In general there are 3 types of ulcerations that can affect the feet and/or legs
 

• Venous statis ulcers
• Neurotrophic (diabetic)
• Arterial (ischemic ulcers)

Ulcers are typically defined by the appearance of the ulcer, the ulcer location, and the way the borders and
surrounding skin of the ulcer look.
 

Venous Stasis Ulcers

Location on body: Below the knee - primarily found on the inner part of the leg, just above the ankle. Ulcers
may affect one or both legs.

Appearance Base: Red in color and may be covered with yellow fibrous tissue. There may be a green or yellow
discharge if the ulcer is infected. Fluid drainage can be significant.

Borders: Usually irregularly shaped. The surrounding skin is often discolored and swollen. It may even feel
warm or hot. The skin may appear shiny and tight, depending on the amount of edema (swelling).

Who is affected: Venous stasis ulcers are common in patients who have a history of leg swelling, varicose
veins, or a history of blood clots in either the superficial or the deep veins of the legs.
 

Neurotrophic (diabetic) Ulcers

Location on body: Usually located at increased pressure points on the bottom of the feet. However,
neurotrophic ulcers related to trauma can occur anywhere on the foot.

Appearance Base: Variable, depending on the patient's circulation. It may appear pink/red or brown/ black.

Borders: Punched out, while the surrounding skin is often calloused.

Who is affected: Neurotrophic ulcers occur primarily in people with diabetes, although they can affect anyone
who has an impaired sensation of the feet.
 

Arterial (ischemic) Ulcers

Location on body: On the feet - often on the heels, tips of toes, between the toes where the toes rub against
one another or anywhere the bones may protrude and rub against bed sheets, socks or shoes. They also occur
commonly in the nail bed if the toenail cuts into the skin or if the patient has had recent aggressive toe nail
trimming or an ingrown toenail removed.

Appearance Base: Has a yellow, brown, grey or black color and usually does not bleed.

Borders: The borders and surrounding skin usually appear punched out. If irritation or infection are present,
there may or may not be swelling and redness around the ulcer base. There may also be redness on the entire

foot when the leg is dangled; this redness often turns to a pale white/yellow color when the leg is elevated.
Arterial ulcers are typically very painful, especially at night. The patient may instinctively dangle his/her foot
over the side of the bed to get pain relief.

Who is affected: Patient’s with poor arterial circulation in the legs and feet.

Foot Care Guidelines and ulcer prevention

The treatment of all ulcers begins with careful skin and foot care. Inspecting your skin and feet is very
important, especially for people with diabetes. Detecting and treating foot and skin sores early can help you
prevent infection and prevent the sore from getting worse.

Every day, examine your legs as well as the tops and bottoms of your feet and the areas between your toes.
Look for any blisters, cuts, cracks, maceration, scratches or other sores. Also check for redness, increased
warmth, ingrown toenails, corns and calluses. Use a mirror to view the leg or foot if necessary, or have a family
member look at the area for you.

Once or twice a day, apply a quality cream to your legs and the soles and top of your feet to prevent dry skin
and cracking. (We have excellent products available in our office) Do not apply lotion between your toes or on
areas where there is an open sore or cut. If the skin is extremely dry, use the moisturizing cream more often.

If you have diabetes, it is important to see us regularly. Do not self-treat corns, calluses or other foot problems.
Don't wait to treat a minor foot or skin problem. Call our office and we will see you in a timely manner to
address any wounds you have.

The Value of Podiatric Ultrasound

• Highly accurate examinations and measurements of the plantar fascia.  The ultrasound can clearly indicate areas of inflammation, rupture, or thickening.  It can also be used, in part, to definitively distinguish between plantar fasciitis and plantar fasciosis, a plantar fibroma, a heel spur, or other heel pad injuries (each of which requiring its own individual course of treatment).
• Clear examinations of the various tendons around the foot and ankle. (especially the Achilles and Posterior Tibial tendons)  It allows our Doctors to ascertain the extent of tears, ruptures and varying degrees of tendonitis.
• Critical differentiation between neuromas (pinched nerves) and capsulitis (inflamed joint). Both are very similar in location and symptomatic effects, but have distinctly different treatment protocols and they can be verifiable under ultrasound examination.
• Clear distinction between assorted soft tissue tumors.
• Unmistakable clarification of the presence of foreign bodies that are often missed entirely under MRI and can be invisible to X-ray. (Indeed, having the ability to avoid unnecessary MRI's is one of the foremost advantages of being able to offer ultrasound to our patients. Our doctors can ascertain the majority of soft-tissue pathologies right then and there, in the office, rather than having to refer you out, like most podiatrists, for a costly, time-consuming MRI.)
• Comprehensive evaluation of deep tissue trauma (as well as ulcers and lesions), where the trauma below the wound and any tunneling can be identified and carefully monitored.

Use of Diagnostic Ultrasound in Guided Injections and Aspirations

• difficult targeted injections of the plantar fascia,
• the targeting of stump neuromas, multiloculated cysts, and intra-articular     injections
• intra-lesional injections,
• biopsies of deep masses and abscesses,
• The aspiration of fluid-filled masses not fully palpable. 

Morton's Neuroma - it sounds serious enough -- but what is it? What causes it? And how is it treated?
A neuroma is an enlarged nerve and Morton's Neuroma is an enlarged nerve located in the interspace between the third and fourth toes. That area of the foot is particularly vulnerable because two nerves combine in that space and become larger in diameter than any of the other nerves going to other toes.
What causes this nerve enlargement? The leading cause seems to be compression on the nerve - compression and irritation. The condition is more common in women and it makes sense because many women wear shoes that force their toes into a very cramped toe space.
Other causes include activities that repeatedly irritate that part of the foot, such as basketball or jogging. We also see Morton's Neuroma in patients who have other foot conditions, including flat feet, bunions, and hammertoes. An accident or injury to the foot can also cause the neuroma.
The symptoms of Morton's Neuroma include:
- Pain
- A feeling that something is in your shoe, sock or foot
- Tingling or numbness in the toes
- Burning sensation in the ball of the foot
The condition starts out slowly, with intermittent pain. Left untreated, Morton's Neuroma results in permanent nerve damage to the foot. Early diagnosis is always best from a treatment standpoint.

How is this condition treated? It really depends on how advanced the neuroma is and the severity of the symptoms. Non-invasive/non-surgical solutions are always our first choice. These might include icing the area, wearing shoes that are wider in the toe area, refraining from repetitive sports activities, steroid injections, special padding techniques, custom biomechanical orthotics to reduce pressure on the nerve and medications to reduce inflammation and pain.
If a patient doesn't respond well to the more conservative treatments, surgery may be indicated. The surgery is minimally invasive and can be performed right here in our SurgiCare center. Recovery time is minimal and you may walk on the surgical foot right away.
After surgery it is best for patients to focus on quality, supportive shoe gear and wear prescription orthotics to properly support the feet and optimize their mechanical function.
Please let us know if you have any of the symptoms of Morton's Neuroma, so that we can conduct a thorough examination to arrive at a proper diagnosis.

Corns and calluses are one of the most common reasons for a visit to our office. In fact, we see quite a few cases each and every day!
A callus is a hardened area of skin on the foot that forms as the result of pressure or continuous rubbing from shoes or socks. It is usually raised and painless and appears on the bottom of the foot or heel.
A corn usually forms on the tops of toes, in between toes or on the tips of toes. Like a callus, a corn is a hardened area of skin, but it is smaller with a harder center that is surrounded by inflamed skin. Corns usually cause pain because they get pushed into the skin, affecting sensitive nerve endings.
Both corns and calluses form as a means for the foot to protect itself from ongoing pressure. The more persistent the pressure, the thicker the corn or callus!
What types of pressure or other types of foot conditions cause corns and calluses to develop?
- Shoes that are too tight, causing pressure on the foot, or too loose, causing the foot to move around within the shoe (can also cause blisters)
- Going sock-less or wearing socks that are too loose-fitting
- Hammertoes - the top of the bent toe is a likely area for increased pressure against a shoe
- Improper gait (manner of walking) that causes pressure on the bottom of the foot, making it easier for calluses to develop
- Pre-existing deformity of the foot or biomechanical problem, such as a bone spur

Although there are numerous over-the-counter (OTC) corn and callus remover products available, many of these products contain different types of acid that can burn the skin and may cause infection. For patients who are diabetic, elderly and unable to feel different sensations, these OTC preparations may prove especially dangerous.
The best (and safest) way to treat corns and calluses is to make an appointment for a complete foot and ankle examination. Treating corns and calluses on your own may provide temporary relief but it doesn't address the cause of the corn or callus.
"Bathroom surgery," using a razor or knife to "trim" or remove the corn or callus is dangerous and may lead to additional problems.
Some things like psychiatry, cardiology and podiatry are best left to professionals. Please give us a call if you are having a problem with corns or calluses and let us help - we know just what to do!

Women’s Feet and Summer Heat

            It’s summer and for most women in Michigan it is the only time of year to show off some fancy and brightly colored toenails. A couple coats of shiny nail polish and some open toed shoes and your feet are transformed back to beautiful and it feels good to not be locked up in a closed shoe or boot.  However, the beauty of your feet can come at a price. 

Dr. Popofski and Dr. Shanahan have some tips to help avoid some common issues.

1. Don’t wear nail polish for more than 3 consecutive days!  Wearing nail polish for a long time period can not only stain your nails but more importantly it can trap fungal elements living on your nails and give the fungus a wonderful opportunity to set up shop and become an infection.  This can cause yellowing, thickening, peeling and odor of your toenails that will require long-term treatment to overcome.  It is important to remove your toenail polish and allow nails to “breathe” for several days before wearing polish again.  Under your nail polish, you should use a basecoat with bionutrients and anti-fungal properties to protect your natural nail from fungal infections and staining of the nail plate. In our office we have products to effectively prevent and treat fungal infections of the nails.
2. Don’t go barefoot in public places or outside as much as possible!  Going barefoot in public places (pools, waterparks, bathrooms, the gym, etc) can expose your tootsies to fungal infections of the skin (Athlete’s foot), viruses that cause warts as well as bacteria than can cause skin infections.   These infections can also be picked up in nail salons so beware of this risk and inquire about the salon’s sterilization of instruments and soaking tubs.  Sanitizing does NOT mean sterilizing!!! Wear shoes that can be cleansed with bleach-based cleaners and cleanse shoes after wear in public areas. Dr. Popofski and Dr. Shanahan see a great number of patients in the summer months with infections of the skin and also many types of foreign bodies in their feet. These conditions can really put a damper on summer fun and also cause serious infections and pain.
3. Wear supportive shoes as much as possible!  In the summer heat, it is hard to tell patients to not wear sandals or flip-flops but beware that these type of shoes can cause foot problems.  If your arch is not supported well, it increases your risk of developing heel pain, tendonitis and other foot deformities.  Wearing flimsy flip-flops forces your toes to attempt to grip the shoe and this can progressively increase your chance of developing hammertoes.  We see a large number of patients in the late summer and early autumn with heel pain and tendonitis from wearing non-supportive shoes.  If you develop foot pain, make an appointment with us so we can get you started on a treatment plan before your pain becomes severe. There are brands of summer shoes that offer better support than those of the past so come in and ask us about them!
4. Closely inspect the condition of the skin of your feet daily!  Skin that is too moist or too dry is susceptible to many different problems.  Skin that is too moist can easily develop fungal and bacterial infections especially between the toes that can be difficult to get rid of. Over the counter anti-fungal medications are not very effective and a prescription medication may be required to treat your condition.  Skin that is too dry is susceptible to cracking and peeling.  If skin becomes callused and then cracked (called a fissure), it can cause serious pain, bleeding and an infection can occur.  Callus development on the feet can result from abnormal pressure and ill-fitting shoes.  Calluses are not only unsightly but they can be painful as well and indicate that there is an underlying bone deformity.  Dr. Popofski and Dr. Shanahan have several ways to treat these conditions and get your feet back in tip-top shape.

Call us at Lakes Foot and Ankles Associates to schedule an appointment!

Happy Summer!

Avoid the Holiday pounds and don’t hibernate too much this winter!!

Ring in the New Year with a resolution to stay healthy otherwise you may have “a weighty issue for your feet”.

There’s an epidemic that’s brewing worldwide and it threatens the health of millions of people. It’s obesity… and it takes a toll on the feet that have to support all that extra weight.

People with a body mass index (BMI) in the range of 25 – 29.9 are considered to be overweight. Those with a BMI over 30 are considered to be obese. For most people, BMI is considered to be a reliable indicator of body fatness. BMI is calculated based on a person’s height and weight.

According to anecdotal (informal) evidence, twice as many patients suffer from serious foot problems as compared to 10 years ago.

According to a survey of patients with past or current foot and ankle pain, or those who have undergone previous foot surgery, a higher BMI or a weight gain prior to the onset of pain seemed to be a fairly consistent factor.

Many people worry about the way they look when they are overweight instead of focusing on the more critical aspects of their health, including the toll that their weight takes on the musculoskeletal system, which includes the ankles and feet. Think of all that additional pressure on your feet and ankles – especially when you walk or climb stairs!

How do excess weight and obesity affect your feet and ankles? Too much pressure on the foot may cause a weakness in the muscles that support the arch in the foot. This changes the way in which you walk, which changes your posture, which can lead to back problems, bone damage and osteoporosis.

Foot and ankle pain usually affect the weight-bearing parts of the feet, along with tendons and ligaments. Some of the more common foot conditions include posterior tibial tendonitis, which causes pain in the tendon that runs down the inside of the ankle and the foot.

Another common problem that is aggravated by weight is plantar fasciitis – heel pain caused by inflammation of the ligament that supports the arch.

Osteoarthritis of the ankle joint is another frequent problem caused by obesity.

And then there’s the fact that obese people find it hard to even reach their feet, so they can’t see if anything is amiss; they usually wear low-heeled shoes with very little support; and they rarely get any exercise because of their weight, which helps them to pack on more pounds!

If you are overweight, we can help design a specific plan that addresses the problems in your feet to help you to walk more easily and exercise more. And that’s a great start to 2012 and getting the load off your feet!

Merry Christmas and Happy New Year from Lakes Foot & Ankle Associates!!!