What is a ganglion cyst?

A cyst is a growth or swelling that erupts on or around a joint on the body, and in podiatry we deal with ganglion cysts, which is a cyst specific to the joints and tendons in the hands and feet.  Cysts are filled with a thicker clear fluid, similar to synovial fluid, and despite a temporary cure being to rupture the cyst so it drains, surgery will provide the best results in terms of recurrence.

In our office, we can puncture the cyst to drain it and then inject cortisone into the cyst to reduce pain and recurrence.  However, should the cyst come back, surgery is certainly the best option as the only way to truly prevent the cyst from coming back is to remove it fully and stop the joint from leaking fluid.

Ganglion cyst in Thousand Oaks

Normally we can diagnose a cyst quickly in our office by looking at the mass in question and confirming with an ultrasound, then if the patient so desires, we can puncture and inject it that day, or schedule a surgery for the future all in one visit.

What is a neuroma?

A neuroma, or more specifically in a podiatrist’s case, a Morton’s neuroma occurs when fibrous tissue forms around nerve tissue of the intermetatarsal plantar nerve.  It is important to note that while a neuroma is similar to a tumor, it is not effectively a tumor, and if often mislabeled as such.  While neuromas can be malignant, neuromas of the nature we are speaking will be benign.  Thinking of these neuromas as tissue that grows and wraps around a nerve is more accurate than simply referring to the mass as a tumor.

Morton's NeuromaAs the tissue gets larger the more pressure is applied to the nerve and the more severe the symptoms will become.  The most common symptoms are pain, numbness, and paresthesia (“pins and needles”).  Normally the pain will come intermittently with weight bearing activity, however it more extreme cases a constant burning pain can occur.

Neuromas are most frequently treated with orthotics and corticosteroid injections, however in cases of extreme pain, the neuroma can be surgically removed.

What are hammertoes?

A hammertoe is a malformation of the proximal interphalangeal joint which results in a bending of the toe. Hammertoe most commonly occurs as a result of the toe being forced into a bent position repeatedly for extended periods of time.  Poorly fitting shoes, either too short or too narrow, and high heels are the two most popular culprits for the bending.  When toes are bent so frequently the muscles inside the toe will contract, and this shortening of the muscle results in a hammertoe.  Occasionally, a hammertoe can be caused by existing muscle, nerve, or joint damage.

A bad case of hammertoes in Thousand Oaks

In a large number of cases of hammertoe, physical therapy and a more appropriately fitting shoe will be the best choice for correcting a hammertoe.  There are a number of exercises one can do to help stretch the muscle back out, and even a brace a patient can wear to aid in the process.  Of course though, there are situations where surgery is a more appropriate choice for correcting the muscle.






How do I treat nail fungus?

Nail fungus, or onychomycosis, is a condition resulting in the growth of either fungus or mold in the nail bed.  As theNail Fungus Thousand Oaks Office at Agoura-Los Robles Podiatry Centers growth progresses, the nail will become discolored and thick, then progressing to degrade the nail itself by making it flaky and brittle.   Over time, if left untreated, it is even possible to lose the nail as the fungus separates it from the nail bed.  Normally, despite the aesthetic problem that nail fungus creates, symptoms are minimal and pain is rare.  Fungus is difficult to treat because it is hard to physically get to it, thus making results varied and prolonged.  As a result of this there are three treatments available, and all have their pros and cons.

The first is topical cream; you want to look for butenafine, ciclopiroxolamine, or amorolfine in the cream, and despite years of use there is not any evidence one works remarkably better than another.  Topical creams are inexpensive in the scheme of fungus treatment, however the downside to them is that one must be near perfect about applying it properly everyday for the treatment to be effective.  For truly noticeable results, some patients have had to apply the cream for a year.

The second is oral medication, terbinafine, or the generic name Lamisil.  Due to the medication being taken orally, it has a much better chance of getting to and affecting the fungal infection.  Oral medications have a better cure rate than topical creams, however the side effects of this drug can be quite severe, and as a result doctors are very stringent about prescribing it.  Terbinafine is frequently linked to liver damage, and the side effect can progress quite aggressively.  Tests will be routinely be run in order to check whether or not a patient has a higher risk of this side effect occurring.    Before they begin the drug regiment, during the period, and after a patient will be subject to liver testing in order to ensure their safety.

The third, and newest form of treatment, is laser treatment.  Lasers had been used previously in other fields of medicine however within the last ten years they have been migrating into podiatry to treat toenail fungus.  The biggest downside of laser treatment right now is the price, despite most offices like ours offering reduced rates should you need a follow up laser.  Most places will charge upwards of $1,000 for treatment, depending on how many toes and other practice specific factors.  Up until very recently the biggest problem with lasers was the size of the beam emitted from the machine, it was approximately 1mm in diameter.  This made treatment long (as the doctor needs to move the laser beam over the entirety of the nail) and ineffective (as the laser needs to kill ALL of the fungus or else the chance it will grow back is high).  Thanks to a company called Cutera there is a new laser out that has a 5mm diameter, and has made the treatment far more effective.  For more details on this process please visit our page on Laser treatment specifically, here.

Toenail fungus is a fairly common issue with a not so simple treatment, however good results are a reality when in the hands of a talented podiatrist.  At Agoura-Los Robles Podiatry Centers, we will ask you to come in for an initial appointment at either our Thousand Oaks or Agoura Hills office, and if you are eligible for laser treatment we will get an appointment made for you so you can get on the road to a quick recovery.

Do I Really Need Sunscreen on my Feet?

Do I Really Need Sunscreen on my Feet?

by: Dr. Stephen Benson, DPM, FACFAS


Most Americans have recently become much more aware of the risk of skin cancer in their everyday lives, and have increased their use of sunscreen as a result.  Feet, however, often get overlooked despite this development.  People don’t often realize that skin cancer can occur on the feet from unprotected sun exposure, and they do not bother applying sunscreen.  It is important to remember that skin cancer of the foot is prevalent and can be fatal if not caught early.  While all types of skin cancer, including basal cell and squamous cell carcinoma, can be found on the foot, the most common is also the most serious form, melanoma.  Melanoma symptoms can be as subtle as an abnormal looking mole or freckle, and these can occur anywhere on the foot, including in between the toes and even under the toenail.  These often go unnoticed without routine foot exams.

Early diagnosis is the key to effective treatment for any skin cancer.  Many people, however, are not looking for the early stage warning signs, or taking the same precautions they do to prevent melanoma for other areas of their body.  Unfortunately, often times, skin cancer in this region is not diagnosed until the later stages.  I have seen cases where skin cancer on the foot has progressed to severe stages, and it was caught in a routine exam, not even a result of the patient noticing an abnormality.  Often times the surgery required to remove the cancer becomes more difficult as time goes on, due to the progression and potential spreading of the illness.  There have been patients in my care where all I needed to do was remove the “bad” skin and they were fine, but there have also been cases where the patient needed to have a part of their toe, their whole foot, or in the most extreme cases their leg removed in order to fully treat the cancer.

Put Sunscreen on Your Feet to Help Prevent CancerI advise my patients to regularly inspect their feet, including the soles, in between toes, and even under the toenails for any changing moles or spots.  It is important to have any suspicious areas promptly examined by a foot and ankle specialist, as they can confirm it being suspect, and have it biopsied for signs of malignancy.  This is easily done as an in office procedure at our practice, or other practices.  While this article might seem a bit grim, there are simple measures that everyone can take to prevent any of this happening, and provided you put in the little bit of extra effort you will be just fine.  Please remember to apply suncreen whenever your feet will be exposed to the sun for a prolonged period of time.  This not only includes the beach and pool, but also when outdoors for any reason with open sandals or flip-flops.

If you would like a foot exam to determine if a mole or spot is suspect, please feel free to make an appointment at either of our offices to come in and see one of our doctors.  Our contact information is here, Contact Page.

Stephen Benson, DPM, FACFAS

The Cutera Genesis Plus has arrived!

Agoura-Los Robles Podiatry Centers is very happy to announce the arrival of our new weapon against toenail fungus, the Cutera Genesis Plus laser!

After a slightly longer than expected wait, the wonderful Cutera Genesis Plus is at our disposal to help you fight off toenail fungus.  We have a nice write up about the procedure here on our website, and here is a link to information on the laser from Cutera’s website.

A reminder; the Cutera Genesis Plus laser is a 1064 nm laser, and 1064 nm lasers are the only type of laser that is FDA approved for the treatment of toenail fungus.

Please contact either of our offices to make an appointment for toenail laser treatment, or to request anymore information you may need.  Check out the video below for a quick rundown of the Cutera Genesis Plus.


What is the nail matrix?

Toenail Diagram

The nail’s matrix is the tissue under the nail that it rests on, it extends under the nail root, and contains blood vessels and nerves.  For just being some tissue under the nail, the matrix is actually responsible for a lot of what makes your toenail, your toenail.  The matrix is the location where new cells are produced that will eventually become the nail plate.  Even more interesting is that the length, thickness, and overall size of the the matrix will determine the width and thickness of the nail plate above.  So provided it is receiving adequate nutrition and is kept in a healthy condition, the nail matrix will continue to grow and keep a healthy nail plate above it.  As the previously mentioned cells are created, they push forward the old nail plate cells as they emerge, which is how your nail “grows”.  These new cells start out white, but as they push forward more they become translucent, and then appear to be pink as they are “back lit” by the capillaries in the nail bed underneath.

End your heel pain with High Intensity Shockwave Therapy

If you have had severe heel pain for over six months, no previous treatments have ended the pain, and you are looking at surgery as the only option, Agoura-Los Robles Podiatry Center may have the solution for you.  Whether a bone spur on your heel, or a case of plantar fasciitis, Shockwave Therapy is a proven means of ending your heel pain.

What is Shockwave Therapy?  Hundreds of sound waves are “shot” into the heel of your foot in an effort to cause micro-trauma.  This micro-trauma will shock your body into reacting to the sound waves, triggering the body’s natural healing process.  Please check out our page on High Intensity Shockwave Therapy here. This is a fantastic procedure that we are proud to be able to offer to your patients as an alternative to surgery.  Feel free to call our office at (818)707-3668 to make an appointment or for more information.

End your heel pain today at Agoura-Los Robles Podiatry Centers!