by Ralph J. Napolitano, Jr., DPM, CWSP, FACFAS

Toes, meet sand. Well, maybe not just yet. It’s obviously still winter in central Ohio. Visions of hot, sunny days and sandy beaches are perhaps hard to conjure. Believe it or not, spring is just over a month away with summer short to follow. Will your feet be ready as they emerge from their winter hibernation when it’s beach season again? If you’ve been thinking about addressing that foot problem you’ve been putting off, now is a great time to do so. You need to be ready to hit the ground (sand?) running when hot, sunny days are here again.

A bit of anatomical trivia to start our discussion. The largest organ we have is our skin. Each square inch of human skin consists of 19 million cells, 60 hairs, 90 feet of blood vessels, and 625 sweat glands. The two main “appendages” of skin are hair and nails. With respect to foot problems, the two most common dermatologic conditions of the foot are nail fungus and athlete’s foot. These are unsightly conditions that affect many, many people. In fact, half of us will develop nail fungus by the time we reach 70.

Nail fungus is a true infection, not just something cosmetic. It can lead to other problems if not treated such as secondary bacterial infections and ingrown toenails. These issues are of particular concern if you’re diabetic, have poor circulation or have a compromised immune system. In the past, the only treatment options for nail fungus have been oral medications which can affect the liver and topical medications which have not shown the best results.

Fortunately the new topical antifungals have shown improvement over the older topicals. At OrthoNeuro, we also offer laser treatment for nail fungus, which has been FDA cleared now for a few years. This technique has proved to be very effective and is on the fast track to become the gold standard. It takes less than a half hour to complete and does not require anesthetic. Our laser is the American made, industry leading “best in class” Cutera GenesisPlus. Not only can our laser successfully treat toenail and fingernail fungus, it can also treat painful warts and unsightly, thick scars. I’ve been using lasers in my practice for about 20 years to treat various medical conditions and have been extremely impressed with the developments we’ve seen over the last five years in the area of nail fungus laser treatment. Considering it takes the adult toenail 4 to 6 months to complete the majority of the normal growth cycle, nail fungus needs treated now in order to have clear, healthy nails by summer.

Circling back to our foot anatomy trivia discussion, each foot contains 26 bones (with both feet together having more than one quarter of the body’s total bones), 33 joints, and more than 100 tendons, ligaments, and muscles. Toe deformities are not only unsightly, but can make fitting in shoes a nightmare and physical activities difficult at the very least if not impossible depending on the severity of the deformity. These deformities are known as bunions and hammertoes. A bunion is a misalignment of the great toe resulting in an enlargement of the inside part of the joint. The great toe turns “out” towards the smaller toes and can even overlap or underlap the smaller toes in severe cases. A variation of a bunion deformity is painful range of motion limitation of the great toe joint from arthritis called hallux limitus. The result is an enlargement of the top of the great toe joint instead of the inside. Hammertoes are deformities of the smaller toes in which the toes remain contracted towards the top of shoe gear resulting in painful rubbing and even open sores. Palliative measures for these foot conditions include shoe gear modification or even a shoe size change as well as toe padding. Definitive care involves surgery to align the toe joints to make them straight again as well as remodeling the joint in cases of arthritis. The surgical techniques to treat bunions and hammertoes are beyond the scope of this blog and are best discussed in a consultation which includes a detailed foot and leg exam, gait analysis and x-rays. If you’re considering surgery for one of these conditions note that recovery can take anywhere from one to three months. If you don’t want crutches to be part of the summer vacation, consider having your foot surgery now.

Get ready to hang ten and not hide them this summer!

Dr. Napolitano is a double board-certified podiatrist and wound care specialist physician. (CWSP). He specializes in medicine, surgery and wound care of the foot, ankle and lower leg. He was the first podiatrist in the state of Ohio to earn the board certification Certified Wound Specialist Physician (CWSP).

“I strive to educate my patients thoroughly about their problem and offer a comprehensive and holistic treatment plan both medical and surgical. I believe healthy feet are the foundation for healthy living and will do my very best at all times to keep you active and moving along life’s journey—whatever your interests and wherever your feet may take you.”

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