John Hollander, DPM

6 Common Toenail Conditions

Unwanted toenail conditions can happen to the best of us and they can range from embarrassing and unsightly to painful and frustrating. The good news is there are various treatments available for toenail conditions that can restore nails back to good health. Here are 6 common toenail conditions, their symptoms, and how they can be treated.

Green Nail Syndrome

Green Nail Syndrome also known as chloronychia is an infection of the nail bed that results in a greenish to blue-ish appearance.  When the toenail has experienced a trauma that causes the nail to lift off the nail bed, it creates a welcoming environment for the bacteria known as Pseudomonas aeruginosa to make its home.  Along with discoloration, one may experience red or tender cuticles.

This is a common condition among those that have their hands or feet exposed to water often, such as healthcare providers, dishwashers, military recruits or scuba instructors.

Because this condition happens under the nail, it can not be washed or filed off.  It needs to be treated with other methods.  Treatment options include: cutting off part of the affected nail, keeping nails dry, topical or oral antibiotics, homeopathic methods of a diluted vinegar or bleach & water solution (1:4) and removal of the entire nail.

Paronychia

Paronychia is a bacterial infection in the skin around the fingernails or toenails that affects the skin at the base (cuticle) or up the sides of the nail. It often results in skin that is red, tender, swollen and oozing puss.

Paronychia often occurs from someone biting or pulling at the skin around their nails (such as hangnails) or having an ingrown toenail, but it could even be caused by a fungal infection.  When the skin becomes exposed, paronychia can find its way in and create an unpleasant experience.

Treatment for this condition starts with warm salt water foot soaks for 5-10 minutes 3-4 times per day.  This is to help reduce the swelling.  If this does not assist in providing you with relief your doctor may prescribe you an antibiotic or an antifungal medication.  If there is a puss pocket present, your doctor will assist in relieving the build up by draining the puss sack.

Nail Psoriasis

Nail Psoriasis is a common condition that can occur in those that have Psoriasis.  Symptoms of this condition include: tiny dents in your nails, white, yellow, or brown discoloration, crumbling nails, nails that separate from your toe, buildup beneath your nail and even blood under your nail.  Currently there isn’t a way to “prevent” nail psoriasis if you have psoriasis.  It can be controlled however, with treatment.  Treatments include, medications to treat both skin and nails, corticosteroids, laser treatment and clinical UVA exposure.

Black Toe Nails

Depending upon the cause, black toenails can be quite common.  Often black toenails are caused by a build up of blood under the nail from some sort of trauma.  They are very common among runners due to the constant pressure against the toe.  Sometimes the build up of blood can be quite painful, and if that is the case, seeing your doctor would be beneficial.  They would be able to help relieve the pressure by draining the blood build up.  In rare cases, a black toenail could be a sign of melanoma.  Early evaluation of melanoma can lead to better outcomes, so do not hold off on being evaluated.

Onychomycosis (Fungal Infection)

Onychomycosis is a common condition that occurs when a fungus infects the tissue underneath the toenail. The result is discoloration of the nail. Nail fungus may cause your nail to thicken and become brittle and even cause your feet to smell! It commonly involves several nails simultaneously. It often occurs in people with persistent moisture in their feet, such as with footwear that does not allow air circulation or in those who perspire excessively in their feet.

There are several methods for treatment depending upon how stubborn the fungus may be.  Often patients will start with an over the counter medication.  If that fails, then they will visit a podiatrist who will offer topical or oral medications or suggest laser therapy.

Ingrown Toenails

An ingrown toenail occurs when the nail itself starts to grow down and inward towards the toe, sometimes penetrating the skin.  It can be quite painful and uncomfortable.  An ingrown toenail often occurs due to poorly fitting shoes, when the nail is cut at an angle or if the nail experienced trauma.

Treatment includes soaking the foot in a warm salt water bath a few times a day or removing a portion of nail that is penetrating the skin.

 

If you suspect that you may have a common toenail condition that needs treatment, please call our office to see one of our Podiatrists at (707) 578-1222.

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MLS Laser Therapy Offers Non-Surgical Alternative for Tibial Tendon Dysfunction

Tibial Tendon Dysfunction (TTD) is a very common acute injury that can be caused from a fall or overuse of the posterior tibial tendon.  While TTD is more likely to occur in women and those over 40, it is also very common among athletes due to the constant strain and impact put on the foot.

The tibial tendon’s job is to hold the leg muscle to the bones in the feet and provide support to the arch of the foot when walking.  When the tendon becomes inflamed or torn, it can no longer provide the needed support and overtime it will cause the arch to lay flat, thus causing one to have a flat foot.

Symptoms that may occur with TTD are: Pain on the outside of the ankle which is due to a shifting of the foot bones, pain that worsen with activity or pain along the foot and ankle where the tendon lies.

There are several methods for treating TTD.  Start by resting your feet, taking an anti-inflammatory and applying ice packs daily.  If you are not finding any relief, your podiatrist may suggest orthotic inserts to help provide support to your arch, but this doesn’t help with the inflammation.  The most invasive option for treating TTD is surgery where the doctor will either remove the inflamed area of the tendon, add a new tendon to the area or even try cleaning the tendon.  With TTD surgery should be the last resort for treatment.

This is where MLS laser therapy can be of assistance.  Pain associated with TTD is due to inflammation and tearing of the posterior tibial tendon.  The MLS laser has the ability to penetrate through the skin to the tendon and encourage healing at a cellular level and reduce inflammation!  It is a non-invasive form of treatment and requires zero analgesics!  Most patients will see positive results within 1-3 treatments and it is performed in the comfort of your own doctor’s office.   Because there is not a surgical site and the device encourages cell reproduction, your healing time is much faster than traditional methods.

If you are suffering from Tibial Tendon Dysfunction talk to your podiatrist to find out if MLS Laser Therapy is right for you. To schedule an appointment with our office, please give us a call at (707) 578-1222.

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How to Incorporate More Walking into Your Day

They say that the new killer is the sitting body.  We sit at our desks while we are on the computer, we sit in the car, bus or train as we head to and from work, we sit to eat, we sit to watch TV or check our phones- we sit a lot!  And all of this sitting means tight muscles, poor posture, higher BMIs and less walking!  So how do we combat the amount of sitting we do? By adding more steps to our day!

Incorporating more steps into your day can be quite easy and sometimes takes thinking outside the box.  But not to worry, we’ve complied a list of ideas to help you get started!

 

  • Wear comfortable shoes- if they don’t feel good, you’re not going to get far
  • Walk your dog- exercised dogs are happier well-behaved dogs and make great walking partners
  • Walk on your lunch break- allows for a chance to get the blood flowing for better productivity
  • Drink plenty of water- keep a filled water bottle on hand at all times
  • Take the stairs- if stairs are an option- take them. They are great for your leg and butt muscles too!
  • Park farther away
  • Try walking rather than driving if the destination is less than 2 miles away- saves gas too!
  • Turn on a walking video on rainy or cold days
  • Walk while you are talking on the phone
  • Stand while the kids are playing
  • Be efficient- try to figure out how you could incorporate walking into your day, even if it is only a few additional steps.

 

If you need tips on ways to stay motivated, check out our motivational blog.  Happy walking 😊

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How to Stay Motivated in Your Walking Routine

Getting started is the first step to having a walking routine, but the hardest step is staying motivated to continue to do it!  Sometimes it takes

motivation from different things to help us stay on track.  To get you started, we have listed a few ways to help you stay motivated in your routine!

  • Set daily goals- Set daily steps for yourself and a monthly step goal
  • Walk with a friend- having someone to be accountable with and to talk to is a great motivator
  • Follow motivational boards on Instagram or Pinterest- you can follow a specific board or a general hashtag like #motivationalquotes or #runningmemes
  • Schedule your walks- put it in your calendar with an alarm
  • Join a walking club
  • Register for a walking challenge event
  • Track your steps, many people aim for 10,000 steps which is equivalent to 5 miles
  • Select a pretty location- walk in an area that is pleasant to look at and makes you feel good!

There you have it!  Simple, easy ways to stay motivated to keep you walking and taking care of yourself!

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Laser Therapy Provides Alternative to Opioids

“In a large retrospective study involving over 390,000 older outpatients [ages 66 and up] undergoing minor ambulatory surgery procedures, older patients receiving prescription opioid analgesics within 7 days of discharge were 44% more likely to continue using opioids 1 year after surgery[1].“  This disturbing information was provided in a peer reviewed study in the Arch Intern Med journal.  We are hearing time and time again that there is an opioid crisis, yet the medication is still being prescribed.  Why?

There is not one prolonged study of opioid use that has demonstrated a long-term benefit to the user. “An epidemiological study by Eriksen et al. involving patients with chronic pain treated with opioids for 5 years provided compelling evidence that opioids were not a panacea for chronic pain. In fact, the patients’ quality of life failed to improve despite escalating doses of opioids over the 5-year study period. The authors concluded that ‘it is remarkable that opioid treatment of long-term/chronic non-cancer pain does not seem to fulfill any of the key outcome treatment goals, namely pain relief, improved quality of life and improved functional capacity’ [2]. More recent studies suggest that long-term opioid use can actually retard functional recovery[3].”

With this ever-increasing epidemic, it is time more doctors and patients look to alternative therapies in treating pain.  Advancements in medical technology have led to the development of the MLS Laser, a device that works at a cellular level.  Approved by the FDA, it is readily available for doctors to use.

The MLS Laser uses certain wavelengths to penetrate the skin down to a cellular level without the need of numbing medications or incisions.  When the laser is able to reach the mitochondria, it is able to provide a therapeutic result, in that, ATP (energy cells) production is increased, there is an increase in cell reproduction, an increase in oxygen transportation to cells and, a reduction in cytokines which in part cause inflammation, in addition, a resulting effect of a reduction in pain[4].

In fact, many well-controlled studies have confirmed the benefits of using laser therapy for improving acute and chronic pain management without the need of medications like opioids. And, additional studies have “confirmed enhanced wound healing in both diabetic and non-diabetic patients” according to the National Center for Biotechnology Information.

So why do so many doctors still over prescribe opioids? It is because they make the choice to do so over offering non-analgesic options like laser therapy.  There are a few possible causes to why they make these decisions: one, while there are plenty of short-term studies for pain reduction with laser therapy, there is still very little data on long term studies, and that can make doctors nervous. Two, there is a “low reimbursement by third-party payers to the health-care providers administering these non-traditional therapeutic modalities” according to NCBI. And three, there are still some in the medical community that question the analgesic efficacy even though there are plenty of studies backing it up.

It will take a progressive and forward-thinking doctor to recognize that the benefits of laser therapy greatly outweigh the convenience of prescribing an opioid to their patients.  It is up to the medical community to put an end to the opioid epidemic and start embracing non-analgesic options.

Sonoma County Foot & Ankle proudly offer MLS Laser Therapy to their patients, conveniently located at their practice.  If you would like to learn more about MLS Laser Therapy, please visit our website johnhollanderdpm.com.  If you would like to schedule a consultation to see if MLS Laser Therapy is right for you, please call our office at (707) 578-1222.

 

 

 

[1] Alam A, Gomes T, Zheng H, et al. : Long-term analgesic use after low-risk surgery: a retrospective cohort study. Arch Intern Med. 2012;172(5):425–30. 10.1001/archinternmed.2011.1827

[2] Eriksen J, Sjøgren P, Bruera E, et al. : Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain. 2006;125(1–2):172–9. 10.1016/j.pain.2006.06.009

[3]White F. Paul, Lazo Ofelia, et al. : Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management.  [version 1; referees: 2 approved]. F1000Research 2017, 6(F1000 Faculty Rev):2161

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749131/

[4] Ojea AR, Madi O, Neto RM, et al. : Beneficial Effects of Applying Low-Level Laser Therapy to Surgical Wounds After Bariatric Surgery. Photomed Laser Surg. 2016;34(11):580–4. 10.1089/pho.2016.4149

 

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Foot Soaks to Soothe the Mind and Feet


Foot soaks have been around for centuries with the intent to soothe the mind, body and soul.  They can be made from many different items found in nature.  Some are designed to relieve aching feet; some help remedy unwanted odor and others are purely to encourage relaxation and a sense of well-being.  Below are a few foot soaks that you can easily make at home with many ingredients found in your cupboard.

 

Foot Soak for a Queen- the name says it all

Ingredients

  • 4 cups warm water
  • ¼ cup mint leaves
  • ¼ cup chamomile tea mix
  • ¼ cup rosemary leaves
  • 1 Tbsp sea salt
  • 1 tsp fresh grated ginger
  • 10 drops tea tree oil
  • 1 Tbsp grape seed oil (or olive oil)

Directions

Pour all of the ingredients (except grape seed oil) into a bowl large enough to soak your feet. Soak your feet for up to 30 minutes.  After soaking, use a pumice stone to help remove dead skin cells from your heels.  Finish your foot soak for a queen by massaging grape seed oil into the skin.

An Orange Pick Me Up- a great mid-day soak

Ingredients

  • 4 cups warm water
  • 1 cup Epsom salt or sea salt
  • Orange peels of 1 orange
  • Juice of 1 whole orange
  • 5 drops of vanilla essence
  • 1 Tbsp coconut oil

Directions

Using a large bowl or basin, pour Epsom salt into warm water and mix. Sprinkle orange peel into water, along with orange juice and vanilla essence.  Soak for up to 20 minutes.  After soaking, pat dry your feet.  Apply Coconut oil to your feet and massage in thoroughly.

Foot Cooler- soothes tired, hot, stinky feet

Ingredients

  • 6 cups hot water
  • ¼ cup mint leaves
  • 1 cup white vinegar
  • 3 Tbsp sea salt
  • 1 tsp cucumber seed oil or 1 cucumber sliced into disks
  • ¼ tsp mint, lemon or lime essence

Directions

Using a large bowl or basin, mix mint leaves and sea salt into hot water for 2 minutes. Add remainder ingredients into water.  Soak feet for 10 minutes.  Rinse off with cool clean water and pat dry the skin.  Apply your favorite foot moisturizer and massage in thoroughly.

Lavender Honey Soak- relax and unwind after a long day

Ingredients

  • 4 cups warm water
  • 1 cup sea salt or Epsom Salt
  • ¼ cup honey
  • 5 drops lavender essential oil or 1 cup dried lavender
  • 1 Tbsp fresh rosemary leaves
  • 2 Tbsp coconut oil

Directions

Using a large bowl, mix all ingredients together.  Make sure salt and honey fully dissolve.  Soak your feet for up to 30 minutes.  Take in slow deep breaths and take note of the fragrance you smell and the warmth on your feet as you unwind for the night.  After soaking, remove feet from bowl and pat them dry. Massage feet with coconut oil. You could even add a drop of vanilla into the oil for an extra delight to your senses!

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How to Combat Diabetes Burnout

Whether you’ve lived with diabetes for most of your life or have just recently been diagnosed, diabetes burnout is real and it could happen to you!  By learning how to recognize the symptoms of burnout and tricks to putting a halt to them, you can prevent getting yourself  into risky life-threatening situations.

What is Diabetes Burnout?

Every day you have a routine you need to follow- count your carbs, check your sugar levels, take your medicine, visit your doctor and more.  That is a lot that you have to do in your day-everyday.  When you suddenly don’t want to do these “chores” anymore, the routine gets old, you slack on taking your insulin, you cancel your doctor appointments, or you stop self-care, that is diabetes burnout.  Experiencing diabetes burnout can also cause anxiety and stress and lead to life threatening situations.

What does diabetes burnout look like?

There are many ways to experience diabetes burnout including: strong negative feelings towards diabetes, feeling isolated or alone with diabetes, avoiding some or all of your diabetes management tasks and self-care, feeling controlled by diabetes or, feeling like you have lost control of your diabetes.

What are the tools that one can use to combat diabetes burnout?

Don’t be perfect:  Everyone wants to have the exact “perfect” number for them and while it is good to strive for “happy” numbers, it’s just not practical to be perfect.  It is OK to be a little above or a little below your target numbers once in a while.  Try to stay within your healthy range but recognize that life happens and just try to do your best.

Set mini goals: If it all just seems to feel like it is too much, take one step at a time. Set yourself mini goals or tasks such as, checking your blood sugar after every meal or going for a short walk at the end of your day.

Ask friends and family for help: They may not fully understand what it is like to be diabetic, unless they are diabetic themselves, but by including your family and friends in your struggles and achievements with diabetes, they can then be able to help cheer you on and provide emotional support when days are tough.  Also, educate your friends and family by making them aware of the comments they say to you. Their comments may have been said with good intentions, but in all reality, they can make you feel discouraged or isolated- let them know!

Relate through support: Reach out to fellow diabetics for tips and tricks and as a safe place to speak your frustrations.  Many others have been in the same boat and they will have ideas to help you get back on track. It is also a great way to support others like you.

Tell your doctor you’re burned out:   Reaching out to your doctor about feeling burned out is a good thing. By doing so, the two of you can set up a new plan of action and new goals that are attainable for YOU!

To read or not to read that is the question: If you are lacking motivation, try reading a book or article or support page for encouragement and to help you bust out of feeling burned out.  If you find yourself reading too much on diabetes take a break from it- disconnect from reading on the topic- instead, focus on activities that make you feel good like crafts, outdoor adventures or volunteering.

As Scott Coulter, writer for Diabetes Self Management said, “Diabetes is a tricky thing. It will always have the capacity to frustrate us, irritate us, scare us, and make us mad, but if we know how to work with our feelings we can avoid serious burnout, or at least catch it early and reverse it.”

If you think you may be experiencing diabetes burnout, talk to your doctor. Don’t put  it off, you are worth the time and you deserve to be happy!

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How to Treat Dry Feet

When the weather is nice, many of us like to expose our feet and that means wearing sandals or walking barefoot. Both of which expose the skin on our feet to the sun and rough surfaces of the ground.

Dry skin and callus build-up tend to occur for a few reasons.  The skin on our feet sweat, especially when they are hot, and this sweat can cause the skin to dry out.  When we walk barefoot, it is often on a rough surface such as concrete, sand or dirt, all of which can cause little abrasions on the surface of the skin, leading to a rough texture.  Exposure to other elements such as the sun, ocean water or pool water can also have a drying affect.

So, how do we prevent or treat these symptoms?  There is a combination of a few things that we can do each day to help our feet look and feel soft.

Wash & Moisturize Daily: By washing your feet, you are removing the debris from earlier in the day that was causing your skin to be scratched.  Using a moisturizer formulated for thicker skin will assist in bringing moisture back to the feet.

Stay Hydrated: Showing signs of dry feet can often be a tell tale of dehydration.  Drink 6-8 glasses of water each day and increase that amount when you are physically active and the outside temperatures are warmer.

Soak: If you are treating dry feet, give them a soak in warm water with Epsom salts for about 15-20 minutes.  Epsom salt helps loosen up the dry skin.  Follow your soak with a quality moisturizer.

Exfoliate: After your regular shower or a good long soak, exfoliate your feet to help remove the dry skin build up, also known as calluses, with the use of a pumice stone and a stiff bristle brush.

Maintain: Keep your feet looking good and feeling soft by applying moisturizer on a daily basis. If you need more help with moisture, try applying a moisturizer designed for feet and then putting on cotton socks while you sleep.

If you need additional assistance in maintaining happy and healthy feet, give our office a call.  We can schedule an appointment to discuss your foot related concerns and help you find a solution.  Our offices are open Monday-Friday and our phone number is (707) 578-1222.

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Celebrate National Wine & Cheese Day in Sonoma County

While we do have our regular wine and cheese festivals at different times of the year, June 25th marks the National Wine and Cheese day.  So, to help you celebrate locally, we have generated a list of a few of our favorite wine and cheese spots.

WINE

Ty Canton Vineyards.  If you are a fan of big bold reds like Cabernet Sauvignon or Malbec, you will want to stop at Ty’s.  He prides himself on using the very fruits produced in his vineyards to inspire his distinct flavors.

Wellington Cellars. Family run, hand-crafted small batch winery.  They offer most styles of wines.  The constant trend that seems to occur when others visit, is that they all end up obtaining a wine membership- that’s how good it is.

Kunde Family Winery.  With five generations of wine production, the Kunde’s remain humble while providing an exquisite selection of fine wines.  The view at this property is breathtaking and there is plenty of lovely sitting areas to enjoy it with your glass of wine.

Muscardini Cellars. As you head south on highway 12, you’ll see their cute brick red building lined with yellow trim, on your right-hand side.  Rosé and reds are what they focus on mainly, but they do offer a white wine and a bottle of grappa! They offer friendly service and comfortable patio seating if you’d like to stay for a bit. It’s also dog friendly!

CHEESE

Joe Matos Cheese FactoryYou can’t get anymore local than Joe’s Cheese. The cows, ducks and smells of cheese greet you upon arrival.  There is nothing fancy here. Just a small “shop” where you can enjoy a generous sampling of their one type of cheese- St. Jorge Cheese.

Bohemian Creamery. While goat, cow and water buffalo milk are personally transported from the local dairies to the creamery, by the owner, all of their cheeses are made in shop.  If you are looking for something extra special in both accessibility and flavor, this is the place. You won’t be able to find her cheeses in the store, so stock up while you’re there and don’t forget to order the sampler plate!

Vella Cheese Co. Located in an old cobble stone building resides a shop full of tasty cheeses. Hard cheeses and soft cheeses, all kinds of Monterey Jack Cheeses and more!  There are even horses next door to look at while you enjoy your snack!

Weirauch Farm & Creamery. Sheep milk and jersey cow milk are what make up the beautiful rounds of cheese offered here. Another local farm and creamery that proudly promotes the welfare of their animals and also partners with their community through food banks and local organizations that support small agriculture.

 

*This is not a paid endorsement or advertisement for wine or cheese. These are simply our opinions.

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Every Gal Wants to Have Pretty Toes

Did you know that we offer our patients nail polishes that were developed by podiatrists?  We carry the nail polish line Dr.’s Remedy.  It is a wonderful product line that was designed with the health of the nail in mind.  Dr.’s Remedy polishes are vegan and formaldehyde free that come in a variety of subtle and vibrant colors.  If you are someone that suffers from dry brittle nails or experiences toenail fungus you should give this polish a try because it contains garlic bulb extract which is a natural fungus deterrent!

Even if you do not suffer from brittle nails or fungus, you will still benefit from these polishes.  They contain tea-tree oil, lavender, wheat protein and vitamins C and E; all of which help to hydrate the cuticle and improve the appearance of dry nails.

Dr.’s Remedy is the best nail polish alternative for anyone that wants healthy, pretty nails without the harsh chemicals. For more information and color options please visit: http://www.remedynails.com/

Give us a call or stop by our office today to purchase your own Dr.’s Remedy nail polishes. (707) 578-1222.

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