Dr. Nick’s Podiatry Blog

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

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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.

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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.

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Sac of the cyst measuring 4 cm.

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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.

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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.

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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

Surgery For Plantar Warts

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Here is a short video of a surgical excision of a plantar wart that was located on the back of a patients heel. These typically will not respond to topical acid therapy the way that warts on the sole of the foot do. Surgery is performed in office and the sutures are generally removed in 10-14 days. Read More

One reason not to delay having bunion surgery. 

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A bunion is nothing more than a dislocation of the great toe joint. As this happens, the joint articulates in an abnormal manner which eventually results in eroding of the joint cartilage- otherwise known as “bone on bone”.   Read More

How to treat toenail fungus.

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Need I say more?  The title pretty much sums it up.  What can a person do to clear up the thick and yellow appearance to their toenail? Well, it’s not that easy.

To begin with, there are a variety of conditions that can cause a toenail to become deformed or discolored.  These include:  fungal infection, psoriasis, peripheral vascular disease, trauma, and certain medications such as chemotherapy.  If the condition is a result trauma then it’s unlikely you will be able to fix the appearance. Read More

Ankle pain? A simple arthroscopy could relieve your pain.

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Ankle pain can be a nagging problem which may be the result of an old injury such as an ankle sprain, or just from chronic arthritis resulting from wear and tear throughout the years. Read More

How to permanently resolve a “corn”.

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What is a corn? Most people think it’s a callus that can simply be cut out.  Not exactly. It is a callus, but making it go away isn’t as simple as you may think. And no, you can’t just put acid on it or cut it out.  Well, you can, but more than likely it will come back.

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Dealing with a painful deformed toenail?

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While many people may initially think this is a result of toenail fungus, it’s more likely caused by trauma resulting in a permanently deformed nail.  Think of the nail as being “scarred”. Read More

Malignant Melanoma? How to tell if you should have a “mole” biopsied.

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You probably never thought of seeing a podiatrist for a skin check, right? Although malignant melanomas are not common in the foot, they do occur and I have seen them.  Here are some examples below.

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SUBUNGUAL HEMATOMAS (RUNNER’S NAIL)

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Subungual hematomas frequently occur in distance runners and I tend to see a lot of them in my practice. While it can be a controversial topic in regard to either draining or removing the entire nail, I learned early in my career that it is best to remove the entire nail.
Read one of my posts on Dr. Nicks Running Blog that gives a detailed approach on the benefits of removing a painful toenail to relieve the pressure from bleeding. 

Training errors and achilles pain – Dr. Nick’s Running Blog

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The following article, or blog post, is a great read for any runner who has been suffering Achilles tendinitis. I see this scenario played out over and over in my office. It’s training patterns that lead to the problem. Too many speed workouts. Running easy runs too hard. Running your long runs at race pace. […]

Source: Training errors and achilles pain – Dr. Nick’s Running Blog

Surgical removal of ingrown toenail. 

Dr. Campitelli 2 comments

Suffering from an infected ingrown toenail?

There are two possible solutions for your problem. If this is the first time you are experiencing an ingrown toenail, then a nail avulsion would be indicated. This is a surgical procedure performed in the office where the ingrown border of the nail plate is surgically excised. Antibiotics are typically not needed and the condition resolves by simply removing the ingrown nail border. The recovery period is usually 7-10 days and heavy activity such as running can be performed within 24-48 hours.

CAUTION:  THE FOLLOWING VIDEO CONTAINS REAL SURGICAL FOOTAGE

For recurrent cases of ingrown toenails, a permanent procedure is typically chosen. This involves the same technique as a nail avulsion, but a chemical is introduced into the nail groove and the nail matrix (cells that form the nail) is ablated to prevent the border of the nail from growing back.  The recovery period is slightly extended for this procedure as drainage usually occurs for 14 days. Regular activity, as well as exercise,  can again take place in 24-48 hours.

Questions?  Post in the comments section below!

 

Allergic reactions to drugs such as penicillin.

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Taking a new medication and you suddenly developed a rash?  It may be an allergic reaction to the medication.  This is not too common, but common enough that it presents to my office.

Here are several examples of the classic eruptions to the skin from a drug allergy.

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Dislocation of the second toe caused by a bunion deformity.

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Patients routinely present to the office with a painful second toe (especially on the bottom of the joint) not realizing the cause of the pain or deformity.  The toe is typically resting higher then the others and the patients complain that the toe is starting to “pop” up in the air.

Below is an example of a bunion correction and relocation of the 2nd toe that is 6 weeks post surgery.  She was back to work and in a regular shoe at this point functioning well with no pain.

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Reoccurring Bunion? It can still be fixed.

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Bunion surgery is sometimes a feared procedure which many times end up a with a great result and reduction in pain for the patient. Sometimes the deformity can reoccur which may require a secondary procedure. Here are some examples of what can be done to correct a bunion that has reoccured. Read More

Melanoma under the toenail?

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It is very common for patients to present with a discoloration of a toenail and are concerned about a melonoma. The above picture is an example of a patient who presented to me with discoloration to the right great toenail as a resulted of concern by the family doctor.

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What happens when you soak your foot in potassium chloride? 

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Nope, it’s not nail polish. This Is what happens when you soak your feet in potassium chloride. Well, a solution of it that is. This patient was attempting to use an old remedy to resolve a chronic foot pain by soaking his foot in a solution of potassium chloride and water. He temporarily stained his toenails as you can see.  Although the acid has left a black discoloration, it is only temporary and will grow out. 

How long does it take to recover from bunion surgery?

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Afraid of having your painful bunion fixed because you’ve heard the recover is very long? This is not always the case. The outcome varies depending on the severity of the bunion which also correlates with how long it has been present.

Procedure section typically will vary upon the severity of the deformity as well as a patient’s age.

Here’s an example of bunion surgery performed on a 55 year old female who had a mild/moderate bunion which required a simple procedure involving realigning the joint.  She was allowed to bear weight immediately post operatively and used crutches as needed. At three weeks progression moves from a surgical shoe/cam walker to a running shoe.  After 6-8 weeks patient will be allowed to begin exercising and more rigorous activity.

Painful Ankle? Look at what was inside of this ankle.

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Here’s a 65 year old male who presented with a chronic painful left ankle that he described as occasionally “giving out”.

Radiographs revealed an abnormally large fragment of bone (os trigonum) to the back of his ankle joint.
An MRI was performed as I was suspicious of a ruptured peroneal tendon. The MRI revealed no damage.

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Topical Nail Solution to soften and clear discolored toenails.
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