Does Your Dermatologist Check Your Feet?

Cancerous skin lesions can develop anywhere that there is skin. Sounds obvious, right? Many well trained dermatologists concentrate their examinations of the skin on areas that get the most sun exposure. You don't have to have alot of sun exposure to develop basal cell carcinoma, squamous cell carcinoma, or malignant melanoma. There is no way to know for sure that a skin lesion is or is not cancer. A clinical exam can give a high degree of probability one way or another, but the pathologist that looks at the lesion under a microscope is the one that decides what it truly is. We perform biopsies and excisions of skin lesions or masses on a regular basis. The great majority of the time this can be done in the office under simple local anesthesia. The specimen is then sent to a lab where the dermatopathologists(pathologists that concentrate on skin lesions) give the final diagnosis. Some times a deeper or wider excision is needed in order to get a border that is free of cancer cells, but most of the time the lesion is removed and the localized condition resolved. We give peace of mind to many people concerned about these lesions. Call our office for an evaluation and exam if you or a loved one may have a questionable skin lesion on your lower extremities.

Training for the Mini?

Training for the Mini?
Many people have aspirations of running the Indy 500 Mini-Marathon in May. They either began their training in the fall or sometime around the first of the year depending on their previous running experience. I see a lot of patients that are concerned about heel pain, arch pain, or ball-of-foot pain because it is interfering with their training. Often times the reason for this pain is that they have been sedentary until now or have tried starting the training too vigorously, thus causing an overuse type syndrome to some aspect of their feet. Orthotics work very well at easing the stresses on the feet that are caused from this type of training. The prescription-custom orthotics are a fine-tuned version that takes individual differences in feet into account. Whether flat-footed, high-arched, or even with a particular “deformity” such as a bunion or an arthritic joint these devices place the foot in a more balanced position which aids in decreased stress to not only bones and joints in the foot, but the ankle, leg, knee, hip, and back. Most of the time the custom orthotics are a covered item by local insurance plans. If you or a loved one are having any foot, heel, or ankle issues call our office today at 896-6655 or visit If your insurance does not cover custom orthotics then mention this article for 20% off in the months of January and February. Happy Training!

The Most Gratifying In-Office Foot Procedure

My favorite thing to see as a doctor is for a patient to get better quickly without hassling with rehab, a long post-op recovery, physical therapy, time lost from work etc. While taking a patient to the OR is often a necessary evil, I believe that it can be avoided much more often. I believe in addressing a patient's main problem and fixing that problem as efficiently as possible.

A perfect example of this is when a patient presents complaining of a painful toe or hammertoe. This pain is usually on the top, tip, or side of the toe and is usually any toe except the great toe. Sometimes there is a callus or a corn. Sometimes there is a little swelling or bursitis around one of the toe joints. As long as the toe can be manually reduced to some degree, I believe a small in-office procedure can significantly reduce or eliminate this pain. The procedure is called a flexor tenotomy. I like to utilize this procedure quite often because it gives immediate results, the dressing is 2-3 bandaids, there are no sutures, no down time or time off from work, minimal chance of complications, it eliminates a trip to the OR and therefore saves thousands of dollars. The thing it is not meant to do is be a cosmetic fix.

The procedure is performed under simple local anesthesia. The sharp beveled edge of a 16g needle is used to pierce the skin on the bottom of the toe beneath the joint where the deformity is. The tendon that keeps the toe contracted down is released with the pinpoint scalpel-like tip of the needle. The toe is then aggressively flexed up and then put through its full range of motion to ensure that the procedure has increased the flexibility in the toe. The toe is dressed and splinted with 2-3 bandaids and the patient is educated on changing these at home for a week and stretching the toe in the opposite direction of the original contracture. The toe that once only touched the ground at the tip of the toe will now be able to lay flatter and the pressure will be placed on the fleshy fat pad of the toe instead of the bony tip. This significantly reduces or eliminates the pain. This has also proven effective for those who have more pain on top of the toe because if the toe is allowed to lay flat then the top of the toe is not fighting with the inside of the shoe. Additionally, if the pain is on the side of the toe from rubbing against the toe next to it, then the increased flexibility in the toe will not so strongly contract it into the adjacent toe and therefore there will be less pressure and less pain.

The flexor tenotomy is not meant to be a cosmetic fix. When not weightbearing, the toe will still appear to be contracted, but when weightbearing it will flatten.

Conversely, the more often performed procedure on these painful toes is to take the patient to the OR, make an incision over the top of the toe, remove a small piece of bone from one or both sides of the most prominent joint, then place a wire down the length of the toe for 4-6 weeks while it heals. Common complications from this are prolonged swelling, pain, and dislocation. Also, since this is an open procedure, the risk of infection is increased.

Conclusion: If you are suffering from any pain in the toes then you should consider the flexor tenotomy in-office procedure.

The Diabetic Foot Problem

The Diabetic Foot Problem

Thousands of leg or foot amputations are performed each year due to complications of diabetes. Very often this is a result of an open sore or ulcer on the foot that goes unchecked and subsequently becomes infected. You may ask why would someone not tend to an open sore. Wouldn’t that be painful, especially on the foot? Well, surprising to most, most of the time there is no sensation in these areas at all. This is one of the most common complications of diabetes…diabetic neuropathy. Neuropathy can present with many different diseases or syndromes, but it is often closely associated with diabetes due to its prevalence.
Diabetic neuropathy can present as a burning, tingling, pins and needles sensation (like when your arm falls asleep) or a more intensified painful feeling. When diabetics get into trouble, though, is when the neuropathy presents as numbness. It creeps up on them and they often times don’t know it is happening until they notice some drainage on their sock from a sore that they were not aware of. If the foot is numb, then the patient cannot experience pain, and therefore does not stop to check out what the problem is because they don’t realize that, for example there is a toothpick stuck in their foot or they have walked so much that the callus that has developed from wear and tear has broken down underneath. Unless they have a loved one checking their feet for them on a regular basis then this may go unnoticed for a long period of time. An ulceration will then often become infected. If the infection lingers it can eventually involve the bone. When bone becomes infected, IV antibiotics and often amputation of part or all of that bone or area must be performed to rid the body of the infection. The 5-year survival rate for all lower extremity amputation patients is less than 50%! This is a staggering statistic.

This is why education of diabetics is so important. Prevention of infections and amputations improves quality of life for the patient and the family. Too often the diabetic patient with neuropathy and an ulceration has the mindset of "It doesn't hurt, so it must not be THAT serious." Herein lies the problem. As practitioners it is our job to relay the gravity of this situation and its very realistic potential of significantly shortening the patient's life if they don't come to grips with their problem.
If you have a friend or family member with Type 1 or Type 2 Diabetes please make sure they are properly educated on their disease state. Look for some signs that they may have neuropathy. If you are riding in the car with them and they are not so great at applying the brakes or gas smoothly it's probably because they cannot tell how much pressure they are applying to the pedal. When they walk if they have a little bit of a slap when there foot hits the ground its something they are probably doing subconsciously because they aren't able to feel their foot hit the floor, so they can at least hear it. This sounds strange to us, but it is reality for many diabetics.

The Truth About Foot Orthotics

“Do I Need Orthotics?”

What is an orthotic and why would I need one? An orthotic is a device that is worn inside of a shoe that supports the arch of the foot and helps to place it in a biomechanically balanced position. Orthotics or orthoses are used for a variety of reasons, not just for foot and ankle problems, but some practitioners will prescribe them for knee, hip, and/or back ailments. The patients that benefit the most from orthotics are the ones that have the most unstable feet. This can be someone that has a flat foot who pronates (rolls their ankle inward) excessively during gait or someone that has a high arch that cannot find a shoe that provides enough support and therefore puts excessive stress on the midfoot joints and the ball of the foot. Many of the most common diagnoses seen in a podiatry practice are treated with orthotics. These include, but are not limited to:
1. Plantar Fasciitis
2. Tendonitis
3. Arthritis
4. Apophysitis/Sever’s Disease (Growth Plate Problems)
5. Ball of Foot Pain (Neuromas, Metatarsalgia)
6. Bunions and Hammertoes

Orthotics both treat these diagnoses and help to prevent or slow the progression of the deformity or painful condition. For example, orthotics will not get rid of a bony bump, such as a bunion, but they will place the foot in a better supported, balanced position which will slow or halt the bunion’s progression.

There are prefabricated orthotics and there are prescription custom orthotics. Both serve a purpose. A solid shell prefab device provides much more support than almost any shoe that is available and is great for someone with an average arch height and a foot that is pretty “normal”. A custom made device is made directly from imprints, casts, digital scans, etc. and is specific for that patient. These are better than prefab orthotics for this reason. Often times a patient will start in a prefab and improve, but may plateau. This is a time the fine-tuned custom devices will give that extra needed benefit. Most local insurance plans cover custom orthotics when they are deemed medically necessary.

At Westfield Foot and Ankle, LLC a digital gait scan is done of the patient's feet both in static(standing) and dynamic(walking)phases of gait. The majority of the information that is gleaned from this scanning comes from the dynamic portion, which tells us what the feet are doing during gait. The pressure distribution is clearly seen. Prior to the scan, a comprehensive examination of the feet is done to determine what modifications may be needed, such as posting to further reduce the amount of pronation or rolling in of the ankle while walking. Overpronation is the culprit in many foot and ankle pathologies. Orthotics prevent this.

To schedule an appointment with Dr. David Sullivan visit or call Westfieldf Foot and Ankle at 317-896-6655.

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.