Skin cancer of the foot is rare but deadly.

Skin cancer of the feet is very rare. But since feet are generally very neglected to daily inspection, a cancerous lesion can be missed.
Like most skin cancers, they arise mostly from exposure to the sun. Many people who use sun screen miss putting protection on their feet specifically the bottoms. Constant sun exposure kills skin cells damaging the DNA setting up the possibility of a melanoma.
Skin cancer is a tumor of the melanocytes in the skin. While they can arise from moles and 'birth marks' called nevi, again it occurs mainly in sun exposed areas. Melanoma generally occurs in the 4th - 7th decade of life (30's - 60's) and occurs more frequently in fairer skinned individuals.
How can you spot a possible melanoma? Here are a few pointers:
Remember your ABC's...
Asymmetrical - the edges of the spot are irregular.
Borders - again are irregular and notched.
Color - spots are multicolored (pink, purple, white, gray, tan, black, blue or brown).
Diameter - greater than 6 mm or a little more the 1/4 of an inch. (Generally the width of a pencil eraser).
Elevation - the spot is generally elevated as compared to the skin next to it.
Also be aware of any spot that has changed in appearance recently and rapidly.
If you have any concerns about a spot on your calf, ankle or foot make an appointment with your local podiatrist immediately. It is better to be safe than sorry.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

What are hammertoes?

OK... I admit it. I see a lot of hammertoes. And I am always asked, "Why are my toes crooked?" Basically you have either a foot with an arch to high or a foot with little to no arch.
Our bodies are three dimensional so hammertoe deformities can happen in all 'three dimensional planes'. The one podiatrists see most frequently is in the 'sagittal' plane of deformity which means the toe is bent in up and down. The second most frequent deformity is in the 'transverse' plane of deformity where the toes move from side-to-side or what most people refer to as an "overlapping" toe. The final plane of deformity is what we refer to as the 'coronal or frontal' plane were the toe wants to 'roll'. We see this mainly on the great toe or the little toe and is generally associated with a bunion. (More on bunions in another post).
Hammertoes occur at the joint closest to the foot. If any of these deformities occur at the joint closest to the tip of the toe, it is referred to as a 'mallet' toe.
If you are interested, here is the physiology of what causes hammertoes:
1: Flat feet - pes planus: (Flexor stabilization) A flat foot is a flexible or hypermobile foot. We in podiatry refer to this as 'excessive pronation'. The middle of the foot fails to lock while walking creating a very mobile front of the foot. The 'flexor' tendons work to early in an attempt to stabilize the foot causing the toes to bend.
2: High arched feet - pes cavus: (Flexor substitution) muscles in the back and side of the calf are weak causing an inability to plantarflex the foot (basically to move the foot down). The muscles located in the foot contract creating a high arched foot and thusly, hammertoes.
I am asked if hammertoes can be prevented. The answer is yes and no. Good custom molded orthotics can help keep the feet in correct alignment thus either helping to prevent or at least slow down the deformity. However, by the time I see people in my office, the deformity has reached a point to where the only correction is to perform reconstructive surgery.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Big Bags should cause Red Flags.

I know. You are wondering, "When is this guy going to start talking about feet and ankles again." Well believe it or not... I am.
I mentioned earlier that the old nursery rhyme, "the foot bone is connected to the ankle bone, is connected to the knee bone, is connected to the hip bone, etc." is truer than one thinks. Our skeletal system has a physiological alignment, that when is close to correct as possible, reduces abnormal stresses thus reducing pain and discomfort. When one portion of this system is out-of-alignment, it can affect a part or the whole body. So, this brings me to my topic of... big bags.
Kids and women have a tendency to purchase big bags to carry massive amounts of 'stuff'. Kids to carry books for school and women... well, I really don't know what all you carry. But these big bags can cause pain, strains, and in younger children, permanent misalignment of the skeletal system. So here are a few tips to reduce or eliminate this problem:
1: Lighten the load: carry no more than 25% of your weight in your backpack or oversized purse. Excessive weight can cut off blood supply and compress nerves in the arms. Cutting off blood supply can lead to fatigue and compressing nerves can lead to numbness and loss of hand and finger mobility.
2: Keep the backpack or purse close to your body: also use both straps on the backpack instead of slinging it over one shoulder.
3: Carry equal amounts of weight in both arms: if you have mutliple bags (like groceries or shopping bags) balance the bags between each side. Unequal balance twists your torso and makes your spine work harder. (If you only have one bag or carry a heavy item over one shoulder, be sure to switch it often to avoid constant twisting of your torso in one direction).
4: Roller bags and luggage: many people have gone to roller bags and luggage to avoid having to carry heavy items. But these can have a hidden problem as well. Make sure that your bag or suitcase handle extends to your waist. A short handle can cause abnormal bending putting extra force on your spine. If the handle is to short, many stores sell extenders.
5: Big fat wallet (if only I had this problem): a fat wallet is a nice problem to have, but sitting on a bulge in your hip pocket can also cause a twist to your torso. Switch your wallet from pocket to pocket or thin it to basic essentials.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Mexican food the new health craze?

It used to be, "avoid Mexican food because it is so full of hydrated fat and calories." Well, for the most part, Americanized Mexican food can be very unhealthy. But when you look at authentic Mexican food you may be able to slash the risk of breast cancer by a third and lose a little weight while you are at it. Here are a few recommendations:
1. Eat more fish: this omega-3-rich staple of coastal Mexico can be tried in seviche, snapper Veracruz, tacos and salads.
2: Go light on meat: only use an ounce or two of lean beef or chicken in your tacos.
3: Add just a bit of cheese: skip Monterey Jack and Cheddar which is practically unknown in Mexico. Try a tablespoon of crumbly, dry Cotija or low-fat feta cheese on beans in burritos.
4: Load up on beans: pinto, black and other legumes are rich in nutrients that help lower cholesterol. Refried beans can be healthy as well if you get the low-fat variety cooked without lard.
5: Pour on the salsa: green or red sauces are made from antioxidant-rich tomatoes, tomatillos, chili peppers, onions, garlic and lime or lemon juice which are low in fat and full of fiber.
6: Pile on the produce: colorful peppers for the fajita platter; lettuce, tomatoes, corn and onions for the tacos; greens and guacamole in the Southwest salad.
7: Wrap it all in corn or whole wheat tortillas: these are higher in fiber, minerals, vitamins than their processed-flour counterparts.
Ummm! I'm hungry already.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

How to burn fat...

I have patients who come into my office with foot pain that is directly attributable to their weight. Now, I don't profess to be a personal trainer, but unfortunately, I have had to lose some weight at various points in my life. I see people at health clubs that are peddling their stationary bike or going a mile-a-minute on the treadmill only to become frustrated that they are not losing any weight. The problem is physiological... the faster the heart rate the less fat you lose. Our bodies were designed this way to shut down certain systems and to reserve energy. So how do you lose weight?
To lose weight, your hear rate should be at approximately 55% (give or take 5%) of your maximum heart rate. So what is your maximum heart rate? Take 240 and subtract your age. This gives you your maximum heart rate. For aerobic exercise you should be at a target 75 - 80% of your maximum heart rate. For fat burning, again, you should be at 55%.
Example for a person who is 55 years old: 240 - 55 = 185 for maximum heart rate. Aerobic would be 185 x .80 = 148 bpm (beats per minute) with fat burning 185 x .55 = 102 bpm.
So the next time you are advised to shed a few pounds, realize that long duration and steady is better than short duration and fast.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

Are pedicures for men?

Frequently I have patients (mainly female) who come into my office and ask, "what do you think about pedicures?" I respond, "they are fine as long as you are aware of a couple of things."
1: I recommend purchasing your own bits and files to be used. Most nail salons are fine with cleanliness but to safeguard against a contaminated tool being used, purchase and take your own and cleanse them yourself.
2: Open cuts, wounds or sores do not have your foot immersed in water. There is a nasty little bacteria that can exist in communal water sources so exercise caution.
3: Thick callouses should be trimmed by your podiatrist. Callouses can mean an ulcer underneath the thick skin, so it is better to have them parred by a medical professional especially if you are diabetic or immuno-compromised. You can maintain your callouses at home using specially designed skin files or a pumice stone.
4: Nail polish. I advise my patients to wear nail polish only for special events and occassions. Put the polish on the nail the day before or the day of and remove the polish one or two days after. Nail polish can cause nails to become brittle and can also lead to fungal nails.
5: If your feet are dry wear socks. Yes, wear natural fiber socks which helps protect your skins natural oils, especially during the summer, and can wick excessive moisture away which can lead to the loss of these oils.
Also, if you are a man and feel comfortable being seen at a spa with a bunch of beautiful women... then by all means... GO!

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

"Hand-me-down" shoes are not good for the feet.

Pre-World War II, hand-me-down clothes existed in a lot of families. Articles such as shirts, pants, coats and shoes if in good condition would be given to younger family members to wear. The practice today is not as prevalent, but occasionally still exists. While articles such as pants, shirts, and coats may be advisable, I strongly discourage handing-down of shoes of any type.
While the individual receiving the shoes may have the same foot length, very rarely does the person have the same foot width and/or height. Shoes when broken-in conform to the initial wearers foot architecture. This can cause foot problems to the second person that can lead to foot pain, change in foot structure and even serious foot injury. Many of these problems are muscular in nature and generally can be resolved but discontinued use of the "hand-me-down" shoe. But if structural changes occur, sometimes the only resolve is to perform reconstructive surgery.
I notice this quite frequently in athletic shoes. Cleated shoes are especially a big culprit for causing foot problems in hand-me-down shoes. Also, it is advised to change running shoes about every three to six months depending on usage.
Spend the time and the little bit of extra money and insure that your child or young adult has adequate shoes for their particular foot architecture and the environment where they will wear the shoe.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

CDC looks at Diabetes and Arthritis.

The CDC back in 2005 and 2007 utilized date from the Behavioral Risk Factor Surveillance System (BRFSS) and found that the prevalence of arthritis in adults diagnosed with diabetes was 52 percent. The survey also indicated that the rate of physical inactivity was 28.9 percent in the diabetes with arthritis population vs. 21 percent of those with diabetes alone. This survey was also independent of age, sex or body mass (BMI).
The study emphasized that inactive people with diabetes who become more active benefit from improved glucose tolerance and increased physical function. The barriers faced by diabetics are just like all other physically inactive people: lack of time, competing responsibilities, lack of motivation and difficulty finding an enjoyable activity. The following are some fitness options that are low impact and can protect the already painful joints of arthritis:
1: Water exercises: more gyms and senior centers are offering pools for aqua aerobics and aqua cross-training. Water provides non-weightbearing environment which decreases the pull of gravity on the patient.
2: Recumbent bike: body positioning also decreases weightbearing on the foot, knees and lower back and is good at raising the heart rate for aerobic exercise.
3: Flat walking with light weights. Walking on surfaces that can provide some shock absorption (cork tracks, etc.) with supportive shoes is also a good means of getting physical activity.
4: Pilates: this exercise strengthens, stretches and tones the body to be better conditioned to handle weightbearing cardio activities.
There is another benefit to become more physically active. With the lack of physical activity, patients often will feel a level of depression. Some reasons may be due to a feeling of being handicapped, a feeling of remorse for their medical condition and a feeling of less-self-worth. Studies have shown that exercise releases endorphins into the body increasing physiological sense of well being.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS

The "symptomless" foot.

I have patients who come into my office and complain of a lack of sensation or worse, burning to their feet. Peripheral neuropathy effects primarily the feet and legs, sometimes affecting the hands. Peripheral neuropathy is dangerous because the onset is so subtle, people don't really know when they lose their sensation.
The main culprit is diabetes with arthritis, especially of the lower back, as the number two cause. Sometimes we don't know what the cause is and we refer to this as idiopathic neuropathy.
The 'symptomless' foot is actually more likely to have a problem because people will see their podiatrist when their foot hurts. But without pain, people with neuropathy delay seeking medical help which can lead to ulcerations, lacerations, puncture wounds with retained foreign bodies, pathologic fractures and worse amputations.
So what do you do if you have peripheral neuropathy? Here are a few tips:
1: Check you feet daily. You will need to use your eyes and hands to compensate for the lack of sensation. Have a family member or friend check the bottom of your feet daily for any of the above mentioned problems. If you live alone, get a small mirror and place it on an out-of-the-way place in the bathroom. This way you can visually inspect the bottom of your feet daily.
2: Check your shoes before putting them on. Turn them upside down and shake them. In addition, use your hands to feel for any objects that may be inside of the shoe.
3: Wear something on your feet as often as you can. I see to much trauma from people who don't wear shoes at home inside or out.
4: If you see a problem, seek medical attention immediately. The cut, ulcer, swelling may not feel bad or even look bad (especially on the bottom of the foot). But don't take a chance. 85% of the amputations I perform on neuropathic feet could have been prevented if medical treatment was sought immediately.
In addition to a lack of feeling, people with peripheral neuropathy can have a change in their circulation. So if the skin of your feet especially around the toes appear blue, purple or white, also seek the opinion of a medical professional.

"The journey of life is taken one step at a time... none of them should be painful." G.M. Barclay, DPM, AACFAS