It's Summer!- Learn the ABC's of skin cancer and tips for prevention

Early detection is extremely important! The prognosis of melanomas and other skin cancers is drastically better for those whose cancer hasn’t yet spread to the lymph nodes. Often, skin cancer often develops in unusual looking moles or skin lesions. In podiatry, there are certain types of melanoma that can appear under toenails as well. A biopsy is the only way to determine whether the spot is benign or malignant. 

A stands for asymmetry. If you draw an imaginary line through the center of a mole, the two halves will look different in shape, color or both.

B is for border. Look for edges that are uneven, scalloped or blurry.

C is for color. A normal mole is one color throughout. Melanomas may contain different colors or different shades of a color.

D stands for diameter. Most melanomas are ¼ inch (roughly the size of a pencil eraser) or larger.

E stands for evolving. This means that a mole or lesion is changing and could indicate malignant progression.

Tips for Prevention

1. SPF!

Putting on sunscreen or lotion with UVA and UVB protection as regularly as deodorant is a habit you will thank yourself for later.

Whatever product you choose, the sun protection factor (SPF) should be at or above 30 (97% of UVB ray protection) for long periods of sun exposure and at or above 15 (93% of UVB ray protection) for daily use. For longer outdoor activities, especially ones involving water and/or sweat, repeated application is a must. Be sure to follow reapplication directions on the label of your sun protection product. Embrace Shade and Protective Clothing

2. Know Your Own Personal Risks

Skin cancer does not discriminate, but there certainly are factors that increase a person’s risk. In addition to increased UV and UVB ray exposure, risks prove higher in individuals that suffered severe sunburns in the past, those with fairer skin and hair, those with a family history of skin cancer, prevalent moles or a weakened immune system and those living in sunny or high-altitude areas. Caucasians and men 50 years or older are at a higher risk for developing melanoma than the general population. Individuals with skin of color are more prone to skin cancer in areas less exposed to the sun, including the palms of the hands, soles of the feet, the groin, under the nails, as well as the inside of the mouth. 

3. Regular Screenings

An essential step in skin cancer prevention is regular screenings. Dermatologists can assess and recommend how often a person needs a skin exam based off personal risk factors. It is recommended that individuals with a family history of melanoma or other skin cancers should have a full-body exam at least once a year. Another beneficial habit is monthly skin self-exams to check for new or changing moles. Approximately half of melanomas are self-detected.

Our skin is the largest organ on our body, so why wouldn’t we prioritize its health as much as other parts of our body?

Can I Get A Cortisone Injection After Having My COVID Vaccine?

 From the American Academy of Orthopedic Surgeons Patient Safety Committee 

The AAOS Patient Safety Committee recommends avoiding musculoskeletal corticosteroid injections for two weeks before and one week after COVID vaccine administration.

Musculoskeletal corticosteroid injections are common procedures which are most often performed in an elective, outpatient setting. These can include intra-articular, bursal, tendon, and neuraxial injections. Currently there is no direct evidence of the impact of corticosteroid injections on vaccine efficacy.

Corticosteroid injections have been shown to cause hypothalamic-pituitary-adrenal suppression. Increased risk of influenza infection has been associated with corticosteroids. It is unknown if corticosteroid injections could result in decreased immunogenicity which could reduce vaccine efficacy. The majority of musculoskeletal cortisone injections are elective procedures that can be safely postponed or rescheduled. Given the potential risk of diminished vaccine benefit, caution is appropriate.

When possible, surgeons should consider using shorter-acting corticosteroid medications and the lowest effective dose.

Surgeons should have an informed discussion with each patient regarding the potential risk of decreased vaccine effectiveness. Special circumstances need to be considered. There will be appropriate exceptions to these guidelines as some patients will choose to proceed with the injection despite potential risk. Surgeons should engage each patient in shared decision-making to ensure appropriate informed consent.

These recommendations are based on the best currently available clinical evidence and may be subject to update as more evidence is available.

References:

1. Manchikanti L, Kosanovic R, Vanaparthy R, Vangala BP, Soin A, Sachdeva H, Shah S, Knezevic NN, Hirsch JA. Steroid Distancing in Interventional Pain Management During COVID-19 and Beyond: Safe, Effective and Practical Approach. Pain Physician. 2020 Aug;23(4S):S319-S350. PMID: 32942792.
2. Habib G, Jabbour A, Salman J, Hakim G, Haddad H. The effect of epidural methylprednisolone acetate injection on the hypothalamic-pituitary-adrenal axis. J Clin Anesth. 2013 Dec;25(8):629-33. doi: 10.1016/j.jclinane.2013.07.002. Epub 2013 Aug 27. PMID: 23988802.
3. Sytsma TT, Greenlund LK, Greenlund LS. Joint Corticosteroid Injection Associated With Increased Influenza Risk. Mayo Clin Proc Innov Qual Outcomes. 2018 Mar 20;2(2):194-198. doi: 10.1016/j.mayocpiqo.2018.01.005. PMID: 30225449; PMCID: PMC6124339.
   Ginzler E, Diamond H, Kaplan D, Weiner M, Schlesinger M, Seleznick M. Computer analysis of factors influencing frequency of infection in systemic lupus erythematosus. Arthritis Rheum. 1978 Jan-Feb;21(1):37-44. doi: 10.1002/art.1780210107. PMID: 414759.
1. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, Perez JL, Pérez Marc G, Moreira ED, Zerbini C, Bailey R, Swanson KA, Roychoudhury S, Koury K, Li P, Kalina WV, Cooper D, Frenck RW Jr, Hammitt LL, Türeci Ö, Nell H, Schaefer A, Ünal S, Tresnan DB, Mather S, Dormitzer PR, Şahin U, Jansen KU, Gruber WC; C4591001 Clinical Trial Group. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020 Dec 31;383(27):2603-2615. doi: 10.1056/NEJMoa2034577. Epub 2020 Dec 10. PMID: 33301246; PMCID: PMC7745181.
2. U.S. Centers for Disease Control and Prevention. How CDC is making COVID-19 vaccine recommendations. Updated 3/3/2021, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations-process.html

What is tarsal tunnel syndrome?

 

The tarsal tunnel is a compartment found on the medial (inner) side of the ankle, through which tendons and nerves and vascular structures traverse to enter the foot. Similar to carpal tunnel syndrome in the hand, the nerve that runs through here (posterior tibial nerve) can become compressed, causing debilitating symptoms. 

 

Symptoms include inner ankle and heel pain, burning, tingling and numbness. 

 

Conditions that can initiate or exacerbate tarsal tunnel include over pronation, prolonged weight bearing activity, pressure from shoe gear, lower extremity swelling, varicose veins, hypothyroidism, diabetes and arthritis. 

 

Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms. Studies used to evaluate nerve problems—electromyography and nerve conduction velocity (EMG/NCV)—may be ordered if the condition shows no improvement with nonsurgical treatment.

 

Treatment options may include rest, anti inflammatories, orthotics, supportive comfortable shoes, physical therapy, immobilization, and in some cases surgery. As with most conditions, tarsal tunnel syndrome is best managed when caught early. If you think you are experiencing tarsal tunnel syndrome give our office a call to find out what your treatment options are! 440-774-1100

Get Your Feet in Shape for Spring!

After hibernating all winter, nothing beats getting outside and getting active at the first sign of spring weather. The sudden jump in activity after months of laying low with little to no activity increases the risk for developing foot pain. Most commonly, we see stress fractures in the foot and the development of heel pain known as plantar fasciitis. Stress fractures are often brought on by a sudden increase in activity or poor choices in footwear and can present as deep aching foot pain with warmth and swelling. Plantar fasciitis results from inflammation of the band extending from the heel to the toes known as the plantar fascia and causes aching stabbing pain in the heel on first rising which worsens with standing and walking. Luckily, both conditions generally heal easily, but must be caught and treated early.

Summertime brings on warmer temps and the switch from heavier footwear to sandals and flip flops. While flip flops are a nice way to free up your feet, the lack of arch support and stability can create abnormal stress on the foot and ankle. This lack of support can not only lead to plantar fasciitis but other tendon and ligament problems as well. Sandal season also offers an opportunity to examine your feet more closely after a long winter of neglect- lumps, bumps, corns and calluses may now be more apparent and need attention. Skin rashes, nails that have thickened or changed in color or texture should be examined by your foot and ankle physician. 

Spring /summer is the time for picnics, pool parties and enjoying the outdoors—not for suffering with foot pain. Follow these tips for keeping your feet pain-free this summer: 1. Don’t walk barefoot-  cuts and puncture wounds can easily become infected. 2. Apply sunscreen to your feet to protect against sunburn and skin cancers. 3. Wear socks to avoid fungal infections, blisters and calluses. Change socks as necessary to keep feet dry. 4. Don’t pop blisters. These are a natural barrier to infection. 5. Don’t fall for fashion trends. When buying sandals, make sure they provide arch support and heel cushioning. 6. Wear larger shoes to accommodate swollen feet, especially if you work outside. 7. Stay hydrated to avoid leg cramps and muscle spasms. 8. Warm up and stretch before exercising and cool down and stretch afterward to prevent injury. 9. If your feet hurt, come see us! Foot and ankle pain shouldn’t be ignored. Oberlin Foot and Ankle 440-774-1100. 

Simple Advice on Diabetic Foot Care

 03-16-2021

Diabetes is a common condition that affects 34.2 million American adults. Today there are many more options and advancements in the way diabetes is managed, and many diabetics are able to live normal lifestyles. That being said, having diabetes does predispose someone to specific complications and concerns that should be kept in mind. These include foot ulcers, impaired wound healing, neuropathy, dry skin, as well as increased incidence of retinopathy, kidney and vascular disease. It is always easier to prevent complications, than it is to treat them.

In order to help prevent complications from diabetes, it is important to carefully manage diabetes, which may mean having a close relationship with your primary care physician and or endocrinologist. Consistently high blood sugars can lead to damage in multiple organ systems. Hemoglobin A1c is the lab used to determine how blood sugar is on average over a several months period. It is also extremely important to perform daily foot care to help prevent diabetic foot complications. Below is a basic list of diabetic foot care do’s and don’ts. As always if you have any specific questions or concerns discuss them with your doctor.

• Inspect your feet daily. Call your podiatrist if you notice any new calluses, dark areas, bleeding, drainage or unusual lesions. 

• Be sure to look between toes.

• If you can’t easily see the bottoms of your feet, try using a handheld mirror or sitting on a chair in front of a full-length mirror.

• Notify your doctor if you notice any new sudden increase in pain, swelling, redness, skin color or temperature changes, wounds, drainage or bleeding.

• Foot checks and routine nail care can be performed by your podiatrist about every 9 weeks with most insurance companies. 

• Clean feet gently daily. Test water temperature with a thermometer to avoid serious burns on parts of your body with neuropathy.

• Avoid using hot water

• Try using a baby bath temperature indicator, which can be found at most department or grocery stores

• Moisturize dry skin, avoid putting lotion between toes. 

• Lotion with urea works well for dry, callused skin (ie. Flexitol heel balm)

• Never walk barefoot

• Change socks daily, inspect socks for any signs of drainage or excessive wear patterns, these should be discussed with your podiatrist.

• Diabetic socks are designed to avoid compression. They can also be worn inside out if you notice the seams are irritating your skin. 

• Shake out shoes or check inside before wearing. If you have neuropathy you may not notice a pebble or object in your shoe.

• Do not use any sharp tools around your feet especially if your sensation is impaired. 

• Avoid cutting your own calluses or using ‘medicated’ pads – discuss new or worsening calluses with your doctor

• Neuropathy can sometimes cause numbness, burning, tingling or pain in the feet. If you think you have neuropathy, let your podiatrist and primary care physician know. 

References:

• CDC “What is Diabetes?” https://www.cdc.gov/diabetes/basics/diabetes.html

• American Diabetes Association www.diabetes.org

 

03/12/2021  Thank you for visiting our blog and we look forward to interacting with you.

We at Oberlin Foot and Ankle are excited to bring you useful information about podiatric conditions and the latest advancements in foot and ankle care. This blog will also be used to post updates about our practice and keep in touch with our patients.

We invite you to share this information with your friends and family. If you have a question about our practice or something you’ve seen in the news, please call the office at 440-774-1100.