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Diabetes Awareness- Lonnie Kaplan DPM

As you may or may not know, November is national diabetes month. Unfortunately national diabetes month is not as well known as breast cancer awareness month or heart health awareness month. Diabetes affects millions of people in the United States and unfortunately the lower extremities are greatly affected by this condition.

Advice for Diabetic Patients:

  1. Check feet daily: Many diabetics cannot feel their feet due to neuropathy (nerve damage) It is common for a patient with diabetes to step on something (a tac, needle, etc.) and not even know they stepped on it. Be sure to use your eyes to inspect feet daily. If unable to do this easily, you can use a mirror or a mirror on a pole to see the bottom of feet. Report any abnormalities to your podiatrist immediately.
  2. Don’t walk barefoot: Diabetic patients should never walk barefoot (even going from the bed to the bathroom at night)
  3. Soaking feet: Don’t soak your feet in hot water. Diabetic patients cannot feel the temperature of the water as well as the general population. If you are going to soak your feet, have someone feel the water before you put your feet into it in order to make sure its not too hot.
  4. Check the inside of shoes before putting them on: It is common for diabetic patients to have pebbles, tooth picks etc. in their shoes that they do not feel due to neuropathy. Check your shoes with your eyes before putting them on and remove any foreign objects.
  5. Don’t remove corns or calluses on own: If you have corns or calluses, see a podiatrist for evaluation and treatment. Removing on own predisposes you to cutting yourself leading to infection. Also NEVER use over the counter medicated corn/callus remover as this can burn the skin and cause ulceration

All diabetic patients should establish care with a podiatrist. It is recommended that a diabetic patient without any complications should see a podiatrist yearly. A diabetic with neuropathy or other complications should see a podiatrist more frequently.

If you are a diabetic or know someone who is a diabetic, the doctors at Quality Foot Care of Doylestown would be happy to evaluate you. Call 215-230-9707 to make an appointment with Doylestown’s community podiatrists.

 

Should I hand down Sneakers from one Child to the Next?! Lonnie Kaplan DPM

Now that the fall is here, many parents will be bringing their children to the store to buy new sneakers. When buying new sneakers for children, there are many things that should be taken into account. It is important to remember that children’s feet grow and you will most likely have to buy a new pair for your child every 3-4 months. You should always bring your child with you to the store so that he/she can be properly sized as every shoe fits a bit differently. If you purchase sneakers for your child that are too big or too small it can cause discomfort and irritation leading to your children complaining about the shoes.

Handing down sneakers between siblings is a big NO, NO! Although a younger sibling may grow into the same size sneaker as an older sibling, over time sneakers lose stability. This lack of stability can lead to injuries of the foot and ankle. It is also very important to check your child sneakers for wear. If you notice that one side of the sneaker wears down a lot quicker than the other side, you should bring your child to a podiatrist for evaluation as there may be a foot abnormality present. It is also important that a sneaker feels good when the child first puts it on. You should not need a break in period and it is also important to have your child try on new sneakers with the type of socks they will be wearing with them.

If you have any questions about the above or have children that wear down their shoes more on one side than the other, contact Quality Foot Care today at 215-230-9707 to make an appointment in our podopediatric center of excellence!

 

 

Photo From Striderite

Is it More than a Callus on Your Child’s Foot? Lonnie Kaplan DPM

One of the most common conditions we see as podiatrists are plantar warts also known as plantar verruca. These lesions commonly occur in children and parents often misdiagnose them as a callus (thickened skin) Plantar warts are very different than thickened skin and treatment is much different as well. A plantars wart is caused by the Human Papilloma Virus and it commonly affects the outer layer of the skin. It is contagious and commonly acquired by walking barefoot in a public pool, locker room, hotel room etc. Most of the time, children will complain of pain in the area as well as a thickening of skin in the area. If this is experienced, it is important to have your child evaluated by a podiatrist. The longer the delay, the more they can spread and the more warts you can develop.

Your podiatrist will typically trim the thickened tissue (usually not painful), and evaluate the area. It is common to see black dots in the lesion (these are small capillaries). There are multiple treatment options available and your podiatrist will discuss this in detail with you. Unfortunately the Human Papilloma Virus vaccine does not protect against these plantar warts. Treatment usually entails salicylic acid (most podiatry offices use a percentage higher than what you can get in the pharmacy over the counter) as well as trimming the lesion. Another treatment option is a blistering agent that exfoliates the top layer of skin. It is important to remember that warts take a long time to go away but the sooner you treat them the better the outcome. Always also be sure to check everyone in your family as they easily spread to brothers, sisters, and other family members.

Call Quality Foot Care today at 215-230-9707 for an appointment with Doylestown’s community podiatrists. We would be happy to discuss the above with you to keep your entire family on their feet!

 

Does your Child Walk Like a Pigeon?! Lonnie Kaplan DPM

In toeing, more commonly known as pigeon toes, is a disorder that is commonly seen in infants and children. The easiest way to describe this condition is that the child’s feet point in while walking. This can lead to many complications such as falling frequently and inability to keep up with friends at school. It is true that sometimes this can resolve on its own especially in infants but it is important to determine the cause of in-toe deformity because not all in-toes will resolve on their own. There are a few main causes of in-toe. The deformity can be in the foot itself when the long bones of the foot are pointing inwards but commonly the deformity is not located in the foot (although the in-toe presents in the foot) but actually occurs higher up in the leg or hip. If the child’s leg bones are turned inwards while walking, this can lead to a presentation of in toeing in the feet. The same can be seen if the child’s knees or hips are facing inward.

Treatment of in-toe deformity cannot begin until a clear understanding of where the in-toe is coming from is determined by your podiatrist. If it is occurring in an infant it can sometimes be controlled by serial casting to hold the foot out of the in toe position. If it is occurring or first noticed after the child begins to walk at around 18 months, certain orthotics for the child’s shoes can be used to allow the child to hold there foot out of internal position when walking. If it is occurring in the knee or hips, certain bracing may be needed and sometimes if ineffective, surgical intervention can be discussed.

Call Quality Foot Care today at 215-230-9707 for an appointment with Doylestown’s community podiatrists. We would be happy to discuss the above or any other foot and ankle concerns you many have!

 

Keeping your Children OFF their Toes! Lonnie Kaplan DPM

A common pediatric foot and ankle abnormality is toe walking. Many people think that toe walking should be ignored and it will resolve on its own. Occasionally, it does resolve on its own but it is very important to have it evaluated by a podiatrist. There are many causes of toe walking in children. Some include cerebral palsy, muscular dystrophy as well as spinal cord problems. Once the neurological causes are ruled out, other diagnosis include idiopathic (unknown cause) toe walking which occurs commonly. Your podiatrist will complete a thorough developmental history including asking questions about strength, coordination, and bowel and bladder control. Other important findings that can help point to a diagnosis include whether the child was walking on the toes since birth or it developed over time and if the toe walking is occurring on one or both feet. Treatment options vary widely based on the root cause. Most include a team approach with a physical therapist specializing in pediatrics to work on stretching and strengthening. Sometimes, AFO (ankle foot orthotics) can be made which sometimes need to extend to the calf while in other cases, orthotics can be prescribed that go directly in the child’s shoes and do not need to extend past the ankle.

Call Quality Foot Care today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above and keep the entire family on their feet!

 

Do I Need to Treat my Child’s Flat Feet? Lonnie Kaplan DPM

Flat feet are one of the most common pathological foot types that are seen in the world. Most people agree that you tend to inherit your parents foot type and thus if your parents have flat feet, your children will develop as well. Most of the time, the parent brings the child to the pediatrician for evaluation- this is fine as a starting point but the child should visit a podiatrist for the condition. Many people think that children “out-grow” flat feet and this is not the case most of the time. Many children who are told to outgrow flat feet present to a podiatrist in their teens and 20’s for foot pain and trouble walking and keeping up with friends due to the progression of the condition. Some start to develop hammertoes and bunions. Many times, if flat feet are treated early on, progression can be slowed or even avoided leading to less long term complications.

Depending on the age of the child, the flat foot can be caused by many factors including compensation in the feet for issues in the hip, knee and ankle. It is important that the child have a complete biomechanical examination from the hips down to determine the root cause to appropriately treat. Many times flat feet can be treated with orthotics (go in the child’s shoes) to help stabilize the arch. In other cases, further bracing and support may be necessary.

Call Quality Foot Care today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above and help your entire family stay on their feet!

 

Does your Child Have Heel Pain? Lonnie Kaplan DPM

Does your child have pain in the heels after playing sports or after activity? One possible diagnosis is Sever’s Disease. Sever’s Disease is pain and inflammation at the growth center of the heel bone (calcaneus) The area of the growth plate of the heel bone in children is also the attachment of the achilles tendon. Sever’s Disease is a very common condition that tends to be seen in growing children.

Most of the time, your child will complain of heel pain either on the bottom of the heel or in the back of the heel bone especially after activity. It is commonly seen in children who are on sports teams, dance teams or are very active. It is commonly seen in children between 9 and 14 years of age as the growth center of the heel starts to close around 14 years of age.

There are multiple treatment option that your podiatrist can discuss with you for treatment. X-rays may be ordered occasionally to rule out other causes of heel pain (fractures, bone tumors). Treatment options can include icing the affected area, stretching the calf muscles, taking NSAID’s, placing heel lifts in shoes (this can decrease the stress on the growth plate), and decreasing activity level. Sometime in cases that do not appear to be resolving with the above, short term casting can be utilized as well.

Call Quality Foot Care Today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above in detail and help your family stay on their feet!

 

Keeping your Children Active! Lonnie Kaplan DPM

When most people think of a podiatrist, they think of someone who elderly people go and see to have their nails and calluses trimmed and diabetic shoes ordered. Most people do not realize how important it is for children to see a podiatrist as well. Children tend to be on their feet and are always running around the playground and chasing after friends. A lot of foot and ankle conditions start in childhood and progress through life. What is important to understand is that catching/ treating common foot conditions early in life will make for a world of difference in children as they get older. A lot of times people think that children will just out-grow their foot/ ankle issues and that there is no need for treatment. I have seen so many teens who come in with their parents having foot and ankle conditions (flat foot, in-toes) that could have been avoided or progression slowed down by having treatment earlier in life.

My next set of blogs will discuss lower extremity conditions that children tend to develop and discuss treatment options and when to see a podiatrist. Conditions will include flat feet, Severs Disease, warts, ingrown nails, in toes/out toes amongst many other conditions. It is my hope that after this set of blogs over the next few weeks, you will be better educated on when to bring your children to see a podiatrist to give them the best chance to live a healthy pain free life when it comes to the lower extremities!

Call Quality Foot Care Today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above in detail and help your family stay on their feet!

VACUUM to Heal Wounds?? Lonnie Kaplan DPM

Sometimes foot ulcerations still do not heal despite all of the previous discussed options and your podiatrist needs to discuss other possible treatment options. For very deep wounds and wounds with ligaments, tendons and muscle exposed, negative pressure wound therapy (NPWT) is an excellent modality. It is commonly used on wound after amputations where the skin is not stitched closed due to infection etc. Negative pressure wound therapy is a vacuum system (yes you read this correct) that creates negative pressure within the wound to remove fluids, drainage, allow for a moist healing environment, and remove infectious materials in order to help in the healing of the wound. The vac can also help the wound edges pull together.

The application of the wound vacuum starts with a foam dressing over the wound followed by an adhesive dressing that forms a seal around the periphery of the wound. At this point a small hole is made in the adhesive dressing and a drainage tube is placed which is connected to a vacuum suction. The vacuum can either be on continuous (constantly on) or intermittent (turns on and off at set increments) There are both portable wound vacs as well as larger wound vacs that are kept at bedside in home bound patients. The portable ones have an arm strap and they are worn similarly to a shoulder bag and of course have a canister that collects the drainage. The podiatrist will usually change the foam dressing three to four times a week depending on the amount of drainage in the canister. One major goal of the wound vac system is to fill in the wound enough to apply a skin substitute. This treatment option has become more and more popular over the last 5-10 years due to its efficacy in helping to resolve difficult to heal wounds.

Call Quality Foot Care Today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above in detail and help you stay on your feet.

Skin Substitutes for Diabetic Ulcerations: Lonnie Kaplan DPM

As you now know from my previous posts, diabetes is a common cause of foot ulcerations. If the ulceration is not colonized/infected, nutrition and blood supply are adequate, and there is adequate offloading you may be thinking, what is the next step if a wound still will not heal. A treatment that can be used are skin substitutes. These products can be used when there is less than 50% improvement in size of wound in a 30 day period using standard of care. Some of these products contain stem cells which allow tissue to differentiate into cells that allow for better healing of wounds. (most of this is taken from placental tissue) Others are just made up of an extracellular matrix with different growth factors that aid in the healing process. There have been many studies recently including head to head comparisons of different products showing excellent results. It is important to differentiate these products from split thickness/full thickness skin grafts which are harvested from another part of the patient’s body in an operating room setting.

Application of these products are completed either in the office or in a wound care center. Most of the time, the product is applied and adhered either with steri-strips (form of tape) or with stitches or staples. Normally after applied, a large sterile dressing is applied to the patient’s foot. The patient will usually keep the area clean and dry for a week after which they will be seen back in the podiatrist’s office or wound care center where new measurements will be taken and reapplication will occur. Good improvement/ healing has been seen in very difficult to heal wounds using the above skin substitutes.

Call Quality Foot Care today at 215-230-9707 to visit with Doylestown’s community podiatrists. We will be happy to discuss the above in detail and help you stay on your feet.