• Toms River Office
    618 Main Street
    Toms River, NJ 08753
  • 732-349-0114

Patient Education

Monthly Foot Topic

Warts


Warts (aka Verruca) typically appear on hands and feet. They present as rough small tumors or cauliflower like or a solid blister. The virus that causes plantar warts is not highly contagious but can be transmitted through tiny cuts or breaks in skin. Since everyone has a different immune system, not every person who comes in contact with the virus will develop a wart. The virus is called the human papillomavirus of which there are 100 types.

Plantar warts have increased incidence in children and young adults between 12-16 years old who share dormitories, gym facilities and common bathing areas. Warts can be persistent and new warts can grow as fast as old warts disappear. If wars are untreated they can grow in size or develop clusters called mosaic warts. They can be painful especially if they grow on weight bearing surfaces. Usually the portion of the wart under the skin is two times the size of the wart you see, it tends to grow into deeper layers of skin due to pressure.

You should seek medical advice if:

  • Your warts change in size or color
  • If they become painful
  • If they persist, recur or multiply in spite of home treatment
  • If you have diabetes, circulatory problems
  • If you cannot confidently identify the lesion.

Simple examination by a podiatrist can let you know if warts are present. The doctor may "pare" the lump (remove the hard outer skin) with a scalpel. Corns and calluses do not have a blood supply and should not bleed but warts have pinpoint bleeding when debrided. If your doctor is unsure or concerned a small sample or biopsy may be sent to a lab for evaluation.

Warts are self limiting and will eventually go away on their own, if you chose to wait. But in the meantime they can be painful, unsightly, and multiply so the advice is to treat them. You can try over the counter remedies which in time will work but this is not the recommended course for anyone who is immuno-compromised, diabetic or pregnant.

Doctors usually use common treatments in combination such as;

Salicylic acid in a 40% concentration. The acid peels off the infected skin a little at a time. This can take months and healthy skin must be protected.

Freezing (cryotherapy) is the most common treatment and usually effective but also requires several applications. The chemical can cause a blister and the wart tissue sloughs off.

Cantharidin is a substance extracted from the blister beetle and has been used for centuries. The beetle juice can cause a blister lifting the wart from the skin.

Duct tape was applied to warts in a study in 2002 where after 7 days the tape was removed, the wart soaked and rubbed with an emery board. It was found that after several months the warts vanished.

Aggressive forms of treatment include:
  • Electrodessication
  • Laser surgery
  • Immunotherapy
  • Imiquinod (Aldara)

None of these treatments should be used without doctors care if you are diabetic, pregnant, breast feeding or immunocompromised. Prevention is the key!

To decrease your risk:
  • Do not pick warts that can spread the virus.
  • Do not go barefoot in public areas. Wear shoes or sandals at public pools or locker rooms.
  • Avoid contact with warts.
  • Keep your feet clean and dry.

Toenail Fungus


Toenail fungus is one of the most common ailments that we see in our practice. It is estimated that 11% of North Americans are afflicted with this medical condition. Although it may not be life threatening, it can be painful, unsightly, and embarrassing.

What is toenail fungus?

Toenail fungus is caused by a living fungal infection of the nail plate. Fungus will grow in damp, dark environments such as under a toenail. It can also grow around pools, showers, and sweaty shoes.

Once the nail becomes infected it will appear thickened, discolored, and sometime brittle. Occasionally, the affected nails will shed or crumble due to the fungal spores.

How do I prevent toenail fungus?

  1. Natural cotton socks will absorb moisture and keep it away from your feet.
  2. Always wear flip-flops or water shoes around pools and public showers.
  3. Dry your feet thoroughly after bathing or showering. Don‘t forget between your toes. (Use a hairdryer if you can‘t reach)
  4. Do not share towels or washcloths.
  5. Wear shoes that breathe. All leather or vinyl shoes tend to cause more sweating.
  6. Antifungal powder in your shoes.
  7. Wearing nail polish can encourage fungal growth in the nail.
  8. Treat athletes foot fungus as quickly as possible to prevent transmission to the nail.
  9. If your feet sweat, change your socks during the day.
  10. Keep your feet as dry as possible.

How do I treat toenail fungus?

Once the fungus sets into the nail it can be very difficult to treat. The earlier your treatment is started the better chance you have at curing the condition.

There are prescription internal medications available to treat this condition especially in severe cases. Medications such as Lamisil, Diflucan, and Gris Peg are available to patients that are healthy. However, these medications can have severe side effects and need to be monitored by your podiatrist. These medications can also be very costly and are not always covered by health insurance.

We also offer topical medications in our practice to treat nail fungus. These liquid medications have no side effects and are very safe to sue. Topical treatment should always be combined with trimming and filing of the nail by your podiatrist to increase the effectiveness of the medication. This treatment can be very effective if the fungus is caught early and treated aggressively.

You may have heard of many home remedies for nail fungus such as: Vicks petroleum, tea tree oil, apple cider vinegar, Listerine, Oregano, Olive oil and Sesame oil. There have not been any scientific studies to prove any of these remedies to be effective.

If you think you may have nail fungus please call the office as soon as possible so that we can start your treatment program right away and get your feet and your nails back to good heath.

**We may soon be offering an all-natural antifungal nail polish at Main Street Foot and Ankle Care, LLC, which will allow you to continue your treatment in the sandal weather.

Bunions


With summer approaching us, we are finally taking off our boots and taking a good look at our feet for the first time in several months. It is time to get those feet back into shape and many of us do not like what we see. This is the time of year when many patients come into the office and ask, "Should I finally get this ugly bunion fixed?

  • As yMark Majeski, DPM, FACFAS, we usually come back with a couple of simple questions:

    • Is your bunion painful and does it limit your activity and ability to wear reasonable shoes?
    • Have you noticed your bunion getting progressively worse over the past year?
    • What have you done conservatively to treat your bunion?

    If your bunion is not painful, then we usually do not need to go any further. We continue to watch the progression of the deformity and recommend continuing to wear sensible shoes. Bunion surgery is usually reserved for the painful condition.

    What is a Bunion?

    A bunion is considered an enlargement or "lump" at the base and side of the big toe (or the first metatarsal phalangeal joint). It is a condition that gets worse over time and can be aggravated by the shoes that we wear. As the big toe bends over towards the others, the "bump" gets larger and more painful, often leading to arthritis and stiffness. "Pain" with a bunion is commonly due to 2 things: 1. Pressure from shoe gear over the prominent medial bump, and, 2. Pain or stiffness from within the joint.

    A bunion can cause other painful conditions like hammertoes (usually of the 2nd digit), corns and callouses, pain under the lesser metatarsals, and ingrown toenails.

    Bunions are considered to be due to a combination of faulty foot mechanics (the way we walk), the foot we inherit, and the use of inappropriate footwear. Those with flatfeet or pronated feet are more likely to develop bunions because of the instability about the joint.

    What to Expect on Your Office Exam

    In the office, you can expect a full clinical exam by one of our board certified doctors. We assess the appearance of the bunion, the motion available of the great toe joint, and the way that you walk. Digital X-rays are taken in the office, which also helps to determine the severity of the bunion, and if needed, what surgery would be appropriate for your particular foot.

    Nonsurgical approaches or conservative care is always the first line of treatment. Simply, by wearing more sensible, wider toe box shoes can eliminate bunion pain. Other simple treatments include:

    • Padding with various materials such as felt or foam. This can be placed over the painful medial bump.
    • Injection therapy (to reduce the swelling, pain and redness over the bunion)
    • Nonsteroidal anti-inflammatory medication
    • Physical therapy (to help with the symptoms and improve range of motion of the great toe joint). Manipulation will NEVER correct the alignment of the big toe; only surgery can achieve this.
    • Foot orthosis (inserts for the shoes which can limit the instability of the joint and progression of the deformity). No insert of over-the-counter braces will correct the bunion we already have.

    The only way to correct the bunion, alignment of the joint, and appearance of the foot is SURGERY.

    Surgery is indicated when conservative care has failed to relieve the pain.

    The goal of surgery is to relieve as much pain and correct as much deformity as realistically possible. The goal of the "perfect" foot usually leads to an unhappy patient.

    The "type" of procedure chosen depends on the symptoms, and severity of the deformity as assessed from your clinical and radiographic exam. Some procedures include:

    • A simple bunionectomy (literally cutting off the enlarged bone). This is the easiest procedure, but does not address realignment of the joint.
    • A distal osteotomy (a cut and shift in the head of the bone which realigns the joint and requires fixation-screws, plates, or wires). This is the most common bunion procedure performed and allows for immediate walking in a protective boot or shoe. Our goal is to have you back in sneakers by 3-4 weeks.
    • A proximal osteotomy or fusion (a cut further back on the metatarsal bone, also requiring fixation). This is reserved for the more severe or unstable cases and usually requires casting and several weeks of nonweightbearing status. This requires longer healing time, but is necessary if your deformity is severe.

    SUMMARY

    The most common cause of dissatisfaction of patients following bunion surgery is UNREALISTIC EXPECTATIONS. Several studies have shown that 85-90% of those who have bunion surgery are satisfied with the results. The goal of bunion surgery should be relief of pain and improvement of the alignment of the great toe. Returning to tight shoes puts you at risk for the bunion returning.

    There are also risks involved, which holds true for any type of surgery. Less than 10% of surgical patients experience complications associated with bunion surgery. These include, but are not limited to:

    • Infection
    • Recurrence of bunion
    • Nerve damage
    • Chronic swelling
    • Long-term pain

    Bunion surgery is the most common surgery performed in our practice. All of Mark Majeski, DPM, FACFAS are board certified in foot surgery and have performed several hundreds of these procedures. With a thorough evaluation, proper communication between you and your doctor, and realistic expectations, you can expect excellent results.

    Our goal at Main Street Foot and Ankle Care, LLC is to help you walk comfortably-if you find your bunion getting worse and pain more consistent, it is time to talk to your doctor about fixing this problem!

  • Ingrown Toenails


    Ingrown toenails are a very common foot problem that we see frequently in the office. This painful condition occurs in infants, children, and adults. The condition is very easily treated with a short visit to your podiatrist, whereas, if this condition is ignored it can progress to an infection requiring more extensive treatment.

    An ingrown toenail is when the nail grows into the skin around the nail. Most often it occurs on the sides of the great toe. Once the nail pierces the skin, bacteria can enter the tissue causing infection, which becomes a more serious problem.

    There are many causes of ingrown toenails:

    1. This condition can be inherited.
    2. Trauma can cause the nail to deform and grow into the skin.
    3. Repetitive activities such as kicking or running.
    4. Shoes that are too short or tight.
    5. Fungus in the toenail can deform the nail causing it to grow into the skin.
    6. Trimming your nails too short can cause the skin to grow over the nail.

    Treatment for ingrown toenails can start at home by soaking the toe in warm water and Epsom‘s salt then cover the toe with a Band-Aid and Antibiotic Ointment to keep it clean.

    Avoid constant cutting or digging at the nail as this can cause the condition to worsen or become infected. If your symptoms do not improve you should call your podiatrist.

    The following are appropriate treatments for this condition by a podiatrist:

    1. Oral Antibiotics. If there is infection present.
    2. Surgery to remove a portion of the nail, which may require local anesthetic.
    3. Permanent Removal of a portion of the nail is another option, which prevents this problem from occurring in the future. This can be done after a portion of the nail is removed and then applying a chemical to the nail root to prevent regrowth of the nail in that area.

    Following the above treatment a small bandage will be applied. Pain after this procedure is usually minimal and people can usually resume normal activity the following day.

    There are many myths about treating ingrown toenails. None of the following are true.

    1. Cutting a notch in the toenail will alleviate an ingrown.
    2. Cotton placed under the nail borders will relieve pain.
    3. You can buy effective ingrown toenail treatments at the store.

    If you feel as though you are developing an ingrown toenail, call your podiatrist. Most patients feel very apprehensive about this appointment, however, most patients tell us they wish they had come in sooner. They don‘t know why they suffered with this problem so long.

    Adult Acquired Flatfoot


    "...All of a sudden, my arch collapsed"

    This is a frequent complaint we hear from many of our patients. It is unlikely that this happened overnight, but rather, a more gradual process that finally became noticeable to the patient. The following information is to give you insight about the cause of this phenomenon and what can be done to help you.

    Symptomatic adult acquired flatfoot (AAF) is one of the most common problems we see here at Main Street Foot & Ankle Care. Usually the patient has a preexisting flatfoot and "faulty biomechanics" that overloads the posterior tibial tendon and surrounding ligaments on the medial side of the foot and ankle. Insufficiency of the structures is what causes the "collapsed arch" over a period of time.

    Symptoms usually occur gradually over time and are frequently seen on one side. There is usually associated pain, swelling, and weakness on the medial side of the foot. There is a strong correlation with obesity, high blood pressure, and diabetes. We often see this problem in patients that have had a knee replacement years earlier.

    "...So, what is the cause?"

    • Heredity
    • Abnormal walking
    • Ruptured tendon
    • Tight Achilles tendon
    • Preexisting flatfoot
    • Trauma
    • Other conditions such as cerebral palsy, spina bifida, and muscular dystrophy

    "...What can be done for this problem?"

    There are various treatment options for AAF, depending on the severity or stage of the deformity. Many times we will see a patient in the acute stage, demonstrating pain, swelling, deformity, and disability. This requires immediate intervention with protection, rest, ice, elevation, and oral anti-inflammatory medication. Often we dispense a device called a CAM walker in the office. This is a walking boot that allows protective ambulation while resting the foot. In the more severe cases, casting is required with several weeks of staying off of the foot. It is important to alleviate the acute symptoms before a thorough diagnostic work-up can be performed.

    Inserts and Bracing
    This is the most conservative form of treatment for AAF and will only be successful in the very early stages. The goal is to realign the foot while supporting the arch and medial soft tissue structures. Physical therapy and a stretching program may also be used in combination. It is a known fact that a tight Achilles tendon directly leads to a flat foot and arch collapse. Early strengthening, stretching and shoe inserts may prevent this condition from progressing.

    Podiatric Ankle Foot Orthoses (AFO‘s) have also become common practice in conservative management for AAF. This is a type of bracing that supports the foot and ankle and can comfortably be worn with sneakers. In our practice, we often prescribe an insert called a UCBL orthotic, which can be made at a local pedorthic office. It is a rigid insert that has an extended medial arch support when compared to a standard orthotic. This also can be comfortably worn in sneakers.

    Surgical Intervention
    In the later stages of AAF, some patients may require surgery. This is performed after a thorough clinical and radiographic examination, and after the patient has failed 3 months of conservative care and bracing.

    Sinus Tarsi Implant --- This simple, surgical procedure requires a small implant inserted between two of the rearfoot bones. This prevents the foot from collapsing by stabilizing the calcaneus (heel bone) under the talus, thus placing less stress on the medial soft tissue structures. This procedure will only be successful in the earlier stages when the foot remains flexible and can adapt to such an implant.

    Other surgeries --- Other surgical options include tendon repairs, tendon transfers, calcaneal osteotomies and medial column fusions. It has been found that isolated tendon transfers do not have good long-term success; therefore, a medial displacement calcaneal osteotomy is now performed in conjunction. In the most advanced stages of AAF, rearfoot fusions may be necessary. This is a more extensive procedure, and would require 8-12 weeks of remaining off the foot with a long rehabilitation.

    If you are experiencing pain, loss of your arch, and progressive weakness of the foot and ankle, it is necessary to come to the office for a full evaluation. A thorough clinical and radiographic exam would help determine the extent of the deformity and a treatment plan can be recommended to you. Unfortunately, we often see a patient for the first time in the more progressive stages. There are many things to take into consideration when recommending what treatment is the best for you. Older individuals often opt for more simpler, bracing techniques and physical therapy for strengthening and balancing to help with everyday walking. Younger, more active patients may require more aggressive care.

    Whatever the case, we are happy to help you back on your feet at Main Street Foot and Ankle Care, LLC Care. Doctors Majeski and Paukovitz are determined to get you better!

    When should I see a Podiatrist?


    Your Podiatrist is your foot and ankle specialist, there is no need to go to the emergency room for foot and ankle injuries, your Podiatrist should be able to treat and evaluate your injury in their office.

    Any of the following symptoms or injuries should prompt you to make an appointment with your Podiatrist:

    • Uncontrolled pain, lasting over 24 hours
    • Open, bleeding type injuries
    • Any injury in which you are unable to bear weight
    • An infection with increasing areas of redness, accompanied with fever, chills or nausea
    • Insect bites, animal bites,
    • Injuries which occur in the water, for example while wading in the bay, a laceration occurs.
    • Any type of foreign body penetration
    • Any type of burn injury
    • All sprains should be evaluated for fracture by x ray studies
    • All traumatic injuries to children should be evaluated.
    • Ingrown toenails
    • Ulcers
    • Skin lesions which bleed or have varied discoloration

    Special circumstances listed below, would necessitate a visit to your Podiatrist, for even a minor injury:

    • Diabetes
    • Poor circulation
    • Immuno-compromised patients, (ie; on chemotherapy, AIDS, Hepatitis, Lupus, MS, Rheumatoid arthritis.)
    • Long term steroid use
    • History of MRSA
    • History of neuropathy
    • Joint replacements

    The Lists and conditions above are not all that should trigger a visit to your Podiatrist, but are a good outline to start. As with any injury, prompt evaluation allows accurate treatment to begin, and in most cases will decrease the disability of the injury time.

    Delay of care can dramatically increase the complications, healing time, disability, and long term outcome of the injury. Use the lists above as a guide for when determining whether a visit to your Podiatrist is warranted.

    Any injury can turn serious, especially when complicated by the above risk factors. If injured and there is any question of whether a doctor should evaluate the injury, do not hesitate and call our office.


    Copyright © 2016 Main Street Foot and Ankle Care, LLC - Dr. Mark A. Majeski All rights reserved.
    Web Site Design & Maintained by Physician WebPages