Ingrown Toenails

Onychocryptosis

An ingrown toenail, medically deemed onychocryptosis, is a very common complaint among patients in a podiatry office.  This condition usually begins with mild tenderness along the edge of a toenail where a portion of the nail border has penetrated the skin.  Over time, the toe may become increasingly painful to touch with localized redness and inflammation.  An infection may develop where the toe exhibits warmth, and pus begins to drain from the site where the nail has pierced the skin.

The severity of the nail’s appearance will vary.  Some will have a nail that appears incurvated and deeply embedded into the skin; others may have a small spike in a corner that penetrates down into the nail bed. Aside from penetrating the skin, a nail can apply pressure in the nail fold area without breaking the skin causing discomfort and mild pain.  This is not technically an “ingrown nail.”

Causes of ingrown nails range can from genetics to an improper shoe size wherein a shoe’s toebox can place pressure on the nail.  Direct trauma to the nail such as stubbing a toe, can alter the way in which the nail grows.  Nail fungus can alter the nails growth pattern as well. Preventative measures include proper nail trimming wherein the nail should be cut straight across without tapering the corners.  Proper fitting shoes can also help prevent ingrown nails.  It is best to seek advice from your podiatrist, and avoid “bathroom surgery.” 

Podiatric treatment for an ingrown nail that’s infected involves antibiotics in addition to soaking the foot in Epsom Salt.  It is important to keep an infection clean and monitor it daily for signs of worsening inflammation.  If a nail is simply ingrown but not infected, Dr. Garvin may trim the nail border to see if the nail will grow back properly.  In the case of reoccurring ingrown nails, Dr. Garvin will perform a simple surgical procedure that will remove the entire nail border permanently.

Our goal here at Foot and Ankle Specialist of the Treasure Coast is to keep you healthy and walking comfortably. There are often many conservative options for treatment with surgery typically the last one implemented. So stay healthy and keep your feet pain free!

Shin Splints

Shin Splits - What exactly are they? 

Have you ever had that sharp pain radiate through your leg after your daily run or walk?

That condition, which is commonly referred to as “Shin Splints” , is a slow healing and painful disorder in the shins usually caused by exercise such as: running, jumping, swimming, cycling, dancing or other high impact sports. In fact, 10-15% of all runners’ related pain or injuries are due to this syndrome.

There are two types of shin splints also known as medial tibial stress syndrome (MTSS), anterior and posterior. The most common shin splint is anterior. Anterior shin splints are often due to over striding or training at a pace that doesn’t allow for healing of the tibialis anterior muscle. Posterior shin splints (also called posterior tibial tendonitis) are a less common condition that is often due to pronation (flattening of the arch).

The onset of shin splints is most common after exercise, caused by high impact training, excessive training, poor technique, or improperly fitting shoe wear. Dr. Garvin can determine if you require properly fitting footwear or an orthotic to prevent a re-occurrence of shin splints.

Interestingly some studies have suggested that shin splints are actually more common in women possibly caused by decreased physical fitness, smaller muscle size or standing for long periods of time and wearing high-heeled shoes.

If you are suffering from shin splints make an appointment to see Dr. Garvin as soon as possible by calling his office at 772-335-7171. Dr. Garvin will immediately address the inflammation of soft tissue known as shin splints with ice, non-steroidal anti-inflammatory drugs and physical therapy. Patients may also be advised to decrease the duration or intensity of their exercise, change their footwear or add an orthotic, then slowly build back up their exercise routine.

Bunions

A bunion is an enlargement of bone or tissue around the joint at the base of the big toe. The big toe generally turns in toward the second toe and the tissues surrounding the joint becomes swollen, tender and often painful. Bunions occur more commonly in women and can sometimes run in families, making some individuals genetically pre-disposed to this condition. People born with abnormal bones in their feet are more likely to form a bunion. Wearing narrow-toed, high-heeled shoes can also lead to the development of a bunion. The condition may become painful as extra bone and a fluid-filled sac grows at the base of the big toe.

Most common reasons for the development of a bunion:                  

• If the foots shape puts too much pressure on the big toe joint.
• Because bunions can run in families, some experts believe that the inherited shape of the foot makes some people genetically pre-disposed to developing a bunion.
• If the foot rolls inward or pronates too much when walking. 
• Flat Feet.
• Wearing shoes that are too tight.

Any of these situations can apply significant pressure on the big toe joint, which over time; will force the big toe out of alignment, bending it toward the other toes.

Early diagnosis is critical. When a bunion first begins to develop, taking a few simple steps such as wearing foam pads on the foot to protect the bunion, or devices called spacers to separate the first and second toes at night can help avoid a worsening of the condition.

If the bunion gets worse, resulting in severe deformity or pain, surgery is the most effective approach to realign the toe, relieve the pain and remove the bony bump (bunionectomy). There are many different surgical techniques that can be used to treat this condition depending on the individual’s situation.

To help our patients get relief from bunion pain Dr. Garvin might recommend, wearing wider shoes, orthotics, or foot pads. Treatment such as oral anti-inflammatories and injections can also help to relieve discomfort. However, Dr. Garvin can perform same day procedures, which will have patients comfortable after just a few weeks of recovery.

Warts on your feet?

Commonly known as plantar verrucae, the plantar wart is caused by the Human Papillomavirus. The virus attacks the skin through direct contact, entering through possibly tiny cuts and abrasions in the outermost layer of the skin. Infection typically occurs from moist walking surfaces such as showers or swimming pools. After the infection, warts may not become visible for several weeks or months. Because of pressure on the sole of the foot, the wart is pushed inward and a layer of hard skin may form over the wart. Depending on where the warts are located, some may cause pain when walking. A common misconception about plantar warts is that they have roots which can grow deep into the tissues and attach to the bone. This is not true. A wart only grows in the top layer of skin and although the wart may extend slightly deeper, this is generally due to walking, putting pressure on the affected area and pushing the wart deeper into the tissue.

Because plantar warts are spread by contact with moist walking surfaces, they can be prevented by not walking barefoot in public areas such as showers or communal changing rooms (wearing flip flops or sandals helps), not sharing shoes and socks, and avoiding direct contact with warts on other parts of the body or on other people. Humans build immunity with age, so infection is less common among adults than children. The virus can survive many months without a host, making it highly contagious. There are many different treatments for warts including topical acid, freezing, laser and surgery to name a few.

Warts on the bottom of the foot can look a lot like calluses, so when in doubt, it is best to have it looked at by a Dr. Garvin. So if you or a loved one is suffering with a painful wart that just won’t go away, call Dr. Garvin’s office today at 772-335-7171 and schedule an appointment. 

Athelete's Foot

Tinea Pedis (Athelete’s Foot)

Tinea pedis, otherwise known as athlete’s foot, is a fungal infection of the skin that causes itching, scaling and flaking on the bottom of the foot.  The infection is caused by Trichophyton, which are tiny microscopic organisms that live on the layers of dead skin our body produces.   Direct transmission occurs in damp, moist environments that are conducive to fungal growth where individuals tend to go barefoot.

It is important to maintain proper foot hygiene and recognize tinea pedis as it has the ability to spread to other crevices of the body, especially the groin.  Notably the bottom of one’s foot may exhibit redness and scaling.  Persistent itching and burning may ensue.  Scratching is discouraged as one can create breaks in the skin, allowing the individual to become susceptible to a secondary bacterial infection. 

Although there are many skin conditions that can mimic the appearance of tinea pedis, Dr. Garvin can readily diagnose this fungal infection through a simple laboratory test.  Treatment may be rendered with the daily use of antifungal creams and washes.  Coincided with a cream or wash, preventative care aims to make the infected area less suitable for fungal growth.  Feet should be washed daily with soap and water, drying thoroughly between the toes.  Excessive sweating should be controlled and treated.  Socks and shoes should be kept clean and dry.  Footwear that is breathable should be opted for.  Medicated powders are available for placement in more occlusive shoe types to help keep them dry.  Most importantly, avoid walking barefoot in public places such as showers, gym rooms, locker rooms and swimming pools, which are all high risk, fungal-loving environments.

Our goal here at Foot and Ankle Specialist of the Treasure Coast is to keep you healthy and walking comfortably.  So stay healthy and keep your feet pain free!

The Diabetic Foot: Common Questions Answered

Close to 24 million people in the United States have been diagnosed with diabetes and another 6 million people have it but are not yet aware they are afflicted with this disease. As the leading cause of non-traumatic, lower-limb amputations, diabetes is reaching epidemic proportions, now more than ever.  It can have a devastating impact on the body, affecting numerous parts of the body including the eyes, mouth and feet.  In fact, the feet, often overlooked at routine checkups, can reveal the first signs and symptoms of the disease.  Commonly forgotten, patients neglect to take off their shoes and socks and ask their health care providers to inspect their feet. Proper education on the signs and symptoms of diabetes and having your feet checked every time you visit the doctor are pertinent to the management of the disease.

1. Why should my doctor ask me to remove my shoes and socks?

The feet, can tell us a thousand words, including the warning signs of Diabetes such as numbness, tingling, or ulcerations.  Taking off your shoes and socks at every doctor’s visit is critical to the prevention and treatment of the manifestations of the disease.

2. Checking blood sugar often?

Since Diabetes is a disease attributed to hyperglycemia (high blood sugars) it is mandatory that you or a loved one make sure to check blood sugars on a daily basis. Most patients will say that since they “feel fine” that their blood sugars are controlled, but little do patients and loved ones know that with uncontrolled blood sugars, comes all the detrimental effects of Diabetes.

3. What can happen if diabetes is not detected in its early stages?

Many people do not find out they have the disease until they develop serious complications such as foot ulcers. In fact, six million Americans with diabetes have not been diagnosed. However, if left undiagnosed or untreated, it can damage the body and result in long-term complications such as lower-limb amputations, cardiovascular disease, stroke, blindness and kidney disorders.

5. Should I see a podiatrist if I have diabetes?

Treating diabetes requires a multi-disciplinary approach. A podiatrist is an integral part of the management and treatment team.  Your primary care doctor may refer you to a dietician, nurse educator, endocrinologist, and an eye doctor to help you manage the disease.


If you need additional information on Diabetes, please contact:
Dr. Michael Garvin
St. Lucie West Office150 SW Chamber Court, Suite 101
(Behind TD Bank Bldg.)
Port St. Lucie, Florida 34986
772-871-6020


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Plantar fasciitis, One of the Foremost Causes of Heel Pain

Plantar fasciitis is one of the most common causes of heel pain. Both heel pain and heel spurs are frequently associated with an inflammation of the band of fibrous connective tissue (fascia) running along the bottom (plantar surface) of the foot, from the heel to the ball of the foot. The inflammation is called plantar fasciitis. It is common among athletes who run and jump a lot, and it can be quite painful.

The condition occurs when the plantar fascia is strained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where it attaches to the heel bone.

When excessive force is applied to the arch of the foot, that force is transferred to the plantar fascia, which can become irritated and inflamed.  The cause of the irritation involves multiple factors.  A combination of over pronation in the feet, unsupportive footwear and overuse can cause microscopic tears in the plantar fascia that begin an irritation and inflammatory process.  In turn, the inflammation causes pain where the plantar fascia inserts on the heel bone.  This condition is prevalent in runners, overweight individuals, and pregnant women with inadequate support from shoes.  Commonly felt in the morning while taking the first couple of steps out of bed, plantar fasciitis causes pain described as feeling like a sharp dagger, stone bruise, deep throbbing or dull ache.

Conservative treatment therapies for plantar fasciitis include icing, stretching, heel lifts, supportive shoes, weight loss, orthotic devices and night splints.  Stretching is one of the most important therapeutic measures that should be performed multiple times a day, especially before stepping out of bed.  Having supportive footwear is also a critical measure.  A shoe which is too soft and flexible will strain the plantar fascia while weight bearing.  Orthotic inserts can be placed in a shoe in order to control abnormal foot motion and prevent arch collapse, both of which stress and tear the plantar fascia.  Individuals with tight calf muscles causing an early heel lift during gait could benefit from a heel lift.  Finally night splints can provide valuable healing time when resting as they help keep the plantar fascia stretched out. The calf and plantar fascia contract and tighten while sleeping.  When full body weight is applied to the foot when stepping out of bed, the plantar fascia overstretches and tears.