Common Foot Problems in Men

By: Williette Nyanue - June is the month that we celebrate Father’s Day! This coming Sunday, many of us will celebrate the day set aside to honor the men in our families for all of the hard work they do for us. How fitting is it then that June is also Men’s Health Month? In case you did not know:

Men’s Health month is celebrated across the country with screenings, health fairs, media appearances, and other health education and outreach activities. The purpose of Men’s Health Month is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among men and boys.[1]

Men are notorious for neglecting their health. Dr. Weil Jr. has even seen it with his male patients. He states, “Men neglect their feet more than women because we can be stubborn. When they do show up at my office, their problems are usually worse off.” Men’s health month is celebrated the entire month of June, with special emphasis this month on June 11^th-17^th, which is Men’s Health Week. We have been celebrating Men’s Health Week by filling our Twitter and Facebook pages with facts, statistics and solutions to common men’s health problems. In honor of Father’s Day, Men’s Health Month and the culmination of Men’s Health week, we have put together a list of common foot problems that we see here at the Weil Foot and Ankle Institute and ways to solve these problems.

Common Foot Problems in Men

•  Excessive Sweating/Foot Odor – Did you know that there are over 250,000 sweat glands on your feet alone? While excessive sweating doesn’t cause foot odor, areas affected by excessive sweat can be the breeding ground for odor causing bacteria. 
• The first step in controlling foot odor is taking proper care of your feet. Talk to your Weil Foot and Ankle physician about proper foot hygiene to control and prevent the development of odor causing bacteria.
•  Wash your feet daily with warm water and a mild soap, and dry them completely.
• Change your socks frequently, at least once a day.
•  Invest in an odor absorbing foot powder and/or a foot antiperspirant if you suffer from excessive sweating.
• Allow your shoes to dry completely before wearing them. This will help to stunt the growth of odor causing bacteria.
•  The SteriShoe Ultraviolet Sanitizer is a shoe sanitizer that works to kill off the germs that cause foot infections and offensive shoe odor.
•  Fungal Infections/Athlete’s Foot –Fungal infections occur when fungus grows on your feet. Fungi usually grow in warm, moist environments, so if you suffer from excessive foot sweating take special precaution. Athlete’s Foot, one of the most common fungal infections, is contagious and can be transferred by the sharing of socks and shoes or through a wet gym or pool floor. It is estimated that 1 in 5 people have Athlete’s foot, with men accounting for the majority of cases.[2]  Fungal infections can also spread to your nails and cause them to become thick and discolored. Symptoms of Athlete’s Foot include red, itchy skin, burning and/or pain and blisters. 
• If you suffer from Athlete’s foot or any other fungal infection, contact your Weil Foot and Ankle physician, who will be able to prescribe you a medication that will clear up the source of the fungal infection.
• For tips on how to prevent fungal infections, refer to our Guide to Summertime Foot Care.
•  Blisters – A blister is a liquid filled bubble or pocket on the skin that is usually caused by friction between the skin and another material. Blisters are most commonly the result of shoes that are too tight or improper socks. While a blister will usually heal on its own, if your blister becomes painful or you see signs of an infection, be sure to contact your Weil Foot and Ankle Institute physician. To prevent blisters from occurring:
• Wear shoes that fit properly and offer enough room.
• Wear proper fitting socks.
• Invest in blister prevention patches that you can put in your shoes to decrease friction against your blister prone areas.
•  Corns and Calluses – Corns and calluses are thick layers of skin that form when there is too much pressure or friction to the skin. They can also be caused by deformities like bunions and hammertoes. Corns usually appear on the toes and calluses on the bottoms of the feet. [3] If not addressed, they can become extremely uncomfortable. To prevent corns and calluses, 
• Wear comfortable shoes that fit properly.
• Regular pedicures will also help to slough off dead skin that accumulates over time.
• The Weil Foot and Ankle Institute offers corn and callus pads to alleviate some of the discomfort that may arise.
• Because there are many different products on the market and different procedures used to treat corns and calluses, be sure to talk to your Weil Foot and Ankle physician, who will suggest the most appropriate products and line of treatment for your individual case.
•  Ingrown Nails – An ingrown nail, as we mentioned in Dr. Klein’s May post, is “a toenail that has curved in at the medial and lateral sides of the nail. It digs into and can cause a break in the skin.” This break in the skin is susceptible to infection. Ingrown toenails can be the result of wearing poorly fitting shoes, but are usually the result of improper cutting of the toenail. Teenagers/young adults and older men and women are most at risk for ingrown toenails, and men are usually affected more than women.[4] Symptoms of an ingrown toenail include pain, tenderness, swelling and redness around the area. An infected ingrown toenail may also ooze pus.[5]
• If you have symptoms of an ingrown toenail, see your Weil Foot and Ankle physician.
• As mentioned in Dr. Klein’s post, physicians can usually take care of ingrown and even infected ingrown toenails relatively easily with either trimming or debridement in the office, or a small in-office procedure.
•  Gout – Gout is a form of arthritis that occurs when there is excess uric acid in the body. Gout is nine times more prevalent in men than it is in women.[6] People with gout suffer from gout attacks, which usually occur at night and in the big toe first. The symptoms of gout or a gout attack are: pain, swelling, warmth and stiffness in the toe joint.[7]
• If you have symptoms of gout, be sure to see one of our podiatrists here at the Weil Foot and Ankle Institute so that you can be properly diagnosed.
• After you have been diagnosed, your Weil Foot and Ankle physician can provide you with anti-inflammatory medication that will help alleviate your symptoms.
• If symptoms continue, consult your podiatrist and your primary care physician for information about further treatment options such as additional medication and possible surgery.

In honor of Men’s Health Month and Father’s Day, be sure to take special interest in your health this month and all the months to come. Schedule appointments with your doctors and get all of the necessary tests and screenings. Become aware of your health status. If you suffer from any of the foot ailments that are listed here, be sure to make an appointment so that one of our physicians can help you address the issue.

Looking for a great Father’s Day gift? Here a few health-related gifts that I am sure your dad would love whether or not he suffers from any of the above ailments.

Health related gifts:

 Athletic/ Walking Shoes – Does your dad do a lot of walking or working out? Get him a pair of athletic or training shoes to keep him supported during his activity.

•  Men's Athletic Tie-Less Lace Closure White Mesh
•   Men's White Strap-N-Lace Leather Athletic Shoes

Custom made inserts

•   Call today and request and appointment to have your dad fitted for our custom made inserts.

Sandals – The summer is here and dad could probably use a pair of new sandals. Give him comfort and support with this option.

• Vasyli Malibu Sandals For Men - Healthy & Stylish Sandals
• Men's Fisherman Leather Sandals-Light Brown

Shoes – How many of your fathers are like mine and buys a new pair of shoes only when his old ones are completely broken down? Do him a favor, throw those old ones away and buy him a new pair!

•  Orthofeet Men's Leather Lace - Brown
•  Orthofeet Men's Leather Strap - Black

If you don’t want to get any foot related gifts, Dr. Weil has given a list of good gifts your dad may like! (Hint, hint if any of his kids are reading this ;))

Dr. Weil’s Father’s Day Gift Guide!

• Gift certificate for a clothing store—ex: Nordstrom. Contrary to popular belief, men do like to shop too…sometimes.
• Golf balls: You can never have enough golf balls. They always seem to disappear...
• Grilling stuff: Men like to cook with fire. It brings out the caveman in all of us.
•  Personalized gifts from the kids: Anything that kids make themselves is always special for dads.

I think everyone knows that when compared to Mother’s Day, Father’s Day can be a little underwhelming. Let’s not make that the case this Father’s Day. Let’s show our dads how much we really appreciate them by making this Father’s Day really special. Have fun celebrating with your families!

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[1] http://www.menshealthmonth.org/

[2] http://www.webmd.boots.com/skin-problems-and-treatments/tc/athletes-foot-how-common-is-it

[3] http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002212/

[4] http://www.emedicinehealth.com/ingrown_toenails/article_em.htm

[5] http://www.weil4feet.com/common_ingrown_toenail.html

[6] http://www.weil4feet.com/common_gout.html

[7] http://www.weil4feet.com/common_gout.html

Melanoma of the Skin

By: Zacharia Facaros, DPM

“Hey, what is that on your foot? Is it a mole?  Is it a scar?”

If you’ve had a family member or friend say this to you at some point, or if you’ve had these thoughts, you’re not alone. Please, do not shake this off as an unimportant concern.  Suspicious areas on your skin, also called lesions, can be one of numerous things, and even experts have a difficult time deciphering between which ones are harmful and which ones are not.

Melanoma is a common cancer of the skin, also known as malignant melanoma, and is the most deadly type of skin cancer because it can spread quickly (metastasize) throughout the body. The incidence of melanoma is growing faster because of the popularity of sunbathing and the use of tanning beds.  Thus, during this summer season in Chicago, when many are heading to the beaches or going away on vacation, proper sun protection is vital. You can often prevent melanoma by protecting your skin from sunburn and excessive sun exposure.    

The National Cancer Institute estimates that over 1 million people per year are diagnosed with skin cancer, approximately 7% of which is melanoma. More than 76,000 people will be diagnosed with melanoma in 2012, of which 9,000 cases will be fatal due to the severe effects on the body.  People in their 60s make up the median age group of those diagnosed with melanoma, with an age-adjusted incidence of 21 per 100,000 men and women.  Roughly 2% of men and women will be diagnosed with melanoma of the skin at some time during their lifetime and as of 2009, there were approximately 876,000 men and women who had a history of melanoma in the United States.

So what is melanoma? Typically, when cells that make melanin, the pigment that produces skin color, become ‘old’ or damaged, they stop dividing, die and are replaced with healthy young cells. A melanoma occurs when these ‘old’ or damaged cells don’t die, but rather continue to multiply and divide uncontrollably. The division and multiplication of cells results in the development of a malignant mass of tissue on the skin. This mass is more commonly known as tumor.  Melanoma can develop into a mole or freckle, or can actively grow within existing lesions. While melanoma can be pigmented, it is not uncommon to have a completely unpigmented melanoma (neutral color). Melanoma can develop anywhere on the body, even places that are not exposed to sun and sunburns.

The specific types of melanoma that pertain to the toenail or fingernail alone are called melanonychia and subungual melanoma. They are both most common in the thumb, great toe, and index finger.  It is important to note that approximately 20% of subungual melanomas are amelanotic (unpigmented) and thus require a close and meticulous inspection.

For those of you who are fans of Bob Marley, the famous Rastafarian and Reggae legend initially injured his foot while playing soccer. He developed a complicated, open wound that seemed unfamiliar.  After seeking treatment, he was diagnosed with a type of foot melanoma, and doctors advised surgical amputation of his toe.  He did not consent to an amputation and ultimately the cancer spread throughout his body.  He sought treatment with a holistic doctor but in the end, his cancer became terminal, and took his life in 1981.

The incidence of foot melanoma has been reported to be between 0.04–0.25 per 100,000 people per year.  Melanoma is the 6th most common cancer in men and women and is the 2^nd most common cancer in women ages 20 to 29 in the United States. 

Symptoms of melanoma include:

·      A mole or lesion that is asymmetrical or has an irregular border

·      A mole or lesion that is growing or enlarging

·      A mole or lesion with abnormal coloring or more than one color, such as white, blue, red, black, or brown

·      Appearance of a new mole, or black/brown ‘spot’

The widely taught mnemonic device for Melanoma is “ABCDE”:

A – asymmetry, as in uneven texture consistency within the spot or mole in question;

B – borders, as in the outer borders being jagged and irregular;

C – color, as in the lesion having an inconsistent or uneven color (variegated);

D – diameter, any spot or lesion greater than 6mm in length causes elevated suspicion; and

E – enlarging or evolving (changing) over time.

All such findings are consistent with Melanoma but are not always 100% definitive, nor do these findings guarantee the disease.  For example, the lesion may or may not be firm to touch.  Furthermore, there are numerous types of melanoma and again, one should not assume the abnormal spot on your skin is nothing to worry about. 

If you notice a ‘weird’ looking lesion, make sure you seek medical care immediately. This allows for the best evaluation of your risks in developing melanoma and the prompt ordering of diagnostic testing for questionable areas. These measures increase the chances of discovering melanoma in its earliest, most curable stage. If melanoma is detected and treated before it spreads, the 5-year survival rate is 99%.

Your physician will test the area to obtain a proper diagnosis. The gold standard of testing is to perform a biopsy, which involves examining a sample of cells from the area. The biopsy can be completed a few different ways. Depending on the size and location of the suspicious area, your doctor will discuss the best method of choice for your particular case.

After a proper diagnosis, your physician will work with you to develop the most effective course of treatment. Melanoma treatment plans use a multifaceted approach that is tailored to maximize treatment.  The factors involved in treatment depend on the person’s age, medical history, coexisting diseases and conditions, the type of melanoma and its stage of advancement. Regarding the spread of the disease to other parts of the body, testing of nearby lymph nodes is required to detect the presence of cancer cells.  Typically, a combination of treatments is implemented, which may include, but are not limited to: chemotherapy, immunotherapy, dietary counseling, and surgery.

As with any skin cancer, the goal of the treatment is to achieve complete remission of the disease. Remission means that there is no longer any sign of the disease in the body, although it may recur or relapse later. 

If you have noticed a weird or funny looking spot or area on your foot/ankle/lower leg, or anywhere on your body for that matter, don’t put off seeking evaluation any longer and contact a Weil Foot and Ankle physician

Bivalved Fiberglass Cast Compared With Plaster Splint Immobilization for Initial Management of Ankle Fracture-Dislocations: A Treatment Algorithm.

Another one of our physicians here at the Weil Foot & Ankle Institute, Dr. Jeffrey Baker, had a paper published in Foot and Ankle Specialist. His paper, which is entitled, "Bivalved Fiberglass Cast Compared With Plaster Splint Immobilization for Initial Management of Ankle Fracture-Dislocations: A Treatment Algorithm," was published in the May 9th, issue of Foot and Ankle Specialist. We have included the abstract below, but make sure you read the full article on our website or in the Foot and Ankle Specialist.

The initial management of ankle fracture-dislocations is the crucial step in the treatment of these emergent traumatic injuries. A stepwise approach is necessary to properly evaluate, diagnose, and treat ankle fracture-dislocations. The goal of initial management is to evaluate the vascular status of the extremity and then restore proper alignment of the talus underneath the tibia. A retrospective review was performed on 40 patients who presented to a community based hospital emergency room treated by the foot and ankle service with an ankle fracture-dislocation. An analysis of patient demographics, injury pattern/classification, number of reduction attempts, and immobilization method was performed and evaluated. This analysis was correlated with a review of the literature to develop an algorithm for the initial management of ankle fracture-dislocations recommending the use of a bi-valved below the knee fiberglass cast for maintained stabilization post reduction.

Foot and Ankle Specialist: Obesity, Feet, and the Impact on Health Care

Dr. Weil Jr., who also serves as the editor of Foot and Ankle Specialist, wrote an editorial entitled, Obesity, Feet, and the Impact on Health Care, for the publication's latest issue. We have provided a sample of the article here on the blog, but be sure to head over to our site or the Foot and Ankle Specialist to read the full publication.

Over the last year, my Fellow Erin Klein, decided to take on projects looking at how Body Mass Index (BMI) influences several common foot and ankle problems.  Our data base includes BMI measurements for all patients dating back to before 2000.  She was able to isolate thousands of patients with diagnoses of plantar fasciitis, Achilles tendonapathy and adult onset flatfoot deformity.  She created a control group of patients whose diagnosis would not typically be associated with increased BMI (toenail conditions, neuroma, ankle sprains).  Comparisons were made between the control groups and the conditions that would be associated with increased BMI.  Additionally, the BMI measurements were assessed to evaluate success of treatment in the study groups.  Many conclusions were made from the research including: 1. Patients in the plantar fasciitis, Achilles tendonapathy, and adult onset flatfoot had higher BMI than control group, 2. Patients with higher BMI had less success with typical conservative alternatives, and 3. Our patients, as a whole, had a high BMI. Obesity in the United States is reaching epidemic proportions.  Statistics on the growth of obesity are staggering.  This was once considered a problem of the United States but other countries around the globe are starting to have similar problems and in India, the second most populous country in the world, their obesity rates are increasing at a much higher rate than in the U.S. Obesity is often associated with lower socioeconomics due to poor nutrition and healthcare.  However, our practice is heavily weighted toward middle to upper middle class.  This is not a problem of a certain class but a problem with all society. We looked at some common foot and ankle conditions and the influence of obesity.  Clearly these are not the most important problems associated with the disease, but illustrate the influence that obesity has on people’s lives.  Diabetes, heart disease, hypertension, and cancer are examples of critical medical problems associated with obesity.  There are few medical conditions that cannot be negatively associated with obesity. As we treat foot and ankle problems, we are in the trenches of how obesity affects people.  We illustrated how common foot and ankle problems are associated with increased BMI.  With these foot and ankle problems, people are unable to exercise due to the pain of the condition.  Lack of exercise often results in increased BMI and now we get a downward spiral.  This all leads to worsening of the patients overall health and we see it in advanced diabetic problems (neuropathy, PVD, wounds, Charcot) and worsening deformities that require surgical intervention, but that surgery becomes more difficult and risky with increased BMI and their co-morbidities.

The Weil Foot and Ankle Institute’s Comprehensive Guide to Summertime Foot Care!

By: Williette Nyanue - According to the almanac, the official start of summer this year will not be until June 20^th. However, with the celebration of Memorial Day this past weekend, many of us are already fully immersed in the summer season.

Because each season brings with it its own set of challenges for our bodies, many of us change our health routines to reflect the change in season. In the fall and winter months the temperature drops and the air gets drier leaving us with dry skin, hair and nails. To combat this drop in temperature and humidity, many of us switch to heavier creams and maybe even shorter, cooler showers. The winter months also have their own uniform: sweaters, thermal underwear and boots to combat the snow. When the summer season starts, this winter routine is almost completely reversed. With longer days, and therefore longer exposure to sun, and higher temperatures, we use lighter creams with a higher SPF, and drink more water to prevent dehydration. As for the summer attire, well, we all know that there is more skin, more skin, and then more skin.

As we change our health routines to adapt to the changing weather, we must not forget that our foot care routines will also require some slight changes. The summer months bring specific problems for our feet that you may not be aware of. Just as you would switch your skincare regimen and wardrobe for the summer, be sure to switch your foot care regimen…or at least implement one if you haven’t already!

So you don’t know where to start? Have no fear! I contacted Dr. Weil, Jr. and he has given me some great information in order to help me create a comprehensive guide for your summer foot care needs. Follow the points on this guide and you’ll be sure to keep your feet healthy throughout these summer months.

Temperature and Sun Exposure

The elevated temperatures of the summer months bring a unique set of challenges for your feet including increased sweating, which can lead to odor and fungal and bacterial infections, and exposure to the sun's harmful rays. Here are a few ways to adjust your routine to combat these issues.

Elevated temperatures

• Invest in a foot antiperspirant/deodorant if you suffer from foot odor or sweating. 
• Make sure that whatever shoes you are wearing allow your foot to breathe. For all of the runners and athletes out there, this is really important if you must wear closed to shoes during the warmer months. See a few options for athletic shoes here and here. 
• Wear lightweight socks when you wear closed toe shoes, and change them regularly. We offer a sock on our website that you may want to check out. It efficiently transfers heat and eliminates bacteria, fungi and odor.
•  If you develop excessive sweating, foot odor or any fungal/bacterial infections, be sure to contact one of the physicians at the Weil Foot & Ankle Institute for an evaluation.

Sun Exposure

• Don’t forget to put sunscreen on your feet! You can use the same sunscreen that you use for your body. Remember that feet burn easily because they are not regularly exposed to sun, so don’t increase the risk by neglecting them with sunscreen. 

What to wear, what to wear?

Just like we need to change our wardrobes for the warmer months, it is important that we make the proper changes to our footwear. Here are some things to consider when buying shoes in the summer.

•  Invest in the footwear of the season: open toe sandals. Open toe sandals, allow our feet to breathe and stay dry. This prevents sweating, odor and bacterial growth.
• Make sure that your sandals provide good arch support. They should not be flat. Higher heels are better.
• Invest in sandals with a stiffer sole, which offer more support for you than flexible soles.
•  Make sure the sandals provide comfort. Do not sacrifice comfort for style because you will regret it in the long run. Believe it or not, there are fashionable sandals that also provide comfort.

To flip-flop or not to flip-flop?

The ease and convenience of flip-flops make them the summer shoe of choice for many of us. Flip-flops, however, lack arch and heel support. The gripping that your toes have to do when walking in flip-flops also puts tension and strain on your shins. When buying and wearing flip-flops:

• Do not wear flip-flops when engaging in strenuous activity such as running, walking for long distances, playing sports, etc.
•  Make sure that your flip-flops are made with a flexible but firm material to prevent foot injuries that may come from excessive bending.
• Make sure that your flip-flops offer good arch and heel support. A great option for a flip-flop would be our Orthaheel sandals. They are cute and supportive and were recommended by Dr. Oz on a recent video segment from his show.

Going barefoot?

Summer is the time when you’re most likely going to be barefoot. Who doesn’t like to feel the grass beneath their feet or the sand between their toes? If you do not have pain, going barefoot is ok, but keep in mind there are many problems associated with barefootedness including heel pain and metatarsalgia. When walking barefoot:

• Beware of foreign bodies and things that can injure the skin including glass, branches, cans, rocks, etc.  
• Limit exposure to moist surfaces that are shared by multiple people. This includes pool decks, locker rooms, etc. This will limit the chances of fungal infections and warts.
•  Be careful of hot sand, which can burn feet. This is especially true for diabetics who don't have good feeling in their lower extremities. 

Prepare yourself for activity

Common foot and ankle injuries due to increased activity in the summer include shin splints, ankle sprains, tendinitis, blisters and bruises, stress fractures of the toes or ankle, and plantar fasciitis. Make sure to take a few simple precautions to prevent these injuries.

• Build up activity progressively. In other words, don't sit all winter and go out and try to run a 5K without training properly and building up your muscles.
• Make sure you stretch properly before and after training.
•  Invest in good athletic shoes and make sure to change them frequently. Athletic shoes that are in good shape will have less than 400 miles of wear.
•  Invest in insoles to properly support your feet and ankles while engaging in athletic activity. We offer insoles on our site, and we also make them custom in our office. If you would like a set of our custom made orthotics, be sure to request an appointment for a consultation today!

If you develop any of the problems mentioned in this post, (foot odor, warts, fungal infection, heel pain, metatarsalgia, plantar fasciitis, etc.) make sure that you call and/or visit the Weil Foot & Ankle Institute so that one of our physicians can get you healed and have you back out enjoying the summer weather as quickly as possible. Now that you have a basic set of guidelines for ensuring your foot health this summer, go out and take advantage of the warm weather. It will be winter again before you know it!

Did we miss anything? Do you have a foot problem relating to summer that you did not see addressed here? Tell us below and we will be happy to provide you with suggestions and solutions!