Skin Cancers of the Foot

Let’s shed light (but not too much) on a topic that is often overlooked. That is the topic of skin cancers and unknow skin lesions of the feet and lower legs. No one knows for sure 100% of the time what a lesion on the skin is unless it is examined under a microscope by a pathologist. That is why educating yourself on what to look for and protecting yourself from the sun are so important.
There are several things that you can look for yourself that can raise or lower your level of suspicion about this “mole”:
A - Asymmetry – normal moles are usually round or oval
B – Borders – normal moles have even borders
C – Color – normal moles are usually a consistent shade of brown
D - Diameter – normal moles are usually less than ¼” and don’t grow
E – Evolution – normal moles remain the same for years
This A-E type of description is specific for melanoma. Other skin cancers may have red patches with open or bleeding crusts or scabs that heal then re-open. They may appear wart-like or have a scar-like appearance that is white, yellow, or waxy. Also, looking for “moles” that look different from surrounding moles raises suspicion.
Squamous Cell Carcinoma and Basal Cell Carcinoma are two other prevalent skin cancers.
Basal Cell Carcinoma is the most common and if caught in early stages is almost 100% curable. Look out for an irritated or red patch, a shiny nodule or pinkish growth, or even a lesion with a crusted, indented center. In dark haired people they can even be confused with a mole. Most importantly look for white-yellow waxy appearing scar like area with abnormal borders. This can indicate that the tumor underneath is larger than it appears.
Squamous Cell Carcinoma is the second most common skin cancer. As with other skin cancers increased sun exposure increases risk of development. Many of these (40-60%) cancers begin as precancerous growths known as Actinic Keratoses or Solar Keratoses that range in size from 1mm to 1 inch and in color from brown to red. 2-10%of Actinic Keratoses progress to Squamous Cell Carcinoma. The carcinoma typically appears as persistent roughened and thick scaly occasionally bleeding patch. They can be mistaken for warts or skin ulcerations that don’t heal as expected.
To accurately diagnose a skin lesion a biopsy is taken. If it is small enough, then the entire lesion is usually excised. If it is a larger lesion, then a 2-millimeter punch biopsy is done. The lesion is then sent to the lab which reports on it in 3-5 days. This will dictate care from that point on.
This article has provided some basic information on what to look for. Do not try to be your own expert. Have a professional examine these questionable lesions.
For prevention, remember, “Slip-Slop-Slap”. Slip on a shirt, slop on sunscreen, and slap on a hat.

Hammertoe Surgery

Thinking About Hammertoe Surgery?

Many people develop what are referred to as hammertoes that are unsightly and often painful. They usually develop because of an imbalance with the muscles of the foot that help flex and extend the toes. The deformity and pain can be worsened with constrictive or ill-fitting shoes. The bony prominence at the joints become pronounced and become an area of increased pressure within the shoe. A bursitis (small, inflamed, fluid-filled sac) may develop over the prominence and be an added source of pain. Conservative treatment options/lifestyle changes include, but are not limited to:
-Wearing appropriate width and depth shoes
-Strapping/Padding of the affected toes
-Corticosteroid injection or Anti-Inflammatory medication for bursitis

There are surgeons who will shorten the toes strictly for cosmetic reasons, but this is not a widely accepted practice. However, surgical intervention is indicated if there is pain. There are several different methods for straightening of the toe. Many of these utilize wires, screws, or other types of implants to maintain the correction of the deformity. Sometimes additional procedures are needed on the joints and bones in the foot where the toes “attach”. A much more simple procedure can be performed in the office with only 2-3 bandaids for dressing and splinting. It requires no downtime. When the toe is contracted or hammered, but can be manually corrected during the exam, a simple procedure on the tendon that flexes the toe can be performed. This is done with local anesthesia. No stitches are needed. There is a small amount of loss of muscle strength in the toe, but this is more pronounced in the other types of surgeries mentioned and also typically not that important to the patient that is suffering pain. For the right patient it is an excellent alternative to enduring a long recovery process. It is also a fraction of the cost when comparing it to the charges associated with performing surgery in an OR setting.
For a more comprehensive explanation of what a hammertoe is, please visit www.westfieldfoot.com. This site will provide you with a library of information that will prepare you for your visit with the doctor. An overview ov anatomy, biomechanics, how hammertoes form, and what is involved with treatment are all covered comprehensively.
Dr. Sullivan performs the above mentioned procedure in his office on a regular basis with excellent results. The recovery is almost not an issue because there are no sutures and only involves a couple of bandaids for 1-2 weeks. Risks of infection and other common complications associated with hammertoe surgery that involves cutting of bone are avoided much better.