AllDr. David Freedman, a founding member and Vice President of Foot and Ankle Specialists of the Mid-Atlantic, is featured on MoCo365. This initiative highlights businesses from all sectors of Montgomery County, Maryland with the purpose of showing the diversity of the area through the stories of successful leaders, entrepreneurs, and inventors. While FASMA began in MoCo, it has expanded throughout the Mid-Atlantic with 35 offices reaching from Pennsylvania to North Carolina. Learn more about our history and what makes us unique by watching this video.
What are some possible causes of toenail injury?Everyday injuries can cause your toenail to fall off. Hitting your toe on a chair or bedpost, dropping something on your foot, or simply pulling your socks on too fast can damage your toenail. Injuries to the nail may lead to a subungual hematoma, which causes blood to collect under your injured toenail. This can delay growth of the toenail and be painful for the first few days or weeks. If it can be tolerated, the best way to treat it is to soak the area in cold water for 15 minutes, clean the area with betadine or an alcohol swab, apply antibiotic cream, and trim straight across the toenail. If the subungual hematoma extends to a little over a quarter or half of your toenail, then you must seek treatment at a doctor’s office. If you experience throbbing or severe pain near the hematoma, your doctor will determine if the hematoma needs to be drained to relieve the pressure. X-rays may also be taken to make sure a fracture has not occurred. In diabetics, or immune-compromised patients, care is important so that infections do not occur. Keep in mind, toenail growth will slow down significantly after the injury. It can take anywhere from six months to two years for the nail to completely grow back. Pressure on the toenail can cause it to weaken and lift off the nail bed. Make sure other toenails are trimmed neatly and wear well-fitting shoes to prevent any future injuries. A half centimeter of room should always be present in the front of shoes to prevent pressure of toenails. A good shoe store can help fit your shoes and make sure you are not feeling extra pressure around your toenails. It is also possible to develop a fungal infection of the nail after a toenail injury. The injury provides an invitation for fungus to grow between the nail bed and loose toenail. If this occurs, your doctor should take a sample of your toenail to confirm that it is fungus, and then treat accordingly. Your doctor will discuss when antifungal medications are necessary on a case by case basis, depending on the results of a nail biopsy. People who have athlete’s foot and diabetes are prone to fungal infections. Diabetic patients have a harder time fighting off a fungal infection and must take extra precaution. Another cause of toenail detachment is psoriasis, an autoimmune condition. With psoriasis, the skin cells begin to build up at a faster rate and cause the toenail to lift off. Many cases of nail psoriasis are mild and don’t persist. Some of the symptoms may include thickening/pitting of nails, unusual nail shape, yellow-brown discoloration, or a chalky-like buildup. If the foregoing remains an issue, your doctor may prescribe topical steroids to rub into your toenail and cuticle.
What to do when your toenail is injured or falls off.Step one: Don’t panic. If your toenail starts to fall off, you must follow a few basic tips to avoid worsening your prognosis.
- First, clean the area with an antiseptic agent as tolerated.
- Second, apply an antibiotic ointment with a band-aid. If part of your toenail has fallen off or is detached, it is wise to let a doctor remove the remaining portion to avoid more pain or exposing your nail bed to infection.
- Do not lead the band-aid on all day and night-- leave the band-aid on during the day, but leave your toe open at night to let the area get some air.
- Change your band-aid regularly regularly-- a dark, moist environment creates a way for infection and fungus to form.
- Also, the doctor will determine how much of your toenail to remove, depending on how much of the toenail is detached.
Ian Beiser, DPM
Man Cho, DPM
Lee Firestone, DPM
Eric Masternick, DPM
Gene Mirkin, DPM
Howard Osterman, DPM
Seth Rubenstein, DPM
Erika Schwartz, DPM
Adam Spector, DPMThank you to our patients who entrust us with your care, and to our professional colleagues for their continued and generous vote of confidence.
Fall PreventionFall prevention is not a sexy topic but as we get older (> 60 years of age) physical changes, health conditions and medications can make falls more likely. Stepping on a crack and breaking your mother’s back, is an old childhood game that we didn’t take too seriously. Something we should take seriously: the 1 year mortality rate for seniors over the age of 60 after a hip fracture is between 14 - 58%. Therefore fall risk prevention is of utmost importance.
Footwear Style and Risk of Falls in Older AdultsThe results of a study reported in the Journal of the American Geriatrics Society 16 August 2004 showed that athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk. Relative to athletic/canvas shoes, other footwear was associated with a greater likelihood of falling, varying somewhat by style. What this means: Contrary to findings from gait‐laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes.
Fall‐Risk Assessment and Management in Clinical Practice: Views from Healthcare ProvidersAnother study reported in the same edition of the Journal of the American Geriatric Society from the August 16, 2004 revealed the following: healthcare providers were most likely to report directly intervening with or referring older patients for gait and transfer impairments and balance disturbances and least likely to do so when encountering foot or footwear problems and sensory or perceptive deficits. Patient compliance was the most commonly reported barrier to successful direct intervention across several risk factors, whereas inadequate availability of other healthcare providers and lack of Medicare reimbursement were the most commonly reported barriers to successful patient referrals. What this means: see your podiatrist for foot or footwear problems and any problems with numbness or loss of balance as these are the key areas that are being overlooked by other health providers.
Begin Fall Prevention now:
- Make an appointment with your Podiatrist for Fall Risk Assessment: (bring with you the following information)
- Medications - that make you tired or affect your thinking
- Previous falls - have you fallen before, near misses where you caught yourself or someone else caught you
- Health - dizziness, joint pain, shortness of breath or numbness in feet and/or legs, loss of balance, weakness
- Physical activity
- Develop a walking, water workouts, tai chi program in conjunction with your podiatrist and physical therapist.
- Appropriate shoes
- Wear shoes with firm non-skid, non-friction soles.
- Avoid wearing loose-fitting slippers that could cause you to trip.
- Do not walk around barefoot or in your stocking feet. Your podiatrist will help you select or will prescribe appropriate shoes that will not add to your fall risk
- Remove hazards to make your home safer
- Remove loose items from walkways, move furniture like coffee tables
- Secure loose floor coverings, repair loose flooring, store things you use regularly in an easy to reach place
- Immediately clean spills
- Use non-slip mats in bath or shower
- Do not take chances! Stay away from a freshly washed floor. Never stand on a chair or table to reach something that is too high.
- Keep your living space well lit.
- If your doctor suggests that you use a cane or a walker to help you walk, please use it! This will give you extra stability when walking and may help you avoid a bad fall. Use assistive devices and get help learning to use them.
- Do not use stairs without rails on both sides for support. If you must carry something while you are going up or down, hold it in one hand and use the handrail with the other.
- Know your limitations.
- See your physician if you have dizzy spells or fainting spells; see your eye doctor at least once a year and have your hearing tested too.
- When you get out of bed in the morning or at night to use the bathroom, sit on the side of the bed for a few minutes before standing up. Moving too quickly can make you dizzy, and you might lose your balance and fall. If your feet are numb from neuropathy they don’t know where they are so turn on the lights and look them onto the floor.
If you fall at home, remember:
- Step 1. Stay quiet for a moment — don’t panic
- Step 2. Decide whether or not to try to get up.
If you decide to try to get up:
- Step 1. Use strong, stable furniture for support as you try to get up.
- Step 2. Take some time to recover from your fall after you get up.
- Step 3. Tell someone that you had a fall.
- Step 4. Get medical advice if necessary.
If you cannot get up, or if you decide not to try:
- Step 1: Slide or crawl to get help if you can. You might be able to reach one of the following:
- Door to the outside
- Personal alarm device
- Something to make a loud noise
- Step 2: Tell someone you have fallen and need help.
- Step 3: After calling for help, lie quietly until help arrives. Keep as warm and comfortable as you can.
- Step 4: Get medical advice if necessary.
- Calf strain
- Achilles tendinitis
- Peroneal tendinitis
- Plantar fasciitis
- Calcaneal apophysitis (Sever’s disease)
Doctor, why do I have this nagging pain underneath my big toe joint?Have you ever heard of a Sesamoid injury? Let’s take a closer look at this problem.
Let’s start at the beginning… What exactly are sesamoids?A sesamoid is a bone embedded in the tendons that course below your big toe joint. Sesamoids are found in several joints in the body. Your kneecap, or patella, is another example. Acting as a fulcrum point, the sesamoids help the big toe move normally and provide leverage when the big toe “pushes off” during walking and running. The sesamoids also serve as the weight-bearing interface for the first metatarsal bone. As such, they absorb the weight placed on the ball of the foot in motion. Sesamoid injuries encompass a variety of disorders involving tendons, bones, ligaments and/or surrounding tissues.
Who is most likely to get an injury to the sesamoid complex of the foot?Sesamoid injuries often are associated with activities that tend toward increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. Repetitive use in the same position (loading the big toe joint) can lead to inflammation and even fractures. People with high arches are also at risk for developing sesamoid injuries.
The three types of sesamoid injuries in the foot:
- Sesamoiditis: This is an overuse injury involving chronic inflammation of the sesamoid bones and the tendons involved with those bones. Sesamoiditis is caused by increased pressure or traction forces around the sesamoids. Sesamoiditis is commonly reported as a dull, longstanding pain beneath the big toe joint. The pain comes and goes, usually occurring with certain shoes or certain activities.
- Fracture: A fracture (break) in a sesamoid bone can be either acute or chronic. An acute fracture is caused by trauma – a direct blow or impact to the bone. An acute sesamoid fracture produces immediate pain and swelling at the site of the break, but usually does not affect the entire big toe joint. A chronic fracture is a stress fracture (a hairline break usually caused by repetitive stress or overuse). A chronic sesamoid fracture produces long standing pain in the ball of the foot beneath the big toe joint. The pain, which tends to come and go, generally is aggravated with activity and relieved with rest.
- Turf toe: This is an injury of the soft tissue surrounding the big toe joint. Turf toe causes immediate, sharp pain and swelling. It usually occurs when the big toe joint is extended beyond its normal range. It usually affects the entire big toe joint and limits the motion of the toe.
What should I do if I think I have sesamoid problems?If you have pain, swelling, or bruising below the big toe joint, it may be a sesamoid issue. It all begins with a test. The x-ray is the most common and widely used first diagnostic test for this injury. During an exam, your foot and ankle doctor will examine the foot, focusing on the big toe joint. Your doctor will press all around the big toe, move it up and down. Your walking may also be assessed.
How is a sesamoid injury treated?At-home remedies can include wearing stiffer shoes, icing the area, and avoiding wearing heels. In most cases, at FASMA, our podiatrists will recommend a non-surgical treatment for sesamoid injuries to be first attempted. Depending on your doctor’s exam this may include: Immobilization, oral nonsteroidal anti-inflammatory drugs (NSAIDs), orthotic devices, physical therapy, and padding, strapping, or taping When sesamoid injuries fail to respond to non-surgical treatment, steroid injections or surgery may be required. Your foot and ankle surgeon will determine the type of procedure that is best suited to your individual needs. Dr. Stewart Chang works in two offices for your convenience: Charlottesville, VA (Rio East Ct) and Fishersville, VA. The information on this site is provided for your assistance only; this site does not provide podiatric advice. You should never diagnose or treat yourself for a podiatric condition based on the information provided herein, and the information is not provided for that purpose. Likewise, you should never determine that treatment is unnecessary based on this information. The information contained herein is not a substitute for podiatric care provided by a licensed podiatric professional. The information provided herein is not podiatric, medical or professional advice. This site does not create a doctor-patient relationship. Dr. Stewart Chang and Foot & Ankle Specialists of the Mid-Atlantic, LLC expressly disclaims all warranties of any kind, whether express or implied, related to any products offered for sale on this web site. Dr.Stewart Chang and Foot & Ankle Specialists of the Mid-Atlantic, LLC further expressly disclaims any product warranties of effectiveness or fitness for any particular purpose or use. You are solely responsible for your use of, or reliance on, any products offered for sale herein, and any consequences arising out of such use or reliance. In no event will Dr. Stewart Chang and Foot & Ankle Specialists of the Mid-Atlantic, LLC be liable for any damages resulting from use of or reliance on any such products, whether based on warranty, contract, tort or any other legal theory. This website, and the information contained herein, is provided to you as a service for use at your sole risk. Dr. Seth Rubenstein fields questions on Facebook regarding foot and ankle health. Dr. Rubenstein is the Vice President of the American Podiatric Medical Association (APMA). Based on an APMA survey of over 1,200 US adults ages 18 to 75, over 75% of those who responded have had foot pain. Almost half of the respondents experienced more than one painful foot condition and over 81% of obese respondents have experienced foot pain. Learn more about foot pain and podiatry by watching the video below. Foot pain is not normal. If you're experiencing foot pain, be sure to make an appointment with a podiatrist. is National Stress Awareness Month. Earlier this month on our Foot Doctor Blog, we featured how stress impacts the entire body and gave ways to combat stress. Being specialists in foot and ankle health, this article will specifically detail how stress impacts the feet. Foot Stress Stress affects all of us in many ways: it can heighten our level of excitement and it can weigh us down and even make us sick. Physical stress can take its toll on our feet in the form of excessive wear and tear of the nails and skin and show up as overuse injuries like tendinitis or bone stress fractures. Excessive emotional stress or anxiety can have more subtle symptoms and be felt all the way to our toes. Many people may endure restlessness of the legs that disturbs their sleep or tensing of muscles that may adversely affect their gait. An anxiety attack involving hyperventilation and a sudden release of adrenaline in the body moves blood away from your feet and may produce uncomfortable burning and numbness, cold feet and even hyperhidrosis (sweating). The mind-body connection is powerful and must be considered when dealing with all injuries and illnesses. Being over-stressed results in perceived hypersensitivity and more painful symptoms that would normally not elicit such a response. Negative stress can negatively affect treatment outcomes, resulting in poor compliance, more discomfort, delays in healing, and a higher rate of complications. Stress cannot be ignored. As podiatric physicians, we evaluate and consider the entire person, not only focusing on their foot problem in order to enjoy optimal results.
- Exercise: Research has shown that just 30 minutes a day of cardiovascular exercise can help boost mood, reduce cortisol levels, and improve clarity and focus.
- Diet: Eat a diet rich in fresh fruit and vegetables, lean protein, and omega-3 fatty acids to reduce cortisone levels and boost the immune system and lower heart disease.
- Sleep More: Sleep allows our brain to re-charge, repair muscle, and improve memory. Adults who get at least 8 hours of sleep at night are more likely to have improved memory, energy, and motivation during the day to manage daily stresses.
- Relax and Connect: Practice yoga, meditation, and deep breathing to boost levels of joy, serenity, and calm. Ask for help from family, friends, community groups, or religious organizations to provide emotional and other support.
- Talk to Your Doctor: If stress is creating health issues, address them early on with a medical practitioner. Intervention can include prescription medication, nutritional support, counseling, and support groups.