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 are Orthotics?

Orthotic InsolesOrthotics are a biomechanical device to be inserted into a shoe under the foot in order to correct proper biomechanical balance and function.  Overpronation, or the flattening of the arch, is the most common ailment to be corrected with orthotics, however there are obviously other uses for both minor and severe cases.  Orthotic insoles can help reduce pain and stress on joints as a result of correcting a condition like overpronation.  Best of all, they are an affordable and effective fix.  There are also orthotics that are created to help correct function in the foot and ankle; these look more like a boot instead of an insole slipped under the foot.

We take custom molds of the feet that need orthotics made, and then send them off to our manufacturer to be crafted to exactly fit your feet.  Then when you come in for your fitting, we will make sure the insole fits properly into your shoe, and under your foot.

For foot and ankle issues we also have Cam Walkers, which are “boots” that allow proper support and correction to yourOrthotic Came Walker whole foot.  They also provide the necessary protection your foot will need in the healing/correction process.

What are ingrown toenails?

An ingrown toenail is one of the, if not the, most common toe ailments that we see in our office.  In simplest terms, because the condition is indeed pretty simple,  the nail will begin to grow into the nail bed or skin of the toe, on the tibial or fibular side.  As the nail grows more, the pressure against the toe will increase, as will the pain and potential risk for infection.  The risk of infection exists because the nail can cut in the inside of the toe, and then with an open wound, bacteria can enter in.

Some ingrown toenails do not need any work, believe it or not, however it is more likely that removal is needed.  In the event that you are experiencing pain or feel there is a risk for infection you should come into our office to have it examined.  If one of the podiatrists feels removal is needed, we will perform a matricetomy.  The part of the nail on the affected side will be cut after some local anesthesia has been applied; then depending on the doctor’s judgement sometimes an acid is placed on the root to prevent recurrence.

Ingrown nails have a relatively quick recovery time after treatment, and the maintenance is relatively simple as well in the recovery process.  Please call into one of the numbers on our contact page to make an appointment.

What are flat feet?

Flat Floot or Flat ArchFlat feet is the term given to the condition when the foot’s arch has collapsed; the result being the entire (or almost entire) sole of the foot rests on the floor.  While the lack of an arch itself does not hurt, flat feet can cause pain in your ankles or knees.  The reason for this is pronation.  Pronation is a condition where the heel bone angles inward and the arch tends to collapse; so in the case of a flat foot, it makes the condition even worse.  As pronation gets worse, as will other complications of flat feet, such as the aforementioned ankle and knee pain.

How Pronation Affects the Leg with Side Effects and Complications

Simply enough, arch support or orthotics are proper treatment for flat feet, and canhelp prevent complications from the condition.

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.

What are diabetic foot ulcers?

An ulcer anywhere on the body is a sore accompanied by the deterioration of tissue at the site, penetrating through the epidermis, dermis, and then sometimes even the layer of fat underneath (the subcutaneous fat). The skin around the sore will be red and inflamed, and will obviously be sensitive and painful.  Ulcers vary greatly in location and cause, however in podiatry we deal with ulcers on the foot, most commonly associated with diabetes.

Diabetic Foot UlcerThe combination of diabetes and an ulcer is especially risky because of the nature of diabetes.  Ulcers, like any laceration or wound, would heal naturally via the human body’s healing process.  In this process the body will produce new skin cells to replace the ones lost, and barring a complication the healing process with completely heal the wound.  Diabetes is a disorder that impedes the human body from completing this process as quickly and efficiently as possible.  This generally prevents the wound from healing, and as time goes on the wound will frequently get worse (larger, deeper, more painful), and the risk of infection is heightened.

Now, ulcers are not necessarily caused by diabetes, however they are complicated by the disorder.  Diabetes patients will frequently suffer from neuropathy and a lack of blood flow; the lack of blood flow contributing to the slower healing process, and the neuropathy contributing to the development of ulcers unbeknownst to the patient.  What this means is, neuropathy will cause a patient to lose feeling in their lower extremities, and then as a result of many potential causes (tight shoes, friction from shoes or socks,  or even heavy friction from a bed sheet) an ulcer can develop and the patient would not feel the pain associated with the ulcer as it forms.  It can then go unattended and develop into a dangerous condition, especially when complicated further by a slow healing process.

 

What is a bunion?

Bunions are growths of bone or tissue around the metatarsophalangeal joint of the hallux (big toe).  As a result of this growth pushing on the joint in your big toe, it can bend or turn inwards toward the second toe, causing angulation ranging from a slight bend to the big toe bending entirely under the other toes.

Large Bunion

As said, a bunion is either a bony anomaly or tissue related; the tissue is a swollen bursa sac.  That sac is fluid filled and exists to minimize friction between bones and muscles.

X-ray of bunions showing swelling Bursa Sac between bone and muscle

 

 

 

 

As the swelling or growth progresses, the pain will obviously become worse, and perhaps more noticeably at first one will see the tilt in their big toe.

What is Plantar Fasciitis?

Plantar fasciitis is an inflammation of the plantar fascia, which is a ligament, or thick band of connective tissue between bones.  The plantar fascia forms at the calcaneus, or heel bone, and extends along the bottom of the foot towards the proximal phalanges of the toes.

Plantar Fasciitis in Thousand Oaks and Agoura Hills

This inflammation is most commonly associated with extended periods of weight bearing, and in non-athletic patients, is usually connected to high body mass index.

The typical means of diagnosing plantar fasciitis is done during an in office examination.  Through a conversation, looking at the patient’s foot, and watching them stand and walk a doctor should be able to see signs of the condition.  In some cases it may be necessary to use imaging, such as radiographs, ultrasound, or MRI to verify the presence of the condition.

With plantar fasciitis, the pain usually derives from the underside of the heel, sometimes spreading up the foot.  It is common, due to fact that while sleeping your foot is in a relaxed state of mending, when you first take steps in the morning the pain is the most intense of the day.  Another common symptom is that the patient has a tough time bending their foot, so as a result the toes are brought up toward the shin.