Treat Heel Pain with Sculptra Injections

Treat Heel Pain with Sculptra Injections

Don’t suffer with heel pain anymore! Sculptra Injections provide foot relief in as few as one visit.

Sculptra Injections are available for patients who have pain in the ball of the foot where there are bony prominences and/or recurrent calluses. The injectable liquid is used to add volume to areas of the body to create a soft, natural cushion. Sculptra is very safe and, in 2009, received full FDA approval for cosmetic use in the United States.

The liquid consists of a synthetic lactic acid that is made in a laboratory and contains no animal or human DNA derivatives. It very gradually disappears by the action of your own cell breakdown, but results will most often last up to two years.

Patients will notice an immediate increase in tissue volume after their first visit. It is also possible for a continued increase of volume for the next 90 days as the body will produce more collagen, which provides even more comfort. You might experience a little bruising and swelling, which is normal and should only last up to a week.

Overall, Sculptra:

  • Lessens pain under the ball of the foot
  • Lowers callus formation
  • Reduces arch, back, knee and hip pain
  • Shortens foot fatigue and muscle cramping
  • Diminishes plantar fasciitis and heel spurs
  • Provides lasting results for years

This minimally invasive office procedure is suitable for men and women and provides cushion for painful bony prominences in the feet. Depending on the amount of correction needed, usually only one treatment per year is needed to maintain the correction.

There is minimal downtown post-surgery, and, if side effects are experienced, they are generally very nominal and short lasting. There is a slight chance that you could develop small, usually invisible temporary bumps, but these will go away on their own. Small visible bumps are also very rare, but can be remedied with a little bit of an anti-inflammatory injected into the bump.

The board-certified doctors at Certified Foot & Ankle Specialists are able to provide excellent patient care and avoid small problems becoming large problems. With seven office locations located in Martin, Palm Beach and Broward counties, you are able to receive the care you need, when you need it.

Understanding and Treating Varicose Veins

Understanding and Treating Varicose Veins

By Dr. Luke Maj

Even if varicose veins aren’t causing you any pain, you might be considering treatment options because of how they make you feel. They most often appear dark purple or blue and some patients state that it keeps them from enjoying their normal lifestyle because they want to avoid their legs or feet from being shown. The good news is that your podiatrist is able to help treat varicose veins so you can get back to being your best, active you.

Varicose veins are gnarled, enlarged veins that most commonly appear in legs and feet, and are a result from a failure of tiny valves inside the veins of the legs. In healthy veins, these valves help to move blood out of the legs and back to the heart. However, if these valves don’t function properly, they can allow blood to flow backward and pool within the veins. This causes an increase in pressure in the vein, and causes them to enlarge.

While this condition can happen to any of your veins, it most commonly occurs in your feet or legs because the pressure in the lower body’s veins increases when you stand or walk. Several risk factors can contribute to the likelihood that you will develop varicose veins, and can include:

  • Age – your veins lose elasticity as you age
  • Gender – women are more likely than men to develop varicose veins because female hormones have a propensity to relax vein walls
  • Obesity – being overweight adds pressure to your veins
  • Genetics – you have a greater risk of developing varicose veins if other family members did
  • Sitting or standing for extended periods of time – your blood does not flow well if you stay in the same position for a long period of time

While the condition of varicose veins is unknown, they are generally benign. They are very common and affect more than 3 million cases per year. Varicose veins can last for a few years or a lifetime, and while treatment can help, the condition cannot be cured.

In most cases, there are no symptoms and varicose veins are simply a cosmetic concern. However, in some cases, they can cause aching pain and discomfort, and can ache, burn or throb. Sometimes, they can also signal an underlying circulatory problem.

The first step for treating varicose veins includes lifestyle modifications including exercise; losing weight; elevating your legs; wearing comfortable clothing; eating a low sodium, high fiber diet; and avoiding sitting or standing for long periods of time. Conservative treatment can also include compression stockings, which help to keep blood from pooling in your legs. These methods can be effective in easing pain and preventing existing varicose veins from worsening. If necessary, your doctor might recommend sclerotherapy, laser surgery, or catheter-assisted procedures to shrink and close enlarged veins. If ulcers have developed as a result of varicose veins, antiobiotics and pain medication may also be prescribed.

In addition to taking at-home measures to reduce varicose veins, you can also seek treatment at Certified Foot & Ankle Specialists. The team of doctors is able to effectively treat a wide range of conditions, including varicose veins, spider veins, and more, to help you enjoy a greater quality of life.

If you would like to seek professional care for treating your varicose veins, visit Dr. Luke Maj by calling (561) 995-0229 or visit www.certifiedfoot.com to make an appointment. Dr. Maj is the vein specialist at Certified Foot & Ankle Specialists and has a comprehensive background in minimally invasive interventional procedures, including national presented work in radio-frequency tumor ablation assisted by contrast-enhanced ultrasound, as well as dedicated to research in limb salvage via catheter-directed thrombolysis.

The pedCAT Weight-Bearing CT Machine Offers Patients Revolutionary Care

The pedCAT Weight-Bearing CT Machine Offers Patients Revolutionary Care

By Dr. Kyle Kinmon

Certified Foot & Ankle Specialists is the first and only podiatrist office in South Florida to offer patients the state-of-the-art pedCAT machine. This machine is a weight-bearing computerized tomography (CT) imaging machine that offer cutting-edge imaging for foot and ankle patients.

Standing CT scans provide greater insight on what may be actually causing foot pain because bone and joint alignment in the feet change when a person stands upright versus when they lie down. Certified Foot added this technology to aid its eight podiatric surgeons in providing state-of-the-art care to their patients so they can properly diagnose foot and ankle conditions.

“With the advent of weight-bearing CT scans, the surgeon will now be able to more fully evaluate bone structure and joint integrity under the patient’s weight-bearing conditions,” said Dr. Kyle Kinmon, a podiatric surgeon at Certified Foot. “This will greatly enhance the understanding and planned treatment for complex disorders of the foot and ankle, increasing our success rate and the overall experience for our patients.”

Foot and ankle specialists rely on “weight-bearing” X-Rays to treat their patients, and will often redo the X-Ray study if a patient comes in with a non-weight bearing study from an emergency department visit. If the standing X-Ray is inconclusive, physicians will often order a CT scan.

Regular CT scans combine a series of X-Rays taken from multiple angles to reconstruct a three-dimensional look at the patient’s bones and joints. However, the patient must be lying down for a regular CT study, and this does assist with assessing bone and joint alignment. The pedCAT machine takes a scan in less than 60 seconds and does this with significantly lower radiation doses than seen with traditional CT units.

Standing CT imaging has the potential to change foot and ankle specialists’ understanding of fractures, midfoot complications and other subtle injuries, bunions, flat feet, sprains, arthritis, and diabetes related complications. There are only about 50 standing CT systems in the United States, and the closest one for patients is now in South Florida!

Certified Foot & Ankle Specialists, P.L. is a comprehensive podiatric team providing all general and specialty food and ankle services in seven convenient locations in Martin, Palm Beach and Broward Counties. The team of eight highly trained, board certified doctors deliver superior foot and ankle treatment in a caring and responsive environment with an emphasis on patient education and specialized attention. With the addition of this weight-bearing CT scan, the doctors can now see deep into the foot, where they could not before, which allows them to provide patients with the best solutions possible for their foot and ankle ailments.

Best Tips for Taking Care of Your Feet

Best Tips for Taking Care of Your Feet

By Dr. Kyle Kinmon

Your feet carry you around every day, so make sure you’re paying attention to them! There are easy steps you can take to keep your feet and ankles pain-free, and these include wearing the proper footwear, self-examining your feet daily, and good hygiene. Healthy feet will help you remain active and have a healthy lifestyle, so follow the guidelines below to properly care for your feet at home.

  • Make sure to properly clean and dry your feet. Use soap and water to clean your ankles, top and bottom of your feet, in between toes and under nails. It is also important to dry your feet well to avoid moisture sticking around to create a fungal infection. It is also a good idea to moisturize your feet daily, but don’t put lotion between your toes in an effort to prevent infection.
  • Pay close attention to your feet. It is important to give yourself a self-examination often (at least once a week) to make sure that you’re taking note of anything new or bothersome. Look for any scaling on your soles, peeling in between your toes, or discoloration of your toenail(s). It is especially important to provide great care to your feet if you are diabetic because you have a higher risk of sores and infections.
  • Cut your toenails properly. Toenails should be cut straight across, not too round at the corners, and not too close to the skin, as this can cause painful ingrown toenails.
  • Don’t ignore a discolored or thick nail, because this could be the sign of a nail fungus. Many people try to hide a cracked or crumbling nail with nail polish but this often makes the fungus worse.
  • Protect your feet when you’re not at home. It’s a good idea to wear sandals in a public shower, in the gym or at public pools. You have a higher chance of coming across fungus that can lead to infections.
  • Don’t share your shoes! This is true for sports shoes, sandals, walking or running shoes, as well as socks.
  • Keep your feet sweat free. You have 250,000 sweat glands in each foot, and it’s safe to say they are running on high alert throughout the day. To keep bacteria at bay, wear breathable shoes and socks that wick away moisture and keep your feet as dry as possible.
  • Wear shoes that fit properly. Did you know that nine out of 10 women wear shoes that are too small? This can cause long-term foot problems, as well as making it difficult to walk properly. It is also a good idea to rotate your shoes so you’re not wearing the same pair every day, and avoid sandals and flip-flops because they lack proper support.
  • Don’t succumb to “bathroom surgery!” Paying attention to your feet is key, but you do not want to take the health of your foot into your own hands. A licensed, trained podiatrist will be able to recognize and safely treat any redness, pain or swelling that you might be feeling, provide relief and track your progress.
  • Don’t smoke. Smoking impairs blood circulation, and is a great area of concern for people with diabetes. Maintaining healthy blood circulation to your extremities is very important to prevent amputation.
  • Never trim corns and calluses. Many over-the-counter medicines and do-it-yourself treatments can irritate your skin and make matters worse. Always see your podiatrist so he/she can properly care for corns and calluses you have.

The board-certified doctors at Certified Foot & Ankle Specialists are able to provide excellent patient care and avoid small problems becoming large problems. Practice these tips at home for great care of your feet and ankles. But, If you have an area of concern, call your doctor!

What are the Benefits of Stem Cells?

What are the Benefits of Stem Cells?

By Dr. Kyle Kinmon

Simply put, stem cells greatly accelerate your body’s ability to heal and repair damaged tissues, thus providing relief without surgery!

Stem Cells are cells within the body that have the remarkable capability of multiplying and dividing into different tissue types during early life and growth. Additionally, in many tissues, stem cells serve as an internal repair system, dividing essentially without limit. These cells have the potential to either remain a stem cell, or become another type of cell with a more specialized function, such as a muscle cell, red blood cell or brain cell.

We have a varying number of different types of stem cells that are located in different tissues in our bodies, such as bone marrow and fat. Mesenchymal stem cells, which are the type that can differentiate into tissues such as bone, tendon and muscle, can be harvested from your own body and can be very painful. Podiatrists, therefore, prefore another source: amniotic membrane. This is a human tissue that consistently contains high numbers of mesenchymal stem cells. These tissues possess properties that are extremely anti-inflammatory, anti-infective and non-immunogenic, and result in the replacement of normal tissue as opposed to scar tissue.

Amniotic membrane transplant tissue is collected from (thoroughly screened) donor mothers’ placentas at the time of c-section deliveries. The stem cell and stem cell products, including chemical messengers, proteins and scaffolding for healing, are then separated from the placentas, processed and preserved. This material is then injected into sites of chronic tissue damage, where it stimulates the body to heal those damaged tissues. The results have been amazing!  

Active adults who have been suffering with painful, chronic, degenerative conditions have seen major improvements, and most within days after the first injection. Stem cells also provide greater relief than Cortisone, which provides temporary relief of inflammation but is also detrimental to healing.

While stem cells offer a wonderful solution for many patients, it is important to note that stem cells, amniotic membrane treatment and/or Platelet Rich Plasma (PRP) are not the best treatment options for every patient or every condition. It is very important to discuss all treatment options with your physician, who is highly and thoroughly trained in, and offers, all forms of treatment for your condition.

The podiatrists at Certified Foot & Ankle Specialists are board-certified foot and ankle surgeons who are trained and experienced in all forms of conservative treatment, including regenerative medicine, so that they can provide the best, long term option for each patient. 

Underlying Adenocarcinoma of the Lung Metastasizing to the Proximal Phalanx of the Foot Causing Complex Regional Pain Syndrome

Underlying Adenocarcinoma of the Lung Metastasizing to the Proximal Phalanx of the Foot Causing Complex Regional Pain Syndrome

A Case Report
Sam Bazrafshan, DPM*
Maria Pacheco, DPM*
Julio C. Ortiz, DPM*

Journal of the American Podiatric Medical Association Vol 107 – No 2 – March/April 2017

We report an unusual case of adenocarcinoma of the lung metastasizing to the proximal phalanx of the third digit in a 56-year-old woman with overlying complex regional pain syndrome. The patient was initially treated for neuroma, fracture, and neuropathic pain with no improvement over a 4-month period before presenting to the emergency department for left third digit pain. Radiographic imaging showed substantial osteopenia and mottling; magnetic resonance imaging demonstrated an aggressive lesion to the proximal phalanx. The patient underwent excision of the lesion, revealing metastatic moderately differentiated adenocarcinoma. (J Am Podiatr Med Assoc 107(2): 150-154, 2017)

Metastasis of primary tumors to the foot is uncommon; however, when it does occur, the most common sources are colorectal, kidney, and lung. Metastatic bone tumors greatly outnumber primary bone tumors. Based on the literature, metastasis to the hands and feet (acrometastases) occurs in only 0.007% to 0.3% of patients with malignancies. Statistics indicate a frequency of metastatic foot lesions of less than 2%.

Metastatic lesions of the foot are rarely reported, likely because of the difficulty or delay in diagnosis.  Autopsy reports have documented that 20% to 70% of all patients who died of their malignant disease show microscopic evidence of osseous metastases. The first case of metastasis to the foot was reported in 1920 by Bloodgood.3 Metastatic tumors can occur in any bone in the foot. Lung carcinoma has been the most common malignancy reported to metastasize to the foot.

An increasing number of cases have been noted in the literature with findings of lung metastasis to the lower extremities. In 2002, a 71-year-old woman presented with atraumatic ankle pain, which resulted in a full radiographic work-up, revealing metastatic lung carcinoma to the distal fibula with bony erosion and pathologic fracture. Another such case involved metastasis of adenocarcinoma of the lung to the first metatarsal, initially diagnosed as gout. The patient underwent partial first-ray amputation and radiotherapy.

Although rare, adenocarcinoma metastasis to the phalanges of the foot has been reported. A similar case to the one encountered herein was a 67-year-old woman who presented with pain to the fifth digit, which resulted from metastasis of lung adenocarcinoma. The patient underwent excisional biopsy.7

Chronic regional pain syndrome (CRPS) is characterized by nonsegmental pain in one or more extremities combined with vasomotor instability, trophic changes, and radiographic osteopenia. It is now classified as two variants: CRPS I (reflex sympathetic dystrophy) is associated with a minor injury, fracture, or surgical procedure with no peripheral nerve injury, and CRPS II (otherwise known as causalgia) develops after damage to a peripheral nerve. Bone scans, particularly triphasic bone scans, add a higher degree of specificity for diagnostic purposes. However, CRPS is a clinical diagnosis and is sometimes considered a diagnosis of exclusion. In recent literature, the pathogenesis and mechanics have become better understood, but these are beyond the scope of this case report.

Reports of associations between CRPS and metastatic lesions are scattered throughout the literature. Various internal malignancies have been associated with CRPS since 1938, particularly the shoulder-hand variant. Two cases reported in 1984 of CRPS in the shoulder revealed an association with adenocarcinoma in the colon and axillary lymph node. Fewer cases have been reported in the lower extremity. A 2005 case of synovial sarcoma occurring in the knee of a 28-year-old woman was made 20 years after the onset of symptoms using magnetic resonance imaging (MRI) and needle biopsy. Findings from clinical examination and a triple-phase bone scan were consistent with a diagnosis of CRPS.

The purpose of this study was to contribute a case to the literature on the occurrence of metastasis of lung adenocarcinoma to the foot and its association, if any, with CRPS.

Case Report

A 56-year-old woman presented to the emergency department with pain in her left foot of 4 months’ duration after bumping her toe into a kitchen table. History revealed that the patient had initially sought treatment with several different physicians. She was treated for Morton’s neuroma and given corticosteroid injections, with no relief and exacerbation of her symptoms. She was referred to a neurologist, who sent her to undergo a nerve conduction study, which revealed no electrodiagnostic signs of peripheral nerve entrapment, although L5 radiculopathy was noted with electromyography. She was prescribed hydrocodone bitartrate and acetaminophen (Vicodin; AbbVie Inc, North Chicago, Illinois) and pregabalin (Lyrica; Pfizer Inc, New York, New York), again with little to no improvement, and was sent for physical therapy.

The patient returned to her primary care physician, who sent her for MRI of the foot, demonstrating a fracture of the left third proximal phalanx. She was referred to another foot and ankle specialist, who treated her with compression and immobilization in a pneumatic CAM Walker (Zinco Industries Inc, Pasadena, California). With her condition worsening she was further referred to a foot and ankle orthopedic surgeon, who evaluated her and diagnosed her as having neuritis and recommended

injections for relief of her symptoms. The patient refused the injections and presented to the emergency department with pain to her left third toe and foot with symptoms of electrical shooting and pin-pricking pain to her left lower extremity. The patient also stated that she has a history of bronchitis over the past several months and a 30-year history of smoking tobacco.

On examination, the pedal pulses to the left foot were palpable, with all sensations to the limb intact. Diffuse erythema with a mottled appearance was noted on the skin dorsally, with moderate pitting edema of the left leg and foot. The skin of the left lower extremity was intact, with no acute clinical signs of infection. Pain with palpation was elicited from the third toe, as was pain with passive, but not active, range of motion. Radiographic evaluation revealed asymmetrical diffuse osteopenia compared with the contralateral side, with an irregular mottled appearance to the marrow of the distal foot with an aggressive erosive process involving the shaft of the third proximal phalanx. Findings from chest radiography were within normal limits, seemingly without signs of pulmonary involvement. A work-up was performed in the hospital, and the patient was referred to our services as an outpatient.

The patient was sent for a triple-phase bone scan and a second MRI to rule out a pathologic fracture and to help diagnose CRPS. The triple-phase bone scan revealed increased vascularity in the left foot centered at the third digit. Patchy areas of uptake were seen throughout the left lower extremity, specifically the left foot, with intense uptake. Radiograph showing diffuse osteopenia and cortical erosion of all of the bones but specifically of the third proximal phalanx.

Patchy areas of uptake were seen throughout the left lower extremity, specifically the left foot, with intense uptake to the third digit in the immediate delayed images. Abnormal delayed tracer uptake was diffusely seen in the tarsal bones, metatarsal bones, and phalanges, which was highly suggestive of CRPS.

An MRI was performed immediately, and its findings described an underlying aggressive process occurring in the left third toe. The left proximal phalanx of the third toe showed marrow signal abnormality with an expanded appearance and loss of cortical detail extending to the surrounding soft tissue. Owing to these findings, the patient was scheduled for a biopsy to definitively characterize the pathologic process.

The patient was taken to the operating room for bone and soft-tissue biopsy of the left third toe. A 3- cm incision was made to the dorsal aspect of the third toe from the proximal interphalangeal joint proximally to the third metatarsophalangeal joint. With careful dissection, it was immediately apparent that there was considerable disorganization of the soft-tissue structures and an atypical appearance of the anatomy. On encountering the proximal phalanx, the bone was noted to be soft and the cartilage was not adhered to the head of the proximal phalanx. A No. 15 blade was used to resect the head of the proximal phalanx due to lack of bony integrity. Bone, cartilage, and soft-tissue specimens were sent for cytologic and histopathologic analysis. The incision was then irrigated and closed in a standard manner.

Bone and tissue analysis revealed that the preliminary histopathologic findings were consistent with a metastatic moderately differentiated bronchogenic adenocarcinoma. An oncology consultation and a positron emission tomography scan were completed to identify the exact location of the primary tumor. Once the positron emission tomography findings were confirmed to be positive for metastasis from the lungs, the patient was referred to oncology for further medical management.

Under the direction of an oncologist, the patient began chemotherapy in an attempt to slow the progression of her metastases. However, the patient died several months into her chemotherapy treatment.

Discussion

A review of the literature noted few reports of lung adenocarcinoma metastasis to the foot. The diagnosis of solitary metastasis to the foot is difficult. Initial presentation usually includes nonspecific complaints of a painful and swollen foot. The present patient’s delay in diagnosis was likely due to the vague symptoms elicited by the tumor. Often, patients are first worked up and treated for more common conditions. Thus, it is not unusual for symptoms in the foot to become apparent before detection of the primary tumor. If possible, a detected tumor should be biopsied. Based on the results of histopathologic analysis in conjunction with advanced imaging, the site of the primary lesion can be determined. The treatment goals should also include reduction of symptoms and maintenance of weightbearing function to the involved extremity.

Occurrences of primary lesions metastasizing to the foot are uncommon in the literature, but the delay in diagnosis may have something to do with that as well. Hattrup et al reviewed cases of metastatic involvement in the foot and ankle, of which the most common primary tumor was lung carcinoma. He also found that diagnosis was delayed 1 to 24 months. Eggold et al reported a case of adenocarcinoma in the lung with phalangeal metastasis. In 2005, Ramkumar et al presented a case of adenocarcinoma in the distal phalanx of the hallux with the primary lesion located in the lung. Although the lesion was excised and biopsied, however unusual these cases may be, bone metastasis should be in the differential diagnosis. Leeson et al showed a 1.7% occurrence of metastasis to the feet in 827 autopsied patients with cancer and only 0.6% to the hand.

Infrequently, CRPS is associated with malignant circumstances. Complex regional pain syndrome is characterized by spontaneous pain disproportionate to the inciting injury, hyperalgesia, allodynia, sensorimotor dysfunction, edema, sudomotor abnormalities, and skin color changes. The diagnosis of CRPS is a diagnosis of exclusion. Therefore, the present case illustrates the importance of identifying a possible etiology for the CRPS due to it representing a systemic process that may be triggered by injury in another area of the body. Metastasis to bone is the most common cause of pain in patients with cancer, with many patients experiencing pain even before skeletal metastasis becomes radiographically apparent.

It can, therefore, be suggested that CRPS may represent a paraneoplastic syndrome in some cases.  Ku et al14 suggested a causal relationship between their two cases of breast adenocarcinoma and lymphoma and the association with CRPS. However, as the mechanism of CRPS has become more recently understood, it is difficult to assess the relationship, if any, with malignancy.

It is speculation, in this case, whether the presence of CRPS was related to the ensuing metastatic adenocarcinoma or whether asymptomatic malignancy could have contributed to the pain biology and clinical presentation. It is difficult to deduce whether this patient developed CRPS as a result of the increasing aggression of the bone tumor to the area or whether this was a case of paraneoplastic syndrome, as suggested by other articles. The onset of CRPS without obvious injury or trauma may warrant a work-up for malignancy.