This is the age old question isn’t it? “Doc, so how long will it take for this thing to heal?”
Where to begin on this seemingly so easy a question? There are sooooo many factors to take into consideration. This explains why you will hear doctors say “on average…” or “typically…”. We know from experience, and what we’ve read in the mountains of medical literature, when things are suppose to heal. This is the easy part. Here is a very short list of when certain body parts heal:
Bone: 6-8 weeks
Tendons: 3-4 weeks
Ligaments: 3-4 weeks
Stitches: top of foot or leg: 2 weeks, bottom of the foot: 3 weeks
Simple huh! Now for the fun part; we add the human factor to the equation and suddenly, all this simplicity flies out the window! What most patients don’t understand is why they may not fall into these criteria! There is a LAUNDRY list of the reasons why things don’t heal when they should and the number ONE reason things don’t heal when they should is that many patients (yes, I could be talking to you!) say they are listening but they are not doing what they are told to do to get them better! They cheat! Not a lot (though there is that distinguished class of patients who do!), but just a little bit! Yes, that little bit over the weeks it could take sets you back even more weeks! I have heard every excuse in the book as to why people couldn’t follow through with what I asked from them and believe me sometimes there is good reason. But all too often the reason is not all that worthy. A sampling of my favorites so far: “I walked around school in a regular shoe because the boot is ugly, but I was really good at wearing it around the house!” or “I know you told me not to, but I walked on it because I just wanted to see if it was getting better and now it hurts worse!”
Let’s keep it real. There is no guarantee that anything will heal at all much less in the intended time frame. But by not following instructions, you are just plain sabotaging your healing. We are a very small part of the healing equation. YOU MUST DO YOUR PART! Regardless of the reasons why you think you can’t, if you don’t, it will take you longer to get back to doing what you want to do in the first place! Do your part and at least give your body the chance it needs to work the miracle of healing. It really is trying and us “Docs” are really trying too!
Tuesday, February 24, 2009
Sunday, February 15, 2009
Got Toenail Fungus? Laser Can Help!
My nails are thick, yellow and seem to have something growing underneath them. I’m not a dirty person, how did this happen?
Toe nail fungus strikes across class, ethnic, age and hygiene lines. In fact, one study showed that almost 50% of people over the age of 40 have experienced some type of toenail fungus. Fungal infections are incredibly common, but are more prevalent in athletes (due to toenail trauma) and the infirmed (due to a decreased immune response).
The typical athlete’s foot fungus, called a dermatophyte, is the same fungus that infects your toenails. Fungus loves a moist, dark environment like in your shoes, between your toes. The affected toenails can have a whitish superficial infection or a yellow to brown discoloration under the toenails that seems to destroy the nail as it grows. Long standing fungal toenail look like thick, brownish-yellow mountains growing on the end of your toes. The thickness makes them painful and susceptible to a secondary bacterial infection (paronychia). This infection can be quite dangerous and has been linked to gangrene in diabetics.
How is toenail fungus diagnosed? Diagnosis of onychomycosis can only be made by a toenail biopsy. Your podiatrist can take a small piece of the leading nail and send it for a special stain that shows the fungus. A PAS stain is usually faster and more accurate than a fungal culture, because often the fungus does not grow in the laboratory. Do not assume you have onychomycosis. Psoriasis and other skin disorders as well as chronic trauma can look like fungus. Also, a melanoma under the nails can mimic fungus, but can be deadly if there is a delay in diagnosis. If you suspect you have toenail fungus, don’t delay, see your podiatrist today!
How can I prevent toenail fungus?
1. If you get regular pedicures, bring your own instruments or go to a spa that sterilizes their instruments in an autoclave (like our spa, Health Steps).
2. Clean your toenail clippers with alcohol before you use them if you do your own toenails and make sure to replace Emory boards and orange sticks regularly.
3. We also recommend you regularly clean your shoes with either antibacterial spray like Lysol or even better an antibacterial with an antifungal like Mycomist at least once a month and dry them with a hairdryer.
4. Changing socks regularly (even a few times a day if you have sweaty feet) and keeping your feet clean and dry is also helpful.
5. Keep your athletic shoes dry and also change them regularly. If you exercise regularly, buy your athletic shoes a half size larger than your street shoes so you won’t bash your toenails as your feet swell with exercise.
How is toenail fungus treated? There is a lot of misinformation out there about toenail fungus. I have never told my patients to use white iodine, Vic’s Vaporub or organic cornmeal soaks on their toes. There is no evidence that it works.
Topical therapy should have some penetration of the nail plate like Formula 3 (my favorite), organic tetre oil, Nailstat or prescription (now generic Penlac) ciclopirox nail lacquer. This should be coupled with a nail treatment plan from your podiatrist.
If this doesn’t work after several months, oral medication, like terbinafine (generic Lamisil) or itraconazole (generic Sporonox) may be needed, but these have serious side effects.
There is now a new option for treatment that includes a painless laser procedure to kill the fungus in the toenail with usually one treatment! Think about it, one 30 minute treatment by a painless laser and 6 to 9 months later, the toenails have grown out normal! Too bad we can’t figure out how to make them grow faster! The new PinPointe FootLaser has given us a much better treatment option for eradicating toenail fungus. Unfortunately most insurance companies deem it cosmetic so they don’t cover it, but if you think about all the hassles, copays and the risk of side effects; the toenail laser looks like the best option for most patients.
Remember, no matter how you treat fungal toenails, it takes at least 6 to 12 months for the toenails to grow out completely. Relapse is also common, so it’s important to play offense (treat the fungus) and defense (try to prevent the fungus) at the same time.
Toe nail fungus strikes across class, ethnic, age and hygiene lines. In fact, one study showed that almost 50% of people over the age of 40 have experienced some type of toenail fungus. Fungal infections are incredibly common, but are more prevalent in athletes (due to toenail trauma) and the infirmed (due to a decreased immune response).
The typical athlete’s foot fungus, called a dermatophyte, is the same fungus that infects your toenails. Fungus loves a moist, dark environment like in your shoes, between your toes. The affected toenails can have a whitish superficial infection or a yellow to brown discoloration under the toenails that seems to destroy the nail as it grows. Long standing fungal toenail look like thick, brownish-yellow mountains growing on the end of your toes. The thickness makes them painful and susceptible to a secondary bacterial infection (paronychia). This infection can be quite dangerous and has been linked to gangrene in diabetics.
How is toenail fungus diagnosed? Diagnosis of onychomycosis can only be made by a toenail biopsy. Your podiatrist can take a small piece of the leading nail and send it for a special stain that shows the fungus. A PAS stain is usually faster and more accurate than a fungal culture, because often the fungus does not grow in the laboratory. Do not assume you have onychomycosis. Psoriasis and other skin disorders as well as chronic trauma can look like fungus. Also, a melanoma under the nails can mimic fungus, but can be deadly if there is a delay in diagnosis. If you suspect you have toenail fungus, don’t delay, see your podiatrist today!
How can I prevent toenail fungus?
1. If you get regular pedicures, bring your own instruments or go to a spa that sterilizes their instruments in an autoclave (like our spa, Health Steps).
2. Clean your toenail clippers with alcohol before you use them if you do your own toenails and make sure to replace Emory boards and orange sticks regularly.
3. We also recommend you regularly clean your shoes with either antibacterial spray like Lysol or even better an antibacterial with an antifungal like Mycomist at least once a month and dry them with a hairdryer.
4. Changing socks regularly (even a few times a day if you have sweaty feet) and keeping your feet clean and dry is also helpful.
5. Keep your athletic shoes dry and also change them regularly. If you exercise regularly, buy your athletic shoes a half size larger than your street shoes so you won’t bash your toenails as your feet swell with exercise.
How is toenail fungus treated? There is a lot of misinformation out there about toenail fungus. I have never told my patients to use white iodine, Vic’s Vaporub or organic cornmeal soaks on their toes. There is no evidence that it works.
Topical therapy should have some penetration of the nail plate like Formula 3 (my favorite), organic tetre oil, Nailstat or prescription (now generic Penlac) ciclopirox nail lacquer. This should be coupled with a nail treatment plan from your podiatrist.
If this doesn’t work after several months, oral medication, like terbinafine (generic Lamisil) or itraconazole (generic Sporonox) may be needed, but these have serious side effects.
There is now a new option for treatment that includes a painless laser procedure to kill the fungus in the toenail with usually one treatment! Think about it, one 30 minute treatment by a painless laser and 6 to 9 months later, the toenails have grown out normal! Too bad we can’t figure out how to make them grow faster! The new PinPointe FootLaser has given us a much better treatment option for eradicating toenail fungus. Unfortunately most insurance companies deem it cosmetic so they don’t cover it, but if you think about all the hassles, copays and the risk of side effects; the toenail laser looks like the best option for most patients.
Remember, no matter how you treat fungal toenails, it takes at least 6 to 12 months for the toenails to grow out completely. Relapse is also common, so it’s important to play offense (treat the fungus) and defense (try to prevent the fungus) at the same time.
Thursday, February 12, 2009
Casting a Severe Ankle Sprain Yields Better Results!
Alert the Media! A below knee cast was seen to provide better and faster results than a removable walking cast or ace bandage in severe ankle sprains! Duh! You can't take off a cast and it forces you to be compliant. Most of our patients want to be compliant but life gets in the way. Ten days in a cast rapidly improves short term outcomes......what will they report next? That physical therapy imporves long-term outcomes? Who funds these studies? Can I get some of their money to prove common sense? Just kidding......
For complete article: click here
Primary source: The LancetSource reference:Lamb SE, et al "Mechanical supports for acute, severe ankle sprain: A pragmatic, multicentre, randomized controlled trial" Lancet 2009; 373: 575-581. Additional source: The LancetSource reference:Hertel J "Immobilization for acute severe ankle sprain" Lancet 2009; 373: 524-526.
Short version:
Severe ankle sprains healed significantly more quickly with a below-knee cast or air-cell brace compared with a Bledsoe boot or a tubular compression bandage, investigators here reported.
The 10-day below-knee cast and the Aircast resulted in 8% to 9% improvement in the quality of 90-day recovery compared with a tubular compression bandage, Sarah Lamb, D.Phil., of the University of Warwick, and colleagues reported in the Feb. 14 issue of The Lancet.
The degree of improvement with the Bledsoe boot did not differ significantly from that of the tubular compression bandage, which was the least effective device.
The quality of recovery at nine months did not differ among the four devices.
"Contrary to popular clinical opinion, a period of immobilization was the most effective strategy for promoting rapid recovery," the authors said. "This was achieved best by the application of a below-knee cast. The Aircast brace was a suitable alternative to below-knee casts."
"Results for the Bledsoe boot were disappointing, especially in view of the substantial additional cost of this device," they added. "Tubular compression bandage, which is currently the most commonly used of all the supports investigated, was, consistently, the worst treatment."
Severe ankle injuries (grade II-III) can cause significant incapacitation and require three to nine months for recovery in most affected individuals, the authors noted. Systematic reviews have revealed lack of high-quality evidence to aid clinical decision-making related to management of severe ankle injuries.
For more information on the treatment of ankle sprains, click here
For complete article: click here
Primary source: The LancetSource reference:Lamb SE, et al "Mechanical supports for acute, severe ankle sprain: A pragmatic, multicentre, randomized controlled trial" Lancet 2009; 373: 575-581. Additional source: The LancetSource reference:Hertel J "Immobilization for acute severe ankle sprain" Lancet 2009; 373: 524-526.
Short version:
Severe ankle sprains healed significantly more quickly with a below-knee cast or air-cell brace compared with a Bledsoe boot or a tubular compression bandage, investigators here reported.
The 10-day below-knee cast and the Aircast resulted in 8% to 9% improvement in the quality of 90-day recovery compared with a tubular compression bandage, Sarah Lamb, D.Phil., of the University of Warwick, and colleagues reported in the Feb. 14 issue of The Lancet.
The degree of improvement with the Bledsoe boot did not differ significantly from that of the tubular compression bandage, which was the least effective device.
The quality of recovery at nine months did not differ among the four devices.
"Contrary to popular clinical opinion, a period of immobilization was the most effective strategy for promoting rapid recovery," the authors said. "This was achieved best by the application of a below-knee cast. The Aircast brace was a suitable alternative to below-knee casts."
"Results for the Bledsoe boot were disappointing, especially in view of the substantial additional cost of this device," they added. "Tubular compression bandage, which is currently the most commonly used of all the supports investigated, was, consistently, the worst treatment."
Severe ankle injuries (grade II-III) can cause significant incapacitation and require three to nine months for recovery in most affected individuals, the authors noted. Systematic reviews have revealed lack of high-quality evidence to aid clinical decision-making related to management of severe ankle injuries.
For more information on the treatment of ankle sprains, click here
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