What are Skin Cancers of the Feet?

Skin cancer can develop anywhere on the body, including in the lower extremities. Skin cancers of the feet have several features in common. Most are painless, and often there is a history of recurrent cracking, bleeding, or ulceration. Frequently, individuals discover their skin cancer after unrelated ailments near the affected site.

Causes

We often view the sun’s harmful rays as the primary cause of skin cancer, due to the fact that the condition is often found on parts of the body that receive the most sun exposure. While this may be true of some bodily skin cancers, it does not hold true for those that arise on the skin of the feet. Skin cancers of the feet are more often related to viruses, exposure to chemicals, chronic inflammation or irritation, or inherited traits. Unfortunately, the skin of the feet is often overlooked during routine medical examinations, and for this reason, it important that the feet are checked regularly for abnormalities which might be indicative of evolving skin cancer.

Types and Symptoms

Some of the most common cancers of the lower extremity are:

Basal Cell Carcinoma: Basal cell carcinoma frequently is seen on sun-exposed skin surfaces. With feet being significantly less exposed to the sun, it occurs there less often. This form of skin cancer is one of the least aggressive cancers in the body. It will cause local damage, but only rarely spreads beyond the skin. Basal cell cancers may appear as pearly white bumps or patches that may ooze or crust and are similar in appearance to an open sore. On the skin of the lower legs and feet, basal cell cancers often resemble non-cancerous skin tumors or benign ulcers.

Squamous Cell Carcinoma: Squamous cell carcinoma is the most common form of cancer on the skin of the feet. Most types of early squamous cell carcinoma are confined to the skin and do not spread. However, when advanced, some can become more aggressive and spread throughout the body. This form of cancer often begins as a small scaly bump or plaque, which may appear inflamed. Sometimes there is a history of recurrent cracking or bleeding. Occasionally, it begins as a hard, projecting, callus-like lesion. Though squamous cell cancer is painless, it may be itchy. Squamous cell cancer may resemble a plantar wart, a fungal infection, eczema, an ulcer, or other common dermatological conditions of the foot.

Malignant Melanoma: Malignant melanoma is one of the deadliest skin cancers known. Nonsurgical treatments are rarely effective and many remain experimental. This type of skin cancer must be detected very early to ensure patient survival. Melanomas may occur on the skin of the feet and on occasion beneath a toenail. They are found both on the soles and on the top of the feet. As a melanoma grows and extends deeper into the skin, it becomes more serious and may spread through the body through the lymphatics and blood vessels.

Malignant melanoma has many potential appearances, leading to its nickname, “The Great Masquerader.” This skin cancer commonly begins as a small brown-black spot or bump; however, roughly one third of cases lack brown pigment and thus appear pink or red. These tumors may resemble common moles; however, close inspection will usually demonstrate asymmetry, irregular borders, alterations in color, and/or a diameter greater than 6 mm. Melanomas may resemble benign moles, blood blisters, ingrown nails, plantar warts, ulcers caused by poor circulation, foreign bodies, or bruises.

When to Visit a Podiatrist

Podiatrists are uniquely trained as lower extremity specialists to recognize and treat abnormal conditions as they present themselves on the skin of the lower legs and feet. Skin cancers in the lower extremity may have a very different appearance from those arising on the rest of the body. For this reason, a podiatrist's knowledge and clinical training is of extreme importance for patients for the early detection of both benign and malignant skin tumors.

Learn the ABCDs of melanoma. If you notice a mole, bump, or patch on the skin that meets any of the following criteria, see a podiatrist immediately:

• Asymmetry - If divided in half, the sides don't match
• Borders - They look scalloped, uneven, or ragged
• Color - They may have more than one color. These colors may have an uneven distribution
• Diameter - They can appear wider than a pencil eraser (greater than 6 mm). For other types of skin cancer, look for spontaneous ulcers and non-healing sores, bumps that crack or bleed, nodules with rolled or "donut-shaped" edges, or discrete scaly areas

Diagnosis and Treatment

Your podiatrist will investigate the possibility of skin cancer both through his/her clinical examination and with the use of a skin biopsy. A skin biopsy is a simple procedure in which a small sample of the skin lesion is obtained and sent to a specialized laboratory where a skin pathologist examines the tissue in greater detail. To ensure that you receive the very best in care, your podiatrist will likely require that your skin biopsy be sent to a lab with board-certified dermatopathologists who have specialized training in the analysis of abnormal skin lesions from the lower leg and foot. If a lesion is determined to be malignant, your podiatrist will recommend the best course of treatment for your condition.


Content developed through generous support from Bako Pathology Services.

As track season is just beginning, I figured now would be the perfect time to write a blog about "stress fractures". Many athletes are now going through grueling workouts and conditioning - and with that comes the increased chances for a stress fracture. Often times this is a result of overuse and overwork. Equipped with some more information will help individuals become more aware of a potential problem and some preventative measures to take to avoid such a problem.

STRESS FRACTURE

WHAT’S THE PROBLEM?
Stress fractures are an injury to bone caused by unaccustomed stress from running, marching, or walking.  They are often seen in military recruits or athletes as they increase their training.  They may also be seen in people with hormonal imbalances or prior surgery that has altered the way their foot or ankle functions.

HOW DOES IT FEEL?
Stress fractures may feel like an ache in the foot or ankle or may feel like a sharp pain when a lot of stress is placed on the foot, or you are doing heavy physical activity.  You will also notice swelling around the site of the pain, but usually no bruising is present.

LET’S DO A TEST!
Your podiatrist will take an x-ray to determine if there is a break or crack in the bone.  After several weeks a large calcium deposit or bone callus may be seen around the stress fracture.  Your podiatrist may place a tuning fork on the area where he or she thinks a stress fracture may be located.  This will result in pain being noted at a very distinct location.  Finally, if doubt still exists about the diagnosis, a bone scan may be obtained, which shows increased bone production if a stress fracture is present.

HOW DID THIS HAPPEN?
Bone is a living, breathing tissue that also has large amounts of minerals that provide strength.  When increased stress is applied (sudden increase in exercise time or intensity) the bone responds by becoming stronger and denser where the extra stress is applied.  If there is not enough time for that adaptation to occur, small micro cracks develop.  In severe cases, these small cracks can result in a complete displaced fracture if treatment is not initiated.

WHAT WILL MY DOCTOR DO FOR IT?
After making the diagnosis of stress fracture, your doctor will tell you to decrease activity levels.  You may be instructed to wear a stiff soled shoe, to reduce bending motions of your foot when you walk.  Depending on the location and severity, your doctor may recommend a case and crutches.  As the pain becomes less intense, you may gradually resume your activity level.

CAN I PREVENT IT FROM HAPPENING AGAIN?
Never increase exercise levels too quickly’ no more than ten percent increase per week.  Always wear good supportive shoes that will absorb and cushion all the stress caused by your activity.  If your stress fracture was the result of a medical condition, closely follow your doctor’s instructions to prevent a recurrence.

It's one week and the pundits are still talking about who's better between Eli and Peyton, whether or not Tom Brady's legacy is tarnished and if the New England Patriots dynasty is over? While both the doctor and I have opinions on each the above, we can debate those points with you in the office. However, one thing we do know is that a Town Center Foot and Ankle dynasty has just begun! Dr. Wilusz and I put our heads together and successfully crafted a championship of our own, by winningAdvanced Physical Therapy Center's Super Bowl contest.

In short, there were 20 questions and prop bets pertaining to the Super Bowl ranging from answering who would win the game to what color Gatorade would be dumped on the winning coach. And for the record, we picked the color of the Gatorade correctly. Thank you to Linda Clay for putting the contest together, and for our prize for winning! We were presented with an awesome Coleman Grill on Friday and are excited to put it to use as soon as the weather breaks. We had a lot of fun and hope to defend our championship next year!

Now that we're all well on our way to a more healthy and fit 2012, I felt this was a good time to include a blog post about Achilles tendonitis. Because many of us are so busy in our daily lives, when we workout, we are so eager to get in and out of the gym we often forget - or choose not to - properly warm up and stretch. With increased physical activity it is imperative we do proper warm ups and stretches to prevent injury. One of these injuries I see a lot is "Achilles tendonitis".

I've taken the time to put together some information about what "Achilles tendonitis" is, how it can happen and what a podiatrist can do for it. While I hope you aren't experiencing any of these symptoms, if you are, I strongly advise you schedule an appointment so we can diagnose and treat the problem.

WHAT’S THE PROBLEM?
Tendonitis is the inflammation of a tendon, the structure that connects a muscle to its bone.  There are several tendons in the foot and ankle that are commonly affected.  The inflammation can occur after trauma, from overuse, or as a result of another medical problem such as arthritis or collagen vascular diseases.   The inflammation puts pressure on the surrounding nerves, causing pain and releases certain chemicals that damage the tendon, causing further pain and sometimes altering the structure of the tendon.

HOW DOES IT FEEL?
Most patients feel an aching pain in the area of the inflammation.  There may also be swelling and/or weakness of the involved tendon.  The pain usually increases with an increase in activity.

LET’S DO A TEST!
Your doctor will examine your foot, moving it through various motions to evaluate more specifically where the pain is originating.  You may be asked to stand or walk so your doctor can determine if your foot structure or walking pattern are affected by or causing the problem.  If tendon damage is suspected, you may be sent for a special test such as an x-ray, MRI, or ultrasound.

HOW DID THIS HAPPEN?
There are a number of ways that tendonitis may develop.  A common cause is overuse, usually occurring after an increase in your activity level, or from improper or inadequate stretching before a work out.  Improper or excess motion in the tendon around the joint may create tiny tears in the tendon, which triggers the inflammation that causes the pain.  Tendonitis may follow trauma, such as ankle sprains, or may be the result of a medical problem such as arthritis.

WHAT CAN I DO FOR IT?
In most cases, applying ice and taking Tylenol, or non-steroidal anti-inflammatory medication will relieve the pain.  Keeping the foot elevated, decreasing your activity level for a couple of days, and wearing a compressive dressing such as an ace wrap will also help a great deal.

WHAT WILL MY DOCTOR DO FOR IT?
If the pain continues, your doctor may send you for physical therapy, such as contrast baths, ultrasound, massage, electrical stimulation, and/or stretching and strengthening exercises.  You may need to start wearing orthotics.  In more severe cases, the tendon may need to be surgically repaired.

CAN I PREVENT IT FROM HAPPENING AGAIN?
The best way to prevent tendonitis is to stretch properly before any work out or athletic event.  Wear high quality, supportive shoes that are made for your specific foot type.  If you have been prescribed orthotics, wear them as directed.  Finally, keep in good communication with your doctor so that if a problem arises, it can be treated quickly and accurately.

Because we often indulge in all the goodies available to us during the holiday season, there is often a spike in the occurrence of gout cases doctor sees. While gout is not caused by our diet, gout can be triggered by one's diet. The type of foods most associated with triggering gout are: beef, pork, lamb, beer, mushrooms, spinach cod, scallops, haddock, asparagus, oatmeal and dried beans - to name a few. Continue reading below to gain a better understanding of what gout is, how it happened and some things we can do to resolve this issue.

WHAT’S THE PROBLEM?
Gout is a systematic disease (i.e. condition that occurs throughout the body) caused by the buildup of uric acid in the joints.  An elevated blood level of uric acid (called hyperuricemia) occurs when the liver produces more uric acid than the body can excrete in the urine, or when a diet high in rich foods (e.g. red meat, cream sauces, red wine) produces more uric acid than the kidneys can filter from the blood.

Over time, uric acid in the blood crystallizes and settles in the joint spaces, causing swelling, inflammation, stiffness, and pain.  Gout usually affects the first metatarsal phalangeal joint of the big toe (hallux) or the ankle joints.

HOW DID THIS HAPPEN?
Gout is caused by the buildup of uric acid in the joints.  Approximately 18% of people who develop gout have a family history of the condition, according to the National Institute of Arthritis and Musculoskeletal and Skin Disease.  Diseases and conditions that increase the risk include diabetes, obesity, kidney disease, and sickle cell anemia.

Regularly drinking alcohol interferes with the removal of uric acid from the body and can increase the risk of developing gout.

HOW DOES IT FEEL?
Gout usually develops in the joint of the first toe (i.e. the big toe, or hallux).  Common symptoms included the following: inflammation, pain, redness, stiffness and swelling.  Touching or moving the toe may be intensely painful and patients often say that having as a bed sheet over the toe increases joint pain.

WHAT WILL MY DOCTOR DO FOR IT?
The goal of treatment is to decrease the amount of uric acid in the joints, which helps to reduce symptoms and prevent further attacks.  If left untreated, affected joints may be damaged, causing disability.

Treatment may involve nonsteroidal anti-inflammatory medication.  Due to potentially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.  Corticosteroids may be taken orally or injected into the affected joint.  These medications usually resolve symptoms in about a week.

CAN I PREVENT IT FROM HAPPENING AGAIN?
Prevention is the best defense against gout.  Medication may prevent continued accumulation of uric acid in the joints and further attacks.  Avoiding alcohol and rich foods that are high in purine (i.e. scallops, sardines, red meat, sweetbreads, gravy, cream sauces) also may help to prevent the condition.

Other preventative measures include the following:

·        Drink plenty of fluids (especially water)

·        Exercise regularly

·        Maintain a healthy diet and healthy body weight

·        See a physician regularly

·        Acute Flare-ups should be treated immediately!