Psoriasis is a very common condition that affects the skin. It is a chronic, autoimmune condition involving a quick turnover of the skin cells, and eventually the older skin cells die, slough off, and new skin cells are formed. Since the skin cells are rapidly replaced, the skin commonly has the appearance of dry, silver/white scaly patches. Psoriasis can occur anywhere on the skin, but is commonly found on the arms, legs, scalp, elbows, and back. However, it can also affect the toes, toenails, and joints as well, and cause discomfort.
What Causes Psoriasis
While the exact cause of psoriasis is unknown, the condition itself is autoimmune, and commonly runs in families with a history of psoriasis. Since it is autoimmune, individuals with weakened immune systems due to other conditions are at risk for developing severe psoriatic reactions (AIDS, cancer treatments, certain medications, etc.). There are also several known risk factors that may trigger bouts of psoriasis. They may not be the same for every person with psoriasis and can possibly change over time. These factors include: stress, alcohol, medications, infections, and abrasive injuries (cuts, scrapes, etc.).
Signs and Symptoms of Psoriasis
People who have psoriasis can experience symptoms in as little as a few days. It should be noted that not everyone with psoriasis will experience these symptoms, but the following are commonly seen in people with psoriasis:
- Reddened skin with dry, white/silver scaly patches (also called psoriatic plaques)
- Itchiness or soreness around affected areas of the skin
- Pitting of the toe and fingernails
- Bleeding from cracked dry skin
- Pain in the joints
Currently, there is no cure for psoriasis, but there are numerous treatment options available to help reduce the irritation, inflammation, and discomfort experienced with psoriatic lesions. The following are some ways to help maintain healthy skin or decrease the pain/inflammation:
- Always ensure your skin is well-moisturized
- Topical steroids to reduce the inflammation, pain, and itching
- Vitamin D analogues to help slow skin growth
- Phototherapy (light therapy) to help slow skin cell turnover and reduce inflammation
- Minimize exposure to known risk factors (i.e. stress, alcohol)
When Should I See a Podiatrist?
Since psoriasis is not limited to just one location on the body, so other parts can be affected as well, such as the foot and ankle. If your feet are reddened and itchy, a podiatrist can help determine if psoriasis is the cause, or if it is due to another foot/ankle pathology. Another common finding in people with psoriasis is pitting of the toe nails, and it can sometimes look similar to a fungal nail appearance. While it is possible to have both a fungal infection and psoriasis of the foot, it is important to distinguish the difference between the two so proper treatment can be started. If you are experiencing psoriasis on your feet, see a podiatrist.
If you are experiencing psoriasis on your feet, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you and ensure you and your family maintain healthy feet.
We podiatrists are here to help you, to fix you. But our job is lot easier (and you often see results faster!) if you do a little prep before your visit. Help us help you!
1. Make your appointment on a day that the problem exists.
A lot of issues (like toenail fungus) are constant and present every day. Some others, like tendinitis or pinched nerve, only occur when you've worn a certain pair of shoes or have been on your feet all day. It can be more difficult for us to give you advice or a definitive diagnosis if we can't examine the problem itself. If your foot hurts after you run, go for a short job prior to your appointment, so we can find exactly where you're having pain.
2. Bring your shoes
One of the most common pieces of advice we give is to change your shoes to something that will not exacerbate your podiatric issue. If your feet hurt in your work boots, please bring them with you when you visit us. Arriving in flip flips only give us half of the equation.
3. Be specific
I'll let you in on a little med school secret, medical providers have a system for finding clues to help diagnose and treat you. NLDOCAT. These seven letters stand for things we want to know about your condition or injury.
The Nature: of the pain or symptoms: sharp? shooting? dull? occasional?
The Location: of the symptoms: not just "my feet", but if you can point to one spot where it's worst, we appreciate that. (And we do understand that symptoms move, or are diffuse over an entire body part).
The Duration: of the symptoms: weeks? months? years?
The Onset: did this happen all at once (like an acute injury playing soccer?) or hast it been a gradual thing?
The Course: has it been getting gradually worse, or gradually better? or has it always been the same symptoms from day one?
Aggravating factors: does cold weather make it worse, or raising on your toes, or wearing heels? Does anything make it better?
Previous Treatment: have you seen another doctor for this, or have you been trying home remedies?
The more of these pieces of information you give us, the more clues we have to help you.
4. Follow directions
We understand that daily stretches, medications, toe soaking, foot cream application, or wearing a heavy velcro walking boot takes a piece out of your day. However, we wouldn't give you instructions if we didn't think they would either decrease or alleviate your symptoms, or give us additional information to help your diagnosis. If you come to your return appointment and have not been to any of your physical therapy appointments, or never picked up your medication, or did not wear the brace we gave you, sometimes we don't have much to talk about. The follow up appointment is there to discuss the treatment we recommended. (That said, if a medication ever gives you side effects, or a brace increases your pain, or something else happens to cause additional problems, stop the treatment and let us know!)
5. Let us know
This one is important. We want to know what is going on. Call our office if you have questions or concerns between appointments. We would like to nip potential problems in the bud, so getting a heads-up about a small blister on a diabetic patient's foot and being able to treat it right away is preferable to seeing them at a later appointment with a full blown diabetic wound. If your bandage gets wet after surgery, let us know. If your new medication makes you sick to your stomach, let us know. If you stop in a pot-hole and re-injure your sprained ankle that had just started to get better, let us know. We may not always need you to come in for a visit: often we can give extra advice or small changes in your regimen over the phone. But just in case it's something that needs attention, go ahead and call us. We also want to know if you're better. When we recommend a treatment, and it works, but if you don't keep your follow up appointment, we don't know whether we were successful in treating you. We like to keep tabs on how well different treatments works on the same problem (like injections versus physical therapy), so I can recommend the better treatment to future patients. Your feedback helps the next patient I have who shares your injury or ailment. So pay it forward!
If you are having any foot or ankle issues, call to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona to address your foot care issues.
Are you a diabetic who is currently suffering pain due to neuropathy or recent amputation? If so, you probably already know it can be a difficult journey to find proper pain relief. Often, patients who suffer from diabetic neuropathy have an intense, sharp, stabbing, and burning pain that they cannot seem to relieve. They try every type of pain reliever or remedy, but have little success in treating their pain. An unfortunate truth is sometimes patients only find relief in strong, addictive painkillers such as opioids (morphine, Vicodin, Oxycontin, etc.), become dependent upon them for pain relief, and end up needing stronger doses due to their body becoming tolerant of the drug; this can become expensive and detrimental to the patient’s health. If this is your situation and are interested in a possible alternative, there have been tremendous successes in treating diabetic neuropathy pain with certain medications as Neurontin® (Gabapentin) and Lyrica® (Pregabalin).
What are Neurontin® and Lyrica®
There are countless medications on the market that have been repurposed to treat other conditions. Neurontin® (also known as Gabapentin) and Lyrica® (known as Pregabalin) are two medications originally made to help treat people with seizures. However, Neurontin® and Lyrica® have shown to provide pain relief in patients who suffer from diabetic neuropathy and provide an alternative to addicting painkillers. Neurontin® has been a beneficial treatment option for patients who have had amputations or complaints of phantom limb pains after an amputation. Lyrica® has also been shown to provide pain relief in patients who suffer from diabetic neuropathy.
What are the Possible Side Effects? Can I take these if I am on other Meds?
Every medication you take will come with the possibility of side effects. With these two medications, the most common side effects tend to be sedation, dysphoria, or the inability to concentrate. It is for this reason, if you begin taking these medications, they should be taken at night, rather than during the day. The good news is these medications do not get metabolized too quickly and this allows you to take them with other medications. Also, these provide the patient with a safer way to manage their pain without the concern of becoming addicted to the medications (as seen with opioid painkillers).
If you are experiencing severe pain due to diabetic neuropathy and have yet to find a way to manage your pain, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and see if Lyrica® or Neurontin® are suitable medications to help you manage your pain.
Just as newborns can be born with extra fingers or toes, they can be born with toes appearing webbed, or fused; when this happens, it is known as syndactyly. Syndactyly simply means “fingers or toes together” and a child can be born with it, or acquire it in an injury. During pregnancy, when a child’s arms and legs begin to form, they initially look like little paddles. During weeks 6th-8th of pregnancy, the fingers and toes start to appear separately, and eventually are divided into individual fingers, and toes. Syndactyly occurs when the tissue between the toes and/or fingers do not separate completely, result in the webbed appearance. Syndactyly can also be acquired at any age due to burn injuries.
Types of Syndactyly
The appearance of syndactyly can be varied and classified accordingly. The following is a commonly used classification system:
- Incomplete – The webbing does not extend the ends of the toes - This is the most commonly seen form and typically appears between the 2nd and 3rd toes
- Complete – The webbing extends to the ends of the toes
- Simple – Only soft tissue connects the toes or fingers
- Fenestrated – There is skin inbetween the toes, but there is a gap between the webbing, and the start of the toes
- Complicated – The bones in the toes are involved and are fused or abnormal in their size, shape, number, and arrangement
- Complicated-Complex – There are 3 or more toes with interrupted, incomplete structures
How Will This Affect My Child or Myself?
This condition occurs in approximately 1 in 2000 births. Often, babies born with syndactyly do not have any major health problems, but the syndactyly can occur with other foot conditions such as polydactyly (extra toes or fingers). If the syndactyly only affects the toes, treatment is not usually necessary since it does not drastically alter the function of the foot. If the parent or guardian desires treatment for their child, surgery can be done to separate the toes, and restore any lost function. Surgery is typically performed when the child is younger to decrease the risk of issues that might occur as the child continues to grow.
If your child was born with webbed toes or you know someone who has syndactyly, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona, and have all your treatment options presented to you and learn more about your child’s condition to ensure you and your child continue to maintain healthy feet.
About High Blood Pressure and Circulation
High blood pressure is not an uncommon condition, especially in the United States, and can be seen in about 1 out of every 3 adults over the age of 20. High blood pressure (also known as hypertension) occurs when the force of blood coursing through your vessels is too high. High blood pressure is often associated with plaque buildup in arteries, and increased levels of bad cholesterol (LDL cholesterol) in the body. When plaque builds up in the walls of blood vessels, it limits the blood flow in that region due to a smaller space for flow. As a result, decreased circulation in your feet and legs can occur and result in a condition known as peripheral arterial disease (PAD). This poses a serious health problem for the areas affected and needs to be addressed.
How Does This Affect My Feet?
The foot is the farthest part of the body from the heart and is a concern for people with high blood pressure or decreased circulation. When a part of the body does not receive adequate blood, it does not receive the nutrients it needs to stay alive, and starts to die as a result. In the legs and feet, a lack of proper blood supply can lead to the formation of open wounds (ulcers), cause death of the tissues in your foot (necrosis), and potentially lead to amputation of the affected toes or limb.
What Should I Look Out For?
There are several things to be on the lookout for if you have high blood pressure and are concerned about poor circulation. The following are a list of some signs and symptoms of poor circulation in your feet and legs:
- Loss of hair on the toes and top of the foot
- Changes in the temperature and/or color of your feet (are they cold? warm? red-pink? blue?)
- An open sore on your leg or foot (ulcer)
- Leg and foot cramping
- Burning feet, feelings of tingling or numbness in your feet
- Swollen feet
- Thin and shiny appearance of the skin on your feet
When You Should See a Podiatrist
If you were diagnosed with high blood pressure or are experiencing any of the previously mentioned issues, you should schedule an appointment to see a podiatrist. Having high blood pressure and/or decreased circulation can lead to additional problems in the foot and ankle, and may show up in the foot first before other parts of the body. When visiting your podiatrist, it is essential to tell them any blood pressure medications you are currently taking.
If you or someone you know is currently being treated for high blood pressure, and are concerned about your foot health, please do not hesitate to schedule an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona and have all of your treatment options explained to you.
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