edge of their feet rubbing on the ground. This constant rubbing led to a painful bump at the base of the little toe.

Causes
Tailor’s bunion are often caused by an inherited abnormal structure of the foot. In these cases, changes occur in the way the foot bones are positioned, resulting in the development of an enlargement of the metatarsal head. The fifth metatarsal bone starts to protrude outward, while the little toe moves inward.  This results in either the head of the metatarsal bone becoming irritated or an actual bone spur forming in the area along the outside of the foot that can become inflamed and painful due to pressure.

The symptoms of a tailor’s bunion are usually aggravated by wearing shoes that are too narrow in the toe, producing constant rubbing and pressure.

Symptoms
The symptoms of tailor’s bunions include redness, swelling, and pain at the site of the enlargement .  These symptoms are caused by wearing shoes that rub against the enlargement, irritating the soft tissues underneath the skin and producing inflammation.

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Diagnosis
A Tailor’s bunion is easily diagnosed during an exam because the bony bump is visually apparent.  In most cases, X-rays can be helpful to the foot and ankle surgeons at Foot Care Centers to determine the cause and extent of the deformity.

Non-Surgical Treatment
Treatment for tailor’s bunion typically begins with non-surgical therapies that include shoe modification or change, padding, oral anti-inflammatory medication, offloading, icing, injection therapy and custom made orthotic devices.

When Is Surgery Needed?
Surgery is often considered when the non-surgical treatment options discussed above fail to improve or eliminate the pain.  The foot and ankle specialists at Foot Care Centers will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors to determine the best procedure or combination of procedures needed to adequately address the deformity. The recovery time from this type of surgery depends on what procedure(s) is performed.

If you think you may have a Tailor’s bunion please contact the Foot Care Centers to schedule an appointment today.

Pictures courtesy of The American College of Foot and Ankle Surgeons/FootHealthFacts.org

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Ankle Sprains

Ankle sprains are a very common injury, according to the Mayo there are about 3 million cases of ankle sprains per year in the United States. This type of injury can affect anyone at anytime throughout their lives. Ankle sprains also have a high association with sport related injuries seen in basketball, football and soccer.

The majority of ankle sprains occur with the lateral (outside) ankle ligaments. This occurs when foot inverts and twists under the ankle. The severity of ankle sprain can be associated with the number of ligaments involved and the degree of damage associated with them. This area has 3 main lateral ankle ligaments commonly injured in an inversion ankle sprain ATFL (Anterior TaloFibular Ligament), CF (CalcaneoFibular ligament) and the PTFL (Posterior TaloFibular Ligament). The injury can range in severity from a stretch to a tear to one or all of these ligaments. These are typically classified from grade 1-3 (see image). Following an acute ankle sprain; swelling, pain, and bruising are typically seen.

If an ankle sprain is suspected ankle X-rays should be obtained to rule out an ankle fracture. Ankle fractures which are left untreated can have devastating long term complications, so early x-rays are imperative.

Treating an ankle sprain will depend on the severity, level of activity and age of each individual. Treatment can include immobilization in a walking boot, rest, ice, compression and elevation. In some cases surgical repair of the torn ligament may be indicated. If you are someone you know has suffered an ankle injury it is important to see your doctor as soon as possible and start the appropriate treatment plan.

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Mucoid Cyst

Mucoid cysts are round, dome-shaped benign skin lesions also known as synovial cysts, periarticular fibromas, myxoid cysts, ganglion cysts, mucinous pseudocysts and mucous cysts.  The underlying cause is unknown but they are the result of a defect in the lining of an arthritic joint or the covering of a tendon that allows fluid to fill a small space that eventually becomes visible on the surface of the skin.

These benign cutaneous lesions are filled with thick, viscous fluid and are usually located over the small joints of the toes and/or around a toenail.  These cysts may or may not be painful and are more common in women between the ages of 50 and 70 years old.

The treatment options include padding, drainage, cauterization, steroid injections and surgical excision and depend on the size, location and whether or not there is pain present.

If you think you may have a cyst on your toe please contact the Foot Care Centers and allow one of our trained foot and ankle specialists to discuss the best treatment option for you.

Picture courtesy of Dr. Fishco/Podiatry Today.

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Broken Toes

Fractures of the toes account for the most common fracture seen in the forefoot. According to Thomas Mittlmeier and Patrick Haar authors of “Sesamoid and toe fractures” 140 per 100,000 people have a toe fracture each year.

Most people believe nothing can be done for toe fractures and they simply heal without any treatment at all. However in some cases, toe fractures may require further treatment to prevent long term pain and complications. It is important to obtain X-rays in the case of any suspected fracture. In some instances fractures may be displaced or angulated which may require them to be reset (closed reduced) into the correct alignment.

In other cases, the toe fracture can occur in conjunction with a skin break resulting in an open fracture. Open fractures are generally more serious and may require antibiotics or surgical washout. Sometimes open fractures can go unnoticed if the skin break occurs under the toe nail.  If  a toe fracture is neglected, it can heal in bad alignment resulting in chronic pain, stiffness, and arthritis. In cases of open fractures there is a risk of serious soft tissue and bone infection.

Symptoms of a toe fracture can include direct trauma or injury followed by pain, swelling, and bruising to the area. Treatment can range from immobilization, splinting, close reduction, and in severe cases, surgical repair. If you or someone you know has suffered an injury and suspect a toe fracture visit your podiatrist as early as possible. Early and appropriate treatment is paramount in preventing long term pain and complications.

Image Courtesy – https://www.pinterest.com/nbradiologists/  (North Broward Radiologists)

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Piezogenic Papules

Piezogenic papules are painful or asymptomatic bumps of the feet and wrists that result from herniation of fat through the dermis layer of the skin. They are common, nonhereditary, and usually are not the result of an inherent connective tissue defect. Piezogenic papules of the wrist were reported in 1991. They are found in a large number of asymptomatic people.

 

Herniation of fat into the dermis causes the papular appearance. The papules become apparent when an individual stands with full weight on the heels, and they resolve when the weight is removed. The papules, which usually occur in both feet, may be present on the right, left or back side of the heels. Piezogenic papules are diagnosed clinically. No laboratory evaluation/testing is required.

 

No effective oral or topical medical therapy is available for this condition. Because the problem is strictly cosmetic for most individuals, therapy is rarely needed.  Rest, elevation, weight loss and avoidance of prolonged standing may be helpful for symptomatic patients if these factors are contributing to the symptoms.  When those lifestyle changes do not relieve symptoms, orthotic inserts from the foot and ankle specialists at Foot Care Centers may be of benefit to symptomatic individuals.  If you think you may have piezogenic papules in your heels please call Foot Care Centers today and schedule an appointment.

Picture courtesy of mddk.com/bing.

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Neuropathy

Neuropathy is defined as disease or dysfunction of one or more peripheral nerves. This condition can present itself with symptoms of numbness, weakness, burning, tingling, as well as abnormal sensitivity usually affecting the hands and feet.

According to the National Institute of Neurological Disorders and Stroke an estimated 20 million people in the United States have some form of peripheral neuropathy. As a podiatrist most cases of peripheral neuropathy we see are related to diabetes. The nerve damage in diabetics is due to prolong periods of elevated blood sugars. Hence, the monumental importance of controlling blood sugar is the mainstay in prevention of diabetic neuropathy.

However, many other causes for peripheral neuropathy do exist, these can include: exposure to chemo therapy or toxins, alcohol induced neuropathy, stroke, autoimmune disease, vitamin deficiencies, and lower back or nerve injury just to name a few. It is important to recognize the signs and symptoms of neuropathy as early as possible to prevent further complications down the road.

In some people the nerve pain keeps them from sleeping at night. In other cases, the numbness is so severe that a fracture or infection will go unnoticed until it becomes limb threatening. Diagnostic testing such Semmes Weinstein monofilament, NCV or EMG, and nerve fiber biopsy/analysis can help determine if you have neuropathy.

Treatment plans are available and are usually tailored to each individual based on etiology and severity.  In some cases the nerve damage may be irreversible in which controlling symptomatic and close monitoring is the treatment of choice.

If you or someone you know is having signs and symptoms of neuropathy it is important to visit your doctor as early as possible. Early diagnosis and close monitoring are paramount in prevention of foot related complications.

Image Courtesy of http://riderchiropractic.com/

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Pigmented Nail Streak

A melanonychia, also known as a pigmented nail streak, is brown or black pigmentation of the nail unit. Melanonychia commonly presents as a dark band arranged lengthwise along the nail unit, and this presentation is known as longitudinal melanonychia. The most concerning cause of melanonychia is subungual melanoma (skin cancer under the nail); although a variety causes can be responsible for such a finding and should be investigated by a foot and ankle professional.

Melanonychia most often occur because of increased production of melanin by melanocytes (cells that produce color) in the nail root. This results in a visible band of pigmentation in the nail plate.

Melanonychia are more common in darker-pigmented individual and are characterized by one or more tan, brown, or black discolored bands in the nail plate. If you think you may have discolored bands within your toenails please call and make an appointment with one of the foot and ankle specialists at Foot Care Centers today.

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LISTER’S CORN

Lister corns are found on the inside and outside of the nail bed, typically on the little toe. Lister corns are often described by the patient as having a ‘second toe nail’ on the toe. This ‘second toe nail’ is actually hard callus that resembles nail.  Pain is described with direct pressure to the corn by shoes.  Lister corns are named after the father of modern surgery, British surgeon Joseph Lister (1827-1912).  Symptoms of a lister’s corn include focal pain adjacent to the 5th toe nail and/or a split nail or secondary toe nail.

Treatment

Lister corns can be prevented by wearing a shoe or sneaker with a wider more rounded toe box in order to reduce the pressure being applied to the lesion.  Periodic trimming of the callus is helpful to relieve pain and callus cream is helpful to soften the corn prior to trimming. Padding of a Lister corn can be accomplished in a number of different ways including the use of foam and gel.

Recurrent Lister corns that do not respond to conservative treatment can be treated surgically depending on their location by either removing a small portion of the last bone in the toe or simply filing the bone spur often found underlying such a lesion.  The incision for such a procedure is very small and is typically tolerated very well. The procedure can be completed in a matter of minutes and requires only mild sedation and the use of a local anesthetic.  Following such a procedure, most patients are able to return to normal activity and regular shoes within 1-2 weeks.

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The physicians at Foot Care Centers are surgically trained lower extremity specialists who will discuss treatment options with you and come up with the most appropriate treatment plan for your condition.  If you think you may have a Lister’s corn or other type of corn or callus, please give Foot Care Centers a call today to schedule an appointment.

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Plantar Warts

Plantar warts are unsightly, annoying, and can be very painful and are typically found on the foot. Warts are a virus and are classified in the HPV (Human Papillomavirus) family of viruses. They are most commonly acquired in wet public areas i.e. gyms, locker rooms, public showers, playgrounds and swimming pools just to name a few. Most often these areas are in places where people are barefoot.

Warts can enter into your skin via small cuts, microscopic breaks or fissures in the skin and begin to seed. Prolonged periods of exposure to moisture can also make the skin more fragile and susceptible to the wart virus. Warts can manifest over a period of weeks, months or even years.  Interestingly, the virus is not easily transmitted from direct skin contact, but can spread in households with infected people who share showers and bathrooms. They can affect any one at any point in their lives.

However, there is a tendency to see younger children and teenagers with warts due to a higher degree of exposure to the aforementioned environments. If left untreated the wart can enlarge and spread to other areas on the foot or hands and can even sometimes infect the elbows and knees.

Plantar warts can form painful lesions and become thick, hard, and surrounded by calluses altering gait and function. Most lesions areas are easily identified with the following criteria: tiny dark spots (pinpoint bleeding); pain with compression (medial and lateral compression); and interrupted skin lines (skin lines absent in the warty lesion).

Once the diagnosis is made the treatment fairly straight forward and consists of freezing, surgical removal and chemical destruction of the lesion.  The most painless treatment which is the one most frequently used at the Foot Care Centers is treating the wart with Cantharone a blistering agent which separates the warty tissue from the healthy tissue over a period of time. Although this treatment may take several applications it is pain free at the time of initial application and generally does very well with small children.

It is important to identify and treat warts as soon as you notice them, because the longer they persist more difficult they are to treat. If you are concerned that you or your child may have a plantar wart make an appointment at the Foot Care Centers in Vineland New Jersey.

Image courtesy of  http://www.nursingconsult.com/

 

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