Footloose and Fancy Free

Health & Fitness / Stories / July 11, 2014


Cosmetic Treatments for the Foot & Ankle

by Dr. Jody P. McAleer, DPM Jefferson City Medical Group

Sandals and summer go together. Tucked away during the cooler weather months, our feet are finally set free and we’re out of the confines of our closed toe shoes. Sometimes this can be a source of embarrassment or great angst and concern, especially if we’re dealing with boney lumps and bumps, abnormal nails and dry cracked skin. Don’t bury your feet in the sand this summer, there are solutions to problem areas.

Solutions for Unsightly Nails

Approximately 30 million Americans are currently affected with nail fungus, also referred to as onychomycosis, which can make your nails thick, discolored or ragged. Contrary to what many think, this infection is not a result of a lack of proper hygiene. Nail fungus may begin as a white or yellow spot under the tip of your toenail and then spread deeper into your nail. This unsightly and potentially painful problem can lead to ingrowing nails, fungal skin infections and bacterial infections of the surrounding tissues.

Fungal nail infections are contagious, worsen over time and can be very difficult to treat. The infection can be spread from person to person through direct contact and by using communal facilities such as showers and pools. It is best to identify the problem early and treat it as soon as possible to avoid permanent nail deformity. The good news is that treatment is available to reverse the process. Options include topical/oral anti-fungal medications and the use of lasers to eradicate the fungal organisms.

Topical medications work on contact to directly eliminate superficial fungal organisms of limited severity and have approximately a 10 percent clinical cure rate. In contrast, oral medications work by attacking the source of the infection through the blood stream and clear the infection over several months.

Laser nail treatment is safe, painless, highly effective and frees patients from dealing with the potential side effects associated with the longterm use of oral anti-fungal medications. A laser is utilized to generate a concentrated wavelength of light to target and kill the infection and halt the spread of the disease as the nail grows out. It’s recommended that all ten nails be treated as fungal spores can colonize nails that do not appear to be clinically infected. Two treatments are usually required one month apart to maximize the result of the procedure, which takes approximately 10-15 minutes and does not require any anesthesia.

Dermal Fillers for the Feet

Women love Manolo Blahniks or Jimmy Choo shoes, even though they can be the source for much pain and can cause significant and permanent harm to our feet. Standing and walking for long periods of time in these and other minimally supportive tight fitting shoes tend to be the worst for our feet. They can permanently damage the specialized fat pad at the bottom of our forefoot, which acts as a shock absorbing cushion and causes individuals to develop problems such as neuromas, metatarsalgia, capsulitis and bursitis.

Common symptoms for patients with fat pad atrophy include forefoot pain that gets worse when standing and walking, toes that may feel as if they go numb, loss of tissue volume and calluses that form over areas of bone prominence. In the past, the only answer was to ‘break-up with your heels,’ but now there are options to restore the cushion at the forefoot and rejuvenate the lost tissue.

Dermal fillers are injectable compounds used to “fill” or plump areas of the face which have lost volume. What was once ‘solely’ intended to refresh the face is now being used to make your feet feel younger and refreshed. These fillers are being adapted by podiatrists to reverse the effects of fat atrophy in the feet providing patients with a virtual ‘foot facelift’. The injectable filler material application can also be modified to cushion corns and calluses secondary to bunion and hammertoe development. It can also be utilized to fill areas of the foot that sink with age to provide a more youthful appearance.

The injection process is simple, performed as a 15-20 minute inoffice procedure. It’s relatively inexpensive and painless, with a one to two day recovery process. The filler, which is broken down over time and is absorbed by the body naturally, can last for up to one year or longer in some cases depending upon patient body weight and activity level.

If conservative treatment options fail to completely relieve the pain, surgery may be indicated. The surgical procedure restores the balance along the metatarsal heads to alleviate the excess pressure at the ball of the foot. This is achieved via cutting the offending metatarsal, shifting it into a corrected position and securing the bone with fixation. The result should be a significant reduction in discomfort at the forefoot.

Botox for Sweat Gland Dysfunction

Chronically wet uncomfortable shoes and the anxiety associated what others will think when you take them off can be a paralyzing social concern. No one wants to feel as if they are walking around in a swampy terrarium on a daily basis.

Plantar focal hyperhydrosis, also known as dysfunction of the eccrine glands, can be a significantly embarrassing problem. Excessive sweat production at the soles of the feet can lead to shoe malodor and increases the risk of developing fungal and bacterial infections of the skin and nails.

A good strategy to help deal with the problem is to cycle the shoes you wear daily. Allowing a pair of shoes to air out for 24-48 hours will help to reduce the growth of infectious microorganisms. Changing socks several times daily can also be beneficial as can the use of topical powders which help with moisture control. Another way to deal with the problem is through the use of topical medications that halt the excess perspiration. These topical compounds can be successful for individuals with mild to moderate cases but may not be effective for those of us with a more severe problem.

Botox injections, which are synonymous with wrinkle reduction and prevention, are successful in controlling the embarrassing problem of excess sweat production in the feet. This muscle paralytic works by shutting off the nerve impulses which tell the glands to produce and excrete sweat.

The procedure is performed inoffice and takes approximately 30 minutes and the effects last for approximately 3-6 months depending upon the individual. The areas of profuse sweating are identified and the Botox is injected accordingly. The process requires approximately 75-125 units of Botox per foot to achieve the desired result. Typically the procedure is repeated after the symptoms return.

Bunion and Hammertoe Surgery – The Cinderella Procedure

It’s an age-old dilemma. Wear those killer heels and suffer or choose your less attractive flats due to the lumps and bumps associated with your painful bunions and hammertoes. Many women are concerned with the appearance of their feet and how they look in their heels and sandals. Yet like Cinderella’s step sisters, they fight in vein to fit their feet into her petite glass slipper.

Bunions and hammertoes are deformities of the great toe joint and lesser digital joints respectively, which are brought on through genetic predisposition and external factors such as poor shoe selection. Seventy percent of individuals who suffer from these deformities are female. Over time, the cumulative effects make shoe wearing painful. Malalignment of the forefoot joints also leads to an unnatural wearing of the articular cartilage and limits proper function of the joints.

Unfortunately, once the deformities are present there is little that can be done to address the problem other than surgery. Custom foot orthotics can be useful to slow the progression of the problem but they will not correct the current pathology. Wider more practical shoes can also help to reduce the pressure over trouble spots in order to ease discomfort.

Early intervention can reduce the chance of developing premature joint arthritis. Severe deformities present for long periods of time tend to require more involved surgical corrective procedures. The earlier the problem is corrected the better the surgical outcome.

These forefoot corrective procedures are typically performed at an out-patient setting and recreate the natural shape and contour of the forefoot making shoe wear more comfortable. The incisions can be hidden to provide the best cosmetic appearance possible. A relatively short period of recovery is required following the surgery.

General Foot tips

Find the right shoe for the event

Smart cute shoes allow you to walk with comfort and confidence. Find something that looks good and feels good. Stylish supportive sandals are an easy choice. Make sure they fit well and don’t slip on your feet, which could cause you to trip or stumble. If wearing heels, watch for areas of irritation and redness. Your shoes should not limit your ability to stand and walk. Avoid wearing heels higher than threequarters of an inch to one inch. Heels that are higher than an inch place too much of the body’s weight on the ball of the foot.

Barefoot Walking: Friend or Foe

Beach sand can act as a natural exfoliant for the skin of your feet. The action of walking in the sand helps to rid you of unwanted dead skin cells which tend to make the skin feel coarse and bumpy. Always make sure to wash the skin thoroughly after exfoliation and apply a rich moisturizer to rehydrate the freshly exposed skin. Exfoliate only 2-4 times monthly to avoid skin irritation and abrasions.

Sun protection

Regular sunblock application is an absolute necessity. Feet don’t tend to have a great deal of sun exposure during the fall and winter seasons. The skin of the lower extremity is very sensitive to the harmful effects of UVA/UVB. Skin cancers such as melanoma are on the rise and we need to protect ourselves form the dangerous effects of the sun.

Proper Nail Trimming/Pedicures

Nails should be cut straight across. Use an emory board to file any sharp corners or edges. Consider visiting reputable facilities that provide pedicures and nail shaping if you don’t feel as if you can or want to care for them yourself. Locations such as JCMG Podiatry and JCMG Laser and Vein provide patients with sterile pedicures to reduce the risk of transmitting serious nail and skin infections. Patient’s with diabetes should avoid pedicures unless they have had a consultation and evaluation by their podiatrist first.

johnny_graham Author: Jody P. McAleer, D.P.M., F.A.C.F.A.S., Jefferson City Medical Group Department of Podiatry. Qualifications: Fellow of the American College of Foot and Ankle Surgery, F.A.C.F.A.S. Board Certified by the American Board of Foot and Ankle Surgery.

Alvin Leifeste

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