Surgical Removal of a Painful Toenail

Surgical Removal of a Painful Toenail

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Suffering from a severely painful toenail that is constantly irritated with shoes and impossible to cut?  Surgical removal is most likely the best option.  Toenail deformities can be the result of trauma to the nail plate which can occur from dropping something on your toe, or simply through years of irritation of the nail plate on a shoe.  Nail fungus can also be the cause of a deformed toenail, so it is imperative to first have the nail tested for fungus before making any decisions to permanently remove the toenail.

Many patients ask if it is possible to temporarily remove the toenail and let it grow back.  While this option may seem possible, if the nail has sustained permanent damage through trauma, then it will grow back with the same deformity.

The best solution in cases of severely deformed toenails is permanent removal of the nail plate by a procedure known as a chemical matrixectomy. The toe is anesthetized in the office and the nail plate is removed.  A chemical called phenol is placed on the cells that form the toenail creating a burn which prevents the nail from growing back.  Recovery is typically two weeks of wearing a band aid with antibiotic ointment.  Most people return to work the next day and runners can usually begin running within two days. 

This is what a toe will look like after removal of the nail:

 


 

Early detection is the best treatment for skin cancer.

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Skin cancer can present in places where you don’t always think to look.  Dr. Campitelli not only encounters cancerous lesions on the foot, but also treats them on the hand as well. 

This patient had a skin lesion under his finger nail that was present for over a year and eventually started draining and caused loosening of the toenai.  The nail was removed and several samples of tissue were taken from the suspicious lesion.  

If you have something that is new or looks out of the ordinary, don’t wait to get it biopsied.  The only person who can tell weather or not it is skin cancer is the pathologist who looks at it under the microscope. 

Infected toenail or nail fungus?

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An ingrown toenail is typically the result of the nail plate growing into the adjacent nail fold or skin next to the toenail. The break in the skin allows bacteria to enter and an infection occurs. 

Sometimes a toenail can acquire a bacterial infection under the nail plate itself. Examples of this can be due to a deformed toenail (which could be from nail fungus or trauma to the toe) causing the toenail to become loose and allowing bacteria to collect under the nail plate and eventual form an abscess. The abscess usually occurs in the eponycium or “cutical” area. 

Here is an example of a nail deformity in which the patient presented with severe pain and drainage from the toenail. Under these circumstances the nail needs to be removed to allow the infection to be drained.  An antibiotic is initiated and recovery is usually two weeks. It’s is important to catch this soon as neglect can lead to a bone infection in the toe. 

Training for the Akron Marathon? Come and meet Dr. Tara Scott and Dr. Leo Kormanik Tonight – Dr. Nick’s Running Blog

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This evening Dr. Tara Scott and Dr. Leo Kormanik will present on training for marathons and endurance events. Bring your questions!

Date: Wednesday June 14th, 2017 Time: 6:30pm Location: Acme Montrose/Fairlawn 3979 Medina Rd

 

Source: Training for the Akron Marathon? Come and meet Dr. Tara Scott and Dr. Leo Kormanik Tonight – Dr. Nick’s Running Blog

Can skin cancer appear on the leg?

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Skin cancer can arise anywhere on the body. In this particular example a patient presented to me at the University Hospitals Wound Center in The Streetsboro Health Center.  She had a lesion or wound on her leg that had been present for almost one year. Initially she felt that it was a blister although it would never completely heal. She was sent to me for evaluation and treatment for a non healing wound.  The wound did not appear to be a veanous stasis wound and as result of being present for greater than six months biopsy was warranted. 


A small 3mm punch biopsy of the wound was performed on initial presentation which demonstrated a basal-squamous cell carcinoma of the lower extremity. 

Treatment will require wide excision of the lesion.

Arthritis of the Great Toe and Surgical Fusion: The First MPJ Arthrodesis Procedure. 

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Arthritis of the big toe is one of the most common joints of the foot to get arthritis in. If caught early enough, the joint can be cleaned out surgically to remove the arthritic areas and fragments. Later stage and more severe great toe arthritis involves either replacing the joint or fusing it.

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Nike and Adidas just rolled out ultra-fast marathon shoes. But do they make sense for the average runner?

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I was asked to give my comments in a recent article published in Mensfitness.com regarding new shoes created to help marathon runners break the sub two-hour barrier.  Will these shoes make you run faster?  You can read my thoughts in the full article here that appeared in Men’s Fitness. 

As part of their rival efforts to break the two-hour marathon barrier, Nike and Adidas have rolled out their ultra-high-tech VaporFly and Adizero Sub2 trainers. When it comes to Joe Marathoner, though, will they even make a difference?

Source: Nike and Adidas just rolled out ultra-fast marathon shoes. But do they make sense for the average runner?




What is an ingrown toenail?

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An ingrown toenail is when the border or side of your toenail breaks through the skin next to it which eventually leads to a skin infection or cellulitis. The skin becomes swollen, red and painful. Sometimes you will see pus draining from underneath the nail. 

Treatment at home consists of soaking the foot or toe in warm water and a tablespoon of Epsom salts or antibacterial soap twice a day for fifteen minutes. The area should be covered with a bandaid and antibiotic ointment at all times. 

If home therapy doesn’t resolve the infection the border will need to be removed surgically. This is a simple procedure performed in the office with local anesthesia to numb the toe. Recovery involves soaking for 7-10 days and wearing a bandaid and antibiotic ointment. 

More serious cases may require taking oral antibiotics and sometimes the entire nail needs to be removed temporarily. 

If it is a recurrent situation where the nail continues to become ingrown every six months or more, then a permanent procedure is performed to prevent regrowth of the nail border. 

Here’s a video of Dr. Campitelli performing the procedure in the office. 

Varicose veins can be cause of foot pain

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Foot pain while walking is not always caused by plantar fasciitis, a clinical surgeon in Taipei said, adding that varicose veins can also cause pain when walking and are more common in women.

Shu Tien Clinic Vascular Surgery division head Yu Tarng-jenn (游堂振) said that a 55-year-old woman who had foot pain, especially when walking, thought she had plantar fasciitis, but her symptoms did not ease after undergoing extracorporeal shock wave therapy several times.

The woman underwent a magnetic resonance imaging scan showing she had varicose veins.

Most people think that varicose veins form in the calves, but when they occur on the sole of the foot the symptoms can be similar to plantar fasciitis, Yu said, adding that the condition is called atypical plantar fasciitis.

He said most people think that varicose veins are visible red, purple, or blue vessels that twist and can also cause pain, numbness, swelling and other easily noticeable symptoms.

“However, because people get sufficient nutrition, collagen below the skin’s surface is usually thicker and the veins are hidden,” Yu said.

Yu said that about 33 percent of women and about 15 percent of men develop varicose veins, which are most often found in people who stand for long hours, such as teachers, healthcare personnel and service industry workers.

Atypical plantar fasciitis can be treated by compression therapy, sclerotherapy or surgery, and patients should discuss with their doctors which method is best for their condition, Yu said.

People who stand or sit for long durations every day should move their legs or let them rest for a while every hour, and seek medical treatment if similar symptoms occur, Yu said.

What’s the Best Running Shoe?

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I am asked this question everyday.  Sometimes I feel like my answer would  best be served by placing an audio player in my office and pressing play each time it is asked!  That may not be a bad idea…

“Shoes do no more for the foot than a hat does for the brain.”

—Dr. Mercer Rang, legendary orthopedic surgeon and researcher in pediatric development

That’s a pretty hard statement to swallow? The American Academy of Pediatrics recommends children not wearing shoes until it is nessecitated by the environment. Why, you may ask? Functioning barefoot enables the foot to become stronger by utilizing the muscles that attach to the toes as well as within the arch. This helps the foot become more stable during a child’s developmental years which will be beneficial later in life. 

Analogies are a great way to get one’s point across, so here’s something to consider. If you were to do a push up, chances are when you place your hands on the ground, you will splay your fingers and “grip” the ground. Your fingers have muscles and tendons that begin in the forearm and cross your wrist and by activating these muscles, the fingers flex and extend to make the hand more stable against the ground. If you were to try to perform a push-up by making a fist, your hand will be unstable and your arms will wobble.  The same holds true for your feet. If your toes are jammed into tight socks, followed by snug fitting shoes (because most people in our society feel that their shoes and socks need to fit tight) your toes lose their ability to function and grip the ground making them practically useless when it comes to providing stability for our feet.

What does all this have to do with selecting shoes?  One first must realize how our feet work properly, or they will not believe or understand my advice when it comes to selecting shoes. 

Wide Toe Box 

The shoes should allow your toes to move freely and your feet to feel the ground. If the toe box is too narrow, the toes will squished together.  

Example of the toebox in an Altra Running shoe.

Focus on finding a shoe with a wide toe box.

Flexible Shoe

Yes. Flexibe. Not a stiff and rigid shoe as we were all taught many years ago which includes a supportive arch and motion control. A flexible shoe allows the foot to work the way it was intended to with being interfered with from a shoe. A rigid shoe will inhibit  joint motions that are normal and helpmwith shock absorption.  When you hear the term “pronantion”, runners think it is bad and leads to injury. Pronation is actually a normal part of running and walking mechanics and leads to natural shock absorption. So that orthotic that you’ve been wearing for the past “X” number of years probably isn’t necessary. 

The flexibility of a TopoAthletic shoe.

A flexible shoe to allow our foot to undergo normal shock absorbing mechanisms

Minimal or No Cushioned Heel

Back in the early 1980s, Nike created a shoe known as the Air Max which had a very high cushioned heel which was thought to help reduce injury. We have since proven this to be untrue. When a large heel is placed under the heel of our foot, it places the foot in an abnormal position and then forces the body to function around this abnormal position. Basically it leads to abnormal mechanics and can create injury not prevent it. 

The heel in a traditional running shoe will place the foot in an abnormal position predisposing the foot and legs to injury.

A cushioned heel shoe can promote heel striking which is an abnormal way to run and will eventually lead to injury. 

The aforementioned three points are what defines the ideal running shoe. The challenge is finding the shoe that perfectly incorporates all three of these principles. Many of the popular shoe companies make a shoe in this category since the industry was redefined when minimalist shoes became popular.  Some of my favorites are TopoAthletic, Altra Running, Nike Free, New Balance Minimus, and Merrell to name a few.  If you’re trying TopoAthletic or Altra then you are probably fine with any model you choose. With the others, you’ll need to do your research to make sure it’s not an outdated motion control shoe which, by the way, are still being made. 

Good luck! Let me know if you have any questions!

In office surgery for Bunions?

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I wouldn’t let someone talk you into foot surgery in their office as most surgical procedures are now being performed in outpatient surgery centers. With that being said, there are some simple minimally invasive procedures which can resolve a painful contracted or dislocated toe. I have performed an overwhelming majority of these types of procedures in my office providing relief to patients who have suffered many years with toe pain but didn’t want the long recovery periods that many orthopedic surgeons offer which require outdated use of complicated external pins. 

Here is an example of a recent procedure performed on a patient with a dislocated second toe that was rubbing on her shoe creating severe pain and wound from irritation. She was told by other surgeons that this type of deformity would require a fusion of her big toe which she did not want to undergo as her previous foot surgeries had failed which created this problem. 


A simple tendon release was performed in office requiring only a small incision and a single suture. A gauze splint is applied for 2 days and a follow up visit is required to remove the suture. At this point return to full unrestricted activity is allowed. 

How can you tell if if this will work for you?

This will not work for every dislocated toe as I also perform fusion procedures to realign toes in more chronic and severe situations.  If you are able to manually relocate your toe to a normal or straight position, than you may be a candidate for this surgery. 

Medical Treatments of the Past

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Here’s and interesting look at some old remedies as well some real life medical treatments we once used! 

Achilles Tendon Surgery : A shortened rehabilitation period.

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Achilles tendon ruptures are known for their long recovery times, which in the past have been known to require five to nine months of rehabilitation on average.  Our office institutes the current standard of care which speeds up the  recovery period to only 3 months.

A recently published case study in the Journal of Foot and Ankle Surgery focuses on a shortened recovery time after surgeons repaired an acute Achilles tendon rupture with the InternalBrace (Arthrex) knotless technique.1 The patient was a 36-year-old physical trainer and elite bobsled pilot who made a complete recovery return to a full baseline level of training after only 12 weeks. The surgery occurred 11 days post-injury.  Read more in my blog post at www.podiatrytoday.com

http://www.podiatrytoday.com/blogged/should-we-reevaluate-post-op-rehab-protocol-achilles-tendon-ruptures

How can you tell if you have a melanoma?

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Melanomas on the feet are rare, but I have seen multiple instances of them occur. Some we were able to excise early enough while others were too advanced and amputation was needed.

Here are some simple rules to follow when looking at a suspicious mole or lesion on your skin.

Read More

Toenail Fungus

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Suffering from toenail fungus?  It’s a tough problem to treat and cure.  If you catch it early enough, you can sometimes clear it.  Most over-the-counter topical agents do not work and more importantly are not studied or FDA approved.  There are currently three approved prescription topical agents:

  1. ciclopirox
  2. Jublia
  3. Keradyn

Oral agents, such as terbinfine  (Lamisil) are more effective in the treatment of more severe cases of fungal infections of the toenail.  Although it is commonly thought to cause liver problems, the truth is it’s a safe medication and is used frequently for the treatment of toenail fungus.  It is now generic and covered by most insurance plans.

Here’s an example of a patient treated recently in my office where a young female was able to resolve her toenail fungus with the use of Jublia.  This is after almost 6 months of treatment.  There are still mild changes to the nail plate which are superficial and will grow out and resolve.

 

 

Surgery for a bunion: How old is too old?

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I have corrected bunions on all ages ranging from 14 year olds up to almost 90 year old patients. As long as the patient is healthy and has no health conditions that would prevent a risk for undergoing surgery or for recovery, then age is really not a factor.

Here’s the foot of a 74 year old who recently underwent successful bunion correction.

Why does stepping on a Lego hurt so bad?

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Here’s an interesting video explaining what happens when we step on a sharp object such as a lego.  Very interesting for those curious minds!

How to determine if you have a plantar wart. 

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One of the most common questions I’m asked about skin conditions on the foot is, “Is this a wart?”.

Here’s a quick way to tell if you have a wart.

The lesion will appear as a callus but will have interruption of the skin tension lines – your fingerprints. Or, in this case, toe prints!  Look close and see if there are no skin lines running through the lesion. You will also possibly see small black dots. These dots are areas of blood from microscopic blood vessels in the warts. They’re not seeds or viral particles as some people say!!  Finally, warts are painful. If you squeeze the lesion from the sides it will typically be very painful. More so than a callus. 
Treating warts can be as simple as destructing with an acid or more severe requiring surgical excision.  We offer both treatment options in our offices. More severe cases may require surgical excision in an outpatient surgical setting which we can determine after an office visit.

What is Raynaud’s Disease: Diagnosing And Treating

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With winter’s arrival, many of us will begin seeing patients with weather-related injuries present to our offices. One of the most common conditions tends to be Raynaud’s disease. It is important to distinguish between Raynaud’s disease and Raynaud’s phenomenon as they are two clinically different presentations that are characterized by the severity of the symptoms. Raynaud’s disease is the milder of the two conditions as it presents with vasospasm alone and has no association with other systemic diseases.1

Read More

Ganglion cyst on the big toe.

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Have a big lump on your toe and not sure what it is?  Most likely it’s a plantar’s wart or ganglion cyst.  Here’s a few examples of ganglion cysts which presented recently to my office.  Ganglions cysts are soft and filled with thick viscous fluid.  If you were to rupture one of these cysts, they ill express a fluid that is thick and sticky like.  To you it may feel firm or even “bony” but if you were to squeeze it firmly, you will notice it is fluid filled.   Most ganglion cysts can be drained or aspirated in the office for initial treatment, but they have a high reoccurrence rate requiring excision.  See the following examples which required excision.

great-toe-cyst

Small Ganglion cyst which required surgical excision.

 

 

 

 

 

 

 

 

 

 


The following example is a larger cyst that was extending from the joint of the great toe.

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Sac of the cyst after the fluid was expressed from it.

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Larger ganglion cyst extending into the joint of the great toe.

img_2933

Sac of the cyst measuring 4 cm.

surgery-toe-cyst

Closure with sutures.

 

Surgery for flatfoot deformities.

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It’s common to hear patients tell me they have foot pain because they have “flat feet”.  An overwhelming majority of the patients who tell me this actually don’t have flat feet at all.  They have a normal arch.  Some of them may have a variant of a foot type which makes them a appear to have a lower arch, but it’s not what we would refer to as a pathologic flat foot.  A pathologic flat foot is one that is severely deformed which many times can make a patient unable to run or even perform daily activities without pain.  Lesser degrees of the deformity also exist which may be symptomatic occasionally depending on ones activity level.

The following is an example of a severe flatfoot deformity which was limiting the ability of the patient to walk and function at work.  He was experiencing severe pain to his midfoot (arch) region with an associated callus.

campitelli-flatfoot-akron-2 campitelli-flatfoot-akron-1campitelli-flatfoot-akron-3

campitelli-flatfoot-preopcampitelli-flatfoot-post-op

The important concept to understand about flatfoot deformity is that although it is not as common as most people think, it’s important to treat or address early. The longer one waits to treat a flatfoot deformity, the more it will collapse and then treatment options become more complicated which will lead to fusion of joints.  If you think you may have a flatfoot, it’s crucial to have it evaluated.  Also, if notice that only one foot is flat, that is more indicative of a pathologic or problematic flatfoot that needs addressed.

When Should You Wear Minimalist Running Shoes?

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What’s a minimalist shoe?  It’s lightweight,flexible and offers not support. More importantly, it will allow your foot to become stronger the more you wear it and ultimately help in preventing injury. Read this new study which demonstrates how the foot becomes stronger by wearing a minimalist shoe. Read More

Money often buys higher-quality goods, but not when it comes to running shoes.

Dr. Campitelli one comments

You don’t always get what you pay for when it comes to running shoes.  Yes, you may get higher quality material and shoes that may last longer, but the extra money won’t necessarily fix your injury.  I routinely explain to my patients that “good” shoes aren’t  always dictated by how much you pay for them.  As an example, Dansko makes an expense clog that is very popular amongst nurses and surgeons in the operating room.  The problem is they’re not good for your feet. They’re heavy, rigid, unforgiving, and have a heel that places the foot in an inclined position which is anatomically incorrect.  Simply put- they don’t belong on our feet.  I often tell my patients (non runners as well), if you wouldn’t  run in this shoe,  you shouldn’t be wearing it.  Read More

Heel pain in a child? Most likely it’s Sever’s disease – Growing Pains.

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Now that fall sports are back in season, I’m seeing a significant increase in children with heel pain that is secondary to a condition called Sever’s Disease. It’s not actually a disease, but an inflammatory condition of the growth plate on the heel bone (calcaneous) medically termed calcaneal apophysitis.  This occur’s most often in children aged 8-13 for girls and 10-15 for boys.

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Neonatal Foreskin Skin Grafts for Foot and Leg Ulcerations 

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Foot wounds and ulcerations are extremely common amongst diabetic patients due to their loss of sensation, decreased blood flow and compromised immune system.  These wounds can sometimes take many months to heal and require weekly visits to debride or “clean out” the wounds. Read More

How To Get Rid Of Odor In Shoes

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Chances are that your working boots have embarrassed you with a thick, cheese-like smell.
Some describe the smell like that of malt vinegar or distinctive putrid smell that has a sulfuric aroma that slaps every ones face within a forty meters radius causing relationship break-ups, family quarrels and awkward situations that may leave you embarrassed or lower your self-esteem. Read More

Are you buying the wrong size shoes? Most Likely.

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Many who know my feelings on shoes or those who follow my blog will understand my belief that our feet work best in their natural state and not relying on shoes or orthotics. With that said, there are times when we need to equip our feet with shoes to protect them. Read More

Do Runners Need Orthotics? 

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I routinely have runners present to our office demanding orthotics for their shoes. Even more common is the request for replacement orthotics. The question is: Should they even be running in an orthotic?  Read my article below that was featured in Podiatry Today to see the latest evidence on using orthotics for running

Source: Do Runners Need Orthotics? | Podiatry Today by Dr. Nicholas Campitelli

Surgery to repair a ruptured Achilles Tendon: A Surgical Video

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The following are real examples of a achilles tendon ruptured that was surgically repaired by Dr. Campitelli.  The video is of a patient that who had ruptured their tendon while playing basketball and presented for repair 2 weeks later. The repair was performed by augmenting the Achilles Tendon with the flexor tendon to the great toe. The Achilles was then wrapped with Arthroflex human tissue graft. Read More

Improve your plantar fasciitis with strengthening exercises. NOT orthotics or shoes.

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Here’s a post from Dr. Nick’s Running Blog that reviews some exercises which can help plantar fasciitis.  It’s important to realize that orthotics and supportive running shoes aren’t always the answer to resolving plantar fasciitis.  Read the follow post on my running blog that explains how strengthening the foot far outweighs shoe inserts or orthotics. Read More

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Topical Nail Solution to soften and clear discolored toenails.
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