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How Peripheral Artery Disease (PAD) caused this man to almost lose his foot

25 Nov

Gary Kautzmann of Orefield, Pennsylvania suffered with Peripheral Artery Disease for more than 10 years. P.A.D. is a condition in which arteries become blocked, restricting blood flow to certain parts of the body. In many cases, P.A.D. is caused by fatty deposits lodged in the arteries (atherosclerosis), but in Gary’s case, arteries behind his left knee had become twisted, greatly diminishing blood flow to his lower leg, foot and ankle.

Gary had always been active – running, swimming, biking, always on the move. But the P.A.D. was now causing so much pain in his calves, that it was impossible to walk even 2 blocks. As gary puts it, “it was no way to live.”

Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.

When you develop peripheral artery disease (PAD), your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication).

Mayo Clinic

Four doctors attempted to restore blood flow to Gary’s leg, all without success. During each of 4 arteriograms, a procedure in which stents are inserted into the blocked arteries to restore their shape, the surgeon couldn’t get past the twisted tangle of arteries behind the knee. But proper blood flow is necessary for your tissues, to feed the living cells, repair damage, feed muscles and nerves, and heal wounds.

A year ago, Gary developed a routine case of athlete’s foot between the toes on his left foot. The only difference was that this time, the athlete’s foot would not heal. In fact, it got worse and worse, resisting every over the counter treatment. Gary sought out Dr. Teichman at PA Foot and Ankle Associates to treat the worsening fungal infection, and what Dr. Teichman told him was unnerving.

Watch the video to discover what Dr. Teichman told Gary.

Getting a Pedicure? Watch out for foot and toenail infections

24 Jul

Sure, you want your toenails to look pretty, especially during sandal season. But any podiatrist will tell you that they see patients nearly every week with foot and toenail infections acquired at a nail salon – viral infections, warts, and athlete’s foot being the main players. Before your next pedicure, you can take a few precautions which will protect you from picking up any hitchhiking bacteria, virus, or fungus that may turn into a serious foot or toenail infection.


Don’t mess with the cuticles

Even the most experienced pedicurist will occasionally cut into the cuticles, and that’s a mistake. The cuticle helps anchor the nail to the skin, and should never be pushed back or cut during a pedicure, as that’s when bacteria may enter.

You want your toenails cut into what shape?

If toenails are cut a little too aggressively on the sides, it can lead to ingrown toenails, which as anyone who’s ever had one knows, are absolutely miserable and will certainly not match your other toenails. Pedicurists should cut the nails straight or at a slight curve, along the contour of the toenail, and not down into the corners.

Clean tools, clean surfaces

There’s a chance of acquiring fungus at a salon, too, if the owners aren’t fastidious about disinfecting surfaces and tools. Pumice and emery boards shouldn’t be used more than once, and tools should always be sterilized in between clients, preferably in an autoclave, which uses high pressure steam to kill bacteria and fungus. Non-metal tools cannot be sterilized, so if they aren’t thrown away after one use, every client that follows is at risk.

At the very least, make sure you can see the pedicure tools soaking in that blue liquid called Barbicide, which barbers have used since… well, since at least your grandfather’s first haircut. There’s a required minimum of at least a 10 minute soak in a bacteriacide, according to Environmental Protection Agency guidelines. And UV lights? Not to be trusted for sanitizing. Some salons allow you to bring your own pedicure tools, which is your best protection.

No bubbles, please

Glass bowls for soaking your feet are preferred over fiberglass or plastic – any porous material allows bacteria to hide out. Whirlpool foot baths should be verboten, as the piping feeding the baths can harbor all kinds of bacteria and fungus, which love the warm, but not too-warm temperatures.

Shaved legs and pedicures demand distance

Wait on getting a pedicure for 2 days after you shave your legs. A razor creates microtears in the skin, which bacteria can easily enter, directly introducing them into the legs. This can lead to an infection called cellulitis, which is very serious and may require hospitalization.

And some should never show up for a pedicure

If you’re diabetic, you should think twice about getting a pedicure. One of the unfortunate side effects of diabetes is that sores don’t heal quickly, especially in the feet. Persistently open wounds, even nicks, invite all kinds of bacteria to take up residence, which can lead to a nasty infection in a diabetic foot.

Other people at high risk include those with HIV, those going through chemotherapy, and those who have circulatory disorders or vascular disease. And if you already have an ingrown toenail, avoid pedicures entirely and see your podiatrist for treatment.

We can send toenail fungus on its way with only a few treatments.

What Your Feet Tell You About Your Health

28 May

foot health

Seems to us that every general physician should ask you to take your socks off. Even if you’ve gone to see your doctor complaining of a chest cold, an inspection of your feet might inform them of the early symptoms of many conditions.

Our feet are farthest from our hearts and spine, so in many cases they’re the first area to indicate problems with the nerves or circulatory disorders. The brain and internal organs receive blood before our toes and feet do, so our appendages are the first to suffer.

Nine health problems which first show up in your feet

1.Always cold feet could be a sign of hypothyroidism, a condition in which your thyroid gland is underperforming. Most common as we approach middle age, hypothyroidism can also cause hair loss, fatigue, weight gain, and depression. A simple blood test ordered by your doctor can confirm this condition, and daily oral medication can get your thyroid gland functioning properly.

2. Suddenly hairless toes and feet could be a sign of a circulatory disorder, as your feet may not be receiving enough blood flow to sustain hair growth. Your doctor should check for a pulse in your feet, and if she has any doubts, should order a thorough cardiovascular screen.

3. Foot cramps that won’t quit may indicate a nutritional deficiency or dehydration. Sure, everybody’s feet cramp up now and then, but what matters is how often and how severe. If you exercise a lot, make sure you drink plenty of water to hydrate your muscles. You also should eat a balanced diet with plenty of potassium, magnesium, and calcium, as a lack of these nutrients can also cause cramping (good sources are nuts, leafy greens, and dairy). To relieve cramps in your feet, stretch your toes up, not down. If the cramping in your feet just won’t let up, see your podiatrist so that he or she can test for circulation issues or nerve damage.

4. Yellowing toenails is a sign of aging, but may also indicate a fungal infection. Yellowing can also occur when you wear nail polish for months without a break. If your toenails are flaky or brittle, you probably have a fungal infection and should see a podiatrist for treatment.

5. Flaky, itchy, or peeling skin between your toes is a sure sign of athlete’s foot. Even if you’re not an athlete, it’s easy to pick up a case of athlete’s foot if your feet are crammed in shoes all day or you walk barefoot in common areas like a sauna or swimming pool. Use an over the counter creme to relieve the symptoms, but if your flaking, itching, or peeling continues, you may have psoriasis or eczema. Your podiatrist can determine which is which and suggest a course of treatment.

6. Your big toe suddenly becomes swollen and painful. This is an almost sure sign that you have gout, a condition that inflames the joint. But it might also indicate inflammatory arthritis or infection. If it’s due to trauma, like someone landing on your foot after a jump shot, well, you’ll probably figure that one out.

7. A sore on your foot that won’t heal is a common side effect of diabetes, skin cancer, or circulatory disorders. In the case of diabetes, blood glucose levels that have raged out of control for long periods lead to nerve damage and small blood vessel damage, which in many cases appears first in your feet.  If the sore gets infected, it can lead to an amputation. But a sore on your foot – even between your toes – can also indicate certain kinds of skin cancer, so be sure to have it checked out by your podiatrist as soon as you discover it.

8. A slowly enlarging “growth” aside your big toe is probably a bunion. Faulty, inherited foot structure leads to this common foot deformity, which can be exacerbated by poor choices in footwear like high heels and flip flops. Unfortunately, bunions rarely stop growing, so that small, slightly sore bump today may be quite large and painful years from now. The only sure way to correct a bunion is with surgery. Splints, toe separators, and the like are temporary measures which will relieve symptoms, but won’t stop the deformity from becoming worse.

9. Pain in your heel may indicate plantar fasciitis, an inflammation of the tissue which connects your heel to your arch. If you have a sharp pain in your heel when you get out of bed in the morning, which slowly subsides as you move around, you probably have PF. There are many causes of plantar fasciitis, but primarily poor footwear, obesity, or working out too aggressively are to blame. To relieve minor symptoms of plantar fasciitis, ease up on your exercise program, lose weight, or wear shoes which support your feet properly. If symptoms persist, see your podiatrist for treatment.

Psoriatic Arthritis In The Feet and Ankles: Symptoms and Treatment

25 Feb

Psoriatic arthritis, sometimes misdiagnosed as osteoarthritis, gout, or rheumatoid arthritis, is a form of arthritis accompanied by psoriasis, a condition which causes scaly red and white patches on your skin. This form of arthritis can cause swelling in your toes, frequently described as making them look like sausages.

Psoriatic arthritis feet and toes

Psoriatic arthritis causes toes to swell like sausages, a condition called dactylitis. In this patient, the toenails have been affected by the psoriasis, which is often misdiagnosed as a fungal infection.

Psoriasis is a condition in which the body’s immune system goes into overdrive and attacks healthy tissue in the skin, creating an overproduction of skin cells. In psoriatic arthritis, the immune system also attacks your joints, causing persistent, painful inflammation, in addition to the skin condition. It typically affects the larger joints in your feet or ankles, but may affect the smallest joints in the toes as well. Swelling of the joints in the toes can be quite extreme, taking on the appearance of sausages, a condition called dactylitis.

Psoriatic arthritis can also cause discoloration and “pitting” in your toenails – depressions or separation from the nail bed. As these symptoms appear similar to a fungal infection, it’s often misdiagnosed. In later stages, toenails may crumble or suffer other damage.

Why the immune system turns on healthy tissue is still somewhat of a mystery, but it appears that genetic and environmental factors are at play. Many patients who suffer with psoriatic arthritis have a family history of the disease, or a family history of psoriasis. In others, physical trauma, or a viral or bacterial infection may trigger psoriatic arthritis.

One of the characteristics of psoriatic arthritis is Enthesitis – pain in the heel or the sole, where ligaments and tendons join the bone. In some cases, this is the cause of plantar fasciitis or Achilles tendinitis. Research suggests that the continual inflammation from psoriatic arthritis causes significant joint damage, so early diagnosis and treatment is important.

If you’re experiencing heel pain, arch pain, or joint pain in your ankles or feet, and you suffer from psoriasis, please inform your podiatrist, as your treatment plan may vary.

Just as with rheumatoid arthritis, the pain and stiffness in joints affected by psoriatic arthritis is progressive, which means it will worsen over time. The pain and stiffness may at times subside and vary in intensity. Additionally, some patients also experience mood changes, fatigue, muscle weakness, and anemia.

Osteoarthritis may accompany psoriatic arthritis, and bones in the feet, ankle, or toes may deteriorate. Your podiatrist can use ultrasound imaging to determine this even before other symptoms occur.

Unfortunately, psoriatic arthritis becomes extremely painful as the condition progresses. Toes and feet may become swollen and tender, and they may no longer fit into your shoes. Your podiatrist may recommend special footwear in this case.

Symptoms of psoriatic arthritis in the foot and ankle

  • Joint pain. Joints may also be swollen or warm to the touch
  • Joints in the toes may develop dactylitis, a unique type of swelling. Dactylitis sometimes develops before pain or stiffness occurs.
  • Toes may become deformed and nails become discolored or pitted
  • Achilles tendinitis or plantar fasciitis may develop
  • Unlike other forms of arthritis, psoriatic arthritis is more likely to cause pain in the tendons of your feet

Who is most likely to develop psoriatic arthritis?

  • People with a family history of the disease. Men and women are equally affected.
  • People with psoriasis, especially those who have psoriasis lesions on their toenails
  • Those between the ages of 30-50, but it may also occur in children

Treatment for psoriatic arthritis

  • Mild exercise like walking, biking, or swimming keeps joints flexible and reduces pain
  • Stretching exercises
  • Custom orthotics (shoe inserts) to relieve pressure on painful areas
  • Wear comfortable footwear like athletic shoes,or if severe, diabetic shoes
  • Over the counter anti-inflammatory pain relievers like ibuprofen (Motrin, Advil), or naproxen (Aleve)
  • Cortocisteroid injections from your podiatrist to reduce joint swelling
  • Prescription medicines used to treat Rheumatoid arthritis
  • Podiatric surgery to replace or repair damaged joints

Are Your Feet Ready For Summer?

14 Jun


The word alone inspires images of swimming, vacations in warm, exotic places, feeling the soft grass underfoot, sticking your feet in a cool stream on a hot day, going barefoot.

How do you feel about that last phrase, going barefoot? Do you have visions of friends and family – even strangers – reacting in all kinds of embarrassing ways when you take your shoes off?

perfect feet

She either has a parent who’s a podiatrist, has never been pregnant, or weighs little more than a feather.

No one’s feet are perfect – that is, no one who’s been pregnant, has walked, run, played, gained weight, lost weight, worn shoes that looked fabulous but didn’t really fit, or in short, lived a life over 30 years. After all, those puppies at the bottom of your legs have carried you through it all, even though you’ve paid little attention to their needs. Heck, you’ve downright abused them at times (can you believe some of those shoes you used to wear?)

Most of us neglect our feet, it’s true. What’s more, we frequently inherit abnormal bone structure, faulty tendons and muscles, or less-than-perfect biomechanics from our parents. Throw all of this together and we frequently end up with bunions, a tendency toward  fungal infections like athlete’s foot or toenail fungus, overlapping toes, crossover toes, corns and calluses, ingrown toenails, premature arthritis, you name it. End result is that we keep our feet covered in public when we desperately want to wear sandals, flip-flops, or roam the world – or even our patio deck – in bare feet.

A regular visit to a podiatrist can solve a lot of your foot hangups. Trained intensively and exclusively in the medical treatment of foot and ankle conditions, a podiatrist can resolve pain, discomfort, and aesthetic issues for most patients without surgery. The first part of a treatment program may include suggestions for changes in footwear, custom designed orthotics, exercises specifically geared to your foot problem, and weight management if necessary. These seemingly small changes can make a big difference to your feet.

So go on – take your shoes off, let your toes hang out, and show the world how beautiful your feet are.

Signs and Symptoms of Toenail Fungus

28 Jan

how to get rid of toenail fungusIt may start as a small white or yellow spot on your toenail. Not believing it’s anything serious, you go on with your life. Soon, the spot enlarges and your toenail starts to actually deteriorate – it starts to crumble, yellow, and become thick and painful.

Patients are usually embarrassed by toenail fungus, believing it’s the result of poor hygiene. It isn’t. Toenail fungus, called onychomycosis, is the result of microscopic fungi which make their way into the toenail, usually through cracks or other damage. It can also be caused by a mold or yeast infection.

If your feet were constantly exposed to air and light, fungus wouldn’t have much of an opportunity to grow. But since your feet are surrounded by shoes and socks all day, creating a dark, wet environment, a fungal infection can grow quickly. There is also little blood circulation to your toenails, making it more difficult for your body to fight an infection in this area.  For diabetics or those with a compromised immune system, toenail fungus can become quite serious if not addressed in a timely manner.

Symptoms of toenail fungus
  • Toenail becomes thick
  • Toenail has a “dull” color and may become darker or lighter
  • Change in shape may occur
  • Toenail may separate from the nail bed
  • Toenail may have a dry, crumbly, or brittle texture
  • Toenail may become painful
  • Toenail may emit a foul odor

Click here for images of  different types of toenail fungus from the University of Iowa

How to avoid getting toenail fungus
  • Don’t walk barefoot in public areas like locker rooms, showers, swimming pools, and saunas – wear flip-flops
  • Treat athlete’s foot immediately, as the two conditions are caused by the same fungus
  • Wear shoes that fit properly so your toes aren’t squeezed together
  • Regular exercise helps to increase blood flow to the feet, important in fighting infection
  • Don’t wear wet socks – put on a fresh pair after exercising
  • Keep your feet dry with absorbent, anti-fungal foot powder and dry thoroughly after bathing
  • Treat hangnails and ingrown toenails immediately – the fungus that creates infection enters through cracks and trauma around the toenail
  • Do not share nail files or clippers
Treatment for toenail funguspinpointe laser treatment of toenail fungus

Once infected, toenail fungus will not go away on its own and requires medical treatment to eliminate. Your podiatrist may recommend topical creams or oral medications, and in extreme cases, surgery to remove the nail may be necessary. Oral meds have significant side effects, so monitoring by your podiatrist is required.

In our opinion, the most effective and best treatment to remove toenail fungus is the Pinpointe Foot Laser which is safe and reliable. Performed on an outpatient basis in the PA Foot and Ankle Associates office, this laser treatment is painless, requires no medication or topical ointments, and can be successful in as little as one thirty-minute treatment.

No matter your age, you can get a toenail fungal infection, and if you’re male, you’re more likely to get it than a woman. Studies have also shown a genetic link. The elderly are more at risk, as blood circulation in the feet decreases as we age, and our nails thicken, making them more susceptible to fungal infection.

How to prevent athlete’s foot

14 Dec

One of the great myths about foot care is that only athletes or people who shower at the gym get athlete’s foot.

Nothing could be farther from the truth.

athletes foot between toes

A typical case of athlete’s foot

In fact, athlete’s foot, called tinea pedis in medical terms, can affect anyone, and just about everyone gets it at one time or another. Minor cases will result in dry, itchy, flaky skin between the toes, while the most severe will also include redness and open and sore areas.

Athlete’s foot is a fungal infection of the skin and is typically picked up in communal areas where you walk barefoot, like the shower at your gym or summer camp, or even your own bathroom. You can also get it by wearing someone else’s shoes (be careful renting footwear in bowling alleys and ice rinks). The fungus grows on floors, bath tubs, shower stalls, clothing, anywhere that’s warm, damp, and dark.

The first place you typically experience athlete’s foot is between your toes. From there, the fungal infection can spread to literally anywhere else on your body, especially those areas which are enclosed and remain warm and moist, like your groin. It can also infect your toenails. As with many foot care problems, your footwear figures prominently. Since your shoes typically press your toes together and perspiration keeps the skin damp, once infected, the fungus can spread rapidly.

Symptoms of athlete’s foot

Athlete’s foot causes scaling, flaking, and mild to intense itching of the affected skin. Blisters and cracked skin may also occur, leading to exposed raw skin, pain, swelling, and inflammation. A bacterial infection can accompany the more serious cases, requiring a course of oral antibiotics. Some individuals may experience an allergic reaction to the fungus, causing blisters or vesicles on the hands, chest and arms.

How to avoid athlete’s foot
bad case athletes foot

A severe case of athlete’s foot

  • Athlete’s foot can easily be avoided by letting your feet “breathe”. Go barefoot as often as possible, especially at home (assuming you have no foot conditions that would prohibit this). In fact, those who go habitually barefoot (such as those in tropical climates), rarely experience athlete’s foot. Being shoewear-free ventilates the skin of your feet, allowing moisture to evaporate and sunlight in to discourage fungal growth.
  • If you frequent the shower or sauna at the gym or other communal areas, wear flip flops to avoid contact with the floor. The infection spreads by direct contact with the contaminated area.
  • Never wear someone else’s shoes or socks
  • Keep your feet dry, especially between your toes
  • Don’t wear the same shoes two days in a row – allow them to thoroughly dry between wearing
  • Wash your feet daily with soap and water
  • Wear shoes which allow your feet to breathe-those that are open toed or are made from materials like leather, cotton, or canvas
  • Wear shoes which are wide and roomy
  • Always wear clean, dry socks
Treatment of athlete’s foot

If a minor case, over the counter foot creams like Lotrimin or Lamisil usually work well. If your case is severe, see a podiatrist for a diagnosis and treatment program.

***Please note that if you’re diabetic, have an impaired immune system, or are elderly, athlete’s foot can quickly lead to a bacterial skin infection called cellulitis, which requires medical treatment.

East Penn Foot and Ankle Associates, Robbins Rehabilitation, donate turkeys for hungry and homeless in Lehigh Valley

8 Nov

Just in time for Thanksgiving, East Penn Foot and Ankle Associates and Robbins Rehabilitation are teaming up to feed the hungry and homeless of the Lehigh Valley. For the second consecutive year, EPFAA and Robbins will donate an estimated one hundred and fifty turkeys to Lehigh Valley homeless shelters and food banks.

From now through November 21, 2012, for every new patient seen at Robbins Rehabilitation or East Penn Foot and Ankle, one Jaindl’s turkey will be purchased and donated to feed local hungry and homeless families.

lehigh valley homeless shelter turkey donation

Dr Teichman and family donate turkeys to the underserved of the Lehigh Valley, November 2011

In 2011, the first year of this event, a total of 174 turkeys were delivered to three homeless shelters in the Lehigh Valley. This year the beneficiaries are the Sixth Street Shelter in Allentown, the Salvation Army of Bethlehem, and New Bethany Ministries in Bethlehem. The day before Thanksgiving, employees and owners of Robbins and East Penn Foot & Ankle will personally deliver the turkeys to the shelters.

“Roughly fifteen percent of the Lehigh Valley lives below the poverty line and many of these families depend on shelters and food banks for their daily meals and other necessities”, says Dr Adam Teichman, Senior Operating Partner at East Penn Foot And Ankle. “We’re humbled by how generously the Lehigh Valley has given to us and this is our small way of giving something back.”

Travis Robbins, owner of Robbins Rehabilitation continues, “Helping the community is a big part of who we are as a company. It’s why we organized this event last year, and decided to make it an annual event for our company.”

East Penn Foot & Ankle Associates provides advanced, innovative and compassionate foot & ankle care for the entire family in eastern Pennsylvania and western New Jersey.

Robbins Rehabilitation is the leading physical therapy practice in the Lehigh Valley, dedicated to providing the best physical therapy experience for their patients.

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