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Posts for: March, 2015

March 22, 2015
Category: Surgery

    It amazes me when I hear a marketing guru (who has little knowledge of podiatry) tell his "herd" (all of those who follow him) that one of THE most successful ad campaigns has been run in the National Enquirer for years - and is worded something like this : "CORNS GONE IN FIVE DAYS OR MONEY BACK!"  No - he isn't lying - and I have a great deal of respect and admiration for the man who took note of this fact, and I am sure he is right.  It IS a great headline to SELL something!   What the company is or was selling (I don't subscribe to the National Enquirer, so I don't know if the ad is still being run) is a product containing SALICYLIC ACID.  While this topical acid preparation is an appropriate treatment for WARTS, which are only skin deep, and due to a virus, this is the WRONG treatment for a corn.  Not only will Saliylic acid NOT "get rid of corns", in many people it causes very undesirable side effects:  INFECTION, ULCERATION, and in those with circulatory problems and diabetes maybe even AMPUTATION!   Of course, there are always disclaimers, in very fine print, that tell those with diabetes and/or vascular disease NOT to use the product.  By this time, the product has probably already been bought and paid for.  In addition, many of those with diabetes have problems seeing the fine print, but the company selling such products made sure they could read the CORNS GONE OR MANY BACK headline.  It is true that these acid preparations will cause the corn (dead skin) to "peel off", but  this is a temporary fix and is due to the "medication" or pad containing the acid to BURN the skin!   Buyer beware!

   Corns are a buildup of thick skin, almost always forming over a bony prominence.  The are most common on the top of a hammertoe (a toe which is contracted or "bent" such that the tip of the toe now touches the ground and the top of the toe "sticks up" rubbing the shoe), on the tip of a toe (from pressure being displaced and now the tip of the toe has weight on it rather than the bottom of the toe), OR between two toes (often called soft corns) such as when two toes are too close together and rubbing, causing the pressure to occur over a bony "spur".  There are basically only three ways to safely treat corns.  One is to trim them, or have them trimmed.  Podiatrists do this all the time.  It is not surgery and is often called routine foot care, similar to a dentist doing cleaning of the teeth or other hygienic measures to prevent further problems.  It is not glamorous, or difficult, but a patient should not be using a blade or a scissors to trim a corn or callous.  The second is to relieve pressure on the outside of the toe.  This can include padding, lamb's wool, silicone sleeves or toe crests to either keep the toes aprart, or relieve pressure from the top or sides of the toe.  Neither the first nor second option will "get rid of the corn."  In some cases, however, this may be the best option.  If the individual is not in good health, has peripheral vascular disease, or just isn't ready for surgery, these first two options will reduce discomfort, make it easier to walk, and at least give relief for some time.

   Surgery for a corn does not mean "cutting the corn out as deeply as possible."   It typically means correcting the underling bony deformity.  If the toe is crooked, straighten it.  If there is a "spur" on the side or end of the toe, remove it.  Sometimes a combination of the two are done to relieve pressure by repositioning the toe(s) or even shortening them slightly to redistribute weight on them.  This can always be done under a local anesthetic agent, and in an office setting as long as the physician has a sterile set up and the appropriate instruments.  In many cases, the procedures may take only 30 minutes or less.  In the vast majority of cases, the patient can walk right away, albeit it in a surgical shoe or boot, and with limited time spent on the feet.  Of course, as with any surgery, there are always possible risks, such as slow healing, infection, prolonged swelling, etc.  The incidence of severe complications, however, is very low.  Sometimes the risk of NOT doing surgery outweighs the risks of the surgery.  If a diabetic patient has a corn which becomes ulcerated, and the ulcer cannot be closed with conservative treatments, surgery may be indicated.  As long as the circulation is adequate, and the blood sugar is under control, there may be a higher risk of amputation if the underlying toe deformity is ignored.  That could lead to bone infection (osteomyelitis), spread of the infection, loss of limb, and even loss of life.

   No matter which option is chosen for treatment of a painful corn and/or underlying toe deformity, anyone or any company which promises "CORMS GONE IN FIVE DAYS OR MONEY BACK!" is not to be trusted.

   Richard S. Eby, DPM

   3603-E Ringgold Road

   Chattanooga, TN>  37412

(423) 622-2663

March 08, 2015
Category: F.Y.I.
Tags: foot   numbness   burning  

   For many, peripheral neuropathy is a painful, nagging, debilitating, and even dangerous condition.  Periperal neuropathy refers to progressive and degenerative changes that take place in the hands and feet off a growing number of people.  The feet, and especially the toes and ball of the foot, are affected sooner and more severely than the fingers and hands.   The most common underlying cause of these nerve changes is from DIABETES.   There are many other causes, however, including the use of -statin (cholesterol  lowering) medications, chemotherapy agents, vitamin deficiency, alcohol abuse, exposure to toxic chemicals and heavy metals (including lead, mercury, and aresenic), and the list goes on and on.  Surprisingly, the second biggest cause of peripheral neuropathy is IDIOPATHIC, meaning no underlying cause can be identified.  This is often seen in otherwise healthy individuals who have family memebers that are diabetic, people often labeled "prediabetic" (who show signs and symptoms of diabetes years later), and others for whom no underlying abomality is seen.

    Symptoms of neuropathy include NUMBNESS, PINS and NEEDLES sensation, BURNING, SHARP PAINS,  LACK OF COLD AND HOT DISCRIMINATION, PARESTHESIAS (unusual feeling such as "crawling sensations" or feeling things that aren't really there).  All of these are classified as SENSORY neuropathy - meaning things that you feel and should not feel, or (more importantly) NOT feeling things that you should feel.  Many people with neuropathy develop slow healing and non-healing ulcerations and infections because of cuts, puncture wounds, pressure from poor fitting shoes, and other external agents.  They may have good circulation, and if diabetic, their blood sugar may be under good or even excellent control, but they may lose a toe, foot, or leg because of NOT feeling something they should feel.  I have seen many bone infections, known as osteomyelitis, that resulted in amputation of a toe (at best), to loss of a leg (much worse), to loss of life (eventually) because of waiting until it was TOO LATE to get treatment.  This is often simply because "it didn't hurt" and the patient down-played the importance of that cut or ulceration until a spouse or other family member noticed blood, or drainage, or a bad odor.  Before it ever got that far, the "normal" non-neuropathic patient would have been in so much pain, they could not sleep at night, walk, or do anything other than "stop the pain!"

   There is no "cure" for neuropathy, but there are treatment options.  Often, a simple biopsy, known as an ENFD (Epidermal Nerve Fiber Density test) can be done to determine how much of the neuropathy is from the small (micrsocopic) nerve fibers.  A piece of skin 3mm in diameter is taken from just above the ankle, sent to a lab, and stained.  The number of nerve fibers per millimeter of skin is calculated, and this can give the treating physician valuable information in guiding treatment.  Nerve conduction studies or EMGs can also be done if the degree of large fiber neuropathy is to be determined.  Various drugs can be used for the PAIN of neuropathy.  These include over the counter pain relievers and anti-inflammatories such as tylenol, Aleve, or Advil.  Prescription drugs such as Neurontin (Gabapentin), Lyrica, and Cymbalta can also be used, and are often more effective for those with a moderate to moderately severe degree of neuropathy.  The bad thing is that all of these drugs can have side effects.  Many of them are dose-specific (Gabapentin for example has few side effects in low doses, but can cause memory loss, dizziness, and more in high doses).  Then...there are the narcotic drugs... best for those with SEVERE Neuropathy, because they are habit forming/addictive and have a whole host of possible side effects.  Constipation, respiratory depression, and much more is associated with prolonged narcotic use. 

   Safer, alternative treatments for peripheral neuropathy are becoming more common.  VITAMIN therapy is very helpful in many cases.  Alpha Lipoic Acid is one that I have found to be very useful.  It takes some time for this to help, but unlike many of the Rx. medications, this often reduces the numbness.   The "feeling" that has been lost in the foot or toes often returns.   I have found that many people using a combination of low dose gabapentin (for mild nocturnal pain), along with 600mg of alpa lipoic acid three times daily, can often keep their pain level low, and after 2-3 months see much of their "lost sensation" returning.  Benfotiamine is another vitamin that is often used successfully in many patients with neuorpathy.  A Thiamine blood level can be determined by a local lab, and if Thiamine is low, the use of Benfotiamine almost always helps.   A prescription "medical food" (classified that way by the FDA because it isn't a drug, but isn't really a vitamin either) known as Metanx is helpful also, especially in those where an ENFD is done and the nerve count is only mildly to moderately abnormal.  This actually will REGROW nerve endings in many people. 

   In my office, we are seeing great results also with LASER therapy for neuropathy.  This is a non-invasive therapy where a focused light beam is directed to the larger nerves in the feet, ankles, and sometimes lower legs, which can bring more circulation into the area, reduce inflammation, and actually heal damaged tissues at a cellular level.  The patient comes into the office for about 10 to 15 visits, usually spaced a few days apart, and receives treatments of each foot/ankle/leg for  10 to 15 minutes.  There are no side effects, and we have found that either a COLD (Class III) or HOT (Class IV) laser can be used for this condition.  In some cases, we use more than one frequency and "pulse" the laser for best results.   The treatment is relatively new, not available in many areas of the country, and is NOT covered by insurance.  Not only does this result in significant PAIN RELIEF, but also brings sensation back to previously "numb" areas, reducing the chance of infection, ulceration, and eventual amputation.  Of couse, this treatment can be combined with OTHER therapy - such as nutritional and vitamin therapy, for the best results. 

    As we see growing numbers of diabetics in the United States, and those individuals live longer because of better blood sugar control, successful treatment of related kidney and heart disease, there is bound to be MORE cases of peripheral neuropathy.  When we also take into account the cases of IDIOPATHIC neuropathy and those who have been successfully treated for cancer with chemotherapy and radiation, there is no question that neuropathy is going to be a problem for a lot more people.  Adequately evaluating and treating this condition becomes more and more important, so that people can lead happy, healthy, and active lives. 


Dr. Richard S. Eby

(423) 622-2663

March 01, 2015
Category: Laser Treatments
Tags: chattanooga   laser   therapy   ankle  

An ankle sprain is a very common injury seen in people of all ages.  The term "sprain" implies that the ankle was turned (usually with the bottom of the foot turned IN or toward the middle of the body) and is often called an INVERSION ANKLE INJURY.  There are other types of injuries to the ankle, but the vast majority of them are inversion injuries.  The fibula (the long thin bone running on the outside of the leg from the knee to the ankle) can be fractured, and this is easily identified on x-rays.  For purposes of this discussion, however, we are going to assume there is NO fracture, and the injury is a soft tissue only injury.  There are three degrees or GRADES of sprain - I, II, and III.  This refers to the severity of the sprain, and whether the ligaments are stretched (I), partially torn (II) or completely torn or ruptured (III).

Ankle sprains are treated in a number of ways.  Conservative treatment typically consists of R.I.C.E.  This stands for Rest, Ice, Compression, and Elevation.  We should also consider IMMOBILIZATION for the Grade II and Grade III sprains, meaning the foot and ankle are put into something to keep them from moving excessively.  Walking boots, aircasts, splins, and fiberglass or plaster casts are typical forms of immobilization.   A cast is used when complete immobilization is needed, and the foot must be held still and not allowed to move at all.  Other forms of immobilization are more partial forms of immobilization, in that the foot can move a little in the device, but the amount of motion is restricted.  In a Grade III stage, surgery has to be considered in some cases.  This is particularly true in the younger competitive athletic individual, where primary repair of the liagment(s) - basically sewing them back together or repairing them as soon as possible after the injury can prevent scar tissue, weakness, instability, and loss of function.

A newer way to treat these types of injuries, especially in the Grade II or MODERATE injury, is with laser treatment.  We are not talking here of laser surgery, but of laser therapy.  The injured person has anywhere from 3 to 5 treatments in an office setting, space 1-3 days apart, and is given a treatment with a CLASS IV laser.  This is also known as HDLT or High Dosage Laser Therapy.  In my office, we use the Diowave 30 watt laser.   This is done without anesthesia, and the patient feels only a profound sense of warmth during each treatment, which ranges from 10 to 20 minutes in length.  This is a deep pentrating light energy delivered into the body to reach damaged cells and tissues.  This not only makes the patient feel better, but results in healing of damaged tissues at a much faster rate.   Healing of ankle sprains is often 20 to 30% faster than by conventional means of treatment alone (ice, rest, immobilization, etc.).    The patient can still ambulate, although it is still beneficial to restrict movement with a walking boot or pneumatic walker.  The patient also experiences a lot less pain and swelling during the recovery.  If this is an athletic individual, it is often possible for him or her to return to sports acitivites much quicker.  As with any other conservative treatment, the sooner treatment is started, the better the outcome.  Unlike some forms of treatment, however, this type of laser can be used for CHRONIC, as well as ACUTE pain and swelling.

If you, or someone you know, has a foot or ankle sprain and needs a little extra help in healing it, call our office.  We are here to help.


Dr. Richard S. Eby