NAILS & SKIN

We treat various nail and skin conditions in the lower extremity. Procedures are performed in clinic, with minimal discomfort.

Athlete’s Foot

Athlete’s foot, also termed tinea pedis, is a common fungal foot condition seen in many of our patients. The infection can affect the web spaces of the toes, or involve the entire foot. Typically athlete’s foot presents in a “moccasin distribution” on the soles of the feet. When the infection is occluded in socks or shoes, it tends to spread. Symptoms include redness, flaky skin, and itching in the infected areas.

Undoctored Treatment

If you suspect that you have athlete’s foot, make sure that you wash and dry your feet well every day. If you tend to have sweaty feet, make sure you change your socks throughout the day. Also, try to spend most of your day without shoes if possible. An over the counter topical antifungal such as Clotrimazole or Lamisil may treat your symptoms. However, if the infection does not resolve, or worsens, it is best to seek medical care.

Medical Treatment

A two week course of oral Lamisil combined with a topical antifungal (i.e. Clotrimazole or Lamisil) is my recommended course of action. An anti-perspirant foot spray is also recommended to eliminate a damp environment for athlete’s foot to reoccur.

Corns & Callouses

Corns and callouses develop from pressure and friction in specific areas during weight bearing. The skin responds by increasing keratin production in these areas. The skin will then appear tougher and thicker in these areas. Boney prominences are the areas that are most likely involved. Corns and callouses can be painful if they are left untreated.

Undoctored Treatment

The use of an over the counter pumice stones can be a daily routine to remove corns or callouses. This practice is best performed after a bath or shower when the skin is softer. Vaseline can help to soften callouses. However, it is not as effective as a prescription keratolytic cream. If your corns or callouses are not responding to home treatment, or if they are getting increasingly more painful, it is best to seek medical attention.

Medical Treatment

Evaluation of the corn or callous will be performed at your initial consult. Corns and callous can be shaved down or removed in clinic using a surgical blade. This is a quick and painless procedure. Prescription keratolytic creams are prescribed, such as Urea 20%. Patients are instructed to apply these creams twice daily. Accomadative orthotics are recommended to offload areas of high pressure and friction to prevent recurrence of these lesions. Cantharone is a topical agent can be applied to recurrent corns. This will be offered during your initial consult. Occasionally corns require surgical removal followed by a three week period of non weight bearing to allow the incision to heal without scarring.

Fungal Nails

Toenail fungus, also known as onycomycosis, is a very common condition amongst adult patients. The condition occurs when a fungal organism, most commonly trichophyton rubrum enters the nail bed and infects the cells resulting in the nail plate growing irregular and discolored (pic)

Undoctored Treatment

There are over the counter topical treatment options that you can try, but these tend to have limited success. Fungus can be picked up anywhere, and is very difficult to get rid off. Throwing away your shoes or trying to disinfect your entire home has limited application in permanently getting rid of the fungus.

Medical Treatment

Treatment must be targeted to treating the nail bed rather than just the nail plate. Since a thickened, discolored nail can also be secondary to nail bed trauma, an objective diagnosis of fungus is warranted before treatment. A nail biopsy is the gold standard way to diagnose onycomycosis. This is a quick and painless procedure preformed in clinic that involves taking a small clipping of your nail. If the nail biopsy confirms onycomycosis, then oral and topical treatment options can be discussed. Oral antifungal medications do have a black box warning regarding liver toxicity. Although rare, we take this into account prior to prescribing oral medications. Liver function tests will be performed prior to starting any oral antifungal medication. Patients are also given the option to remove the infected nail permanently.

Ingrown Toenails

Ingrown toenails stem from irregular growth from the nail matrix (see pic). Tight fitting shoes or micro trauma to the nail can cause an ingrown toenail to occur. Ingrown toenails are painful and may develop a concomitant soft tissue infection.

Undoctored Treatment

If you suspect an ingrown toenail, avoid tight fitting shoes. Monitor for signs of infection: redness, swelling, warmth, pus, etc. Avoid trying to remove the nail yourself. Most home treatment regimes for ingrown nails don’t address the matrix. As a result, patients who self treat their ingrown nails tend to develop recurrence.

Medical Treatment

We offer partial or complete nail removal options in a sterile clinic field. The procedures are painless and efficient. We use a local anesthetic to numb the toe prior to the procedure. During your consult, you will have the option to have your ingrown nail permanently removed. Permanent removal of the nail involves the application of a chemical, sodium bicarbonate, to the nail matrix, which prevents this area of the nail from growing irregularly again. You will also be given the option to have the nail or nail border removed without sodium bicarbonate application. Although, this can serve as a good option in some cases, the likelihood of the nail become ingrown again is rather high. All ingrown nail treatment options will be discussed with you at the time of your consult.

Plantar Warts

Plantar warts are caused by certain strains of the human papillomavirus (HPV). The virus can enter the sole of your foot through open areas of skin. Warts tend to develop in on areas of your sole that has sustained mild trauma.

Undoctored Treatment

There are various topical over the counter treatment modalities for treating plantar warts (i.e Compound W). Plantar warts can be self limiting, meaning that they can resolve within several months without any medical treatment. Moreover, many cases of plantar warts don’t resolve on their own, and may even spread in mosaic patterns (pics).

Medical Treatment

Although there are various treatment modalities for plantar warts, cantharidin application is our preferred method. Most patients have resolution of their wart after two weeks of cantharidin application. However, more resilient warts may take up to three clinical applications. Surgical cauterization of warts is the last line of therapy if conservative care fails.