Bone infection

Here’s an x-ray where you can see where the little pointer is at the second metatarsal, there is kind of eating away at the sides of the bone on both sides and this is causing a problem in there where the bone is kind of being eaten away and it’s difficult for the patient because there is a bone infection. The way to treat this is to cut out that infected bone and make sure you get enough of it so you get all the bad infected bone. This is called osteomyelitis. It is a bone infection and it is something that you don’t want and you try to avoid with people with diabetes which this patient had.

To Your Health,
Dr. Donald Pelto

Ulcer by sarcoidosis and neuropathy

There was a patient that showed up in the office. They had something called sarcoidosis. This caused a problem with neuropathy where they lack feeling in the bottom of the foot. They developed this wound or sore on the bottom of their right foot. It’s a challenging thing to deal with because they didn't feel this wound, it wasn't painful, and we had to find a way to keep them off of this utilizing special padding until this was healed. Just be aware that if you have sarcoidosis, you could develop some neuropathy or a lack of sensation and a wound is always something that is possible to happen.

To Your Health,
Dr. Donald Pelto

Children bunions

So a lot of children have bunions on their feet and the parents always want to know what to do with a bunion like this.  Here’s a little girl, she has a bunion, you can see that her growth plates are almost closing in foot, and they want to know what to do.  My recommendation is if it doesn't hurt we don’t do anything until she gets to be about 16, but if it does hurt we can certainly do a bunion procedure to help correct that.  The risk, though, is for recurrence with something like this so you want to make sure the bunion procedure is done along with orthotics afterwards to help reduce any of the abnormal motions that caused it such as flat feet.  

To Your Health,
Dr. Donald Pelto

Detached toenail

I frequently get questions with patients that have a toenail that looks like this. You can see that the toenail is detached and not reattaching to the top of the toe.  This can be caused by a number of things. It can be caused by nail fungus, it can be caused by injury, it can be caused by digging into the edge of the nail, and it’s one of the more frustrating things that we can treat. A few types of treatments are removing the whole nail, that’s one option. You can also, if you don’t want to remove the whole nail, remove a portion of the nail and do something we call a phenolization or nail plate procedure that re-adheres the nail. That’s where you cut the nail all the way back, apply a chemical, and hopefully as the nail keeps growing out it’s going to reattach.  It’s something that’s challenging, it doesn't always work, but it sometimes is the best option that we have for patients because they don’t like it when their nails don’t reattach.  The last option would be to totally remove the toenail and put on either a fake nail or something similar.

To Your Health,
Dr. Donald Pelto

Raynaud's Syndrome

This is a condition where the toes tends to get really red or even white in the wintertime when the feet are cold, and sometimes this can even happen in the cold of the summertime and you see all this redness to the tip of the toes. This can sometimes happen with people with Raynaud’s. There tends to be pain to the tips of the toes. The best type of treatment is to keep your foot warm. That is not always easy, though, here in Worcester, Massachusetts and so you can sometimes use some hand warmers in your shoes or an extra pair of socks that aren’t going to be too tight, but just be aware of this and try to stay out of the cold as much as possible to make yourself comfortable.

To Your Health,
Dr. Donald Pelto

A nice article in the paper - I thought you would enjoy

Here is a nice reprint of an article from the T&G in Worcester.
Dr. Pelto

Lancaster amputee helps others handle the challenge


LANCASTER — Rose-Marie Bissonnette should have been preparing for retirement in the fall of 1996, but instead she was contemplating life as an amputee.

On the eve of her ninth wedding anniversary, on Oct. 19, 1996, the car Mrs. Bissonnette was driving collided with a truck on Route 13 in Brookline, New Hampshire. The car was crushed under the truck, with her inside. Practically every bone in the left side of her body was broken. She wasn't expected to survive.

"I was so badly crushed, I was literally bleeding out from all of my broken bones. I had a broken pelvis, broken ribs, a severed right ankle, broken arm, broken wrist," Mrs. Bissonnette recalled. "I had multiple, multiple injuries and they tried to save my left leg. I had either years of reconstructive surgery ahead of me with no guarantee that I would walk again, or amputation."

As she considered her options, she asked to speak with someone about what life is like as amputee. To her surprise, there were no resources available.

But Mrs. Bissonnette, 69, whose left leg was amputated below the knee, has changed that. In 2004, she founded what is known today as the New England Amputee Association, a nonprofit organization that is a resource for amputees and caregivers looking for support and information.

To date, the New England Amputee Association, which was originally called Central Mass Limb Loss Support Group, has 250 on its rolls, and receives requests for information from families, patients, doctors and hospitals across the region. Mrs. Bissonnette has met with Boston Marathon survivors to help them as they deal with limb loss.

Mrs. Bissonnette fields the phone calls herself from her Lancaster home, and most requests usually fall into two categories: a spouse or child who is looking for help because they've noticed a change in their loved one's personality after an amputation; or a new amputee who is having trouble adjusting physically or emotionally.

The New England Amputee Association just started a new branch at Kent Hospital in Rhode Island and is working to have at least one branch in every New England state.

The impetus for Mrs. Bissonnette to start the association was not just her accident, but the tragedy that followed three months after her amputation — the unexpected death of her husband from undiagnosed cancer.

"I wanted to give back," Mrs. Bissonnette said. "I was having difficulty dealing with how I had lost my husband, but I lived through this accident. He took care of me for the last six months of his life, and I had a lot of guilt."

Mrs. Bissonnette attended the Amputee Coalition's annual conference in Boston in 2003, and registered to be a peer visitor. As a peer visitor, she had to go to a local support group, but there weren't any. She began working with the Lancaster Commission on Disability, Clinton Hospital and prosthetists in the area.

The hospital allowed her to use a conference room the second Tuesday of every month at 6 p.m. There are speakers or themes each month. Mrs. Bissonnette wants the association to be there not only as a resource, but a reminder that there is still fun in life. For instance, the association has held a pizza and prosthetic party, announcing "We supply the pizza, you bring the prosthetic." There are dances and barbecues and fundraisers, including one in the works to raise money to send a child with an amputation to Camp No Limits, a camp in Maine for children and families dealing with limb loss.

Charles Milewski a former Douglas resident who now lives in Dayville, Connecticut, had his right leg amputated in May 2010.

"I had a diabetic problem that caused me to end up in the hospital with the choice of dying or having my right leg cut off. I chose to live," said Mr. Milewski, 70. "Every morning I wake up, I look at my prosthetic and say, 'Some assembly required.' "

As he recovered, his podiatrist, Dr. Donald Pelto of Central Mass Podiatry in Worcester, suggested he connect with Mrs. Bissonnette and the New England Amputee Association. He served as treasurer of the organization for two years before stepping down so he could move to Connecticut.

"The people who come to us for the first time may be in a wheelchair and they don't know what's down the road," Mr. Milewski said, adding that his limb loss has not prevented him from enjoying life with his family. He still plays with his grandkids, he shovels snow, he travels, he even had a scene as an extra in the HBO show "Boardwalk Empire." "We offer a lot of life experience, and we are here to help."

Mrs. Bissonnette has stepped down as president of the organization and is now focusing on working with doctors and other medical professionals on what happens after amputees are discharged from the hospital.

"The health care community is very good at what they do," Mrs. Bissonnette said. "But once a patient leaves their care, that patient is now facing real life. It is not unusual for depression to set in. You don't get a new limb and have a fairy tale ending when you leave the hospital."

"I think a lot of new amputees think life is over," Mr. Milewski said. "Your life is not over. Your whole body and living is controlled from the neck up, not if you lose an arm or a leg. It's how you mentally figure it out."

For information on the New England Amputee Association, go to 

Pain to base of nail

I had a visit from a patient today that has a common problem at the base of his mail. You can see that the nail is very large and that can filled with a fungal infection or another dermatological infection and what happens when he tries to trim the nail or wears shoes and hurts the base of the nail. This is because as he hits the front of the nail it causes kind of like a teeter totter reaction and lifts up at the base of the nail. Therefore if you have a very loose nails thisay be a reason for pain at the base of the nail.