Thick, ugly toenails.

Everyone has seen them, nobody wants them! People often associate these unhealthy nails with fungal infection.
In truth, about 40-50% of thick, discolored toenails are due to fungal infection. The other 50-60% aredue to a variety of other conditions, including psoriasis, lichen planus, injury, and , most commonly, degenerative changes of the nail.

T is important to determine the exact cause of diseased toenails, as the treatment varies based on the cause. Your podiatrist can determine the diagnosis by taking a small clipping of the nail and sending it to a laboratory for analysis. When the results are available, treatment options can be discussed.

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Obesity is a true epidemic. According to World Health Organization statistics, worldwide obesity incidence has tripled since 1975, with 1.9 billion people being overweight and 650 million being obese. In the USA, 36.5% of the population is obese, and it is expected that by 2030, the incidence will climb to 50%. More alarming is the fact that childhood obesity rates have increased from 4% in 1975 to 18% currently.

Overweight and obesity are associated with higher rates of foot and ankle problems that in normal weight individuals. Additionally, certain conditions are more common in overweight people. These include heel pain, plantar fasciitis, midfoot pain, acquired flatfoot, arthritis, as well as edema (swelling),vein problems (including varicose veins and thrombophlebitis), balance problems, gait problems, knee pain, hip pain, back pain, and poor foot function. Diabetes is also associated with obesity.

Overweight children are especially prone to foot problems, especially flatfoot deformity. These conditions, if untreated, can lead to more serious problems in adulthood.

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Most of us have observed small children walking on their tip-toes. About 5% of children toe-walk. Often, this is a phase or habit which stops after a short time. In other cases, however, it can represent a problem requiring treatment.

Any child who continuously walks on their toes should be evaluated by a podiatrist. The podiatrist will observe the child’s gait and will examine range of motion and strength of the foot and leg. Sometimes, an X-ray may be taken to rule out bone or joint abnormalities.

The majority of cases of toe-walking are “idiopathic” or habitual. These cases have no identifiable underlying cause, but often still require treatment.

Another common cause of toe-walking is called “equinus”, which is tightness of the Achilles tendon and the muscles of the back of the leg. This tightness pulls the Achilles tendon down too much as the child walks.

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Florida living promotes the casual lifestyle and casual attire, including flip-flops. These skimpy sandals are seen everywhere. The variety of available flip-flops is endless, from the cheap, dollar-store type to contoured, thick-soled flip-flops to elegant sequined sandals.

Are flip-flops a healthy choice of footwear? According to extensive biomechanical research conducted over the last ten years, no! To keep the flip-flop on during gait, the toes must bend and grasp the sole of the shoe with each step. This strains several tendons of the foot, resulting in compensatory problems such as plantar fasciitis and Achilles tendinitis. Some studies have also associated flip-flop use with knee and back pain.

Flip-flops are especially dangerous for people with neuropathy and for those with balance problems, as they can increase fall risk. They can put diabetic patients at risk for chafing, getting foreign bodies in the shoe, and for microtrauma.

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Dr. Breithaupt was puzzled. The year was 1855, and this Prussian army doctor was noticing that many of his young military recruits were experiencing severe pain in their feet or ankles early in their basic training, particularly after prolonged marching. Dr. Breithaupt discovered that the soldiers were actually developing incomplete fractures of the bones from overuse. He called the condition “march foot , and wrote the first paper describing it. Today we call it “stress fracture”.

Stress fractures are defined as incomplete partial fractures of bones. They comprise 10% of all sports injuries, with 99% of them occurring in the lower extremity.

Unlike “pathological fractures” which occur in weakened or porotic bone (especially in elderly patients), stress fractures occur in otherwise healthy bone due to repetitive mechanical loading. It non-athletes, they often occur when a sedentary period is followed by a sudden increase in activity, or performance of an unaccustomed activity. In athletes, they occur after increasing level of training too quickly.

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Are you one of the 25 million Americans suffering from varicose veins? This condition affects 50% of all women and 40% of all men, with the incidence increasing with age. Over 70% of people over age 70 years have the condition.
What exactly are varicose veins? Veins are the blood vessels that bring blood back to the heart. They contain valves that prevent backflow of blood. If these valves fail, the blood “refluxes”, or back flows , causing the vein to become engorged. These engorged veins are referred to as “varicose veins”, “reticular veins”, or “spider veins”, depending on their size.

The engorged veins of all sizes are cosmetically unsightly. However, they can also cause problems such as leg swelling, burning, pain, itching, restless leg symptoms, skin breakdown (ulceration), and skin damage (dermatitis).
In addition to age, risk factors for varicose veins include female gender, obesity, heredity, estrogen therapy, and prolonged standing.

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Just as with the mighty Greek warrior Achilles, whose only weak spot was his Achilles tendon (for whom it is named), the Achilles tendon continues to cause pain in people today.

The Achilles tendon begins in the muscles in the back of the calf and attaches to the back of the heel bone. Although ruptures , or tears, of the tendon are commonly treated injuries, most Achilles tendon problems are due to abnormal tightness.

Abnormal tightness of the Achilles tendon itself is referred to as “equinus”, from the Latin “equus”, meaning “horse”. The Achilles tendon pulls the foot down, or “plantarflexes” it. When tested, if the ankle cannot move up at least ten degrees from the neutral position, the patient is considered to have an equinus condition. Symptoms associated with equinus include Achilles tendinitis, pain in the back and/or bottom of heel (retrocalcaneal bursitis and plantar fasciitis), calf muscle pain, bunions, pain and/or calluses of the forefoot, arch pain, knee pain, back pain and toe-walking.

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The ingrown toenail is probably the most common condition that we treat. It presents as pain along the edge of the toenail. Although the great toenail is the commonly involved, any nail may be affected. Often, the ingrown toenail area is infected.

Treatment involves clearing any infection and removal of the ingrown section of nail. This is a minor procedure performed in the office. Patients may walk, wear shoes, and resume normal activities immediately after the procedure.

Treatment of ingrown toenails is available by all of our doctors in each of our offices: downtown Melbourne, Eau Gallie, and Palm Bay. If you or a loved one has been suffering from an ingrown toenail, please call us!

Because the feet support the entire body, it is important that they do so in a correctly-aligned manner. Many people have feet that are malaligned, and this malalignment affects the entire body. This can result in a variety of symptoms and compensation mechanisms.

One way to make feet “straighter” is to wear a device in the shoe called an “orthotic” or an “orthosis”. The terms “orthotic” and “orthosis” come from the Greek “orthos”, meaning “straight”. An orthotic device it is specifically designed to realign abnormal foot function. Unlike an arch support, which is a cushion that provides shock absorption, an orthotic device actually treats a biomechanical problem.

Pre-fabricated orthotic devices of different shapes are often dispensed for various conditions. These suffice in many patients, but others will have a greater benefit from a custom orthotic. A custom orthotic is made from a plaster impression of the foot and is specifically created from the impressions. It is the most effective type of orthotic device.

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Blood clots in the legs of airline travelers were first reported in the 1950s and were termed “traveler’s thrombosis”. The condition is now known as “venous thromboembolism” (VTE) and is not specific to travel. However, long-haul travel is
a significant risk factor for VTE, and the association has been extensively studied in recent years.

An international concensus statement categorizes VTE into three risk groups: low, moderate, and high. High risk includes people with a history of blood clots; malignancy; pregnancy; obesity; and coagulation disorders. The risk of long-haul airline travel ranges from 0-2%
in a low risk person and rises to 5% in a high risk person. Although there is a risk of VTE from all long distance travel including long
rides in cars, buses, and trains, air travel has a much higher risk, up to 26% highe, for unknown reasons.

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