John Hollander, DPM
Halloween is upon us and in just a few short days the streets will be filled with the familiar sounds of laughter and greetings of “trick or treat”.
Halloween is all about having fun. Getting outside, dressed as your favorite super hero, goblin or ghost or humorous theme. Let’s keep the holiday fun by following a few safety tips!
- STAY ON THE SIDEWALK. Keep the roads for the cars and utilize the sidewalk whenever possible. This keeps everyone safe and happy.
- WALK IN A GROUP. They say there is safety in numbers. And besides, isn’t it always more fun to trick or treat with your best buds.
- STAY VISIBLE. Wear bright colors or reflective tape on your costumes. Grab a few glow sticks or a flashlight too! It is dark at night, and having lights can help keep you from tripping and for others to see you.
- WEAR COMFORTABLE SHOES. As a podiatrist office, it is our duty to suggest you wear comfortable, well-fitting shoes at all times- especially on Halloween! Sneakers are a great option! Don’t forget your orthotic inserts if you use them. And it’s always a good idea to double knot your shoelaces too!
- INSPECT YOUR CANDY. Keep an eye open for choking hazards for little trick or treaters. Don’t eat handmade goodies (you never know their cleaning habits). And if a candy looks opened, it’s probably best to toss it.
- DRIVE SLOWLY. Take this one night to drive a smidgen slower than the speed limit, especially in the neighborhoods. Kids get so excited, that sometimes they forget to look for cars. Help them, by keeping an eye out for them as you drive.
We wish you all a fun, happy and sppppooooooky Halloween night!
Some say that Lisfranc injuries are rare, but that may be due to the fact that up to 20% of Lisfranc injuries are misdiagnosed as a sprain by physicians. The reason for this may be the methods for determining the type of injury the patient has based on first evaluation. The different types of tests a physician can use, usually all result in some level of discomfort in the foot region which can lead to a misdiagnosis. That is why further investigation is necessary in the form of medical imaging. Medical imaging will allow the physician to look for fractures in the metatarsal bones, widening between joints or dislocation of the joints in the mid foot.
What exactly is a Lisfranc injury?
Lisfranc (midfoot) injury is when the bones of the midfoot become broken or dislocated, or the ligaments that support the midfoot have been torn.
This type of injury can occur from a simple twist and fall, to direct impacts by falling from high elevations or car accidents.
Symptoms of a Lisfranc injury include:
- Swelling & pain of the midfoot
- Decreased or inability to bear weight on the foot
- Bruising on the top of the foot and especially the bottom of foot
- Pain that worsens with standing, walking or bearing weight on the foot
A proper diagnosis of a Lisfranc injury is crucial. “When one misdiagnoses Lisfranc injury as a sprain or renders insufficient treatment, complications such as osteoarthritis and midfoot pain result. The outcome of Lisfranc injuries depends on the severity of injury to the cartilaginous joint surface with the most common outcome being midfoot arthritis.” There is also a chance of one developing a flat foot if proper treatment is not taken.
The treatment of Lisfranc injuries depend upon the severity of the injury. It can vary from applying a compression bandage and ice, to wearing a short leg splint or boot, a brace with compression wrap, or surgery.
If ice and rest do not provide your foot with relief please make an appointment with your podiatrist for an evaluation, the sooner the better!
 Weatherford, B. M., MD. (2017, September). Lisfranc (Midfoot) Injury – OrthoInfo – AAOS. Retrieved October 5, 2018, from https://orthoinfo.aaos.org/en/diseases–conditions/lisfranc-midfoot-injury/
 Shah, N. N., MD, & DeMeo, J., DPM. (2016). Keys To Diagnosing And Treating Lisfranc Injuries. Podiatry Today,29(4), 60-67. Retrieved October 5, 2018, from https://www.podiatrytoday.com/keys-diagnosing-and-treating-lisfranc-injuries
Raise your hand if you are guilty of not cleaning your nail clippers or callus removing tools after each use? Do you think that just rinsing them off with hot water is enough? Sorry guys and gals, it is not! We as humans carry bacteria on our bodies that when exposed to a cut in our skin, can potentially cause painful or life-threatening infections. This is why it is required by law for nail salons to follow specific sanitizing and disinfecting procedures with their equipment. Today’s blog is going to teach you how to take care of your tools at home by cleaning and disinfecting them, so that you don’t find yourself (or a family member) with an unwanted infection.
Cleaning your tools
Always start off by washing your hands with soap and water. Place your scrub brush into a bowl and pour 70% to 90% Isopropyl Alcohol over it until the brush is completely submerged. Allow your brush to soak for 5 minutes. Once you know your brush is sanitized, you can use it to clean your other tools. Add antibacterial soap to your brush and use it to scrub your nail clippers, glass nail files and callus removing tool. Your goal it to remove debris build up. Once you are done scrubbing, rinse off the tools with hot water until all of the soap is gone.
Disinfecting your tools*
Place your nail clippers, glass nail files and callus removing tool into a clean bowl. Again, using the Isopropyl Alcohol, cover your tools completely. Allow them to sit in the solution for 30 minutes. If you do not have Isopropyl Alcohol, you can boil your metal tools in water for 20 minutes. Be sure to wash your hands before picking up the disinfected tools. When soaking is complete, allow them to dry on a clean paper towel.
Storing your clean tools
Always store your clean tools away from other tools and supplies. Never place them in a plastic bag or storage container as that can create a breeding ground for unwanted bacteria. Instead, keep them wrapped in a clean paper towel, in a designated “clean” drawer or makeup bag specifically for your nail tools.
*Please note these techniques are not directions for nail salons. Nail salons should refer to the cleaning and disinfecting requirements of their specific state, which in California can be found on the Department of Consumer Affairs barbering and cosmetology page.
If you have a red, tender or hot spot on your foot or around your toenail, don’t wait to get it treated. Call our office today or schedule an appointment online to see one of our dedicated podiatrists.
Every summer my feet tend to get dry and I develop thick and sometimes cracked calluses. But another symptom I have regularly when my calluses get thick, is pain on the outer pad of my foot, you know, the area under your pinky toe? I find that when I have a pedicure appointment and request the “Callus treatment” my feet feel a lot better and pain is eliminated.
This got me to wondering, is the area of pain solely a callus, or could it also be a corn? This led me to do some research.
Calluses and corns are areas of thick skin caused by pressure or friction. They can be found on your feet, between your toes or even on your hands.
“Calluses and corns are caused by repeated pressure or friction on an area of skin. The pressure causes the skin to die and form a hard, protective surface. A soft corn is formed in the same way, except that when sweat is trapped where the corn develops, the hard core softens. This typically occurs between toes. Calluses and corns are not caused by a virus and are not contagious.”
Calluses can be found on the bottom of your foot where as corns are usually found on the top of your foot or in between your toes. Walking barefoot or wearing improper fitting shoes will increase your chance of forming a callus. “Calluses and corns often form on bunions, hammer, claw, or mallet toes, or on the bumps caused by rheumatoid arthritis.”
Callused skin is typically hard, thick and may be discolored yellow or grey. You may or may not feel pain from the callus or corn while walking or wearing shoes. Sometimes, when you apply pressure by touching or squeezing the callus it can cause pain or discomfort. The pain is often described as walking with a pebble in your shoe or taped against your foot. They can become very uncomfortable. If left untreated then the callus will increase in size and may cause the skin to split and become very painful.
So, there we have it! My particular issue is callus build up!
There are several conservative treatment options to help maintain callused skin. Schedule an appointment with one of our podiatrists today and they can discuss them with you, 707-578-1222.
Additional information can be found at: https://www.apma.org/Patients/FootHealth.cfm?ItemNumber=1346
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 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 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.
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.
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.
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 😊
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!
“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.“ 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’ . More recent studies suggest that long-term opioid use can actually retard functional recovery.”
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.
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.
 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
 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
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
 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
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
- 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)
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
- 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
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
- 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
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
- 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
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!