Why does my toenail have black streaking?




Many patients come in concerned that there is some danger with their toenail because there is a black streak on it.  The first thing you need to look at is how long the black streak has been there. Is it something new or has it been there since you were born? If it’s brand new then we’re more concerned about it and we may have to take a sample or a biopsy of that toenail to see if there’s a problem.  If it’s been there your whole life, look at really what type of a descent you are from.  If you have more of an African American descent, it tends to be more common in that type of a population. If you are concerned, you should see a dermatologist or a podiatrist to have an evaluation.  You can take a simple trimming of the area, but more commonly what is necessary is to do a biopsy of the nail to make sure that there is no problem. Normally these are just pigment changes, but occasionally they can be a melanoma, so it is something that you should get checked out.

To Your Health,
Dr. Donald Pelto

My child’s ankle bends inward. Is that a concern?


 
 
There are many patients that come into the office, or parents actually that bring their children in, because the ankles are either hitting one another or they are kind of bending in against the ground.  Usually when patients come in for this type of ankle condition, it’s not for ankles; it’s usually because their foot is very, very flat and they’re pronating.  So if there is a pronation problem, this should be treated for children to not allow for any arthritis changes or tendon problems in the future because having such a flat foot like that puts extra strain on all the tendons, joints, ligaments and bones in that area.  One way of treating it is with an over-the-counter orthotic that can be put in the shoe that helps kind of lift up the arch and would also realign the ankle.  If that’s not enough, you may need a higher type of a device that can be made either by a podiatrist or your foot and ankle orthopedist.  If the problem is truly of the ankle, you may need to see a foot and ankle orthopedist because there may be some alignment problems with your tibia or your femur, which is like your leg or your thigh region. 

To Your Health,
Dr. Donald Pelto
 

What shoes do you recommended that work with my new orthotics?


 
Many patients that come into the office, when we give them the orthotics or even before we talk about orthotics, we really want to talk about shoes first.  You have to be really practical about the shoes that you wear with orthotics because first of all orthotics are not going to fit in every type of shoe.  A lot of patients ask, “Well, how come my orthotic is so big and so bulky?” And the way I explain that is that the bigger the device, the more correction you can have.  The narrower or smaller the device, the less correction it is going to do.  So I always recommend getting a full size orthotic initially and then we can do a second pair or a dress orthotic if you want later on.  So a full type of orthotic, it will fit in a shoe that is like a dress shoe that has a removal sock liner in there.  For those of you that do not know, a sock liner is that little piece of fabric that is inside the shoe that you can take out in all good shoes.  If you buy a shoe that is not as good quality, usually that sock liner is glued inside of there and you have a harder time getting it out, but pulling out that sock liner you should be able to fit your orthotic right in there.  It works very well in tennis shoes like Asics or New Balance as well.  One tip is if your orthotic is not a full length, meaning if it does not have a full top cover on it and if it is only, for example, three-quarters length, if you notice that drop off at your toes and that is uncomfortable or bothersome, you can actually take the sock liner and make a little cut and just fit that into the front of the shoe and then put the orthotic before it.  So there are a few tips for finding shoes.  As well, on the side of this blog at www.drpelto.com, you can find shoe help and there is a list of a lot of shoe stores both online and actual stores in the Massachusetts area that can help you with finding the right type of a shoe.

To Your Health,
Dr. Donald Pelto

Wearing socks can fool you if you have neuropathy... Got Socks?


Many of my patients have diabetes and neuropathy and they are always looking for tips to make them feel better with this really debilitating problem.  I will first start talking about neuropathy.  Neuropathy is a condition where your nerves become affected, usually due to diabetes, but there are other conditions that happen, and your nerve tends to either have lack of blood flow to the area of the nerve or the nerve gets kind of intoxicated by the blood sugar level causing it to swell.  One little tip that a patient gave me is he wore socks at nighttime and that really helped fool himself and his brain because there was some type of pressure on the foot.  He didn’t have the neuropathy pains as much. So just a thought, if you do have neuropathy, you may want to try on a pair of socks at night to see if that helps a little bit with your pain.  If it does not, you may want to see a neurologist or your podiatrist. There are different types of medications or medical grade foods that can be used typically in the office. There is something called Metanx that is a medical grade food that you can use, and there is also Neurontin, Lyrica and Cymbalta, which are all medications that can be used to help with the pain that you have with the neuropathy.

To Your Health,
Dr. Donald Pelto

When does my bunion need surgery?


A lot of patients come in asking me this question, or they have sent me emails asking me about exactly when they should get bunion surgery. Bunions, first of all, don’t always hurt and they don’t always need to be treated with surgery.  Many patients that come in initially, when I look at a bunion, it may be very large but it’s not painful, so we don’t have to do anything to treat it.  If it is painful, though, there are different types of treatments.  So my main distinguishing factor is looking at, first of all, pain level.  If it’s painful then we will consider it; if they have also tried wider shoes and other types of pads that can help it, but I also like to look at their age.  If they are under the age of, for example, 15 or 16 and their bones haven’t totally healed at the growth plates, I will have them wait until they get a little bit older.  Also, you have to look at how old a person is.  If someone is 70 or 80 and they have poor blood flow or high risk of complications of surgery, we also would not want to do surgery for that type of patient.

To Your Health,
Dr. Donald Pelto

Fixing a short toe.

 
Here is an example of a patient that had a really short fourth toe. The technical term is called brachymetatarsia and this is a condition where the toe is actually shortened in the middle of the foot called the metatarsal bone.  Since that area is too short, the toe looks like a midget and so in order to treat this there are a lot of different options. The option that we chose here is something called lengthening of the metatarsal and we use something called an external fixator, which is this little black device that goes on the top with a few little pins that go inside.  So what happens for this patient, you actually make a little incision on top and you cut through the bone in a proper position and you put two pins before the cut and two pins after the cut and you put that little black device on there.  Then every day you want to increase the length about a millimeter until it’s out to the proper length, and you also see in this picture, coming out of the toe there’s a little pin and that’s just to hold the toe in the proper position so that it doesn’t cock up during this process of lengthening this short toe or brachymetatarsia. 
 
To Your Health,
Dr. Donald Pelto