Showing posts with label nails. Show all posts
Showing posts with label nails. Show all posts

Monday, March 21, 2011

Chemical Matrixectomy for Ingrown Toenails

Ingrown toenails are a common complaint of patients visiting a podiatrist. This involves the nail plate growing into the surrounding skin, most commonly at either the medial or lateral borders of the nail, with or without a localized infection. They can be very painful, and generally will worsen over time. In the presence of infection, a small abscess may form at the area of the ingrown nail, with a small amount of pus present. The infected skin will become red and swollen, and there will likely be some discharge from the area.

In the podiatrist’s office, these are typically dealt with by excising the offending border of the nail. This consists of making a small cut in the nail longitudinally, and rotating the ingrown border out of the skin. This procedure is done under local anesthesia to minimize the discomfort to the patient during the procedure.

Once the nail border is taken out, a common procedure is the chemical matrixectomy. This involves taking a strong chemical and essentially burning the nail matrix that produces the nail. By burning the matrix, the nail is prevented from growing back in that area, thus preventing recurrence of the ingrown toenail. The chemical matrixectomy has a very high success rate, with a reported recurrence of only 5-7%.

The process most commonly involves the use of phenol, a strong chemical used to burn the nail matrix. Phenol causes proteins to denature, which will not allow the nail to grow back where it is applied. The phenol is usually applied to the nail matrix several times. A piece of gauze may be used to protect the surrounding tissues, so that they are not damaged by the phenol. After the use of phenol, alcohol may be used to dilute the solution. The procedure is commonly referred to as a “P&A”, which stands for phenol and alcohol.

Some clinicians may prefer to use sodium hydroxide to remove the nail matrix, though phenol is much more commonly used. If sodium hydroxide is used, it is followed by an application of acetic acid to neutralize the reaction and stop the damage to the tissues.

Following the chemical matrixectomy, the surgical site is treated like a burn. Silver Sulfadiazine is often used as an antibiotic, and the wound is dressed with a bandage. The procedure will generally heal very well, with minimal time off of work and activity. Generally the doctor performing the procedure will want to follow up with the patient in a week’s time to ensure that the site is healing and there is no infection.


Central Florida Foot and Ankle Center
101 6th St Nw
Winter Haven, Fl 33881
(863) 299-4551

Friday, July 24, 2009

Insight on Insoles

Have you noticed that removable flap of material that lies inside those shoes you have just bought? Sometimes you may have noticed that this piece of material has come loose and has bunched itself deep into the shoe. Why is such a section of material necessary? Exactly what is it?

That shoe-bottom shaped material is called an insole.

Insoles or otherwise known as foot care orthoses are tools that podiatrists can use to help to cushion the foot and help to correct the biomechanics of your gait. They may also be used to alleviate pain, maintain and support the arch of your foot, accommodate foot deformity, and to relieve pressure.

The world of insoles is populated by devices in all different sizes, various shapes and a vast multitude of colors! They also have different classifications depending on their function. Foot care orthoses (especially custom made devices) work by slightly changing the angle that your foot strikes the ground. As a result, the biomechanics of your foot are slightly altered to better address the foot pathology that you may be experiencing.

In typical store bought shoes, the insoles you find really only have the purpose of cushioning your feet. However, specialized insoles can be made to deal with your problems and improve your ability to walk and maintain proper foot posture.

What goes into determining whether an insole is right for you?

Biomechanical evaluation
X-rays
Casting

A biomechanical evaluation consists of a series of objective measurements of the movement of the joints in your hips, knees, ankles and feet. Since your feet and their impact directly affects all the joints in your leg, it only makes sense to measure all of the body parts involved to accurately gauge what kind of insole will work best for you. This evaluation also involves a gait analysis so that your podiatrist can see how you walk without them and see if corrections need to be made. X-rays will give your doctor an internal look into the bone structure to verify some of the elements suggested by the biomechanical evaluation. Finally, a cast either in plaster or fiberglass is done to get an impression of your foot in its neutral position. Finally, all the measurements and casts are used to assemble your custom orthosis!

Insoles are a great non-invasive way to get you walking and functioning correctly! Talk to your podiatrist if this is a treatment right for you!

The majority of foot problems are associated with malalignments or imbalances in your feet. Problems that you may experience may include pain, fatigue, and/or deformity. Orthoses are a non-invasive way to correct those imbalances and help you stride in comfort.

Insoles are made of strong materials that can be subjected to the repetitive stresses of your body weight and the impact of the ground upon them without wearing down quickly. They are best used in close-toed shoes that will prevent them from sliding or slipping out! The beauty of these orthoses is that they can be transferred from one close-toed shoe to another. So for individuals that play a variety of sports, these devices can easily be placed into all your athletic foot gear!

Orthoses are durable and are not likely to be replaced if you are receiving them as an adult. As an adult, your bones and the resulting foot structure are probably at the point where significant change will not occur. Children who are prescribed orthoses for their foot pathologies will need new prescriptions due to their rapid foot growth. Orthoses may eventually see some wear and tear to them, and they can be refurbished if necessary.

If both you and your doctor feel that orthoses are the right therapy for your ailments, here are some factors that you might want to consider in order to get the most out of your treatment.

- Bring your shoes to your podiatrist’s office when you are called in to pick up your orthoses. This is a good way to make sure that the doctor sees these insoles properly fit in your shoes. If minor adjustments need to be made, your podiatrist will be qualified to make them.

- Whenever you go shoe shopping, make sure to bring your orthoses with you (along with the socks that you plan on wearing with the shoes).

- Make sure that you return for the follow-up appointment with your podiatrist for an evaluation of your orthoses. Your doctor will be able to ensure that that both your orthoses and your feet are in sync with each other.

As far as insoles go, there are so many options that podiatrists can choose from to suit your needs. nsoles are grouped into classifications depending on their material and subsequent function. The basics of orthoses and their categories are as follows:

Rigid
Orthoses

These insoles are called rigid because they are made of a stiff material like carbon fiber or plastic. Such devices are primarily used in controlling foot function. Rigid orthoses can run from heel to the ball of the foot or from the heel to the toes. These insoles are supposed to be used in close-toed shoes which are mainly used in walking.
Rigid orthoses are durable devices are inflexible and resistant to deformity. They are hard to break and do not change their shape. Their major role is to control the motion in the two foot joints following the ankle. They are usually constructed for patients experiencing ailments in the legs, thighs or lower back. In addition, if a patient has a slight limb length discrepancy (one limb is longer than the other) these orthoses can be considered to help with gait and posture.

Semi-rigid
Orthoses

This class of orthoses functions to maintain foot balance during sports activities. This type of insole helps muscles and tendons of the foot to perform efficiently and guides the foot through functions. The soft material layers are strengthened by the rigid materials giving the insole the nature of flexibility and stiffness.

Soft
Orthoses

The materials that make up this type of insole are soft, moldable and compressible. As a result of these orthoses being easily deformed by pressures, they are not as durable as rigid orthoses and need to be replaced more often. Soft insoles have multiple purposes: ease pressure off of certain foot areas, enhance balance and absorb impact.
This class of orthoses are particularly suited for individuals with deformed feet where there is not protective tissue to help with shock absorption, arthritic patients, and people who have diabetes. Soft insoles are constructed with layers of soft materials making them substantially bulky. As a result, deep shoes or prescription footwear are necessary to accommodate these orthoses.

Central Florida Foot and Ankle Center
101 6th St Nw
Winter Haven, Fl 33881
Phone: (863) 299-4551

www.FLFootandAnkle.com

Thursday, July 23, 2009

Foot Circulation

When you walk into an appointment with your podiatrist, you may have noticed that observation plays an important part in their evaluation of your foot health. Before the doctor even touches you, they are looking at the color of your skin, its hydration and the presence of hair. Why?

Biologically the skin is the largest organ on our bodies and many problems can be detected just by assessing it. For example, skin color is directly related to the amount of blood circulation in that area. If blood circulation to the foot is normal, the skin will appear a healthy pink. Another indicator of good circulation is the presence of hair on your toes and feet. The doctor takes all this into consideration when determining your foot health.

When the doctor starts to touch your feet it is to feel for skin suppleness, skin temperature, and pulses. Good circulation to your feet means that all the tissues of your feet such as the bones, muscles, ligaments and skin are able to get essential nutrients and oxygen to help them survive. Nutrients and oxygen are essential for cell repair and vitality. In addition, waste products made by these tissues will be carried away the blood to be expelled from the body. Blood flow to your feet also helps to keep skin supple and brings warmth to your feet.

Arteries are the blood vessels that take blood pumped by the heart to different areas of the body. They are direct extensions from the heart and just as the heart has a beat, so do the arteries. However, an artery beat is referred to as a pulse. With proper blood flow and unobstructed arteries your feet will get the nutrients it needs and the doctor can detect this by feeling your pulses.

What factors or ailments can lead to poor foot circulation?
Smoking
Obesity
Inactive/sedentary lifestyle
Diabetes
Increased age

If you feel that you may have poor circulation in your feet, it is important to see your podiatrist as soon as possible. Inadequate circulation to the feet may lead to very serious complications. Talk to your podiatrist on ways to manage and improve your foot health!

Central Florida Foot and Ankle Center
101 6th St Nw
Winter Haven, Fl 33881
Phone: (863) 299-4551

www.FLFootandAnkle.com

Monday, June 22, 2009

How to Cut Your Toenails


Clipping toenails – it seems like an everyday, mundane task, but the technique behind it is more important than you may think. Improper technique can lead to pain, ingrown toenails, and infection. What follows are tips on how to cut your toenails to avoid some of these problems.

§ If you have diabetes, or any other problems with circulation, it is important to have a trained professional do this work for you. A healthcare professional, like a podiatrist, will help you avoid injury and infection that is very common with diabetic patients.

§ Use the proper equipment. Toenail clippers are wider than fingernail clippers. They are made to handle the wider and thicker nails of the foot. You can keep your toenail clippers clean by disinfecting them with some rubbing alcohol before and after use.

§ Straight Cuts. You want to cut straight across the edge of the toenail, without curving the corners. This will help you to avoid ingrown toenails, which is when the corner of the nail grows into the skin. Also, keep your nails a little long. Cutting the nails too short is another way to get ingrown toenails, plus it can really hurt.

§ A Few Small Cuts. Don’t try to get the whole nail in one clip. Instead, make a few, smaller cuts across the whole nail. This will give you more control, and you’ll be able to shape the nail a whole lot easier, without getting into the corners.

§ Cut When Dry. Cutting your nails when they are wet, such as after bathing, is never a good idea. Wet nails are much easier to rip and tear, which can lead to cutting the nails to short, or tearing at the nail matrix, the living tissue underneath the nail. Instead, trim your nails when they are dry, perhaps before bathing.

§ One Way Filing. If you like to file your nails, file in one direction, straight across the free edge of the nail. Filing can be an easier way to trim the nails, and an easier way to shape them so they look nice.

§ Don’t Cut the Cuticles. This can lead to infection, irritation, and pain. If you want to do anything to them, use a cuticle stick to push them back a little bit, but be careful not to dig into the skin. You can buy a cuticle stick at most pharmacies.

§ Timing may vary. Different people’s toenails grow at different rates. One person may have to trim them once a week, while others can go several weeks between trims. When you think it’s time to trim them, go ahead. Just be careful not to trim them too short.

Follow, these steps, and you’ll be well on your way to a healthy nail regimen. If you have any additional questions or concerns, or if you notice any changes in the nail, contact a local podiatrist. Changes in the nail can often indicate disease, and should be dealt with promptly.

Central Florida Foot and Ankle Center
101 6th St Nw
Winter Haven, Fl 33881
Phone: (863) 299-4551

www.FLFootandAnkle.com